President’s message – Drug Labeling

Such call in the Medical Council follows the recent media report on 8^th September 2003 of doctors printing chemical names instead of approved trade names or pharmaceutical names in the drug labels to patients. To avoid getting into trouble, it may be nice to revisit the proper way of drug labeling as stipulated in Clause 10.1 of our Professional Code and Conduct of the Medical Council of Hong Kong.

All medications dispensed to patients directly or indirectly by a medical practitioner should be PROPERLY and SEPARATELY labeled with the following essential information :

1. Name of doctor or means of identifying the doctor who prescribes the medication;
2. A name that properly identifies the patient;
3. The date of dispensing;
The trade name or pharmacological name of the drug; {If a generic drug is used, a doctor may add the term “generic substitute for (name of patent drug)” on the label to further facilitate identification of the generic drug. Reference could be made to the “Compendium of Pharmaceutical Products” which lists all the drugs registered in Hong Kong and is published by the Department of Health.}
4. The dosages, where appropriate;
5. The method and dosage of administration; and
6. Precautions where applicable.

I have come across many colleagues being disciplined mostly because of putting more than one drug into one bag, incomplete patient name, no date of dispensing and improper drug name. The penalty is getting more severe nowadays, and some unfortunate colleagues may even have their licenses suspended. For the unlucky colleagues, the later application for restoration to the register may mean a half defeated battle in front of the full Medical Council. I would advise colleagues that it does not worth to risk with an improper drug label.

However, since the introduction of drug labeling in our Professional Code and Conduct from 1966, we have witnessed a lot of drawbacks which are harmful to both the patients and us. It is unquestionable that since the start of drug labeling, many of our patients disappear and they end up in front of the pharmacies to queer up for drugs with the pill bags from us in their hands. Needless to say, there is a severe disturbance of patient doctor relationship as a result. Many a time, some colleagues may come across their old patients one day suffering from side effects of the drugs being prescribed to them “long time ago”.

Such mishaps occur because of the lack of control of import and sale of drugs from the drug stores by the Government. The demand for black market drugs is high and is evidenced recently on 5^th September 2003 by a seizure of $1.24 million worth of fake medications by the Customs Department. In a recent dinner meeting with Dr. E K Yeoh, the Secretary for Health, Welfare & Food, your Council has expressed deep concern on the illegal drug sales by the drug stores all over the territory. And it was nice to hear Dr. Yeoh’s promise to look into the matter seriously and to consider granting more prosecution power to the Department of Health to exercise the control of drug sale from drug stores. Furthermore, he promised to look seriously into the problem of infrequent proper drug labeling by the drug stores with the Pharmacy Board and to make sure that the standard of drug labeling of doctors and drug stores are equal so as to protect the interests of the public.

The sacred mission of drug label from health care providers is not to allow the patients knowing the names of the drugs so that they can buy anywhere and anytime they wish BUT to ensure accurate communication among health care providers so that the health care workers can manage the patients more efficiently. However, if the name of the drug inscribed in the drug label is not understood by the profession, the purpose of protecting the health of the patients through drug labeling would be defeated. Therefore, if a patient brings to you a pill bag of another doctor with the name “4-hydroxyacetanilide 500mg” on it next time, you would scratch your head just like me when I was asked by a newspaper reporter recently and did not comprehend what was in front of you is just “Panadol” (Trade Name) or “Paracetamol” (Pharmaceutical Name). And worse still, you could not take reference from the Compendium of Pharmaceutical Products published by the Department of Health and you are in a lost of nowhere and do not know whether the “4-hydroxyacetanilide” is causing side effects to the patient in front of you. It may mean imminent danger to your patient and your practice. Would you be convinced not to label “Panadol” as “4-hydroxyacetanilide” then? Would you agree with me to ban any doctor to use chemical name in drug labeling? I presume the answer is definitely YES.

So, please do practise safe medicine with proper drug labeling and you will help us in our savings, particularly in the premium of Medical Protection which is going to increase by 60% to 80% in early 2004.

Dr. Yeung Chiu Fat Henry

President's message for October 2003 HKDU Bulletin (2)/email02