SEPT 30 — There is no doubt that the majority of the 8,000 doctors in Singapore are ethical professionals. But time and again, black sheep who indiscriminately prescribe drugs for profit and not for their patients’ health rear their ugly heads.
There are greedy people in every profession. But where doctors are concerned, such greedy behaviour can have serious, if not lethal, repercussions.
In the past five years, 23 doctors have been hauled before the Singapore Medical Council (SMC) and penalised for dispensing sleeping pills indiscriminately.
With the influx of foreign doctors, the expanding intakes of the two medical schools and plans for a third, this would be a good time to consider if we should institute more protection for patients from greedy doctors.
The Health Ministry has tried to stop these unethical practices by imposing stiff penalties on the offending doctors. But cases still surface with regularity.
The planned sharing of electronic medical records might put a stop to this. But it will be years before the system covers GPs and not all private doctors would want to be involved.
About the only way to stop the indiscriminate dispensing of pills is to make sure doctors cannot profit from it: by separating prescription from sale.
Unlike medicine such as paracetamol, sleeping pills can be both addictive and dangerous. Taken in greater than normal doses, it can give people a high. Too high a dose can kill.
Addicts have been known to clinic- hop to get their supply of the drug.
Over the past four years, six doctors have been found guilty of freely dispensing Subutex — a medicine that’s meant to help heroin addicts wean off their habit. But the solution to a problem became the problem itself when addicts turned to Subutex as a legal way to get high.
Again, there was a small group of doctors more eager to line their pockets than to help their patients. Addicts desperate for the drug willingly paid the high prices these doctors demanded.
Last week, The Straits Times found several doctors equally lax in prescribing slimming medication.
No one would call reporter Jessica Jaganathan obese. She’s not even plump. She is in fact svelte. Yet, she had no difficulty getting anti-obesity medicine from several GPs. One even offered her a range of pills to choose from.
About 15 clinics here are openly listed on the Internet as easy places from which to get such pills. All five that Jaganathan approached lived up to that reputation.
But that Internet list is obviously not complete, since one in five randomly selected GPs she visited behaved in the same way.
Obesity pills are prescription-only medicine with dangerous side effects, including palpitation of the heart and even convulsions.
One veteran GP said these doctors took the quick and easy way. Convincing a patient that she does not need such medicine takes time, which a busy doctor might be unwilling to give. And obesity medicine is a good source of income since patients tend to return for more.
These cases are a clear indication that a fair number of doctors here are more concerned with making a fast buck than truly taking care of their patients.
Separating the prescription of medicine from their sale might appear harsh, but it might well be the only way to curb such malpractices. This issue has been debated several times in the past, and on each occasion, doctors have protested vehemently against the proposal since they get a large chunk of their income from selling medicine.
Patients too have argued that it would inconvenience them, especially when they’re sick, to have to go to a pharmacy to buy their medicine.
The separation of prescribing and selling medicine can also be circumvented by doctors setting up their own pharmacy as a separate company, next door to their clinic.
These are all valid arguments. But an exception should be made for certain medicine, such as sleeping pills and obesity drugs.
Patients who need such medicine are not “sick” in the usual meaning of the word. Nor would they normally need the medicine urgently.
Not letting doctors profit from the sale of the drug eliminates the greed factor from a doctor’s diagnosis. A doctor who sets up his own pharmacy to sell such drugs would immediately be suspect.
Further protection can come through registering patients prescribed such drugs, so they cannot over-purchase the medication. This will put a stop to the doctor-hopping that now goes on.
Patients in hospitals would not be inconvenienced since they would have to get their medicine from the pharmacy in any case.
An exception should be made to allow specialists to dispense such drugs, since patients who consult them tend to be suffering from more serious illness.
Conscientious GPs would not generally sell many such medicines, so are unlikely to lose much business as a result.
The ones who will be hit hardest would be the greedy ones who need to be stopped in any case.
But most importantly, such a system would protect patients from overdosing on medicine that could do them much harm. — The Straits Times
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