Chandigarh: Doctors having their own dispensaries that sell branded medicines to patients are not something that people have never heard about. Everything is available under the same roof, from prescription to dispensing medicines, and a patient does not have to run to the nearby pharmacy store to get medicines that have been prescribed. A dispensary situated at a doctor’s clinic is definitely a relief for a patient, but the question arises how ethical is it to sell medicines in a clinic’s premises?
“The practice is completely unethical and comes laced with a lot of drawbacks, but is quite beneficial for a doctor who indulges in this activity, in terms of monetary gains,” Dr V V Pillay, professor, forensic medicine, Amrita Institute of Medical Sciences, Cochin, told AalaTimes. “There is nothing positive about the whole practice. It is obvious that the kind of medicines a patient gets from the dispensary will definitely come wrapped in a huge profit margin for doctors.”
Though dispensing medicines by a doctor is legal in India, still it has become an issue of concern in some quarters as the patient is often prescribed what is available in the dispensary. Also, the patient has to buy what is offered by the doctor’s dispensary and is left with no choice, even if the prescribed medicine is costly and an alternative medicine might be available outside for a less price. A doctor may also prescribe additional/unnecessary medicines, which a patient doesn’t require, just to increase sales in the dispensary.
If this practice is so unethical, why are doctors indulging in it? All of them can’t be just profit-oriented. There must be a positive side of this practice. And if we look closely, it’s not so hard to find.
By purchasing medicines at a doctor’s dispensary, the patient can almost be sure that the doctor’s writing will not be misread and in case of confusion, the doctor will be around to clarify. Also, just to ensure that he or she doesn’t get a bad name, the doctor would be cautious that the medicines dispensed at his or her dispensary is of good quality and is not expired. And of course, purchasing medicines at the doctor’s dispensary saves a patient’s time and efforts, as the patient doesn’t have to visit another place to get the medicines.
“In the past it was fairly common that doctors used to pour medicines in small plastic bottles and throw a few pills in a white paper bag. But, back then, no brand name was mentioned on the medicines handed over to a patient. But now-a-days, it’s all about making extra money,” said Dr Vinay Kumaran, director, liver transplant, Sir Ganga Ram Hospital, New Delhi.
“There are black sheep in every profession and medical line is no different. But, this doesn’t mean that everyone is tarnished,” said Dr Rohit C Agrawal, former president, Indian Academy of Paediatrics (IAP), Mumbai. “Doctors are underpaid in our country and the amount one has to pay to get professional degrees costs a bomb. The government has to consider this and frame a system where the profession pays well and in turn stays in a respectful zone.”
Dr Agrawal further told AalaTimes, “The first route that people take when they fall ill is visiting their family physician, which most of the times is a general practitioner, in most cases just an MBBS or of a lower grade. In this case, a doctor charges a certain amount that includes both the doctor’s fee and the cost of medicines. These doctors have their own limitations as they can’t prescribe medicines like consultants, who have no right to dispense medicines.”
According to Dr Agrawal, dispensing medicines by a doctor is an old practice, which is almost extinguished now and is just prevalent on a small scale in states like Uttar Pradesh and Madhya Pradesh. He said, “One needs to clearly demarcate if the doctor is a general practitioner or a consultant. Prescribing and dispensing medicines at the same time has become very rare. When it comes to metropolitans, it is no more in fashion.”
A very strong reason put forward for why doctors should not have their own medicine stores is that in case a mishap happens after a patient has taken medicines purchased from a doctor’s dispensary, it might be difficult for the doctor to escape blame. The doctor can’t get away by saying that the medicines might be spurious, or might have expired.
“The primary culprit in this case would be the pharmaceutical company. The doctor is a secondary source to be held responsible as he won’t sell medicines from a dubious source, risking his practice and reputation, just to generate some extra profits,” said Dr Pillay, but Dr Kumaran felt that both the doctor and the medicine source should be held responsible.
A doctor, who spoke on the condition of anonymity, told AalaTimes, “The whole system is rusting and the standards in India are dropping lower than one could have imagined. It is a murky situation and everything is going haywire in the medical profession. People are misusing every source they can for profits. The government pays no heed to any such situation, which gives all bad elements the confidence to continue working their way without any sense of responsibility. It’s a sad situation and from the government to the doctors to the pharmaceutical companies, everyone needs to be shaken to get the kind of respect they feel is missing in our country.”
by Jaspreet K Walia