While the laws allow doctors to dispense medication, the Pharmaceutical Society of Jamaica is concerned about how this is being done, with receptionists and other untrained persons sometimes being the ones dispensing the drug.
And the Medical Association of Jamaica (MAJ) shares that concern, although it is convinced that only a small number of doctors would be involved in that practice.
“The Medical Act of Jamaica says a doctor can prescribe and dispense drugs because he has been trained… but he must talk to the patient about the drug. Having a nurse, receptionist, or even a pharmacy technician dispense the drug, that poses a problem,” MAJ President Dr Clive Lai told the Jamaica Observer.
“Dispensing the drug may be time-consuming so the doctor may get someone to do it for them, but that is where the MAJ has a problem. You cannot use a receptionist or a pharmacy technician who are not trained in pharmacology to do it,” added Lai, as he noted that most doctors do not have the time to dispense drug, and find it easier to write a prescription and send the patient to the pharmacy.
But it is the doctors using untrained persons to dispense drug, who have earned the ire of the Pharmaceutical Society.
“The practice of dispensing drugs by untrained personnel is dangerous. Receptionists are unable to identify prescribing errors, drugs interactions, and to counsel patients on medications,” said the Pharmaceutical Society of Jamaica in a news release last week.
“The problem of [an] unregulated doctors' office dispensing drugs is becoming more prevalent in the western parishes, which have an influx of Asian doctors who practised similarly in their home countries. Any unregulated practice means that there is no assurance of standards. This compromises the quality of care that the patient is due,” added the Pharmaceutical Society.
Health care law and ethics expert Shereen Dawkins, says the issue is one which Jamaica needs to address with urgency, particularly in the case of doctors who have migrated to Jamaica.
According to Dawkins, while the majority of local doctors follow the rules and offer patients medication in accordance with best practices, there are some who are registered to practice locally, having been trained abroad, who are putting patients at risk.
“Most of the doctors in Jamaica, especially those who are trained at UWI (hospital), they do not practise like that. They call us as pharmacists and we have very good relationships with them, but what we are finding is that there are some doctors, who are trained overseas, of a certain ethnicity… who come from countries where they practice like that. They bring those practises to Jamaica and we are saying to them, don't do it,” Dawkins told the Sunday Observer.
“The Pharmaceutical Society is not against a doctor giving any form of immediate care to a patient, because that is the role of the doctor. As it relates to giving a few tablets, the laws of Jamaica speak to that. So a doctor might receive samples from a drugs representative, or he has a few tablets in his practice, he may give some.
“So if a patient comes in and he needs to lower their blood pressure immediately and the doctor gives the patient some tablets, that is acceptable — both legally and ethically,” added Dawkins.
She noted that the concern of the Pharmaceutical Society is when doctors go beyond immediate care and start supplying medication that they ordinarily would put on a prescription and send out.
Dawkins argued that when a doctor writes a prescription and sends it out, the pharmacist provides an additional check by looking at issues such as drug interaction.
“Most of our doctors are competent but to err is human, and sometimes there may be reactions that the doctor might not realise when they write the prescription. And the pharmacist who is trained as it relates to drugs, might realise this and contact the doctor, as we do every day, and the pharmacist, and the doctor agree on the best way forward,” said Dawkins.
That is a position underscored by the Pharmaceutical Society of Jamaica, which argued that pharmacists are trained for four to five years and are experts in identifying drug interactions, appropriate dosages, and can counsel patients as well as advise doctors on the right drug to prescribe for a condition.
For Dawkins, pharmacists also provide invaluable assistance to doctors who might be writing prescriptions for multiple complaints by a patient without taking into account how the drugs will react to each other.
“There are times when I get a prescription and I might have to call the doctor and say, 'Hey doc, if the person has high blood pressure he can't take this cold medicine, because it has an ingredient that will also push up the blood pressure,'” argued Dawkins, as she pointed to examples of cases she has seen before.
Dawkins noted that with the quality of locally trained doctors this is not a usual occurrence but added: “These things happen when people are tired, when they work long shifts, etc. So when the patient comes to us, we identify it and we call the doctor to address the issue. When you eliminate the pharmacist, the risk is increased.”
