The Doctor Will See You Now [Non-Fiction]

Chapter 108: The COVID Series

One of the major pharmacy chains in Hong Kong has offered a new service in light of the nCoV outbreak: that patients could order their regular medications there that they would otherwise get from specialist outpatient clinics, and collect it at a designated pharmacy branch instead, for a small handling fee. (Some conditions apply, such as no refrigerated drugs like insulin, no controlled drugs like morphine and benzos etc.)

It sounds great at first because they're further reducing the patient flow in and out of hospital and people still get their drugs, but it's self-serving and actually unhelpful in the scheme of things.

One: we already have drug refill service at outpatients. The patient needn't come in person; a relative can bring the patient's ID and, after the patient's notes are screened by a doctor to ensure recent blood test are OK and the patient can safely just get a drug refill without being seen by a doctor, the relative can collect the meds and go, along with a new follow-up appointment and blood test appointment. The pharmacy chain service does not have a doctor screening the patient's notes or lab results (actually, they don't have access to that information). They also do not/cannot issue a new follow-up appointment or blood test appointment for the patient, which means the hospital cannot follow-up the patient in the future. This actually ends up giving us more work to do and puts the patient at risk.

Two: medicines issued by the outpatient department have a fixed charge per piece issued and the rest of the cost is covered by government funding. The handling fee issued by the pharmacy chain lands in the pockets of the chain itself and no money goes to the already stretched and underfunded public hospital for those drugs. The hospital is expected to provide the entire prescription for free. The pharmacy chain is basically robbing the hospital and thus the taxpayer by doing this 'service'.

Three: the worst part? This was not discussed with the public hospitals to begin with, but just announced publicly by the pharmacy chain.

Call me sceptical, but I can't help but feel the pharmacy chain deliberately blindsided the public hospital by announcing this without prior discussion and negotiation for an otherwise unnecessary and unhelpful 'service'. The chain won't make money from the small handling fee, but the 'look at what we're doing to help the public in these troublesome times!' is an excellent advertisement for their company.

I also wonder: what will happen if a patient comes to harm from this? For example, a patient is on a blood-thinner that needs adjusting (Warfarin) and recent blood tests actually show their blood is too thin (over-warfarinised) and they are at risk of major bleeding, but the pharmacy chain can't access those records and just re-issue the same drugs and the patient has a massive brain bleed, who is responsible then? The hospital that issued drugs based on the pharmacy's request? Or the pharmacy making those orders thinking they can function just as well as a full specialist outpatient department with specialist physicians screening each and every single patient's results?

In better news, Hong Kong has seen 3 days this week where we have had no new cases of nCoV.