Conflict of interest when docs dispense medicine

SINGAPORE - Mr Elgar Lee ("Ensure more transparency in doctors' bills"; Sept 5) suggested that the dispensing of medication be separated from the prescribing function.

In Western countries, the patient is given a prescription for medication by the doctor and is charged for only the consultation as well as any procedures carried out. The patient then takes the prescription to a pharmacist, who owns the dispensary, to buy the medication.

In Singapore, the dispensary is owned and often located within the premises of the doctor.

Clearly, there is a potential conflict of interest when the doctor prescribes and sells medication to generate profit.

It would be interesting to conduct a study on the prescribing patterns of doctors under these two systems, as well as on whether a wide range of generic drugs is stocked by doctors in Singapore.

Having been trained as a medical doctor and living in Australia for a number of years, I have had experience of the two systems.

Anecdotal evidence suggests a significant difference in prescribing patterns for similar conditions, with more medication being prescribed under the Singapore system as well as a lack of generic drugs in clinics.

Changes to the system will likely face significant resistance.

Perhaps, for a start, doctors in private practice can disclose the profit margins on the medication they sell.

There are clearly vested interests in maintaining the current system in Singapore and I wonder if this is in the best interest of patients, both in terms of the care they receive and the money they have to spend.

I hope the Pharmaceutical Society of Singapore and the Health Ministry can initiate a dialogue with the different parties, in particular, the consumers, to improve the system.

Taching Tan (Dr)

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