Why docs should keep dispensing medicine

Why docs should keep dispensing medicine

Comment by V.K. CHIN

PHARMACISTS are making another attempt to get the Health Ministry to stop doctors from dispensing, in other words selling medication to patients. They want to do the job as its members are better trained to do this.

The Malaysian Pharmaceutical Society has been trying to have such separation of functions between its members and doctors for some years now but with little success so far.

Their present campaign is not likely to be successful due to several factors that remained unresolved over the years. The main concern is that there are insufficient pharmacists and pharmacies to enable patients to buy their medication.

This is mainly due to the shortage of qualified pharmacists as it was not a popular course until recently. Most of the early graduates were trained overseas and few were interested in this profession then.

Those with A-level science, for example, would prefer medicine or dentistry since there is greater scope – and, of course, status – in these two professions.

It was only in the last decade or so that medical schools were established locally to cater for the rising demand and such overseas training was also too expensive for many families.

Pharmacology has always been closely related to the study of medicine since those with health problems have to rely on medication to cure their conditions.

This is where pharmacists play a key role.

In the early days, most pharmacists were in government service since there was little opportunity for them to come out and start their own pharmacies. When patients wanted to buy medicine, they would just get it from their doctors.

This system has been in place for so long that patients would want to just go to a doctor for diagnosis and buy the medicine from the clinic. It was so convenient for them.

If doctors were forbidden to dispense medicine, it would not go down well with their patients.

This mindset would be hard to change unless legislation is introduced to force the issue.

But the ministry cannot ignore this public sentiment and perhaps for this reason, it is reluctant to introduce a new system anytime soon.

The ministry also has to take into consideration public convenience and the logistics involved in introducing such a scheme.

Even if an experiment should be conducted on the feasibility of such a change, it would still be difficult to cater to the needs of consumers. While there may be pharmacies in more developed parts of a city, they are not open 24 hours a day, unlike clinics.

For example, where are patients going to buy medicine in the early hours of the day after consulting a doctor? The only place they can get it is from the dispensary in the clinic.

The plan to separate functions between doctors and pharmacists may be good for the latter, but will it be in the best interest of the sick and the general public?

In the short-term, the number of pharmacists coming out to practise will be further curtailed since they now have to serve the three-year compulsory service in the government just like doctors and dentists.

This inclusion is strictly due to the dire shortage of pharmacists in government service and this is the only way the ministry can ensure healthcare to the people will not be disrupted.

Health minister making doctors ill

  Health minister making doctors ill

Dr Raj Kumar Maharajah in Malaysiakini | Apr 2, 08 4:15pm

I am a doctor practicing in a clinic in the outskirts. I was totally taken aback when I read the media reports wherein the DG of Health was reported to have said that doctors will eventually be relieved from their right to dispense medication at their clinic. This is another unpopular move by the DG of Health who also happens to be the president of the Malaysian Medical Council.

Indeed, there was a lot of rumbling and grumbling on the ground almost immediately and many were not pleased by this statement by the DG. I think sooner or later the DG aims that doctors should be out of jobs.

There will come a day when medical laboratory technologists will say that they can run blood and urinary tests and are capable of inferring results so there is no need for the doctors to infer the results. Then the radiographers will say they can do X-rays and scans and therefore patients who need an X -ray or scan may just walk in to their ‘clinics’.

As it is the health ministry is trying to phase out doctors from hospital administration. Now we have paramedics who have reached the stage of deputy directors of government hospitals. Soon computers may be able to diagnose diseases and there you go – the mission and vision of the health ministry will have been achieved.

The right to dispense is the right of the doctors and that’s why we read pharmacology in medical school and journals/CMEs now. No one can say that a doctor doesn’t know much about drug interactions, drug reactions and adverse reactions. Only fools will believe that. If a patient is supposed to get a prescription from a doctor and goes to the nearby pharmacy, what guarantee is it that the medicine is being dispensed by a qualified pharmacist and not a helper in the pharmacy?

We all know that you only get to see the pharmacist in any pharmacy if you request to see one. All other transactions are done by helpers with no medical back ground whatsoever at the counters. You mean to say these helpers are better than a doctor in a clinic who gives personalised treatment to his patients ?

I also found out that doctors in Taiwan and Korea went on a strike for three days despite government warnings. When there were demonstrations last year in Malaysia, the government was quick to belittle the organisers by saying that ‘this is not our culture’.

Well, Health Minister Liow Tiong Lai, the dispensing of medicines at clinics in Malaysia has been a Malaysian culture ever since time can remember and this system has worked very well in the Malaysian scenario. Kindly do NOT change this workabale, time-tested Malaysian culture.

The guardians of healthcare in this country are the doctors and not with the minister, the DG, the pharmacists, the MLTs, the radiographers or anyone else. The body that represents us is the Malaysian Medical Association and NOT the Malaysian Medical Council.

Any change in policy should be done in consultation with the doctors and not by force by the Minister or the DG as in the case of the Private Health Act which was bulldozed past us last year

Repeal draconian private healthcare Act

Repeal draconian private healthcare Act

ZARIM KAMARUL’s letter in the Star Online_

I REFER to Dr John Teo’s letter, “Act unfair to doctors” (The Star, March 28).

The PHFSA (Private Healthcare and Facilities Act) was created in 1993 at the urging of consumer associations as they claimed they often handled complaints from the public on poor services provided by private hospitals and clinics.

But they were told that the Health Ministry’s hands were tied.

This is untrue.

The Medical Act 1971 is very clear, especially in trying to apprehend bogus doctors.

Doctors wanting to practise in Malaysia must have graduated from a recognised university, must have registration with the Malaysian Medical Council and must posses a valid Annual Practicing Certificate.

Anyone not complying is a fraudulent or unlicensed doctor and is liable for a fine or jail term of two years or more.

The Medical Act 1971 is in itself comprehensive.

But what was absent was enforcement.

One of the bizarre edicts of the new law was that it applied only to private doctors but not to government ones.

Among others, private practitioners will need to work in specified clinic conditions, pay a suspicious registration fee of RM1,500 and buy medical equipment they may never use.

The Act was passed in parliament despite the objections by MMA presidents.

The recent elections have shown that the Government must pay attention if unfair laws are proposed or are being promulgated.

This country must not exchange democracy for the rule of little Napoleans as the de facto method of governance in the civil service.

The PHFSA must be repealed.

Shah Alam.

Act unfair to doctors

DR JOHN TEO’s letter in Star Online

AS our Prime Minister announced his new Cabinet and as the unprecedented general election results unfolded before our eyes, what was clear to all Malaysians, regardless of race, gender, religion and profession, was that our destiny and objectives are the same. That is: equality, fairness and the ability to share and prosper together as one race in this great nation of ours. 

One of the very important tasks ahead for the new Health Minister and the Cabinet to look at is the Private Healthcare Facilities and Services Act 1998 which came into force last year amid an outcry by private doctors throughout the country. 

With the usual government modus operandi of implementation of similar regulations like the introduction of Fomema to monitor foreign workers’ health and the proposed E-kesihatan to monitor transport workers’ health which was later scrapped, the stakeholders i.e. the private doctors and even patients do not play any major part in its formation.  

The threat of a RM300,000 fine for not registering is enough to send all private doctors scurrying for the registration forms. The concession was that the authorities will not use the Act without due care and disregard to the private practitioners and that its main objective is to weed out bogus doctors and unqualified practitioners. 

It is now necessary to ask why is a fully qualified doctor from a local university with a valid annual practising certificate that qualifies him to practise professionally in this country as in the case of Dr Basmullah Yusom languishing in jail because of the PFHSA?  

His only crime is of course failing to register his clinic as he is planning to move to another locality soon. 

I speak for myself, but I also believe that I speak for a big majority of private doctors in this country, that the PFHSA should be repealed. 

Most doctors, whether in government service or the private sector, have only one main objective in mind and that is only their patients’ welfare and health first and foremost. 

I am not suggesting that errant doctors or practices should not be regulated. But there are many Acts in place already to do that and the fact remains that the PFHSA has too many regulations that can be yielded and enforced in so many forms that many doctors are objecting too. 

In all fairness, the PFHSA should also be renamed and revamped as the Facilities and Health Services Act without the word “private” as I believe that the same high standards should be demanded for all health facilities and services, be it private or government, as all Malaysians are equal under the law in this great nation of ours. 

It is the fervent wish and hope of many doctors that this great injustice called the PFHSA is corrected swiftly and effectively by the new Cabinet in this dawn of a new era in Malaysian history. 

Kota Kinabalu.

Malaysian doctors appeal to the PM to repeal or review the harsh act

  Malaysian doctors appeal to the Prime Minister

to repeal or review the harsh

 Private Healthcare Services and Facilities Act

Star on line

Doc paid heavy price

A TRAGIC and grave social injustice occurred when Dr Basmullah Yusom was sent to jail for not registering his medical practice.  

The Private Healthcare Services and Facilities Act (PHSFA) came into force two years ago, and since then, it is apparent that the authorities concerned have been actively implementing the regulatory aspects of the law.  

The big stick came, as we feared, ironically for a tragic reason when a qualified doctor was charged as a criminal.  

When the PHSFA first came into being, private doctors jumped up in protest, only to be assured by the Health Minister and Director General of Health, that such laws were meant for the good of the nation, even winning the support of the then Malaysian Medical Association (MMA) president, who was quoted as saying that the law “bodes well for the medical profession”.  

The Health Ministry has broken its word of assurance given by both the ex-minister and current director general.  

Newspapers reported that the Deputy Public Prosecutor from the Health Ministry had pressed for a deterrent sentence. Surely, this is again contrary to the spirit behind any law, to deal with an intentional criminal strongly, but to be lenient to a first-time offender. 

The good doctor, who serves the poor and rich, the sick and the well, has to subscribe to four or more licences and fees, to practise these days. 

There is the Malaysian Medical Council licensing, the PHSFA licence, the medical protection insurance fee, the specialist registry fee and the professional body annual fee and the MMA, the last being a social body, supposedly to look after his interests. 

To charge and then allow the process of law to jail him, without warning him or giving him a second chance, is a grave social injustice that must be addressed urgently.  

The swiftness of the legal and justice process, in comparison to other legal cases, is also befuddling.  

He was charged on Dec 13, and sentenced on Jan 17, and of course, the doctor did not have the funds to pay the hefty RM120,000 fine and thus ended up in jail. 

The observant reader would also have noticed that he did not have a qualified attorney and spoke in his own defence, which was obviously ineffective.  

His clinic in Jalan Kampung Pandan was also taped in yellow, a very humiliating act by the authorities. This high-handed way of enforcement is not the way to handle a medical doctor, whatever his error.  

Sadly, the guillotine has fallen on the medical profession.

Who will speak up for the doctor?

We appeal to the Prime Minister to repeal or review this harsh law. 


Kuala Lumpur. 

Star online letters

Tuesday January 29, 2008

Explain why doc was sent to jail

I REFER to “Doc paid heavy price,” (The Star, Jan 25), about a doctor being imprisoned for contravening the Private Healthcare Act.  

I recall “Ismail assures private docs over new law,” (The Star June 20, 2006) by the Director-General of Health that quoted him as saying:

“I want to give them the guarantee that we’ll be careful when enforcing the legislation, and that we won’t send them to jail for the slightest offences.” 

It is thus very important that the Health Ministry clarifies what serious offence led to the jailing of Dr Basmullah Yusom. 

The ministry has officially informed some doctors that the way their toilet door opens is in contravention of the Act; it should open outwards instead of inwards.  

But if a patient faints inside the toilet and is accidentally locked in, it is easier to force open a door that swings inwards.  

Furthermore, there is more space for the door to swing inwards into the toilet, than for it to open out onto a narrow corridor.  



The Health Ministry had sent letters to the clinics_

  1. in office complex blocks,
  2. hotels,
  3. condominium shop houses
  4. and supermarkets
  •  asking to build their own private toilets
  • and open the private back doors for the clinics.

Actually those modern commercial complexes already have their own toilets, safety measures like safe emergency exits, fire extinguishers etc.

Actually Health Ministry should look and renovate its hospitals whether their various clinics, Out Patient Departments etc have separate clinics and back doors for each and every unit.

Although our clinic groups’ doors are big enough and I had witness the stretchers and wheel-chairs passed through easily many times but noticed that we may need to widen them according to the Ministry’s new guidelines. I still remember that the old hospitals I had worked had very narrow doors, my friend doctors and my overcoats were accidentally caught with those door knobs and torn many times.

Instead of just searching the easy-way-out by trying to push the GPs to handle the emergencies, Health Ministry should also_

  1. upgrade its ambulance service to be quick and effective.
  2. It should also upgrade its service by assigning only the competent emergency staff on the ambulances.
  3. If could not introduce the helicopter squad for emergency at present, Health Ministry should start the Motor-bike emergency rescue service.
  4. When we used to see the police-helicopters to control the crowds and cars, we hope Health Ministry should be allotted more budget to be able to serve the public with the Ambulance helicopters soon.


Unregistered clinic no reason to jail doc

Reuben Sher | Jan 30, 08 3:46pm

With reference to the media reports of a doctor being convicted for not registering his clinic,

  1. it is completely meaningless that this registered doctor was fined a whopping RM120,000 for not registering his clinic.
  2. And since he couldn’t come up with the fine,
  3. he was sent off to serve a three- month jail term.

In April of last year, the Health Ministry director-general asserted that the Private Healthcare Facilities and Services Act 1998 was enacted to ensure private hospitals carry out their social responsibilities and was not meant to be punitive or detrimental in nature.

He and the previous health minister, Chua Soi Lek, further assured the medical community that since the Act was outdated, changes would be made and ratified by the Attorney-General’s Chambers. These changes have yet to be agreed upon or ratified but the Act has already been applied, leading now to a doctor being convicted on a technicality.

Will the DG now tell the judge that she should not have passed this type of sentence? Of course not, because that is not how the law works once an Act is passed.

This is the end result of laws that are not debated transparently or done so secretly or in a callous manner. Someone down the road will have to bear the consequences and this unfortunate doctor will now have to pay a heavy price.

This doctor’s ‘crime’ was not that he performed an illegal operation, killed or maimed a patient, cut off a baby’s arm or transfused HIV blood into a trusting patient. He apparently is a qualified doctor unlike some ‘sinsehs’, ‘bomohs’ or beauticians who masquerade as doctors and carry out clinical procedures.

His crime was a technical one. He did not register his clinic. His first duty would have been, like any other doctor, to see to his patients’ health. It doesn’t bear logic that not registering his clinic would kill his patient.

Many doctors were wary of the implications of these punitive punishments when Chua and the current DG were actively campaigning for this law. All their assurances that doctors will not be punished on technicalities has now come to naught as evidenced by the lop-sided punishment this doctor – who apparently didn’t have the financial means to defend himself – received.

Not only will his family will be left to fend for themselves but in all likelihood his career as a doctor may come to an end. This Act was passed in a rush and now has clearly been applied in bad faith.

Without doubt, this incident will only erode further the trust doctors will have on an already disorganised Health Ministry.

Jailed doc: Health DG to blame

JB Edwards | Feb 4, 08 3:26pm

I refer to the letter Unregistered clinic no reason to jail doc.

It is with regret that medical practitioners learn of a doctor being jailed under the Private Healthcare Facilities and Services Act 1998 (PHFSA) for not registering his clinic. This is clearly not what was promised to doctors when both the current Director-General of Health Ismail Merican and the previous Health Minister Chua Soi Lek were all gung-ho about implementing an Act that was clearly poorly drafted.

When the PHFSA came into effect on Nov 1, 2006, there was great resentment and distrust among private doctors. Despite the misgivings of senior GPs, specialists, ex-DGs, ex-Malaysian Medical Association chairmen and even a senior judge both the minister and the DG ran roughshod over their objections in implementing this law.

Doctors still recall how Chua and the DG quickly convened a meeting when medical practitioners threatened to march to parliament. At the meeting, they promised various amendments to the Act. The MMA and other medical associations trusted the word of both the minister and the director- general and did not even push for all the changes to be in writing before the law was passed.

But today it is clear that the word and the credibility of the director-general means nothing as the regulation has now claimed its first victim, Dr. Basmullah Yusom, a USM graduate, registered with the Malaysian Medical Council with a valid Annual Practicing Certificate. He was fined an unbelievable RM120,000 and jailed subsequently for three months when he could not afford to pay this fine. He couldn’t even afford counsel.

Anyone, long enough in the profession will tell you that there are many medical practitioners who serve their communities quietly without expecting too much in financial returns. Unless the DG thinks nothing of the jailing of doctor, is this what the DG had in mind regarding the PHFSA? It is common knowledge among the medical profession who the real culprit and draftsman of this dubious act but the DG must now shoulder the ultimate blame.

That the Act was so badly drafted was plain to everyone but the DG and the previous Minister. Chua went ahead and tabled it to a trusting parliament including his own Barisan Nasional colleagues. The minister despite being a doctor was more of a politician, and was probably playing to the gallery and consumer associations.

But the PHFSA was a highly technical and professional issue. The director-general should have forwarded his concerns but instead chose to also play politics.

Will Chief Secretary Mohd Sidek Hassan demand for the director-general’s resignation for misleading Parliament and lying to doctors about the implications and consequences of the PHFSA?

If we are going to have responsible governance, civil servants must be held accountable for their follies. The implementation of this vague and ambiguous act must be put on hold until proper discussions with all doctors affected by it are held.

It must be debated properly and transparently in parliament and implemented only if it is really proven that the current legislation is inadequate. New laws should not be passed just because someone had returned home with a law degree and has this sudden urge to implement a piece of legislation so that he can be promoted.