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This site is supported by Health ONE is an offence to sell or supply expired, unsafe or unregistered medicines - Mr Sivalingam, Head, Inspectorate, Pharmaceutical Department, Ministry of Health

"SMA Ethics and Practice Convention 1998"

The 1998 SMA Ethics & Practice Convention was held on 14 and 15 November 1998. This was a four-part Convention. The first part was the Seminar on Clinic Dispensing. This was held on 14 November and the SMA publication titled "The Medical Profession and Pharmaceuticals" was released on that day. A synopsis of this publication can be found on Page N6.

The second part was the Mini-Course on Medical Ethics held on the morning of 15 November. The third part was the 1998 SMA Lecture titled "Not To Be Ministered Unto But To Minister" held in the afternoon and the fourth part was the Seminar on "The Medical Profession and Media". It was a weekend of pertinent information and the general consensus was the Convention was useful professionally.

In this issue, Dr Au Kah Kay reports on the Seminar on Clinic Dispensing. The Mini Course on Medical Ethics and the Seminar on the Medical Profession & The Media will be reported in the December issue. The 1998 SMA Lecture will be published in the SMJ in January 1999.



Laws and Regulations on Medicine

The import, storage, sale and dispensing of medicinal products in Singapore are governed by three important pieces of legisture, namely, The Medicines Act, The Poisons Act and The Misuse of Drugs Act. Mr R Sivalingam, Head, Inspectorate, Pharmaceutical Department, Ministry of Health spoke on the relevance of the Acts with regard to medical practitioners.

Doctors are privileged under the Medicines Act to be exempted from the requirement to hold a license to order drugs for treatment of his own patients. In a similar manner, the Misuse of Drugs Act allows them to legally prescribe controlled drugs like morphine and tranquilisers in their professional capacity. All clinics are legally required to maintain separate dispensing record books to record all receipts and supplies of poisons and controlled drugs. The information must be entered on the day on which the medicine was dispensed and the registers must be kept for 2 years in the case of poisons and 3 years for controlled drugs. Mr Sivalingam cautioned that it is an offence to sell or supply expired, unsafe or unregistered medicines.

Challenges in Clinic Dispensing

Clinics in Singapore offer a unique service in dispensing medicines in-house. This is for the convenience of the patients. Dispensing involves reading the prescription, dishing out the drug in its correct form and dosage, labelling, giving instructions to the patient and rational pricing. Dr Lee Pheng Soon, medical director of an international pharmaceutical company, highlighted some of the common pitfalls and errors encountered in clinic dispensing.

Dispensing errors commonly arise as a result of the doctor’s illegible handwriting or the use of abbreviations in their prescriptions. Ambiguous prescriptions may also result in the wrong form or dosage of a drug being dispensed, resulting in serious clinical consequences.

Dr Lee advised doctors to train and supervise their clinic assistants, especially new staff, because they are the ones who are ultimately responsible for any mishaps arising out of a dispensing error. Critical tasks like asking for drug allergies and concomitant drug use should be done by the doctor personally and not delegated to the clinic assistant.

State Certified Healthcare Assistants as Dispensers

Dr Chong Yeh Woei, a general practitioner in private practice, outlined the development of the SMA Healthcare Assistants Training Programme. It was developed in 1990 as an ITE (Institute of Technical Education) course with a grant from the Skills Development Fund to train healthcare workers at the technician level.

The programme aims to train healthcare assistants to provide healthcare for inpatient, outpatient and homebound patients. The course comprises two main components - a one-year supervised on-the-job training programme and attendance of a basic healthcare module, and another relevant module. Upon satisfactory completion of the course and passing the examinations, an ITE certificate is awarded which confers the skilled-worker status to the healthcare assistant.


Computers in Clinic Dispensing

Computers are increasingly used in clinics. More than 50% of private clinics in Singapore are using a clinic management software which may cost between $3000 and $8000. Dr Lim Poh Heng, general practitioner in private practice, gave an on-line demonstration of the usefulness of clinic software in clinic dispensing.

Besides increasing productivity and saving time, dispensing software can assist the doctor with drug inventory control, alert him to drug allergies and interactions, and generate drug registers and statements of accounts. In Dr Lim’s experience, clinic computerisation has also increased the morale and efficiency of clinic staff.


Rational Pricing of Medicines in Clinics

A workshop on rational pricing of medicines was conducted for doctors. SMA President, Dr Cheong Pak Yean highlighted the salient points of the 1996 SMA survey of the practice costs of clinics in housing estates and GP fees.

The survey found that the mean consultation fee component, comprising professional fees and practice costs, was $19.04 while the mean medicine cost was $6.63, thus adding up to an average total patient bill of $25.67.

However, it was possible for the GP to assign varying proportions of his total bill to the consultation and medicine components. One method would be to increase the medicine charge, resulting in an apparently low consultation fee well below the SMA guidelines. It is SMA’s policy to discourage this method of computation of the patient’s total bill.

SMA recommends doctors to quote their consultation fees according to the SMA guidelines and to price the medicine such that it would be comparable to what the patient would have to pay if he were to choose to fill the prescription at a pharmacy instead. When the ‘pharmacy price’ is not known, the following alternative prices are acceptable:

  • drug index price eg. DIMS

  • manufacturer’s list price

  • 1.25 times the nett price for single-user pack size

  • 2 times the bulk-packed price

  • for very low-cost medicine, a rounded-up price of 10 cents/tablet, $1.50/5g cream or $1.50/30 ml mixture or a minimum charge of $2 per item per week


During the discussion, questions were raised over the issues of prescription fees and telephone consultations. A doctor is entitled to charge a prescription fee of $10 per monthly supply of medicine when the patient is not physically present in his clinic. This is to cover the doctor’s time spent in looking through the patient’s case notes and professional judgement exercised in issuing the prescription. Although telephone consultations are theoretically chargeable, SMA discourages this practice as the doctor can be held liable for any advice given over the telephone.