Today, I received an interesting referral letter, not from a doctor but a pharmacist! The letter was actually directed to a government hospital but the patient decided to come and see me.
It is interesting to see that a pharmacy can treat patients and even write a referral letter to the hospital !!. According to the patient, they saw a “doctor” but I don’t see any doctor’s name in this letter. Only a pharmacist has signed the letter. I presume the pharmacist was wearing a white coat and thus the patient thought he or she is a doctor. The pharmacy has been prescribing medications for this patient over the last 1-2 weeks and decided to refer to the nearest government hospital with a plan : “provide a brain scan (MRI)”. I also like this sentence ” cluster migraine without etiology“.
The issue of pharmacists acting like doctors has been going on for a long time but unfortunately the enforcement is really weak. Even though raids are conducted but very minimal. Pharmacist is not allowed to diagnose, do investigations and treat patients. Their job is just to dispense medications on doctor’s prescription and to explain the side effects of the medications. They also act as an adviser to the doctors in terms of dosages etc. I have seen pharmacist who even conduct routine blood sugar, HBA1c and BP monitoring for patients. They even adjust medication dosages and prescribe new medicines, taking over GPs work.
I can only see this situation getting worst as pharmacist are also learning to survive. Soon, they may even employ our jobless doctors to work with them as an adviser! Who knows? anything can happen in this bolehland……………….. I am going to send this letter to MOH and see what action they are going to take.
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I suspect I know what action they will take…sit on it until the writing fades.
Interesting that the individual concerned claims to be a Pharmacist and Pharmacologist – two very different professions!
In a way it’s not very surprising as public tend to go to pharmacy to get symptomatic relief – and get “consultation” from the pharmacist then the “prescription”. But I guess they should have clearly identified themselves to patients instead of being mistaken as “docs” like what happened in this example. And this is the first time I’m seeing a referral letter by them, and perhaps there has been more. I agree that this matter should be brought to MOH attention.
I believe you are slightly mistaken…pharmacists have all the rights to dispense medications (OTC drugs) which does not require doctors prescriptions…and of course this includes counselling and ‘consultations’ as well.. Their job is not ” just to dispense medications on doctor’s prescription” and “to explain the side effects of the medications”… ..maybe you should do more research about the roles of pharmacists in the health care system before relegating them to mere medication dispensers..
But in this issue i believe the pharmacist is breaking the code of conduct for doing things out of his/her job scope..
Of course you are right. They can prescribe OTC Class C drugs but the consultation/counselling should be on medications only. They should not make a diagnosis and initiate any treatment. They should refer to a doctor for further management.
Unfortunately, Diabetic medications are under Class C and thus the pharmacist are initiating diabetic meds. It is class C as those days there were no doctors in rural areas and MAs were given authority to prescribe DM meds. It should change to Class B.
I just got an auntie who trusted pharmacist last week. She was diagnosed DM 2 years ago with FBS 14 & HbA1c 14.4%. Before seeing me, the pharmacist just prescribed Metformin 500mg tds for 2 years. She has been out of control for 2 years with lethargy, sugar in urine, neuropathy and others. After doing Diabetic work up, DM was out of controlled with HbA1c 14. If fact nobody consult her for diet control, check for retinopathy and others.
I have seen cases like this countless number of times!
Obviously pharmacists have the right to dispense medications. This is a common sense and need not to research about it. We are talking about managing a patient. Please refer to the points by Dr Paga below. Thanks.
The big lab companies are already doing this currently by employing doctors whose job is just ordering and sell investigations packages. However we should not blame the pharmacist only, I knew lots of patient who self diagnose and demand medication from the pharmacists.
Demanding is one thing but the pharmacist must practise ethically. I know some pharmacy which is strict and do not sell any medications without prescription.
I have even experienced having a Hospital Assistant treating me in a clinic when he replaced the doctort who is not available on that night! Really serious.! I walk out immediately!
Please forward that as a complaint to the MOH. If you don’t know who to contact, u can make e-complaint via the NCCC portal.
I have sent this to JKNJ and MOH, so far no reply
How about Doctor of Nursing Practice (DNP) who can order many different tests & prescribe meds per her/his protocols. There are lots of DNP/NP nurses who are qualified to do so, how about it is soon become reality in Malaysia? It helps a lot to overcome incompetent HOs/unavailability of MOs in the wards.
Very far ahead, my friend.
[…] March 2012, I wrote an article of the same topic. It was about a referral letter from a pharmacist who was managing the patient’s Diabetes and […]
How condescending of Letchumanan to be surprised that a pharmacist can write a letter of referral. If he wants to take issue with what a pharmacist is doing, it does little for his credibility to slam all pharmacists as illiterate, especially from someone whose own command of English writing is poor.
It looks like the person who don’t understand what is written is you, with better command of english. The article is Not about the referral letter. IT was about the fact that the pharmacist was treating this patient by acting as a doctor!AND I never generalised it despite many such instances.
A pharmacist is NOT supposed to make diagnosis, treat patients, make referrals. He/she should have advised the patient to go see a doctor from the onset. I am not sure how the literacy of a pharmacist come into the picture.
Phoebe has a point.
I think it is a matter of how you view that piece of paper from the pharmacist. It does not say “referral”. He/she probably had good intention…to just summarise the medication taken by the patient and what he knew about the patient. Its up to the specialist how he wants to use the info on the paper.
Doctors n Specialists often tend to be very sensitive about referral letters…even from fellow doctors. Too much ego i guess.
Btw Dr.Pag…u r making an assumption too that this pharmacist was “treating” the patient. It is very common for people to walk into a Pharmacy n ask the pharmacist about treatment n medication. It is possible that the so called patient (person actually) could not understand the jargon and hence asked the Pharmacist to write down for him/her.
So u see…dont just pull out one piece of paper…n make your own assumptions. Maybe you sld hv called the pharmacist n hear her version b4 you published that piece of paper. MUCH ADO ABOUT NOTHING
I don’t write something without confirmation! This pharmacist was treating this patient for a month before this ‘referral’ was made. The same pharmacist has done this many times before( treating patients) so much so, many patients think that they are doctors! Even Jabatan Kesihatan has given a warning before!
I am really sorry for the sick language of yours but you deserve no respect. I am seriously detest a condemning culture what more it comes from medical fraternity. Please be professional in your language and if you wanna prove a point do it in a dignity and proper discourse.
How do you diagnose a migraine?
If the person chooses to see or consult a pharmacist…to obtain medication , thats his perogative. U cannot claim that the pharmacist was “treating” him.
Even i sometimes go and “consult” the pharmacist and get his opinions. Believe me my regular pharmacist is very professional n very knowdgeable about medicines….and alternative brands. Most GPs have little knowledge.
Pharmacists are experts in their own field…and they are more knowledgable on chemistry aspects. DOCTORS ARE NOT, this is why the dispensing is separate in most countries.
Now please dont use that line…”Jabatan Kesihatan has given warning”. They r only good for that…
I am just curious…so what happened to this Pharmacist? Do u know if he was charged etc? Because you have made this Pharmacist to be a “villian”.
The law is very clear on this. Pharmacist. SHOULD NOT treat patients. They can only dispense and give advise on medications prescribed by doctor!! This is the rule in ALL developed countries. FYI, I know more about this case than you. This pharmacist claim that she is a doctor and treats patients like a GP clinic. The last I know the Bahagian Pharmacy of KKM is keeping a close watch on this pharmacy after 2 warning letters. I am not sure whether the pharmacy was suspended.
The pharmacist is committing an offence against the law. But I suppose, if people can ignore scholarship bonds, they can ignore the medical act as well.
You are pathetic jk. Did u not read what Dr P wrote. That pharmacy was served 2 warning letters and possibly suspended.
You truly are a self centred, self righteous person. Go impose your self righteousness somewhere else.
Medicine has no place for people like you.
“Straighten up the wet yarn” if there’s such an idiom in english lol.
“We begin to learn wisely when we’re willing to see world from other people’s perspective.” ― Toba Beta, Master of Stupidity
Don’t kid yourself, this is not the only case of pharmacist acting as doctors. Warning? In any civilised country with enforced rule of law, if proven, the pharmacist will be stroked off the register.
Why is advocacy of enforcement of the rule of law considered ‘self righteousness’?
People have said enough, if you don’t understand or you don’t want to understand it’s totally your choice and it’s your right to express your opinions.
I’m not against the advocacy of “Rule of Law”. In fact I agreed a stern action against the pharmacist that impersonating doctor . It’s your latter argument about scholarship bla bla which I think everybody said enough and I am tired to reply already. It goes the saying “Makin dilayan makin meroyan”