Medical Consultation and Dispensing by Pharmacists

Since the day I entered medical school, a contentious issue is that the doctor should be confined to seeing the patient, making the diagnosis and writing out the prescription, then the patient moves on to get his medications from the pharmacist. Till this day, this debate is still ongoing.

There are several issues involved here:

1) Will patient accept these arrangements, having been so used to getting all his treatment at the one-stop centre the doctor’s clinic?

2) Cost will definitely go up;

3) Inconvenience to the patient;

4) While the number of pharmacists has increased and the shortage of pharmacists is not as acute as 5 years ago, we have the problem of distribution of pharmacists since most of the pharmacists are clustered around the major town. Most pharmacies do not operate 24 hours. How is the patient going to get his medications at night?

In most medical practice, the dispenser is not a trained pharmacist. They are trained just to read the prescription and dispense the medications often with no idea about the functions and the side effects of the drug been dispensed. This may not be the most ideal condition to dispense medications. However, in the Malaysia context, it has served us well with minimum cost and hassle.

Some Malaysian pharmacists unfortunately do not function professionally. They would sell medications without a proper prescription. Most pharmacists would not even bother to tell the patient of the side effects of the drug. In fact, the patient hardly has any opportunity to interact with the pharmacists in a pharmaceutical outlet. What is worse is that some pharmacists also branch out into other healthcare activities that should be the domain of the doctors.

Hence, the present arrangement where the patient gets to see his doctor and his medications in a one-stop centre setting seems to be acceptable.

我踏入医学院那天，医学界已经在讨论一个争议性问题，认为医生的职责应限于为病人诊断和开药方，然后由病人凭药方到私人药店配药。直至今天，辩论仍持续进行中。

实行看病和配药分家制前，有几项问题必须探讨：

1) 病人既已习惯在同处看病和配药，他们能否接受新的安排？
2) 成本必定上涨
3) 对病人造成不便
4) 药剂师人数近年来不断生增加，而且多数分布在主要城镇。问题是，药店非24小时营业，那病人在晚上问诊后要到哪儿购药？


在多数情况，配药师并非经过培训的药剂师。他们只受训阅读配方和按配方开药，通常他们并不了解有关药物的功能和副作用。这并非最理想的做法。然而在马来西亚，这钟低成本和省麻烦的做法相当普遍。

不幸的是，我们发现国内一些药剂师没有专业地执行工作。他们没有根据处方售卖药物。一些药剂师甚至懒得告诉病人该药物的副作用。事实上，病人在药方买药时几乎没有机会和药剂师沟通。更糟的是，一些药剂师还兼任其他本由医生担杠的医药活动。

因此，维持目前挂号、诊病到配药一站式医疗服务似乎是最可行及被接受的做法。