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Words of Thought |
"There cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted. But assertions, speculation
and testimonials do not substitute for evidence. Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments".
Angell M Kassirer JP. Alternative Medicine - the risks of untested and
unregulated remedies, N Eng J Med 1998, 339:839-41.
Malaysian Medical Association (MMA) president Datuk Dr P. Krishnan dismissed the claim but critics of the existing system argue that polypharmacy exists because doctors derive a substantial portion of their income from dispensing.
"For some doctors, up to 50% of their income is derived from dispensing. The rest is from consultation," said Malaysian Pharmaceutical Society (MPPS) president John Chang.
Federation of Malaysian Consumers Association (FOMCA) president Prof Hamdan Adnan said it is for this very reason that Fomca has been calling for a separation between prescribing and dispensing. He wants the task of dispensing to be given solely to pharmacist, as is the practice in countries such as Britain, Indonesia, India, South Africa and the United States.
Selangor and Federal Territory Consumers Association manager Ismail Abdul Aziz concurs with Hamdan saying the pharmacists are best suited for the job as they have been trained in all aspects of the preparation, distribution, action, uses and side-effects of drugs and medicines. He said that present system where the dispensing in private clinics is often carried out by doctors’ assistant might not be in the patient’s best interests.
This is the same argument put forward by the MPS and the Consumer Association of Penang (CAP).
MPS has set 2003 as the target year to spearhead its request to the ministry to transfer the medication dispensing function to pharmacists. Chang is confident that a change in the system will result in improved services from both doctors and pharmacists. "Doctor’s income will then come only from their consultation fees and they will have more time to diagnose and counsel patients. "There is also no incentive for them to push unnecessary medications on patients, thereby avoiding a potential conflict of interests," he said.
The Sun (Malaysia) 11 December 2000
Protecting Patients' Money, Time and Safety By Allowing Them To Continue Getting Medicine From Their Doctors
Patients presently enjoy the choice of having medicine dispensed at doctor's clinics or if they so choose, a prescription written and filled at drugstores. This not only saves time but also saves them money, because doctors in fact subsidise patients by absorbing the drugs cost into the consultation fee, which for the general practitioner at 150 to 170 dollars is very little for professional fee compared to accountants and lawyers, and the drugs are not really charged. If they have drugs dispensed only from the pharmacists, the danger is that another drug may be substituted if the exact one is not available. Also, more than the exact amount may have to be purchased. ....... Filling prescriptions at dispensaries and paying doctors for consultation actually cost the patients more. Besides there are still many faults with the supervision of drugstores in Hong Kong where many prescription-only medications can be easily purchased without prescriptions, where advice on drugs and diseases can be erroneously and unnecessarily given. Doctors in Hong Kong are totally responsible for the drug labelling and the medication dispensed by the nurses whom they supervise closely and thereby have won the confidence of patients. If compulsory separation of dispensing and consultation is enforced, patients will be deprived of their right of choice of drug dispensing.
Towards a Realistic Holistic Health Care for Hong Kong
The greatest unifying factor for any profession is a well -defined and worthwhile goal, by which is meant an aim that is seen equally by the membership and the public as wholly desirable. There is an staring pharmacists in the face, if only they realised it. It is to ensure that medicines are, as far as possible, used to make patients better.
A Worthwhile Goal p.679 The Pharmaceutical Journal 4 Nov 2000
Doctors and patients have to share the responsibility for over-prescription, says Dr Choi Kin, a member of the Medical Association Council and the president of the Practising Estate Doctors' Association.
Not only do many people in Hong Kong believe every illness requires medication for treatment, he says, but many also feel a prescription is proof of a consultation's value.
"Some patients are not satisfied if they go home empty-handed. They do not appreciate that a medical consultation aims to provide professional advice. If the doctor gives no drug, they feel cheated."
In addition, Hong Kong people have fast-paced lifestyles and so they look for quick cures, Dr Choi says. Too often, that means antibiotics. "Many patients want an injection for fever, but they may not realise some of these injections carry the risk of damaging white blood cells."
Sometimes, he says, doctors feel compelled to comply with patients' uninformed requests for medication. "Local patients shop around for doctors. If one doctor gives too little medicine, they'll switch to another doctor who gives more. And it is always easier to dispense than to argue."
SCMP Prescription for disaster 21/11/00
哈佛教授蕭慶倫在九七年十一月﹐以五百萬元受聘於前衛生福利局長霍羅兆貞﹐聯同另一名哈佛教授葉志敏﹐撰寫一份數據詳盡的醫療改革報告﹐報告在九九年四月發表。衛生福利局最後以不合用為由﹐決定不再討論哈佛報告內容。
Throughout this era(16th&17th centuries), doctors became increasingly able to keep out competing healers. They used their power to achieve laws that made practising medicine a closed shop, and the gulf between doctors and traditional healers widened. But apothecaries, once merely the "grocers" who supplied the medicines prescribed by physicians, gained a growing role. After a 17th-century battle against the physicians' monopoly, they won royal permission to train in medicine and give advice, but were allowed to charge only for the remedies.
The Natural Pharmacy by Miriam Polunin & Christopher Robbins, p.16 Bantam Books1992
The Internet could actually evolve to be something of an agent for social change.
Give it a few years and everyone will have heard about it.
Give it a few more years and everyone could be using it,
often, without even knowing that they're using it.
Now that could be pretty exciting!
Martyn Bailey, February 1994
"You will not grow if you sit in a beautiful flower garden, but you will grow if you are sick, if you are in pain, if you experience losses, and if you do not put your head in the sand. Take the pain as a gift to you with a very, very specific purpose."
--Elizabeth Kubler Ross
每 次 普 通 科 門 診 只 須 支 付 一 百 二 十 五 元 ， 專 科 收 費 則 為 三 百 二 十 元 。 他 批 評 ， 由 於 和 記 並 無 補 貼 診 金 的 差 價， 結 果 參 與 計 劃 的 醫 生 便 被 變 相 剝 削 ， 不 參 加 計 劃 的 醫 生 則 不 獲 免 費 宣 傳， 而 光 顧 的 病 人 則 被 將 價 就 貨
香港藥學會會長鄺耀深:‘本港現時監管配藥的制度最嚴謹﹐衛生署去年便有三千次針對藥房的『放蛇』行動﹐但對醫生的就根本沒有。’
The simple question asked by many from outside the profession is: " Why does it take four years (and soon become five years) to learn how to put tablets in a bottle?" This is a pertinent question. It is imperative that the profession examines whether it achieves anything other than this. Pharmacists do not operate in a vacuum, and it is clear that current payment structures are such that there is a perverse incentive for
much of community pharmacy to be passive. However, the future sustainability of the profession, to a large extent, will reside in resisting this paradox. Although it is easy for those outside community pharmacy to preach about resisting passivity, with the resultant decline in somebody else's remuneration, it is clear that, if pharmacy fails to reinvent itself, its lack of perceived added value will lead to its ultimate demise. It will be better to take
the pain now and have some chance of a sustainable future, rather than only to consider the short-term benefits of ignoring change but having no viable future.
Blame does not rest with community pharmacy. The whole profession is responsible for its current lack of identity and purpose. However, to some extent, the salvation of pharmacy is in the hands of forward
thinking, clinical practitioners in primary care. In short, if pharmacy is to survive it will be because community pharmacists have become an integrated part of the clinical services provided in primary care.
最新更新日期:2002/03/19
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