Are Doctors Criminals? — Dr John Teo

The tabling of the Poisons Act amendments.

The recent proposal put up in Parliament to amend the Poisons Act (in layman’s term Medication Law) read like a horror story to me.

There are multiple areas of grave concern and questions that as a practicing doctor, I really need to clarify.

1) Mandatory issuance of prescription upon request by patient

In the government sector, usually all doctors will issue a prescription for medications if needed after consulting or examination of the patient.

The patient will then take the prescription to the pharmacy to collect the medicines.

It is different in the private sector whereby many clinics outside hospitals serve as a one-stop centre and the doctor consults, examines and dispenses the medicine if needed in the same clinic to the patient. Hence, usually a prescription is not being issued to patients.

However, if the patient prefers to obtain the medicine from an outside pharmacy, the doctor can write the prescription for the patient for medication that requires prescription. Commonly, most painkillers, antibiotics, hypertension and diabetic medication, for example, require a prescription.

The Malaysian Medical Council and the Ministry of Health require that doctors write the prescription for patients upon request if they wish to obtain their medication from outside the clinic after consulting the doctor. It is also good medical practice to do so as to support the various means a patient can obtain his or her medications.

Refusal to do so without proper reasons in in breach of medical ethics. In an analogy, it’s akin to an insurance agent who refuses to help in processing a claim when he or she had sold the insurance policy to the insured.

These are unethical acts, but certainly not criminal that warrant the potential of a jail term as in both situations, the patient can see another doctor to obtain a prescription or the insured can request another agent to help in processing the claim respectively.

Jail terms usually are meted out to offences that may have severe consequences or are criminal in nature.

The criminalisation of what essentially is an ethical problem is a slippery slope towards treating doctors in the most harshest of ways and doesn’t augur well towards being a caring society.

There are also multiple questions that needs to be answered from the proposed amendments as it simply mentions that doctors must provide the prescription upon request by patients without further elaboration.

Does it mean that even without proper consultation, as long as a patient requests a prescription, the doctor must provide? How about if a patient requests a prescription that the doctor doesn’t deem necessary like sleeping pills or antibiotics etc? Is the doctor mandated to give that prescription?

2) Allowing the use of electronic prescriptions

Currently all prescriptions are written by hand by the prescriber after consulting and examining the patient.

With the advent of e-technology, online consultation by doctors is possible.
There are however many potential pitfalls which we need to be aware of, such as online consultations are limited by the inability of doctors to do a proper examination which may assist in making the diagnosis and give the right medication, for example.

Many practitioners are of the view that online consultations should be limited to patient follow-up rather than first consultation in order to minimise making incorrect diagnosis and endangering patient’s health.

In addition, certain conditions can be diagnosed online, such as some psychiatric cases for example, while others like neurological cases need thorough physical examination.

Without proper framework and guidelines to ensure that patient safety are always prioritised when online consultation occurs, the potential for great harm exist.

Simply allowing electronic prescriptions to occur without first putting in place all the regulations and guidelines can be dangerous as issuance of those prescriptions can be abused.

What if a patient doesn’t want to see a doctor and simply continues obtaining his or her prescriptions online while his or her condition goes unmonitored? What if online prescriptions are being abused to buy sleeping tablets or any medications that results in dependency? How do we monitor all the online prescriptions?

How can we ensure that those online prescriptions are genuine and the prescribers are issuing them in good faith? Can commercial entities now take advantage of the situation and effectively get the prescriber to issue any prescriptions that patient wanted online and direct those prescriptions to their own outlets?

Does this move really augur well for patient safety or in fact may bring more public harm? Are there any pilot studies that are done to ensure patient safety before we make it a law?

3) Enforcement officers have a lot of power to enter, search and take records from private clinics or hospitals as long as there is reasonable cause to believe an offence may be committed

Under the Federal Constitution, citizens get to enjoy certain privacy and generally, even police usually need a warrant to enter private premise or property to search if they believe there are offences being committed, unless under certain exceptional circumstances, they may not need a warrant.

However, it seems that private doctors, clinics or hospitals may not enjoy the same privilege as the Act allows the enforcers to do the above without any warrant as long as “there is reasonable cause to believe” which is not properly defined. This opens the potential for abuse as any reason can be given as “reasonable cause to believe”.

5) Enforcers cannot be sued

Even if the enforcers are proven wrong in the end, there is no accountability or responsibility for their unwarranted acts.

The unfairness in such a situation may be too much as private clinics, hospitals etc may suffer untold damages as a result of such searches.

6) Agent provocateur is allowed and evidence can be used in court

Usually agents provocateur (entrapment) are allowed for serious crimes such as drug trafficking, money laundering etc.

Now it seems doctors, clinics and hospitals may be treated in the same category, which is extremely worrying.

The big question now is should doctors be potentially treated like criminals, health care be potentially driven by commercial interest and private clinics and hospitals potentially lose their rights under the Federal Constitution?

Perhaps the authorities who came up with these proposals can explain to us so that we know indeed the amendments are for public health and safety and that doctors are their partners in health care rather than the villains?

I feel like giving up doctoring.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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