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Dispensing medicines by doctors – How ethical?

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?

Dr V V Pillay

“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.

Dr Vinay Kumaran

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.

Dr Rohit C Agrawal

“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

18 Comments

  1. Mayank Dabral Mayank Dabral Saturday, August 17, 2019

    How about pharmacist in India who dispense medicines without a prescription, and are responsible for drug resistance, organ failure (including renal and liver due to painkillers). By creating a division between drug prescription and sales, the government has created a non viable solution for doctors to work in underserved communities. Since those people are too poor to afford the fees, they purchase it from the local pharmacist, who does not even have the necessary know how about disease and its management. And, since the doctor can’t stock and sell medicine he can’t practice.

    By creating such rules, the government is promoting quack culture, who are nothing more than salespersons for diagnostics and pharmaceutical industry.

  2. NAND KISHORE PHARMACIST NAND KISHORE PHARMACIST Friday, November 13, 2015

    in india every doctors want capture every field which is attached with him . as per rule a pharmacist is only outhorised person to medicines. but docters want to take commission from every part like lab xray ultrsound mri, ct,company ,chemist,m.r, canteen,parking,illitrate staff services,reffering etc. afterthat docters are saying pharmacists are erning more than docters very bad

  3. vivek vivek Monday, November 17, 2014

    “6.3 Running an open shop (Dispensing of Drugs and Appliances by Physicians): – A physician should not run an open shop for sale of medicine for dispensing prescriptions prescribed by doctors other than himself or for sale of medical or surgical appliances. It is not unethical for a physician to prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.” so I guess no one is breaking the rule??

  4. karthi karthi Tuesday, July 22, 2014

    But in mci code of ethics allows doctors to dispense medicines.so better put a end to discussion or change mci rules.i feel its far better for a doctor who is dispensing medicine than a doctor who get trips, cuts,gifts from pharma companies

  5. karthi karthi Tuesday, July 22, 2014

    super sir! a group roams for this slogan “unethical,” unethical”

  6. Sulabh Sulabh Monday, July 21, 2014

    Hi

    I came across my doctors who write presrciption which are not available in the market and at the end you need to get back to the doctor to get them filled.

    Is there a forum where we can make a complaint of this and some necessary action is being taken on that?

    I am not sure why medical profession is such a cheap business where money is utmost important for the doctor rather than getting patient getting well.

  7. narendra narendra Tuesday, May 6, 2014

    Doctors should not dispense drug which has no bactch no, manufacturer details, because dispensing this kind of medicines is definetly illegal and surely Dr is playing with patients life..

  8. kapil goyal kapil goyal Monday, July 8, 2013

    can i complaint against this doctor in medical council of India
    please advice me

  9. kapil goyal kapil goyal Monday, July 8, 2013

    the medicine is trademark by doctor and medicine have only on his dispensary and costly. recently I purchase a medcine his dipencry the medicine was more coastly by 40 % of another reputed pharma company.my no. 9350907462

  10. Dr. Ramesh Vardhan Dr. Ramesh Vardhan Saturday, November 3, 2012

    dear pre & para(e) medics , you have to live the tag of a non clinician with out proscribing medicines .( nam bade darshan chotee ) . prof , hod , dean , director , principal, warden …..even the medical colleges prefer such people so that they make best use ( misuse ) of them .( like rubber stamp). as i mentioned i n one my comment in aala times that any body can start a chemist shop with or with out diploma or with an borrowed licence . selling all sorts of funny items – blade, pen , biscuits, tooth brush etc. so i think there is nothing wrong in dispensing the medications. in fact the clinic is also called dispensary . in india most of the patients get bloody tears when comes to pay as a consultation . they expect injection ( ingeesion , suuee, prick , shot , & many more names, & at 3 or 4 different tablets \ capsules\ creams \ tonics \ powder .( it is like buy one- take many free).. added to this blood test , x-ray ( x -rate ) ,scan , ct , mri & referral to so called corporate hospitals ( with sealed letter with a name of a particular\ specific doctor ) for cuts \ commissions\ gifts \ tours \ travels are almost a must ( musth majaa karo ). with all said & done a decent , dignified , doctor with ethics , morals & values should be give free hands to practice with in the limits his knowledge& skills . setting up of hospitals , medical colleges by non professionals , should be curtailed it is open secret the purpose of these establishment is get name , fame & money .( it is a big business ) dr.ramesh vardhan

  11. Dr.Arun Kurhe Dr.Arun Kurhe Tuesday, October 30, 2012

    India is largest manufacturer of Generic Medicine. Why this generic medicine are manufactured ? Does it for Pharmacist to earn more. Pharmacist are earning more than Doctors. Why doctor should not earn ? Does anything is available free or at less price to doctors.

  12. DR.L.V.RAGHAVRAO DR.L.V.RAGHAVRAO Monday, October 29, 2012

    Most patients want to know the treatment cost which includes medicine costs along with the consultation and other costs. In the treatment ,every one knows the medicines cost more than other costs. you can be cynical and say the doctor can make more money in the medicines than his own consultation .but majority of doctors are not business minded and donot view having a meidcal shop in their pemises a profit making unit, but rather consider it a service to the patient as he can assure quality medicines at an affordable rate.This is thescenario in the rural set up and most single doctor and small hospitals. hold a parmacy for this purpose. in fact the big hospitals and corporates not only cost the medicines at mrp rates and add a dispensing fee as well. Having medical shop in the doctor’s clinicmakes more sense as there is less chance of substiution,and dispensing spurious drugs. Of course it all depends on the doctor’s conscience. Besides, they are scrutinised by th drug inspectors more rigorously!

  13. Saikumar G Saikumar G Sunday, October 28, 2012

    In India, doctors having their own medical shops may not be advantageous for the patient.The companies are chosen by the doctor depending upon the offers made by them and drugs are not cheaper. You can see many local brand drugs in small hospitals because they are given at cheap rate.These medical shops are usually are run by the unqualified people. This is also the trend in most of the private medical colleges in our country.

  14. Dr K A Naryana Dr K A Naryana Saturday, October 27, 2012

    Misuse of the Medical profession is taking place at multiple levels starting from manufacturers to consumers and there are no supervisory mechanism in this country or if there is one it is defunct. In Bangalore there are private hospitals [High tech hospitals] who charge from Rs.15000 to 1,25000 for a simple operation of Appendicitis. Thank God, the Government does not know what is Health Care System.

  15. devidas devidas Saturday, October 27, 2012

    dispensing medicine by doctors is cheap n best solution for patients ..doctor knows well the quality n result of the medicines he is dispensing…else he will loose his reputation if the medicines turn out to be spurious or no acting. so also other govt body is there to decide efficacy of drug /standardization of drug.anytime generic medicines are cheap n best!!
    its not fair to say doctors are earning money out of it..price controll body id theer to look after all these matters..doctor is pillar or backbone of the whole sysytem..he knows well whats is right or what is wrong.once again i cld say generic medicines are cheap n best solution for patients.!!

  16. drd drd Saturday, October 27, 2012

    Errata: read the second sentence as..anything which can lead to monetary gains for a doctor will always be unethical……

  17. drd drd Saturday, October 27, 2012

    The profession of medicine has been cursed by so called ethics……anything which can lead to monetary gains for a doctor will always be ethical…….

  18. Bharat Bharat Saturday, October 27, 2012

    What is wrong for a professional cannot be right for a manager managing the profession.

    That means hospitals with pharmacies , especially those that the inpatient buys only from them, will face similar ethical challenges.

    Even more so because in a managers’ case , the patient isn’t afforded protection by ‘professionalcode of conduct’ that a doctor has to at least appear to uphold!

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