24 July 1999

Strengthening drug dispensing law enforcement must come
before Separation of Diagnosis and Dispensing functions

(Keywords:- diagnosis, dispensing, compulsory separation, genuine choice)

          The long drawn dispute between the advantage, or otherwise, of separating diagnosis (by the physicians) and dispensing (by the pharmacists) is again in the lime light.

          Whatever the outcome must be for this mature society of ours to decide with one ultimate aim -- for the best interest of the patients. The public is understandable still very confused as exemplified by two recent surveys with conflicting results. Whilst the study done by a pharmacists association indicated some two-thirds of the respondents supporting a separation of diagnosis and dispensing, another survey done within the similar time frame indicated only 15% supporting this concept.

          Few would dispute that getting your medicine in the doctor¡¦s clinic has the convenience of a one stop service. Imagine the hassle an old lady will have to go through having brought a month-old grandchild to see a general practitioner in an outlying housing estate at nine at night with a high fever and has to go around Hong Kong dispensary hunting.

          Many patients still feel more secured getting medicine in a doctor¡¦s clinic. To them, at least in perception, they are getting the ¡§right¡¨ medicine. Not uncommon a patient will return to the doctor¡¦s office after filling his prescription in a dispensary to seek the doctor¡¦s confirmation that ¡§that is the drug the doctor prescribed¡¨.

          Dispensing from a doctor¡¦s office also has the added advantage that you would not be asked to buy more than you need. It is a known fact that for less used medicine, dispensaries are not enthusiastic in dispensing a few tablets to a patient worrying that the rest in the bulk package will find no market.

                   The proponent of independent dispensing will argue that the patients are better care for as the pharmacists will act as the ¡§check and balance¡¨ of the doctors -- is the dosage right; is it the best medicine for the condition; is the combination of different drugs proper? Some will even claim that it may be cheaper to fill a prescription in a dispensary.

          No matter how the society will side on the debate, one area must be addressed -- proper implementation of the law on controlling buying drugs over the counter.

          Whilst the law stipulates that certain drugs could only be dispensed under a doctor¡¦s perception, many of these are often sold across the counter illegally. Often times too, doctor¡¦s prescription are being retained and filed in a dispensary, from which patients can get a refill, any time, for similar symptom on quoting a file number.

          Such act from unscrupulous dispensary owners make a mockery of the law; worse, exposing the public to the danger of drug abuse or at least taking the wrong medicine.

          The pharmacists face the major brunt, for as employees in dispensaries, they are often subject to such amoral, if not illegal, demands of their business orientated employers. They  risk exposing themselves into professional discipline hazard or lose their jobs. The pharmacist profession should settle this fundamental principle without delay.

          Other than plugging this legal loophole, strengthened law enforcement should be assured before attempting even to discuss  separation between diagnosis and dispensing functions.

          If caring of our patients is our ultimate concern, the battle should never be on whether there should be a compulsory separation of diagnosis and dispensing functions. Instead, war should be to ensure that our patients will have a ¡§genuine choice¡¨ -- that they have a right to decide on their own whether to obtain their medicine in the doctor¡¦s clinic or in a dispensary. In this respect, the medical and dental professions have a vital role to play.

(Hongkong Standard)