Doctors, who have long enjoyed an ex-alted place in society, took to the streets on March 11 to get the Department of Health to restore their right to fill prescriptions. The pharmacists refused to be outdone, mounting their own demonstration in opposition to concessions the Department of Health was making to the doctors. In this battle of professionals in white smocks, who loses out?

On March 1 the Department of Health instituted new policies- largely aimed at giving people a clearer understanding of what drugs they are taking-that have revamped the prescription process. President Lee Teng-hui came out in favor of the plan earlier this year.

Ideally, the new regulations would allow patients to take prescriptions from a doctor and have them filled at any pharmacy. If the patients regularly used the same pharmacy for every prescription, then the pharmacists would have a complete record of the drugs that had been prescribed to them, including a list of the medicines to which they are allergic. The pharmacists would also be able to ensure that none of the drugs prescribed to a patient by different doctors were incompatible. Apart from doing this double guard duty, the pharmacists would also be able to get feedback about the effects of drugs on patients and exchange such information with doctors. It would represent progress in the professional cooperation between doctors and pharmacists.

As far as patients are concerned, the new policies separating the roles of doctors and pharmacists are sensible rules that protect patients' rights. Under them, clinics must hire qualified pharmacists to serve patients, and pharmacies that operate with rented licenses will have to close up shop. And pharmacists will benefit by gaining exclusive rights to fill prescriptions. Doctors, however, are alarmed. Apart from their concern that patients will get into the habit of just going straight to the pharmacy and skipping the visit to the doctor altogether, the new rules will rechannel the flow of money for prescription drugs (estimated at NT$14 billion a year) so that it bypasses the MDs.

Fighting to protect their own interests, the doctors have been protesting ever since the policies went into effect, and have forced the Department of Health to make one new concession after another. These have included raising the fees doctors can charge for making prescriptions; designating Taiwan Province (i.e. not Taipei and Kaohsiung) as a "remote district" lacking certified pharmacists so that the new regulations can be temporarily suspended there; and allowing patients who are disabled, elderly, children or pregnant women-according to their respective medical conditions and need for "urgent medical treatment"-to spare themselves a trip to the pharmacy and have their prescriptions filled by the doctors themselves up until the end of February 1998.

These results not only did not fully satisfy doctors, they also prompted sharp protests from pharmacists. The two sides took to the streets in separate protest marches, and some of them even boycotted performing their professional duties in order to make their points. Needless to say, such actions did not consider the needs of patients. It got to the point where more than 5000 clinics from across Taiwan together sent in applications to leave the National Health Insurance system. Even students of medicine and pharmacology joined their voices to the conflicting choruses of protest.

The Department of Health, under fire from both sides, seemed to lack the determination to just go ahead and stick with a policy. Vacillating, its authority was brought into doubt and challenged. The public, apart from sighing about doctors having lost their ethics, also prayed that they wouldn't fall ill while the doctors and pharmacists were at war instead caring for the sick.

p.83

Even before the policies separating the duties of doctors and pharmacists were formally instituted, members of both professions were on the street demonstrating. It has all been quite confusing. The slogan on the banner reads, "In separating the duties of pharmacists and doctors, the public's rights ought to come first." But who are meant by the "public"? (photo by Diago Chiu)