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Title: Plight of Retail Pharmacist by Yusof Hussien
Date: 05-Oct-2006
Category: Issues and Guidance

Tan Sri Dr  Ismail (MRCP)  issued  a warning and Dato Dr  Chua(MBBS cum GP)  endorsed it as a policy.  That made a perfect team of medical men against their arch rival, the pharmacists.   To them, the pharmacist cannot play doctor, but not otherwise.  Is there a law that can prevent a doctor from playing pharmacist ( i.e more than just dispensing medicnes ).  When they incorpoated the terms pharmacy and pharmacist into  the Private Healthcare Services and Facilaities Act 1998, I think it was meant to allow the private doctorss to continue to play pharmacist.  So where can we find the official status of the retail pharmacy in Malaysia?  The irony is, some medical traders called the managed-care organizations managed to get a quick legal recognition in Malaysia, where they could not get it even in the country like the Great Britain.

Dr Chua himself was a GP for many years. I have seen how Dr Chua practiced in his clinic when I was a medical rep many yeras ago.  A GP would get worried to see a large crowd at a pharmacy nearby, especially when he recognized some of those people who used to be his regular customers.  He would seek information from the medical rep about the business of his rival,  whether the pharmacist is getting better bonuses or selling more drugs than him.

This scenario is not unique. It is like a history repeats itself. Thanks to the pharmaceutical industry for helping this set up to take place again in a modern country like Malaysia..  The industry, especially the big brothers, has created a furtile process for the private doctors, pharmacists and others to compete for the multi-billions drugs trade.  It is the trade for a grab, not wrong play.   I used to sell in every three months a huge quantity of a painkiller product to an orthopedic specialist and I knew that amount was meant for distribution to others in Johor Bahru.   When I walked in many pasar malam, I used to see traders offering many brands of drugs for ED and the labels showed the products are for distribution in Malaysia.

I am beginning think that certain  type of  drugs like those for treatmentof ED should not be allowed to come into this country in the oral dosage forms like tablets or capsules.   The moment these products become available for distribution, they will reach the black market. 

I would like to tell a little bit about the history of pharmacists practising in shops.   It was not the falult of a large number of pharmacists in this country to practice a brand of western medicine by keeping their shops opened to the public. Perhaps, this is a common feature in practising as an independent professional, just like the GP and lawyers, where one can make an individual judgment and to accept the consequences of ones action.

A GP may practice in a shop lot, but the clinic cannot practice like a shop. I do not know whether our Malaysian Medical Council is aware about this, because there are some private clinics in this country which maintain a small section in the premise to operate like shop.  Medical practice is a time-honored service and  with the patient registration system,  it would not be possible to pracice for walk-in customers at  all the time ( except for emergency cases ).  Look at our practice system in the retail pharmacy, not all customers are coming to the shop to ask for a pharamcist.  That what a community pharmacy is all about.  The shop!  In fact, when the British implementaed the National Health Insurance in 1911, their pharmacists refused to accept remenuration by the per capita basis which reqiuired the patient registration system. 
 
According to the theory of evolution, modern birds are derived from the dinausours, based on the features like scales on the body.   I like to borrow the principles of anthropology to explain the origin of our retail pharmacies and it was their predicesors who created the modern pharmacy education that produced scientific knowledge and skill which later found new applications in the manufacturing industry and hospitals. 

It was the story of grocers who expended their business into the medical field, but they were not alone.  By the late 18 century, the term medial practitioner could not exclude the pharamcists.   When they began to outmatch the general practitioners in the late 18 century, the conflict exploded into battle against all fronts, including court cases.  The elites of the medical establaishment ( Members of The Royal College of Pysician and Surgeons ) have no symphaty towards the GP except to put all the medical systems ( including pharmacy ) under their control.   Coincidently, our Director General of Healt is a member of one of these elite medical establishments, but in Malaysia he is a subordinate to a former GP. 

Since visiting patient at home was considered a medical practice, the pharmacists were prevented from doing this and they eventually managed to confine the pharmacists to practice within the walls of their shops.    Even with this harassing measures failed to stop the pharmacists from competing with the GPs.  As their final agenda was about to succeed, that was to use the parliment to enforce  a compulsory registration for all medicial practitioners ( that meant, including the pharmacists ) which did not recognize the shop style practice as one of the medical system.  For the pharmacists,  to have their name in the medical register meant to ruin their business which they been forced to practice for generations  and to start a new practice from scratch.  When the pharamacist abandoned the medical registration, indirectly gave a de facto recognition  to a profession called pharmacy for the people of Great Britain who like to eat fish and chips. 
    
If we want to mimic a pharmacy education and to taste it exacly like the  fish and chips or coco cola brands, there is nothing to be ashamed about practising it from a shop.  It was unfair for the Director Geeral of Helath for reminding the pharmacists to stick to the practice of dispensing prescribed medicines.  In the private sector,  that was like asking a person to sit down, but there is no chair around.  The message is, the pharmacists have to sit on the floor for a long time to come!  From a status of grocers to professionals in the west, it was like a long journey of 200-300 years.  We cannot expect to achieve that within 50 years or during our life time.  If we still try to pursue it, dont get shock to see some of the unexpected outcomes, because that what we want our pharmacy to take its course.  

To my best estimate, the climate of  practice in the  private healthcare services and facilities in this country is no different from the Great Britain prior to the implementation of their health financing scheme in 1911, where even the most educated pharmacists in London had to survive by prescribing and dispesing from the shop.  In that situation, it was difficult, if not impossible for a pharmacist to avoid playing doctor.  Only after the separation between prescribing and dispensing roles had brought a final end to the competition between doctors and pharmacists.



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