E-drug: Pharmacists and Medical doctors
---------------------------------------------
Dear all,
RE: Irrational Drug Use, Characterizing the entire health sector, of
developing countries:
What is this funny, deep seated struggle, between medical doctors and
pharmacists all about?
Is it designed to achieve a good health care system, or to fulfill greed
and selfish agenda?
A medical doctor should diagnose, which is no-easy, one-minute feel of a
patient.
A medical doctor should also suggest a prescription, and end here.
A pharmacist picks the ball from there. The pharmacist should look at
the prescription, and authenticate it, to cross check for any possible
errors, and dangerous errors. Errors causing useless expenditure, keeping
us sick, and poor. This is double checking. Because medicines are
chemicals, and human life is precious. Resources are also limited. A
pharmacist should then supervise or dispense the medicine. And
dispensing is no easy, one-minute talk at a patient.
So, to start assuming, is too light to come from educated human beings.
Friends, this is the cycle God prepared humanity to have. Violate it.
You will sing irrational drug use, year in, and year out, forever. You
will also, at the same time, pretend to brave through the consequences,
and become fully insensitive to the results.
You will say, well, i have been diagnosing, prescribing, and my nurse -
who has not been retrained to handle medicines, has been doing a good job
for the last 30 years. Very good, my friend. Too long does not make it
right. You are human. The nurse is under qualified to cross check your
prescription. And how do you keep those medicines. How about laws
governing their use, are you aware? Do you believe that dispensing, and
drug information to the patient is very necessary. Do you acknowledge
that the patient is for the health care team, and not for you? And that
the patient has the right to sue you, for technically avoidable errors?
Do we have human rights activists around? There is work for you.
Health professionals also suffer. For example, after a reckless use of
vital antimicrobials, health workers can also get infections (and
infections account for most disease in the developing countries), that
can not respond to treatment, and the speed at which that happens is too
high, and often restricted to where medicines are misused, and overused.
The only scientific explanation for such, friend, is misuse and overuse
of medicine.
And the drug authority should work of course, closely with Pharmaceutical
Societies, and pharmaceutical societies should handle pharmacy practice.
If the drug authority entangles, in licensing pharmacy practice, you will
see all sorts of inferior generics, on your medicine market. What will
be the results? You all know them. Yet your population is poor. See
it, you should put money in that area.
A drug regulatory authority should be empowered with an excellent staff,
and equipment or laboratory. And should do aspects or activities
involved in drug control. Results of laboratory analysis, and procedure
used, should be reviewed and discussed by a panel of technically
competent personnel, that should be with in the drug quality control
department. Before sending results to higher authority, for action. If
you arrange otherwise, or, if, you would like to experiment, your
experience will never forget my name.
And, if, you say that you can do excellent diagnosis. Do excellent
prescribing and dispensing. All the 3 steps, alone, then I am almost
100% certain, that you are telling a lie. You are not with patients, but
some where in the limits of administration, and policy making.
WHO(World health Organization) medicines policy advisers, should not
watch, as pharmacists and doctors, in developing countries fight a
senseless war, while the taxpayer, and ordinary citizens-from whom the
pay rise comes for a living, for either professionals, undergo trauma, in
all innocence.
A dispensing medical doctor, will induce purchase of medicine from a
wholesale pharmacy or retail pharmacy. The retail pharmacy, will also
purchase medicine, from the wholesale pharmacy. The dispensing doctor,
will charge his paracetamol syrup at 3,000/= and, the retail pharmacist
will charge-the same paracetamol, at 1,500/=. The dispensing doctor will
charge his consultation fee, plus over priced medicine, and call the sum
of the two, 'total treatment bill.'
Do you see this dear! The retail pharmacy will inevitably close, to open
a wholesale pharmacy. Why not?. To earn a living, since pharmacists
hardly charge consultation fee. They only depend on sales, from medicine
to pay rent, salaries to support staff, and other expenses.
If the retail pharmacy is adamant to become wholesale, the moment the
supervising pharmacist goes to the loo, the owner of the business
instructs, the nurse, or pharmacy technician, to sell, so that they get
salary for the month! What will you see friend? All prescription only
medicines will be sold without prescriptions, in the private sector. And
you will observe, essential drugs get off nice looking shelves, like
oranges tumbling from market stalls.
Attack the problem from the cause. Wipe the symptoms, and you get back
to zero, wasting money.
Look, is the result of the automatic shift, from retail to wholesale
pharmacy trying to get pharmacists closer to patients, or further away
from patients?
WHO, remember how UN watched the Rwandese butcher one another. Yet
being privileged, should call for neutrality and sympathy for the
under
privileged.
Therefore, instead of spending money on all sorts of studies, designed by
medical doctors, to show how pharmacists are poor at diagnosis, and,
studies, designed by pharmacists to show how medical doctors are poor at
prescribing or dispensing- the donor community should put money in
pharmacy schools, to churn well trained pharmacists, with good clinical
skills.
And medical schools to churn well trained medical doctors with excellent
diagnostic knowledge. Donors could also think about pushing money into
training laboratory technologists, and avail excellent diagnostic
facilities, where feasible. As the quality of medicines is checked, from
time to time, the quality of laboratory reagents should not go unchecked.
And money is wasted in senseless wars. What a 'gimmick'!
Otherwise, watch the way the UN watched 1,000,000 people in Rwanda,
die, in 1994. And later, they tend to show they are concerned. But
friend, human beings had died. I can not call UN a hero, in at least
in that
case. However politically correct, you may seem, to look at UN.
Now, the other reasonings about resistance, can contribute, but you and
me can not do much about those other causes, or mechanisms of resistance.
But we can do much or rational use.
Notice that there is a happening, in the developed world, of using
natural ways and natural products, the so called alternative medicines.
Believe this my friend, those medicines or ways are not developed here in
my country, and I am almost 100% certain, i will say. If alternative
medicines, especially herbal derived, are misused, and overused, even
unnecessarily, they will also become worthless.
WHO, which statements will you issue. Act now or behave the way the UN
treated the Rwandese, in 1994.
Back to patients or the general public. As you know majority are
illiterate. The literate are ignorant, but think they know everything.
Literate or illiterate, the population must be taught, properly, clearly,
without prejudice. Leaving all stones up side down.
Do not give dangerous material still on research. Or hatched out of an
ill defined research technique. Give reality, facts. Research material
is suitable for only health workers. And once in a while you can keep
the public posted on what is on going. Patients you have put on research
without notice can sue you.
(Ethics of research on medicines, require you to teach patients about
their plight!)
Remember that clear, drug use education, with helpful impact, as i have
stated above, needs health workers, to have their house organized, first
thing, top priority. This is top priority. Do not see a new health
centre as top priority. I mean, you must plan. If your plate is always
next to your shoes and, your tooth brush is kept in the sink, of your
kitchen. Have you planned with a sober mind? You, then, rush to put all
the money you have into buying more new shoes, and more toothbrushes
and plates, to be handled in a similar way. Look friends!
I will not stop before this statement. When your Pharmaceutical Society
teaches X, to the general public, while your Medical Association teaches
Z, to the same community - intelligent lay people will doubt either of
you. And there will be no sense, in the whole money, human resource, and
time consuming exercise. Intelligent lay people will say, surely, they
are making us fight their, trivial, inter-professional grudge, which our
fore healthworkers, clearly, and without mercy to the patient -
started.
WHO(World Health Organization), HAI (Health Action International), and
other mindful bodies, i challenge you to break the silence, on this
matter.
Sincerely,
George Kibumba, MPS(Uganda)
Drug Information Pharmacist,
Joint Medical Store, Nsambya,
P.O.BOX 4501,
Kampala,
Fax: 256 41 267 298
Tel: 256 41 268 482
e-mail: did.jms@imul.com
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.