Dispensing Separation : Amalgamation NOT Separation

There has been quite a lot of debate in the press about this issue of dispensing separation with doctors, mainly against and pharmacists, all for it. One may wonder why the sudden interest in dispensing separation of late.

Dispensing separation which is separating the duties of prescribing, done by the doctors and dispensing, done by the pharmacists. This is nothing new as most hospitals already practise this separation for some time now. Even our government health clinics have a resident dispenser/pharmacists to do the dispensing. So in public-run institutions, this is not an issue.

The issue is mainly dealing with private doctors and pharmacists. The area of dispensing is a grey one, as both fields of medicine and pharmacy, covers this to some extent in their training. The issue of patient safety is actually a separate problem. Solving one problem can potentially give rise to others.

Safety can be improved with additional measures and stricter guidelines. The separation of duties in fact, may not solve the issue of patient safety. With dispensing separation, there will inevitably be additional steps in the process of getting one’s medication and as such, may be prone to errors. Imagine getting your prescription from another place, which has no record of your detailed medical history and may not be familiar with your doctor or medical condition. Remember medical history taking and examination, is an art that is honed in medicine, NOT pharmacy.

Just the other day, I discovered a dispensing error in my hospital. The prescription clearly stated “Famotidine 20 mg PO daily”, however, the patient was dispensed “Trimetazidine 20mg PO daily”. It was the patient that brought it to my attention. I am sure such errors also do occur in a doctor’s prescription. My point is that dispensing separation may not solve issues with patient safety if the core fundamental basics are not adhered to.

At its current state, the country is not ready for dispensing separation. The private doctors and pharmacists have not even set a framework as to how this would work. It is not as simple as a doctor writing a prescription and a patient getting it from a pharmacy. There has to be some sort of communication channel available apart from the prescription sheet. From issues like distance between a clinic and pharmacy and the availability of the drugs at the pharmacy of choice, there is in fact a lot to consider.

Ultimately, the business of a doctor is to diagnose and treat. Dispensing medication has been historically part of his duty. From Wikipedia

“The history of pharmacy as an independent science dates back to the first third of the 19th century. Before then, pharmacy evolved from antiquity as part of medicine.”

So pharmacy is an off shoot of medicine. So for pharmacist to deny doctors the right to dispense is wrong and likewise, doctors must acknowledge that pharmacists are more specialised in dispensing and knowledge of medicines. So they should never be separate as their duties has been so intertwined through the centuries.

The challenge is how to work cohesively and harmoniously with each other. Amalgamation and NOT separation, is likely the key.

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One thought on “Dispensing Separation : Amalgamation NOT Separation

  • March 12, 2015 at 5:00 am

    1. For all i can see in this article is that it is obviously written supporting doctors who are against the DS.

    2. Additional steps in getting a medication won’t be a major problem and wouldn’t much of a error. If developed countries are doing it, why can’t us do it here in Malaysia? Putting it in a simpler way, as DS being implemented, there surely will be demand for it and inevitably, 24 hours pharmacy will be all over the place. To see it in another way, don’t you think the DG himself is stupid enough not think about this?

    3. To quote a dispensing error incident without giving any proof or evidence and the real source of mishap is rather irresponsible. I myself can make up such story and blame it on the pharmacist or perhaps the doctor who is prescribing it. Who knows the handwriting of the doctor is in actual event is rather confusing? (It is rather a common problem as we all can agree. Read : doctors’ poorly illegible handwriting). Thus, I agree that : “…dispensing separation may not solve issues with patient safety if the core fundamental basics are not adhered to.” And one of the CORE FUNDAMENTAL BASIC is to write properly so that other people can read it clearly. Nevertheless, going back to the issue on the dispensing error incident, we all know there are SOP that all hospital adhere to when dealing with incident reported. Simply putting it in an article without people can clearly know what’s going on is, frankly speaking, not right.

    4. Ultimately, to quote from Wikipedia as a source is rather weak. And to justify that DS is irrelevant because of history said that it is actually evolved from / intertwined with medicine is clearly a weak argument.

    5. For how long have we had clerks, post spm students working in a clinic dispensing medications that they had no knowledge about? I rather have a pharmacist double checking on the medication during dispensing. And if doctors did the history taking and examination properly and correcty, then what are we afraid of giving the pharmacist dispensing the correctly written and prescribe medication from the doctors?

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