Separation
of Prescribing and Dispensing in Hong Kong
(A Summery of Arguments)
Separation
of Prescribing and Dispensing in Hong Kong
Under
the present system in Hong Kong, a registered medical doctor, registered
dentist or veterinary surgeon can legally prescribe and dispense the prescribed
medicine within the clinic. Only a limited range of medicine is stocked
and the medicine are "given out" by "unqualified" staffs( although some
doctors claim they employ nurses(EN or RN) or dispensers for the work of
dispensing, majority are unqualified(i.e. not received formal training
in dispensing or nursing) "nurses".
These place the Pharmacy profession in a difficult position. The retail pharmacies cannot survive or rely on dispensing prescription, they have to rely on selling sundries, "own brand " products, some are even tempted to sell prescription medicine without prescription and cough medicine for abuse. Running a professional pharmacy by a pharmacist is not economically viable in most cases. Most pharmacists are employee pharmacists who are working in small dispensaries or pharmacies whose bosses are merchants (named Authorized Seller of Poisons legally) with a sole desire to make profit. No minimal education requirements required by P&PBoard for an ASP, they are very willing to take small "risks" to gain large profits. To make the situation even worst is that the Pharmacy and Poisons Board only allows a very limited range of medicine available without prescription. The pharmacists, if they want to continuing in the business, they have to lower their professional standard and practising thieir skills with tighten hands and blocked mouth in some cases. This turns our noble profession into a "corner shop". And the medical profession is keep using this sort of argument to against pharmacists.
We are not caring only about our profession in our mind, we are caring about our patient and our helath fuirst always! One thing we are sure: We are trained for doing dispensing (and many pharmaceutical usage and counseling) and the doctors are not(please don't mention about the unqualified staffs) and many pharmacist is now moving out from the dispensaries and play an active role in clinical decision. For the sake of patients' benefits, medical doctors should concentrate their efforts which on diagnosis and surgery which they are trained of, and let the pharmacists do the dispensing and patient counseling on practical drug usage. Dispensing is not just counting tablets!!!!!!!! We have to ensure the right patients, taking the right dosage of the medicine at the right time using the right method with minimal unnecessary side effects. Pharmacy can provide a free, convenient and an easy assessable place for patient counseling (you don't need an appointment!).
There is a simple way to cut the current health budget: by allowing retail pharmacist to screen the patients with minor illness and let them to take care of the own health. The pharmacist can utilise their professional judement to refer the more serious cases to the GP or hospital.That will certainly cut down majority of patients number visit the GP and emergency room (Many of the private GP may not happy about this!). By adoptiong this "Free" arrangement, the health budget can be maintained without the quality or quantity of care are being reduced.
The Pharmacists and the Medical Profession should working together for a better system. A better system with doctors doing the diagnosis and prescribing , pharmacists doing the dispensing and counseling on the usage. That is also the system working in all western world, hospitals and China.
NB. Taiwan has just passed the law to restrict law from dispensing, a huge demonstration from the doctors groups who do not want the law to be enforced was met the pro-law demonstration from the pharmacists groups in March 97 . The news was post on the local news papers.(See the Articles and the Current issues)
Around 1980, the debate on the separation issues was hot and the Governor in Oct.80 had set up a party to work on the issue and published the following reports:
( The above booklets and video can be borrowed from Library of Hong Kong Polytechnic University, and should be available at the other Universities' libraries of Hong Kong)
