After 15 years since the publish of the "Report of the Working Party on the Practice of Pharmacy and Ancillary Matters (June1982)", the situation in Hong Kong hasn't change a bit. The discussions on the issue has not heard anymore.Is it because of disapearnce of the problems, I would like to believe sadly because many pharmacists have already given up and "wisely" decided not to fight for a fair deal. However a group of "minority" still dreaming and singing in the darkness....

The public hospitals helath care system has improved quite a lot since the establishmeent of Hospital Authority of Hong Kong. However private health care system are proliferated freely and independently. In the UK, the NHS (National Health Service) are keep watching over the prescribing policy and bugeting of the medical professionals, but no such system is existed in Hong Kong( except in hospitals). Almost all medical doctors are self empolyed. However a "good doctor is not a good bussinessman", more they care about their business, the less they are capable to care about their patients (That is exactly same for the pharmacy profession).

Prescribing and selling medicine to lack-of-knowledge patients may tempt the profession to dispense more unnecessary items( since the patients believe that is what they pay for).On the other hand most doctors only charge a fixed drug cost (say $30-50), more they give out cheaper alternatives, more money they can earn from it.e.g. many cheap anti-histamine has been replace by more expensive non-sedative anti-histaime with fewer side effects, but many doctors are still using it unnecessarily.( Analysis from the NHS, stated the dispensing doctors dispense more items and more expensive drugs to their patients)

[That maybe the reasons why when you go to see the private doctors in Hong Kong, you can obtain several types of pills and a liquid medicine, but if you go to see a doctors in western countries you can only receive one or two prescribed item, or none at all]

I am not saying that all private doctors are doing these, may doctors are caring and gentle professionals. What I want to point out that prescribing policy should solely depend on the interests of patient. When a patient go to see the doctor, they want to receive the best possible treatment. The choice of treatment should not affect (even subconsciously) by the limited range of medicine available at the doctors' clinics and/ or finiancial saving of the doctors. The decision of buying the items or using cheapter generics is the responsible of the patients.

Nowsaday, professions are rely on each other expert in order to provide the best possible services. Pharmacists and doctors should work hand in hand for a better caring teams and mind the interests of their consumer or employer--the patients

This is only my opinions, I would like to hear other people opioions, please write it down in the Guestbook provided.

Here are the summery of agruments from the paper of "Report of the Working Party on the Practice of Pharmacy and Ancillary Matters(June1982)"

A. Concerning Safety:

A Doctor's View

• Stock only a limited range of drug
• Simple jobs-count the ready made medicine
• Simple system- nurses familiar with doctors' hand writing
• Sequential method of call in patients-less chance to mix up patients' prescriptions
• Simple work-only copy out doctors' instruction on frequency and dosage
• Question over the quality of drugs obtainable in retail
• Small stock and rapid turnover-keep the drug"fresh"
• Listed seller may not aware of the storage requirements
• Retail outlets may tempted for reasons of profit to stock cheaper, inferior , fake drugs or outdated medicine
• Concern over easy available of prescription drugs without prescription

• Ethical control
• Ensure only quality medicine are stocked and dispensed
• Double checking system to ensure free of prescribing errors, drugs interaction etc.

• Provide details instruction and warnings of the use of medicine
• Interprofessional monitering for the sake of best health care services
• Pharmcists are qualified and trained to do effectively and correctly with the interest of the patients
• Qualified to provide drug information services
• Patients medical recording
• Better computer labelling service
• Awareness of Over the counter(OTC) interactions with the prescription drugs
• Better control over the drugs having abusive potentials
• Provide daily moniter of side effects and detection of earily signs of toxicity)

• Want to know the drug from the prescription (*already have drug labelling nowsaday, but most patients still cannot identify the names)
• Knowing the drug name may cause unnecessary distress
• Knowing the name may tempt to self medicate
• Untrained and unsupervised staff may cause dispensing errors

A Pharmacist view

• Cost less because of serving more prescriptions
• Better service-counselling, more time and explain the matter better
• (Avoiding "dispensing" interfere the "prescribing")
• (Cutting patient visit to the GPand emergency room, maintaining the health budget without reducing the quality and quantity of care)
• Provide easy assessable free counselling service
• Provide a friendly environment for counselling and assess at any time of the day
• Patient Education
• Reduced unnecessary items
• Provide a wider range of medicinal choices
• Provide repeated prescrption services
• Trained to moniter storage and dispensing matter ethically
• Trained for minor aliments,and referal patient to the doctor
• Determine by the pharmacist, the patient can avoid unnecessary visit to the doctor office if the problem is minor or self-limited or can be treated by self medication
• No fixed price, selling base on the cost of the drug
• (Improve the situation of illegal drug selling)

• Already have a choice to obtain dispensed medicine orprescription
• Doctor "no need to make profit" on sale of drugs
• Stoked fewer medicine, not employ qualified staff--less overhead
• Doctors are best able to offer advice and answer question to establisha rapport and gain confidence of patients
• Many patient regard as end-product of consultation
• Psychological soothing effects of the patients

• Not knowing the bill of the medicine
• Lack of redress in cases the doctors declined to issue prescription--practically no choice
• Allow them to "shoparound" to obtain the most economical source
• More convient and cheaper to obtain drugs from clinic, particularly at night; while other believed the neighbourhood medicine store provided easier access
• Majority believed it is safer to get it from doctor
• Report from the Consumer Council: largly agreeable " doctor dispensing" & no evidence to indicate that the consumer are being taken advantage of***