Doctors bypassed as patients go straight to their pharmacists

With easy access to medication, many patients bypass the doctor and go straight to the pharmacist.

DUBAI // Pharmacists say more than half of their customers do not visit a doctor before coming to them, in a trend towards self-medication that has health experts concerned.

A chemist in Al Barsha said of the nearly 70 customers he saw daily, about 40 expected a consultation and medication without prescriptions.

The most common request was for painkillers or antibiotics.

Another, at a pharmacy near Umm Suqeim, said more than 10 per cent of his customers asked for antibiotics without a prescription.

"Many patients even walk in with a specific name … and say I want this antibiotic," the pharmacist said.

"We try to communicate to the patient that this is something that should be assigned by their doctor but they are not convinced."

But Dr Amin Al Amiri, the Ministry of Health's assistant under secretary for medical practice and licensing, said antibiotics could not legally be bought without a prescription.

"There are certain medicines that are available over the counter and those that are accessible after consultation with the pharmacist according to FDA guidelines," Dr Al Amiri said.

"All antibiotics require prescription and pharmacies found dispensing them without prescription will be penalised."

The trend is less common in Abu Dhabi than Dubai, where health insurance is not compulsory. Dubai pharmacists can also dispense medication more freely.

The pharmacist in Al Barsha said chemists were trained to be able to respond to basic health enquiries, but if the customer was complaining of more serious symptoms such as heart problems, dizziness, bleeding or gynaecological complaints, he suggested they consult a doctor.

He said the challenge came when customers began to demand stronger medication.

"In Abu Dhabi, antibiotics cannot be dispensed without a prescription, but in Dubai and the Northern Emirates it's possible," he said. "Antibiotics are not governed by prescription, but they should be."

There are two broad categories of antibiotics, the pharmacist said.

Broad-spectrum antibiotics target three or four types of bacteria that are responsible for common illnesses such as chest infections. The second category of antibiotic targets specific types of bacteria that can only be identified through a culture test.

"We cannot determine exactly what bacteria is infecting that individual in the pharmacy," he said. "If we give them the wrong antibiotic, their microorganism might develop resistance to the drug and this will make it more difficult when the doctor comes to treat the patient.

"There may even be a chance that their infection was viral and antibiotics are not necessary."

Dr Ihab Ramadan, a specialist in internal medicine at Medcare Hospital, attributed the short cuts patients take to a lack of time or money.

"Insurance is an important factor, especially among low-income individuals," he said. "The price of a doctor visit, lab tests and medicine can be very costly. So people bypass the doctor and go straight to the pharmacist."

According to the 2010 Dubai Household Survey, three-quarters of workers in the emirate do not have health insurance.

The average cost for a doctor consultation at a private hospital in Dubai is Dh300, exclusive of any required laboratory tests and medication.

The Dubai Health Authority (DHA) initially announced a health insurance plan for residents in 2009, but the plan now has a deadline of next year.

Dr Lamya Al Barasi, a pharmacist in the capital for nearly 13 years, said there had been a significant drop in the number of patients seeking pharmacy consultations since the Health Authority - Abu Dhabi introduced compulsory insurance in 2006.

"Previously, people would rely on old prescriptions and go back to the pharmacist requesting the same medication," Dr Al Barasi said. "Now we're witnessing another extreme. When people sneeze, they immediately go to the doctor. This is a good thing."

Another concern, doctors said, was that some medication could have serious side effects, or even worse, mask a more serious health problem.

"For example, diarrhoea and vomiting can be indicative of food poisoning, but if the vomiting contains blood the individual should go straight to the emergency department," Dr Al Barasi said.

The rule of thumb is that if symptoms are persistent and do not improve within five days, see a doctor, he said.