Dispensing separation: Yay or nay?

An old argument within the Malaysian healthcare scene has emerged once again. Pharmacists and doctors are once again at loggerheads over the issue of who should be allowed to dispense or sell medicines to the public. This issue and all its associated arguments have been featured across a wide range of media channels including print, social media and the Internet. This issue is also commonly known as the separation of dispensing functions or dispensing separation.

The key point of contention is whether the sale of medicines should be restricted exclusively to licensed pharmacists or remain available to both doctors and pharmacists and a wide variety of points have been raised both for and against dispensing separation. Among others, pharmacists have argued against the potential conflict of interest that arises when a prescriber who determines what medicines you need is also the person selling it, while doctors have argued that the provision of medicines is central to the practice of medicine. The arguments being thrown around are not new, indeed many of the points in favour and against dispensing separation are older than many of the healthcare professionals debating the issue.

The main points from each camp are summarized below.

Pharmacists contend that the main idea of a dispensing separation system is to boost the safety of medication for the public. With the prescribing and dispensing of medicines done by separate parties, dispensing separation allows for an additional pair of learned eyes to check for potential errors in prescribing which can include the wrong choice of medicine due to factors such as the health of an individual patient’s kidneys, wrong dosages or missed interactions between different kinds of medicine which may render the combination inert or toxic. Pharmacists also contend that by allowing them to be the providers of medicines, patients are able to benefit from the education and advice provided by the pharmacist on how to best make use of their medicines. Indeed, the experience of pharmacists in hospitals where dispensing separation is practiced indicates that errors in prescribing and using medicines is common and these errors are often caught and prevented in the pharmacy.

Doctors, on the other hand, contend that the introduction of dispensing separation will ultimately burden the patient both in terms of time and money. Patients, after being seen by a doctor, would have to make their way to a pharmacy to obtain the medicines before going home. As such, there is concern that the shift from the current system would incur greater costs that may both directly and indirectly burden the patient. Indeed, many doctors contend that the sale of medicines subsidizes their consultation fees and should that source of revenue be denied them, the cost of consultations would have to be increased further. There are also concerns regarding the availability of pharmacies in areas outside the city and during non-working hours.

Many of the points coming from both camps are valid, with varying degrees, and they certainly sound convincing. After all, these points have been polished over the last five decades, so it’s no surprise that representatives from both camps are particularly erudite when debating this issue.

But how do you, as a patient, as a member of the public, make sense of all of this? With such convincing arguments, how do you decide what system would ultimately benefit you? Which parties are trying to make a quick buck at your expense and who really has your safety and health in mind? Unfortunately, there are no easy answers to this problem and the best way for you to safely navigate the complexities of this issue is to be an active, enlightened consumer.

So how do you become an active, enlightened healthcare consumer with regards to this messy issue? Start by exercising your rights as a consumer with each healthcare provider, be it the doctor or the pharmacist. If you choose to get your medicines from your doctor, demand that he or she give you the information you need. This includes the name and purpose of the medicine and the price that he or she is selling it to you for. Ask for an itemised bill so that you know what you’re paying for exactly, with regards to medicines and consultation fees. Demand that your doctor teach you how to use your medicines, especially if they come in devices like sprays, inhalers or eye drops. At no point should you allow a secondary school leaver to teach you how to use a complicated drug housed in a complex device. Again, exercise your rights as a consumer and move on to another doctor if you feel that yours isn’t giving you enough transparency, information and quality of service.

Similarly, you should exercise your consumer rights if you choose to obtain your medicines from a pharmacy. Demand that the pharmacist fulfils his or her responsibilities in checking the prescription from your doctor for errors and hold them accountable for mistakes made. Medicines should be prepared or packaged with instructions that you can understand with the information that you require in order to use the medicines safely. Demand that your pharmacist educate you about every medicine that you get from them and the right way of using medicines, especially those that are housed in devices. At no point should you accept subpar service from your pharmacist with regards to helping you use your medicines.

In summary, issues pertaining to the healthcare system and how we obtain services from it are often complex, without clear answers as to how it will impact the patient and members of the public. It is therefore recommended that the public start becoming educated healthcare consumers in order to get effective and economical healthcare services.

Mark Cheong was formerly a clinical pharmacist for the medical department for various public hospitals. He now manages clinical operations for a multinational healthcare organisation. Mark is also an editor for the Malaysian Medical Gazette.