My
new problem with stock control of my ethical stock is from the companies
that are establishing and managing the large bulk billing medical
centres.
The Doctors they employ are mostly foreign and are offered many
benefits to come to our country to practice and their families are
more than willing to settle in a country not dominated by war or
political oppression. I am told that there is supposed to be a mentoring
system to help these young Doctor's assimilate into our complicated
health system but it does not seem to work very well unless the
Doctor asks for help.
The Australian system of the Federal PBS system and the different
State legislate laws is complex for us who have been educated and
mentored through the system let alone those who have come into it
after they have been practicing in another country.
As Pharmacists
we have extended an offer to help these new Doctors learn the
complexities of the PBS prescribing process only to be told that
their management prefers that they prescribe only in quantities
that they consider necessary.
Therefore we are daily faced with many prescriptions for quantities
of four tablets of Norfloxacin 400mg or five tablets of Ciproxin
500mg or ten tablets of diclofenac etc.
This prescribing behaviour throws the stock control system into
chaos as well as raising the anger of the consumer who has to
pay private price for these quantities, as they do not meet the
PBS criteria.
The other
problem here, that is more worrying, is based on the Quality Use
of Medicine concept.
These Doctors are not following the accepted Therapeutic guideline
principles that the excellent Australian health system has developed
and defined.
These Doctors prescribe certain antibiotics for conditions that
they are not indicated for in Australia, as well as using very
large doses of medications that are not in our guidelines.
As Pharmacists and concerned health professionals, we have tried
to address this issue with the Doctors themselves, the Division
of General Practice and the Australian Medical Association but
we are told that unless the Doctor is willing to accept peer intervention
there is not much that these bodies can do.
My question to that reply is what happens when this young Doctor
is lured by more money and freedom to practice in a more rural
community where there may not be a pharmacist to oversee the prescriptions
written?
What if these foreign Doctors are issued with a dispensing licence
as well?
Who will watch for the inappropriate use of antibiotics or the
large doses for children?
In my community
the family medical practices are struggling to retain their medical
practitioners or to persuade new Doctors to come to our area.
We are a regional town on the fringes of the one of the world's
seven wonders - the Great Barrier Reef and we still cannot lure
medical professionals to this beautiful area.
The bulk billing clinics are thriving and have increased our workload
substantially, not only by the number of prescriptions but by
the fact that we have to be extra diligent in watching the strengths
and doses of medication as well as ensuring the medication ordered
is appropriate for the condition presented by the patient.
Where do I
go from here?
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