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    Why Should Medical Doctors Not Dispense?


    Medical doctors are motivated into providing patients with the right knowledge regarding their illness, treatment, and how to avoid it, or to minimize its effects. A good doctor is one who is able to explain well the right information and make patients feel they are being taken care of. This kind of competent and caring sharing of knowledge has its economic incentives in the form of fees, honoraria, and/ or salaries. The government would willingly pay for the services of a medical doctor seen as intelligent, compassionate, and trustworthy. But what if the medical doctor has other things in mind?

    Dispensing Distracts From Caring

    Dispensing medicines are in itself an economic activity and motivates those who dispense with incentives like profit margins, kickbacks, and performance bonuses. A medical doctor who is dispensing medicines may find motivations in conflict. How can I achieve greater profit margins and better bonuses when the medicine demand of my patients do not meet sales targets? This distracts the medical doctor from focussing on caring and providing knowledge. In the process, the medical doctor moves from the motivation to care to the motivation to earn. In a system where medical doctors are socially expected to be prosperous as an indicator of their competence, shortcuts to wealth can be seductive.

    Pooling Demand Can Make Drugs Cheaper

    A dispensing physician is free to determine the price of the medicines they dispense. Higher prices are then justified with convenience, assurance of superior quality, and even exclusive access. Susceptible patients comply with an intent on keeping the patronage of the medical doctor. Drug costs are thus elevated with patients cooperating in the belief that the higher prices are worth it. However prices for a wide variety of drugs can be made cheaper. Economies of scale can bring prices lower. By pooling the storage & dispensing activities, the cost of drugs can be made cost-effective by pharmacies and drugstores. To support the pharmacies & drugstores, government institutions are in place to ensure that prices remain competitive and in favor of the public even when larger interests are abroad.

    Drugs Require Proper Storage and Handling

    Pharmacists are professionally trained to prepare, store, and dispense medicines, maintaining the safety, quality, and efficacy of drugs from source to user. Most medical doctors are not trained as pharmacists or chemists and have a limited understanding of the cold chain necessary to preserve medicines in the best possible condition. In the event of supply shortage, a pharmacist would be able to identify substitutes that are effective and on occasion cheaper. Pharmacies are bound by strict guidelines in both law and profession to observe optimal storage and handling conditions. Pharmacists simply are better able to assure patients that the drugs they dispense remain safe, of quality, and effective.

    As the Philippines grows to be a wealthier society, the health care demands are expected to grow. Knowledge sharing and communication by medical doctors allow the public to most importantly learn how to prevent disease. Should disease set in, medical doctors are trained to provide care, comfort, and to first do no harm. Dispensing medicines distracts a medical doctor from this training. The economic motivation to profit from dispensing and sales can also elevate the cost of medicines. Further, the act of dispensing is better performed by co-equal health professionals and in doing so, drug safety, quality, and efficacy is maintained. In the interest of public welfare, medical doctors ought not to dispense medicines and reaffirm their vocation of providing knowledge, extending care, and sowing compassion.

    2 June 2016 Peter Glenn Y Chua


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