But the times haven’t been kind to general practitioners (GPs) like her, and the drop in business has forced her to cut out over-time shifts for her two nurses and the cleaning service she used to outsource.
The reason behind such lacklustre “business”, she claims, is that many pharmacies are now assuming the functions of doctors by diagnosing patients, recommending alternatives to prescription medicines and even dispensing medication without prescriptions.
“Nowadays, there are so many pharmacies, some of them do blood sugar or cholesterol tests and even recommend medicines based on symptoms which their customers say they have.”
At the same time, she said, GPs are suffering losses because they spend thousands every month stocking up on medicines while having fewer patients.
Another doctor, with a clinic here, Dr John (not his real name), also pointed the finger at pharmacies, saying his business has decreased by some 30% over the past year.
“You have pharmacies that are dishing out medicine without prescriptions or simply recommending alternative types of medication.”
John, who is now operating with a “skeleton” team of nurses, said it was important for the public to realise that doctors prescribe specific medications according to a patient’s condition.
“One prescription can’t be used forever. Say a patient comes to see me and I prescribe a medicine, over time, the patient may require a different kind of medication depending on what their needs are at that time.
“Pharmacists cannot diagnose patients, that’s what doctors are for.”
Separation of roles
The proposed Pharmacy Bill, which would see doctors being restricted to only diagnosing and prescribing medicine, and pharmacies dispensing them, has been talked about for years, but has yet to be passed, FMT was informed.
Some doctors have argued that Malaysia is not yet ready for it, especially in rural areas, while last year, pharmacists objected to five provisions in the draft bill, citing insufficient protection of consumer rights and patients.
But Khatijah said the separation of the roles of doctors and pharmacists would be a welcome move, as it would save her and other GPs a big chunk of their operating expenses.
“Right now, I spend no less than RM7,000 a month on medicines. Life would be much easier for me, because I would only have to stock up on medication administered through injections and life-threatening medicines which pharmacies cannot dispense.”
If the bill were passed, Khatijah said that she would have to increase consultation charges in line with Malaysian Medical Association (MMA) guidelines, as consultations would be her only source of income.
“Now because I dispense medicine, I can afford to subsidise consultation charges. Sometimes, if a family brings in two or three children who are sick, I don’t even charge for consultation.”
According to the 13th Schedule of the Private Healthcare Facilities and Services Act 1998, private GPs can charge between RM30 to RM125 for consultation.
A 50% surcharge can be imposed for consultation beyond a clinic’s operating hours and a 100% surcharge can be imposed for house calls.
Health ministry must act
Meanwhile, Malaysian Medical Association (MMA) president Dr Ravindran R Naidu said that MMA has received numerous complaints on pharmacists who aren’t abiding by the rules.
He added that MMA has been consistent in urging the health ministry, particularly the Pharmaceutical Department Services’ enforcement unit to take action against such pharmacists.
“Pharmacists are supposed to dispense drugs like antibiotics or drugs for treating diabetes, hypertension and cholesterol only with a doctors prescription,” he said.
He added that treatment of non-communicable diseases, such as hypertension and diabetes, wasn’t only about dispensing medication but also involved regular monitoring of the outcome, preventing complications, and counselling on diet and also lifestyle.
It was previously reported that nearly 50% of Malaysians over the age of 18 are overweight or obese, almost 40% have high cholesterol, 39% have hypertension, and 17% are diabetic.
“A proper history, physical examination and identifying necessary investigations needed is done before arriving at a diagnosis, let alone starting any treatment,” Ravindran told FMT, adding that only doctors were trained to do this.
He added that the MMA also supports the Pharmacy Bill in its current form where doctors have the dispensing rights.
It was reported earlier this year that independent GPs are struggling to stay afloat, with many having closed down their clinics due to rising costs, among other things.