It's really all in our hands now! (Rating: U-PR)

Dear Diary,

I read with great interest the article “Pharmacist help to ensure safe and right use of drugs” submitted to the Straits Times’ forum (29 Sep) by Pharmaceutical Society of Singapore (PSS)’s vice president Ms Fatimah, and the ongoing attempt by the Ministry of Health to implement the mandatory itemisation of medical charges in clinics by APRIL 2008. Another interesting move is to ask doctors write prescriptions regardless of whether the patients fill them at the clinics’ dispensaries or the pharmacies. Frankly, these are very optimistic signs if you ask me. The PSS has to be given credit in handling the situation very carefully and shrewdly (if you ask me).

The lack of excessive response from a pharmacy professional body is a clever move. A move to prevent the impression that the pharmacy profession is fighting for its own benefits… but rather for the good of the patients… By responding intermittently, it also seems to allow the public to “feel” that this is a natural development of the medical practice and not something the pharmacists initiate.

Almost a year back, I estimated that we may get our dispensing rights by the year 2012, when the first batches of local PharmDs and MDs graduate from our local university. The MD graduates from the Duke-NUS GMS should be adopting the American perception of full-dispensing rights to the PharmDs. A possible start of a paradigm shift?

However, now that the tide has turned in our favour…. What do we do? In fact, right from this point of time… if we still do not get full dispensing rights in the near future, we will have only ourselves to blame. Let me highlight some of the potential slips we may face from this period onwards.

Banana Skin 1:
When doctors write prescriptions, they may write the “branded” medications on their prescriptions. If the patients collect them from their dispensaries, they may just be dispensing out the generics. If the patients collect them from the pharmacies outside, they will be paying a lot more because the pharmacists (on instruction from the prescriptions) will dispense the more costly branded medications. The patients will develop a perception that it is costly to fill the prescriptions at the pharmacies. Hence a solution will be to actively educate the public on the differences between branded and generic medicines and their costs. The pharmacists should also take a more proactive role in calling up doctors to suggest alternatives and generics whenever appropriate.

Banana Skin 2:
If pharmacists keep only branded medications (which many of them do because of the higher profit margins), the public may soon have the perception that dispensing rights to the pharmacists will mean increased medication costs. The solution to this, will be a united movement amongst the pharmacy chains to encourage the stocking up of generics especially chronic medications. In the future, when the patient gets a prescription… he will most likely just fill it up at the nearest pharmacy and if that particular one only dispenses expensive branded ones, you can be sure that the perception of pharmacists’ holding sole dispensing rights will go downhill. There must be a united effort among all the pharmacies in Singapore.

Banana Skin 3:
Pharmacists must be more daring in stocking up on medicines especially those which have to be administered as soon as possible (ie. antivirals, antibiotics, painkillers etc). Pharmacists must also keep as wide a range so as to ensure that the patients have a much higher chance of getting the prescriptions filled at the first pharmacy they stop by. Keeping a limited range of essential medications will be detrimental to the perception of the public towards us again. This is a serious problem which we may hate to admit. The problem is that keeping too wide a range increases the risk of “writing off” expired medications if they are not sold after a long time. The solution will be to encourage the keeping of generics so that if such a circumstance should happen, it would not be too costly. Also knowing the prescribing pattern of the doctors near the pharmacy is a good way to solve this.

Banana Skin 4:
Whether we pharmacists admit or not… it is absolutely true that many of us have allowed our pharmacotherapy knowledge go down the drain over time. We tend to stop studying, stop remembering and just be “dispensing machines”. We need to keep abreast of the latest drugs, be capable in spotting drug-related problems (DRP), be proactive in making prescription interventions, and be able to counsel the patients on their drugs properly. The problem is that a pharmacist is expected to know all the drugs well, while a doctor may need only to know the drugs in his own dispensary or his own specialty well. Sadly, we have to live up to that expectation. The solution is to have in-house trainings on prescription medications. The PSS has been focusing too much on P-Medicine. It is really time for the society to focus on the knowledge of prescription medicine.

If we can tackle the following potential problems listed above, I can confidently say that we will see the dawn light down the dark tunnel of this profession. All the best to us! At last, we have a blog entry rated “U-PR” (Undergraduates - Please Read). Hee… =) Hopefully, I am spreading more optimism and good cheer from now onwards! ;-)

God Bless,

Andrew