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I'm Jo Muirhead and this is the Entrepreneurial Clinician podcast.
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This season is all about the future of working within healthcare and what it takes to stay
in meaningful work without being consumed by it.
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Across this season, we're going to be talking about capacity, identity, leadership,
ethics, and the systems that we're working inside of, including the ones that may not be
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serving us as the healthcare clinicians that we are.
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You'll hear from clinicians, founders, system shapers who've expanded how they've served
all without abandoning themselves, their identity or their credentials.
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And you'll also hear some solo episodes where I step back and name the patterns many of us
are living but rarely given language for.
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Things like psychosocial risk, moral injury, identity strain and the quiet exhaustion that
comes from carrying way too much for way too long.
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This isn't about hustle.
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This isn't about burning it all down and needing to find a brand new career.
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It's about learning how to work with clarity, capacity and intention so that we can
continue to contribute in ways that matter.
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I'm really glad you're here.
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Let's begin today's conversation.
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And welcome to yet another episode of The Entrepreneurial Clinician where today's guest is
possibly from a discipline you never expected to hear on this podcast.
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So stick around because we are going to be talking to a pharmacist about all things
pharmacy, but then how on earth this person has created such a powerful service for people
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who genuinely need it and the service providers who are trying to help them.
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But before we get into this interview with Luke today, I would like to thank the
traditional custodians of the land that I find myself on.
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This is the land of the Darug people in the greater west of Sydney.
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Thank you for allowing me to live on your land and for giving me the opportunity to live
in such a beautiful place.
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I pay my respect to the Darug elders, past, present and emerging, and extend that respect
to all Indigenous people who might find themselves listening to or watching this podcast
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today.
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So Mr.
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Luke McGrath, thank you so much for saying yes and for getting the memo about the uniform
that we're wearing today.
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For those of you who can't see us, we've both turned up in black t-shirts with white
writing.
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Luke, share with us who you are, what you've done and how you ended up here today.
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Yeah.
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Jo, thanks for having me on to start with.
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think this is a really exciting platform to share this journey because believe it or not,
I'm an entrepreneurial clinician.
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You know, so I am a pharmacist, but not in its traditional sense.
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So I began my journey back in 2013 doing community pharmacy, you know, the standard
dispensing medications, labeling boxes, that'll probably get me some hate, but giving
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medications out to the public.
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Right.
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And so.
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During that time, I didn't really see any passion or impact that I could have in that
industry in its traditional sense.
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I actually left community pharmacy and began medical repping with a company in Australia
that's predominantly, well, at the time it was predominantly heavy with selling opioid
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medications.
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So Purdue in the US was its subsidiary.
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So I had a firsthand experience as to
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Firstly, I was a pharmacist.
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Secondly, was pushed into this sort of potential career path where we're going down that
medical pathway.
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I just, my visions and values did not align with that career.
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And so I took a step back from that as well and began doing independent pharmacy reviews
for a different provider in the workers' comp space.
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So I was one of the first pharmacists in Australia to do this.
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And off the back of that, obviously my mindset was that
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I think I can do this better.
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And so I kind of ventured out and did my own thing.
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And as good as that experience was, again, I think my hand was better served and I could
have better outreach in upskilling other pharmacists to do what we do.
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And instead of me being able to review, you know, 20, 30 claims a month, I can now educate
other pharmacists and have a way wider.
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impact on the medications being prescribed.
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So I've obviously started building a company called Independent Med Management and we
oversee medications being prescribed to injured workers or injured people all across
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Australia.
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So that sort of got me to where we are today.
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Wow.
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What an, what an incredible need.
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Like talk about a niche or for the US listeners, a niche, like finding this problem, which
was medications not necessarily being used properly and through no fault of anyone's not,
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we're not blaming anyone here.
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It's just people prescribe medications.
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don't always know what the other, the interactions are.
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People don't always know to talk about what medications they're taking, but
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you there comes a point where like you said to me, uh off air, was like in community
pharmacy, you could see what some people were being prescribed and what some people were
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taking and you kind of went, Oh, God, this can't be okay.
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Like, have you got a bit of an aha moment?
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Oh, okay.
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when we started working in this workers comp CTP personal insurance space, that was the
aha moment for me because what we saw for general community patients was so different to
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what we see in the insurance space.
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And I kind of want us to know why.
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And so it seems like people as bad as it sounds, and we do get to see the worst case
scenario.
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So I'm sure this is not the case across the board, but it seems like
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Unfortunately, people are treated a little bit like a commodity in workers' comp and CTP
where everybody wants to have a hand in their treatment.
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Everyone wants to be a provider and assessing the patient.
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These people are going to see different IME providers every second week for a lot of
cases.
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They're seeing multiple different doctors, multiple different specialists that are
treating them.
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And no one's really overseeing the big picture.
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And that's sort of why we came about in its first instance, because we get to have a look
at these medications as a holistic.
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that's exactly
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what needs to happen because the insurer in this instance is probably the person that has
the most comprehensive picture of this person's treatment, but they're not clinicians.
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So how are they supposed to make, you know, treatment or, you know, assessments on whether
the person's on appropriate medications or not, because they're not pharmacists.
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So that's sort of how we landed in this space.
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And the workers comp personal injury space is so different to what you're seeing in
community.
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Wow, that's alarming, to say the least.
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But I reckon there's people all over the world who are listening to this in whatever
jurisdiction they're working in, whether it's personal injury in Europe, personal injury
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in Asia, personal injury in the USA.
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And they're going, yeah, we know this to be true.
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We know this to be true.
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Thank you for calling it out because most of my listeners are the type of people who just,
they want to see people heal.
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They want to see people.
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recover and they there's frustration when when it's like I can't actually help you any
further in your recovery until we get this medication management stuff sorted out.
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Yeah that's that's a big deal.
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I think almost everybody on a workers comp or CTP motor vehicle accident claim are
prescribed medications, even if it's for the first couple of weeks.
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But what we see is that as they become maybe dependent, reliant on the medications,
whatever the case may be at the start, almost all of those people are taking the same
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medications at week 52, just because no one's had a conversation around how we can improve
this in the first couple of weeks.
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So if no one's
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If no one's having a game plan at the start, then these things just spiral out of control.
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And that's sort of the crux of what we do.
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We combine all these medication issues, come up with a structured treatment plan, and we
discuss this with the doctor and the treatment teams.
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And really, that's our job.
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We just have clinical discussions with the doctors, and you wouldn't believe it.
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If you get the medications right, people generally recover better and faster.
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Surprise, surprise.
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laughing because it's like, well, that's what the medication is supposed to do.
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I know for me, I had a, you know about my medical history, I'll disclose this.
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I actually got Luke involved in looking at all of my medications at one stage.
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And it surprised me how much medication I was being given.
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And like, remember walking out of an oncology session with more, more Codine than I
thought.
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I didn't feel safe walking to my car.
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Like I just looked at my husband and went, but they didn't feel to me like, this like, was
no check in around that.
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was like, come back if your symptoms don't change, come back.
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If you find another lump, come back.
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If you start to get sick.
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And I'm like, I.
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uneasy about this so I became very anti my medications which is also problematic right
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Yeah.
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Yeah.
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And we talked about this, especially in like that physical space where, you know, if you
get the medications right, then they can be a really good tool to help people recover,
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especially when they're going back to that physical rehabilitation and all those types of
things, not to mention psych as well, but I just don't have this desire to have people on
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lifelong antidepressants.
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I don't think that's the, that's the goal, but it seems like this is that quick fix that
everybody's sort of after.
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and no one's really doing that deeper work or looking upstream from what's going on with
that.
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So we obviously have a big passion on de-prescribing medications, but also where it's
appropriate.
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So a lot of people are going to be on medications for a long time, maybe not lifelong, but
they might be on for a period of time to help them recover.
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And that's fine.
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But for the ones that are on, you know, 10, 20, 40, 50 medications, like we have seen
people taking 40 or 50 medications.
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every day and most of those medications are taken multiple times a day.
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And you just think, how is this an appropriate treatment for this poor person?
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Like I have sympathy for the person because no one's the put the time and effort into
improving that poor person's medication use.
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So, you know, and I think let's look at some of yeah, it's concerning and it's not
uncommon.
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I mean, yeah, 40 and 50 medications is probably less common than you'd hope.
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But
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The tens and 20 medications is very common in workers comp.
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And I think this this crazy push for people being on lifelong medications and this
prescribing cascade where people are prescribed two, three, four different medications
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just to treat a side effect associated with the primary med, you know, so.
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Yeah.
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Yeah.
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And I can speak into that because my question now when, particularly with my migraine
condition, because it's taken us four years to find a group of medications that are
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starting to work, but the side effects of that trial and error along the way, it's like,
I'm just not playing this game anymore.
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It's just, I don't want to be the 20 person.
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I don't want to be the 30 person.
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just, that's, this is not the life I envisaged for myself at all.
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uh
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as treatment though, Jo, like we got to do better than that.
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You can't just treat symptoms associated with condition with a drug and think that that's
treatment.
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We've got to treat the actual condition to reduce the need for the drugs.
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And I think that speaks volumes to like how this becomes an issue.
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So, you know, in the traditional sense, a doctor was the prescriber, the diagnoser, they
prescribe the medications and you'd probably go and see the same doctor for all your
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ailments.
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Your family saw them.
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Yeah.
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saw them, you kind of have that family history with the doctor.
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And then not only that, you took the scripts to a pharmacy and you had your drugs
dispensed and you saw the same pharmacy over and over and over again.
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So they get that comprehensive view of what's going on and their job.
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Traditionally, a pharmacist responsibility was to make sure that the drug was appropriate
for you.
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There was no interactions with the other medications you're taking.
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The dosage was correct.
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They also gave you some counseling points to say, Hey, you know, that box of codeine that
you just got.
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that's going to cause some issues and not just adverse effects.
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You might actually find that you'll be dependent on this medication over a period of time,
in which case we're to have to start to reduce that at some stage as well.
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These counseling points, none of that's happening anymore.
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So you're going to see different doctors in workers comp, not you specifically, but you're
going to see different doctors, different specialists.
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They're all probably prescribing.
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Sometimes now you've got this self-referral to a med cannabis prescriber, often
interstate.
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And so there's this
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huge disjoint in treatment and people's care that no one's really overseeing this broader
picture.
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So that's why sort IMM became so valuable to insurers was that we can give an opinion on
whether the medication is appropriate or not.
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We do everything a pharmacist should be doing.
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We obviously give the insurers some information on what they shouldn't be funding in
respect to what condition they're liable for.
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But outside of that,
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Our goal is to improve the medications being used by these people so as they recover
better and faster.
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Wow.
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I can remember a story.
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We used to get a cohort of clients coming into my rehab practice, which we kindly referred
to as the grumpy old men.
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These were usually men in their fifties who'd had their lifestyle, their work, their
identity stripped away from them, usually because of a work related injury that wasn't
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their fault.
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And
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the amount of pain medication that these gentlemen usually were on meant they shouldn't be
driving.
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Right?
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And so you start working with these people and you're going, well, we had the confidence
at that time to actually say, talk to me about the medications you're on.
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Because if we're going to put somebody back into a workplace, then they're not supposed to
be using heavy machinery.
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We've suddenly lost a whole heap of vocational goals that we can't recommend anymore.
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100%.
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Right.
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So we took that very seriously and it was something that all of my team members became
confident and competent in asking about.
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But helping when we identified particularly with these gentlemen, that losing their
license was the worst thing that could happen to them.
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That motivated them to go, can we go and talk to your doctor?
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I'm happy to come with you or help you develop a script to be able to go and talk to your
doctor about.
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how we're gonna change this medication usage.
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But it wasn't until there was another huge threat presented to them that they wanted to
take action.
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And you know, these guys have been on injury claims sometimes for 10 years.
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And yeah, it's just sad.
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Okay, this is making me sad.
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So we already know that in the general community that there is widespread misuse and
overuse of opioid medication.
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Like we just know that that's there.
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And traditionally, most of us, especially the mental health professionals here are gonna
start thinking that that's an addiction.
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Like somebody is got genuine addiction seeking behaviors like we normally think of
somebody on the street with that.
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Is there instances in what you're finding where
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People don't even realise that that is a possibility for them with the amount of
medication they're taking.
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00:14:46,762
yeah, okay, that's a big nod.
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00:14:47,628
definitely.
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00:14:54,842
But the problem is, because they're not getting this information from the doctor, they're,
you know, they're trusted sources, they're not getting this information.
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00:15:01,687
They don't necessarily know that they're even dependent or addicted in a lot of cases to
these medications, until they try and stop them.
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00:15:05,058
And then they go, hang on, I've got a headache or my pain's flared up again.
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00:15:08,580
And actually, this is just a withdrawal effect from you from your medications.
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And if we taper that slowly, you'll probably find that you're
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a lot better off once you're off these drugs than just taking them.
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But unless they've been given that information, they're not aware that they're addicted to
these drugs.
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00:15:23,248
a lot of people don't even know that they're taking opioid medications.
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00:15:26,689
They're not even told, privy to that type of information.
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That's obviously detrimental to their health and recovery.
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00:15:34,104
And external to workers comp, this is a systematic issue, right?
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00:15:35,421
So this is not just workers comp.
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I just see that it's
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highlighted way more and it's obviously the prescribing is a lot worse.
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00:15:49,734
But this is still a system issue in the healthcare systems, especially in Australia, but I
think globally, where if you're not given any information around the drugs, what do you
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00:15:50,395
know to expect?
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00:15:55,889
You can either chat GPT it, you can Google it, you can come to your own conclusions.
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00:16:04,253
But I had a family member that was prescribed Lyrica, like 150, and was taking 300 every
day for a couple of days just for his back.
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00:16:08,587
pain that he'd had as a first initial back pain and his mental health was bad.
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00:16:12,592
He started like having these bad dreams, suicidal ideation.
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00:16:17,059
And it's not until he asked me, Hey, is there any concerns around this drug that I should
be aware of?
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00:16:23,533
And I was like, yeah, everything that you're experiencing is almost directly like
correlated with that drug use.
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00:16:25,687
He's like, God, no one's told me this.
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It's like, yeah, because the system's broken.
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00:16:28,641
Yeah.
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00:16:37,992
And I guess most of the doctors and the pharmacists now, there's always those leaflets
that come when you get a medication and they just assume you're going to read it.
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00:16:39,192
Do you know how hard it is?
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00:16:42,112
Number one, the print is so small, I can't read it.
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00:16:44,668
So I would like some enlarge print, please.
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00:16:53,210
And number two, if I'm getting medications, it's usually to help me resolve a problem I'm
having now or preventing a problem.
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00:16:54,621
I just want it to work.
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00:16:57,201
It's like me getting into my car and expecting it to work.
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00:17:03,998
I'm to take this drug because I've trusted the person who's giving it to me and I just
want to take and I just want to work because I just want it to feel better.
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00:17:09,566
So, you know, it's easy to blame consumers like myself or the person having receiving the
prescription.
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Well, you didn't read the information.
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You didn't ask the question.
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00:17:16,137
We have such terrible levels of health literacy in this country.
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00:17:17,858
That blaming scares me.
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00:17:21,082
I'm a university graduate who's worked in health care who ended up
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00:17:23,955
having a chemical dependence on medication post-surgery.
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00:17:26,980
Like, yeah.
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00:17:28,271
any of this information?
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00:17:35,115
yeah, I think, you know, we need to be starting to hold prescribers and dispensing
pharmacies accountable for this.
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00:17:41,409
Pharmacy is a little bit challenging because it's not really their responsibility if they
don't have the whole picture.
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00:17:46,351
But a lot of the times it's the prescribers that do have a bigger picture.
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00:17:50,574
I mean, in Australia now for high risk drugs, we've got real time prescription monitoring,
meaning that
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00:17:53,066
If you're a pharmacist, can kind of see end of prescriber.
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00:17:58,230
You can see who's prescribing drugs for your patients, where they're getting it dispensed
and what they're getting dispensed.
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00:18:00,012
But it's state specific.
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00:18:02,253
Now we have interstate prescribing.
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00:18:08,217
in workers comp, we've got New South Wales patients having their New South Wales
prescriptions prescribed.
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00:18:16,680
They're getting cannabis or other drugs prescribed by Queensland doctors dispensed from
pharmacies in South Australia and couriered to them in New South Wales.
249
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00:18:17,281
So it's like.
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00:18:22,346
why is this a state-specific thing when it's a national problem?
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00:18:29,378
I mean, thankfully, there are providers out there and services available that we can join
these dots now.
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00:18:32,154
But now, unfortunately, one, it's a cost to the insurer.
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00:18:35,456
They have to pay for these types of services, and they have to request it.
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00:18:41,305
So that in itself is challenging for insurers to manage for the costs and processes.
255
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00:18:46,541
Yeah, to you know, we, most of the listeners here are probably going to think we don't
really care about the insurers.
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00:18:53,298
But like you've said, the insurers are the people that usually have all the information,
they don't necessarily know how to interpret or what to do with it.
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00:18:56,181
But they have a lot of information about a person.
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00:19:02,117
being up for someone like yourself being able to get in there and have a look at
medication history, when was it spiking?
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00:19:03,369
When was it changing?
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00:19:03,840
oh
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00:19:09,728
what other symptoms have started, what other conditions are now being treated, and is that
related to the medication?
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00:19:15,326
It's like we can't expect somebody who's like I can't be expected to do that.
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00:19:18,230
I need somebody like you who can do that.
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00:19:20,105
Like that's a big ask.
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00:19:20,953
Wow.
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00:19:26,707
And I think that's what sort of come about because the insurers need support to make these
types of decisions.
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00:19:30,228
look, to be honest, a lot of them want the best outcome for the patient.
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00:19:38,200
Yeah, of course, it's probably cost motivated, but still, they don't want this patient to
develop other conditions, secondary conditions that they're going to be liable for.
269
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00:19:46,983
But in general terms, if you're a decent human being, you don't want that person to
develop the secondary conditions because we want the best outcome for the person, not for
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00:19:48,414
the insurer, just for a cost.
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00:19:50,565
liability condition decision.
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00:19:54,507
But yeah, so I think, you know, there's, there's hope, there's definitely hope out there.
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00:20:06,333
And I think coupling, you know, risk identification now through this all med system that
we've built into medication management through IMM is the perfect sort of tool and process
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00:20:13,279
that insurers can start to use now to, to make sure that the injured person's not
developing their secondary conditions or
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00:20:15,147
adverse effects from medications and things.
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00:20:16,099
Yeah, that's great.
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00:20:22,140
So that's a great segue now into just explain to us what allmeds is and how it works.
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00:20:22,410
Yeah.
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00:20:31,306
So I mean, through the work that we did with IMM, independent med management, that's sort
of this manual process where we have a team of pharmacists that really comprehensively
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00:20:37,122
assess medications being used, recommend treatment plans to doctors, and sort of see
those, those treatment plans through.
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00:20:46,219
But in doing that, as I said before, with the insurer having the most comprehensive view
of what the person's taking through medication reimbursements and things that they're
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00:20:48,762
funding, unfortunately, they're the ones with the most
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00:20:52,344
visibility around medications, but they're also not trained clinicians.
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00:20:54,825
So how are they going to identify these tools?
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00:21:03,633
We've tried hundreds of hours of education with different teams and different insurers to
try and upskill, you know, non-clinicians and non-clinically trained people, how they can
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00:21:05,135
identify high-risk meds.
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00:21:09,059
You know, there was some tools that were being used with let's run cost analysis.
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00:21:11,021
And yeah, that's a great starting point.
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00:21:13,984
But at the end of the day, somebody could be on two $7 medications.
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00:21:18,297
And that's a direct interaction and that could cause a death.
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00:21:24,283
um So cost is not the greatest key identifier, let's say that.
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00:21:33,860
And so we were unable to sort of upskill them to a point where they can look at a list of
five or 10 different medications and think, they're on two opioids, they're on a benzo,
293
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00:21:37,624
they're on Z drugs, they're on gabapentin or pregabalin.
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00:21:41,187
These types of higher risk drugs, they still can't identify that.
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00:21:41,678
m
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00:21:47,932
And, and nor should they need to and have to because their job is not to be a pharmacist,
their jobs to manage the claim.
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00:21:53,786
They've been put in, in a position where there's a lot going on for case managers outside
of just doing that.
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00:22:01,130
So we developed an AI tool, um, that they can put pharmacy receipts into sort of any, any
list of medications that they've got.
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00:22:04,092
So it could be a patient health summary, list of medications from a doctor.
300
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00:22:06,984
They could put an IME in there if they've got mentions of medications.
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00:22:14,271
anything that sort of notes medications, but the best thing that we use is pharmacy
dispense histories and things, dump that into the system and it'll give you an
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00:22:16,513
instantaneous risk assessment for that person.
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00:22:21,240
And that sort of helps them triage claims that are low, moderate, high and critical.
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00:22:25,695
Critical obviously being life-threatening concerns that need immediate action.
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00:22:32,671
And high is still considerable enough that it needs a medication review or a pharmacist to
implement medication management strategies.
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00:22:34,193
And then low and moderate sort of
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00:22:37,905
gives them the option to just monitor and watch and act over a period of time.
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00:22:40,487
And we're trying to get this rolled out across the board.
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00:22:47,041
It's a really cheap service in comparison to an IME and the independent pharmacy reviews
style report that we do.
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00:22:53,414
And so the intention is to remove that responsibility from a case manager to identify
these risks.
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00:22:59,488
They can put that into their helps them triage their claims and they can sort of focus the
attention on the high and critical risk.
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00:23:01,921
medication profiles, which there are plenty of.
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00:23:03,743
Yeah, wow, what a great tool.
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00:23:06,615
And again, it's a part of a solution.
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00:23:08,326
It's not the entire solution.
316
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00:23:10,058
It's a part of a solution.
317
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00:23:17,603
So you've talked about these claims assessors and case managers who have all this
information that they don't necessarily know what to do with.
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00:23:21,175
I'm just thinking of the people who are listening to this podcast now.
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00:23:28,254
And I know a lot of allied health professionals, mental health professionals dealing with
people with chronic pain or, you know, chronic illnesses.
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00:23:32,026
We've got osteopaths here, we've got naturopaths, we've got physios.
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00:23:44,165
And I'm just curious, where's something that we can start when we're not experts in
medication, but is there a place we could start having conversations that build rapport,
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00:23:51,396
that allow our clients to know that we trust them, but also give us some insight to know,
hey, yay.
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00:23:57,231
as so the all med system is a perfect segue into this, but the all med systems are cheap
service that's going to be implemented across.
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00:23:59,934
We're leveraging our existing clients from IMM.
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00:24:02,077
So that's personal insurance across Australia.
326
00:24:02,077 -->
00:24:10,296
But there's so much scope for this for rehab physicians, allied health, at home nurses,
NDIS, know, case workers in the NDIS.
327
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00:24:17,011
Anybody that sort of thinks, on, this medication might be a problem or this person's
sedated, I wonder if it's the medications that are an issue.
328
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00:24:21,704
And they don't want to refer to a pharmacist or they want an instant result now.
329
00:24:21,704 -->
00:24:31,893
um They can simply upload a medication list to this platform and have risks, adverse
effects, interactions, all those sorts of things at their fingertips, like straight away.
330
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00:24:35,805
Now, obviously we don't give recommendations on changes to medications.
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00:24:37,276
That's definitely not
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00:24:38,196
the place for it.
333
00:24:38,196 -->
00:24:42,567
And that still needs to be the responsibility of a pharmacist and a clinician and all
those sorts of things.
334
00:24:42,567 -->
00:24:45,398
But what it does is it reframes the conversation.
335
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00:24:54,500
we're now having, you know, the case managers, rehab guys can say, in the best interest of
you as a person, and as a patient, I want you to be on the most appropriate medications.
336
00:24:54,500 -->
00:25:03,480
And I don't want there to be adverse effects or interactions and things for you to
therefore develop secondary issues and, you know, suicidal ideation or
337
00:25:03,480 -->
00:25:08,051
major depression or anxiety, sleep issues, these sorts of weight management is another big
one.
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00:25:08,051 -->
00:25:17,793
know, so many meds can contribute to weight that if we can identify that as a concern
early on, we can have these conversations around, we need to have a look at your diet,
339
00:25:17,793 -->
00:25:26,913
have a look at your exercise capacity, all these sorts of things, because we know that
these medications ideally don't be prescribed long-term or lifelong, but there might be a
340
00:25:26,913 -->
00:25:29,073
tool to assist with that period of time.
341
00:25:29,073 -->
00:25:31,813
We can have other strategies in place whilst we
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00:25:31,813 -->
00:25:33,615
manage those adverse effects.
343
00:25:33,615 -->
00:25:40,775
I think it's a huge benefit to have information readily available to you that's accurate
and reliable.
344
00:25:40,775 -->
00:25:43,108
And that's what the All Meds tool is going to be doing.
345
00:25:43,108 -->
00:25:45,669
Yeah, this is going to be such a great tool.
346
00:25:45,669 -->
00:25:52,328
And I think for those of us listening now who are like, Jo, I'm really uncomfortable about
starting these conversations with your clients.
347
00:25:52,091 -->
00:25:56,335
Okay, so we know Luke that you've got this great tool that is going to become available.
348
00:25:56,335 -->
00:26:02,891
So for listeners, you probably want to get to know Luke and I'll share with you his
contact details in a little while.
349
00:26:02,891 -->
00:26:04,642
So you'll know how to do that.
350
00:26:04,642 -->
00:26:13,880
But as a way of starting for us as health professionals to become more confident and
competent in having conversations with clients about medications, some of the things that
351
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00:26:18,767
worked for myself and my team was getting supervision and clinical consultation around it.
352
00:26:18,767 -->
00:26:30,903
Realizing that I'm not there to re-prescribe or tell anybody that their doctor's doing
anything wrong, it's genuinely to be curious and to empower the patient or the client to
353
00:26:30,903 -->
00:26:33,594
have an informed conversation with their doctor.
354
00:26:33,594 -->
00:26:43,202
For example, you might find that somebody's on the same medication, like three different
medications for the same condition, like heart conditions are common for this.
355
00:26:43,202 -->
00:26:45,668
It's like, does your doctor know you're actually taking
356
00:26:45,668 -->
00:26:52,633
these three medications at the same time, because usually they get you to stop and start a
new one.
357
00:26:52,633 -->
00:26:58,191
And sometimes that gets missed in translation and it doesn't even have to be a different
language translation.
358
00:26:58,191 -->
00:27:04,370
Again, we've got to help our clients understand that when they're in a medical practice,
they're probably a little bit anxious, right?
359
00:27:04,370 -->
00:27:05,565
And when you've got somebody
360
00:27:05,565 -->
00:27:09,218
probably nailed it with the like genuine curiosity.
361
00:27:09,218 -->
00:27:19,402
When you're genuinely interested in helping the person, obviously your conversation
changes because especially as a non-pharmacist, you've got that ability to say, Hey, I
362
00:27:19,402 -->
00:27:22,713
don't think this is right, but I'm actually not a hundred percent sure.
363
00:27:22,713 -->
00:27:26,475
But now we've got a tool that can help us determine whether it is right or not.
364
00:27:26,475 -->
00:27:31,118
And I'm only doing this in the best interest of helping you because I don't want you to
have
365
00:27:31,118 -->
00:27:32,870
any adverse effects from your medications.
366
00:27:32,870 -->
00:27:34,852
And I just want to make sure that you're on the right meds.
367
00:27:34,852 -->
00:27:43,802
And I think a lot of the times what we see is, especially when there's multiple doctors
involved and know, cardiologists might start meds and then the GP's responsibility sort of
368
00:27:43,802 -->
00:27:46,145
continue them or psychs do the same thing.
369
00:27:46,145 -->
00:27:52,471
They'll start a medication, GP continues it or sometimes they'll just continue prescribing
that and the GP doesn't even know about it.
370
00:27:52,471 -->
00:27:54,764
And that's where the things sort of start to come undone.
371
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00:27:55,375
So
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00:28:05,639
There's so many issues that you can see that happen with prescribing medications where a
doctor will prescribe even just a statin, you know, a pretty low risk drug.
373
00:28:05,639 -->
00:28:08,561
I don't agree with them being used in a lot of cases.
374
00:28:08,561 -->
00:28:13,916
They have a purpose in some people, but look, some people might start a statin and they
come with five repeats.
375
00:28:13,916 -->
00:28:19,901
So they've got six months worth of medications and they go back and see the doctor in a
month's time and the doctor says, actually that's not really working.
376
00:28:19,901 -->
00:28:21,693
Let's change it to this other one.
377
00:28:21,693 -->
00:28:25,928
Now they've got two scripts, two active scripts of the same drug class or different.
378
00:28:25,928 -->
00:28:29,913
And now the patient, poor patient doesn't know what they're supposed to be taking.
379
00:28:29,913 -->
00:28:32,265
So they take both.
380
00:28:32,265 -->
00:28:34,381
Couple that with brands and generics.
381
00:28:34,381 -->
00:28:38,110
So now they go to the pharmacy and they get prescribed and dispensed the brand name.
382
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00:28:39,180
Then they get the generic.
383
00:28:39,180 -->
00:28:45,196
And if they're going to different pharmacies, both the drugs that they've taken home with
the packet, say take one in the morning.
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00:28:49,910
They go, all right, well, I'm taking one of these in the morning, one of these in the
morning, not knowing that they're the exact same drug.
385
00:28:49,910 -->
00:28:52,974
And that is such a simple, common issue.
386
00:28:52,974 -->
00:29:04,049
And that's why we see like, I think it's 2%, almost 3 % of hospitalizations in Australia,
entire hospitalizations is caused by medication, preventable medication related concerns.
387
00:29:04,049 -->
00:29:10,496
It's all these sorts of sorts of things that just get missed, which is what needs to be,
you know, tidied up in my opinion.
388
00:29:10,496 -->
00:29:16,948
So having those conversations, I think is actually quite easy because I've got a genuine
interest in making sure that person's on the right meds.
389
00:29:16,948 -->
00:29:26,224
And if we're not making treatment gains or if people are reporting things like excessive
fatigue all the time, it's very easy to go, let's go and get something else sorted out or
390
00:29:26,224 -->
00:29:27,535
it's a mental health condition.
391
00:29:27,535 -->
00:29:39,863
But like you identified with that family member of yours taking Lyrica, suicidal ideation,
if you know that drug, that it's very clear that that's what that drug causes or has the
392
00:29:39,863 -->
00:29:43,195
potential to cause, but it works great for other people.
393
00:29:43,195 -->
00:29:44,417
It did not work for me.
394
00:29:44,417 -->
00:29:47,222
I can assure you I was like no thank you.
395
00:29:47,222 -->
00:29:47,962
And that's the thing.
396
00:29:47,962 -->
00:29:51,485
Like a lot of people actually don't get benefit from that drug and that's fine.
397
00:29:51,485 -->
00:29:55,779
You can trial it, but if you're not getting the benefits, there's obviously no reason
continuing to use it.
398
00:29:55,779 -->
00:29:59,803
But a lot of doctors are seeing this not stopping it or not canceling the script.
399
00:29:59,803 -->
00:30:03,497
And the person still with access to that for if needed, you know, down the line.
400
00:30:03,497 -->
00:30:09,339
So if we tidy up the prescribing process, then, then there's so many things that can be
improved.
401
00:30:09,339 -->
00:30:09,700
Yeah.
402
00:30:09,700 -->
00:30:12,613
Yeah, and I think it's, again, I want to come back to this.
403
00:30:12,613 -->
00:30:13,914
It's not my responsibility.
404
00:30:13,914 -->
00:30:18,670
think your patient care is our responsibility and learning how to have these
conversations.
405
00:30:18,670 -->
00:30:24,155
They might be uncomfortable in the beginning, but let's face it, the first time you ever
interacted with a client was uncomfortable.
406
00:30:24,616 -->
00:30:27,658
It's like, my God, you let me do this on my own.
407
00:30:28,584 -->
00:30:35,729
We've got pharmacists that come to us from like hospital pharmacies, a great asset for us
when they, when they come to IMM.
408
00:30:35,729 -->
00:30:41,543
And that's because they've already had those face to face conversations with, with doctors
and other clinicians.
409
00:30:41,543 -->
00:30:48,538
But we've also got other pharmacists that are great at IMM that have come from all
different walks of life in the pharmacy industry.
410
00:30:48,538 -->
00:30:54,463
But none of them have really spoken to doctors the way that we need them to speak to
doctors to get changes made to medications because.
411
00:30:54,463 -->
00:31:01,179
There's often this huge hierarchy difference between a pharmacist and a doctor and the
doctor's like, how dare you question my prescribing?
412
00:31:01,179 -->
00:31:07,827
It's like, hang on, we've got four or five different health clinicians that have got eyes
on this person's treatment plan.
413
00:31:07,827 -->
00:31:10,409
How are these things being missed?
414
00:31:10,409 -->
00:31:19,300
So our responsibility and our pharmacist's responsibility is to make sure that those
things are all tidied up and then the person can be on the appropriate meds and on their
415
00:31:19,300 -->
00:31:20,452
way to recovery.
416
00:31:20,452 -->
00:31:22,653
Yeah, it's such a useful tool.
417
00:31:22,653 -->
00:31:26,887
And I think it just speaks into that whole, we've got to our egos out of the way.
418
00:31:26,887 -->
00:31:32,365
And there are medication I do not know, especially GPS, how they keep up with everything.
419
00:31:32,365 -->
00:31:41,110
And I know when I engaged you, I took my information, the information you gave me back to
my medical team and said, this is an independent pharmacist that I've had a look at this.
420
00:31:41,110 -->
00:31:42,461
They were grateful.
421
00:31:42,461 -->
00:31:46,304
They didn't necessarily like it in the beginning, but they were grateful.
422
00:31:46,304 -->
00:31:55,294
because then they had a template, like they had somewhere to start with me and went, yeah,
maybe some of this, maybe we need to help you navigate this differently, Jo, because it's
423
00:31:55,294 -->
00:32:01,079
always been my goal to come off as many medications as I can, starting to realize that
it's harder.
424
00:32:01,079 -->
00:32:02,770
It's a lot harder than getting on them.
425
00:32:02,770 -->
00:32:04,001
Yeah.
426
00:32:04,230 -->
00:32:05,341
especially if there's plan.
427
00:32:05,341 -->
00:32:12,432
We have, I presented at PIEF this year around and we presented on a case study where this
person was referred to us for an opioid reduction plan.
428
00:32:12,432 -->
00:32:14,012
And yeah, the opioids were bad.
429
00:32:14,012 -->
00:32:14,572
Don't get me wrong.
430
00:32:14,572 -->
00:32:21,254
Like high dose, 20 odd milligrams of oral morphine and something across three different
opioids that were being prescribed.
431
00:32:21,254 -->
00:32:27,982
But that actually wasn't the primary concern in my opinion, as a pharmacist, it was the
ongoing
432
00:32:27,982 -->
00:32:33,774
double dose Z drug that was being used with a bottle of whiskey every night to
self-medicate for sleep.
433
00:32:33,774 -->
00:32:38,215
It's like, hang on, if we can address that concern, all the other stuff's easy.
434
00:32:38,215 -->
00:32:46,208
And that was actually the harder one to address, but God, the person felt a lot better
once we got him sleeping better off the Z drugs and stopping the alcohol.
435
00:32:46,208 -->
00:32:53,851
Then the person's in a way better mindset to start looking at all those other medications
that can be de-prescribed or rationalized and improved.
436
00:32:53,851 -->
00:32:54,839
So huge win.
437
00:32:54,839 -->
00:32:55,263
study.
438
00:32:55,263 -->
00:32:56,165
Yeah.
439
00:32:56,165 -->
00:33:04,105
different medications over 12 months was on Mobic Moxgam, at the end of the 12 months just
for his back pain, and feeling so much better.
440
00:33:04,105 -->
00:33:04,616
Yeah.
441
00:33:04,616 -->
00:33:08,287
And he's like all these other internal organs would be feeling better too.
442
00:33:08,287 -->
00:33:09,758
What a great case study.
443
00:33:09,758 -->
00:33:10,410
Yay.
444
00:33:10,410 -->
00:33:11,430
Yay us.
445
00:33:11,430 -->
00:33:12,570
Yay Luke.
446
00:33:14,430 -->
00:33:14,881
Yeah.
447
00:33:14,881 -->
00:33:15,481
Yeah.
448
00:33:15,481 -->
00:33:23,227
the right tools and the right attitude and the right providers and the right person, like
the case manager still had to identify that at the start.
449
00:33:23,227 -->
00:33:26,731
So without them referring, this person would have probably still been on the same drugs.
450
00:33:26,731 -->
00:33:27,191
Exactly.
451
00:33:27,191 -->
00:33:31,132
So that then speaks into my point is that everybody has a role to play here.
452
00:33:31,132 -->
00:33:43,739
If we are genuinely in this business for patient care, right, then we are genuinely going
to be curious about how that care is being interrupted by other things, not blaming, but
453
00:33:43,739 -->
00:33:45,259
from a place of curiosity.
454
00:33:45,259 -->
00:33:54,243
And I'm so glad that you, um, you, you affirmed me around that because I found becoming
curious was so much better than getting people offside and defensive.
455
00:33:54,312 -->
00:33:54,892
Yeah.
456
00:33:54,892 -->
00:34:04,510
And even our pharmacists that we have, like we do a really comprehensive three month
training plan before they start working on live claims for IMM, just because you can't
457
00:34:04,510 -->
00:34:07,593
plug and play a different pharmacist from community into doing what we do.
458
00:34:07,593 -->
00:34:09,445
It's so industry specific.
459
00:34:09,445 -->
00:34:17,542
But as part of that package, know, framing conversations with doctors, we actually just
have, we don't have, you know, this question, answer, question, answer, question, answer
460
00:34:17,542 -->
00:34:20,776
approach, because you don't get an open discussion with doctors.
461
00:34:20,776 -->
00:34:31,842
So if you can just have genuine curiosity, ask the questions and have a conversation, you
get a lot more information from a health professional that's going to lead to improvements
462
00:34:31,842 -->
00:34:36,008
for that person than just saying, hey, you're doing this wrong, change it.
463
00:34:36,008 -->
00:34:36,899
Nobody likes that.
464
00:34:36,899 -->
00:34:37,871
Let's face it.
465
00:34:37,871 -->
00:34:38,788
We would...
466
00:34:38,788 -->
00:34:40,475
I don't like it.
467
00:34:40,475 -->
00:34:41,938
That's super defensive.
468
00:34:41,938 -->
00:34:48,909
So Luke, when you were studying pharmacy at university, did you think this is where you
would end up?
469
00:34:48,909 -->
00:34:56,606
I thought it'd be a rich community pharmacist actually and not anymore.
470
00:34:56,606 -->
00:35:00,609
I think it changed about six months into me starting my degree.
471
00:35:00,609 -->
00:35:04,034
Well, I actually went through a bit of a slower journey through university.
472
00:35:04,034 -->
00:35:06,896
So I did a bachelor degree and then I did master's of pharmacy.
473
00:35:06,896 -->
00:35:14,437
um So it was a five-year degree plus I did two of my last years as part-time whilst I
worked in the mining industry actually.
474
00:35:14,437 -->
00:35:15,679
for the bachelor degree.
475
00:35:15,679 -->
00:35:20,016
So I wanted to be rich, but pharmacy wasn't going to get me there.
476
00:35:20,016 -->
00:35:22,467
And neither's workers' compensation, as it turns out.
477
00:35:22,467 -->
00:35:29,387
But at least I get to use the tools that I've learned along the way to have impact on
people's lives.
478
00:35:29,387 -->
00:35:30,317
That's hilarious.
479
00:35:30,317 -->
00:35:33,572
I never expected you to say so I went and worked in the mining industry.
480
00:35:33,572 -->
00:35:36,055
It's like, yeah, I can see how you would do that.
481
00:35:36,055 -->
00:35:38,347
That's a great way to go earn a lot of money.
482
00:35:38,421 -->
00:35:41,101
My parents were in the mining industry and I lived in the Hunter Valley.
483
00:35:41,101 -->
00:35:44,961
So it's a big mining industry area.
484
00:35:45,961 -->
00:35:51,914
And yeah, I ended up there doing that crappy work for a little while, but yeah.
485
00:35:51,914 -->
00:36:00,696
So given that you did something fairly traditional that had fairly traditional career
paths along the way, but somewhere along the way you went, not, not, not, not, not, not
486
00:36:00,696 -->
00:36:03,368
for me, not for the community, not for the good of mankind.
487
00:36:03,368 -->
00:36:12,961
What's the number one or is there a piece of advice you'd like to give other clinicians
who are maybe noticing something that's problematic and they think they've got a solution
488
00:36:12,961 -->
00:36:16,104
to it, but they just like, nobody else is doing this.
489
00:36:16,104 -->
00:36:17,349
You've done it.
490
00:36:17,349 -->
00:36:18,455
What would you say to them?
491
00:36:18,455 -->
00:36:22,427
Just because it's always done that way doesn't mean it's always going to be done that way.
492
00:36:22,427 -->
00:36:23,969
Like think outside the box.
493
00:36:23,969 -->
00:36:29,691
you know, there's so many, so many things that we get to learn as pharmacists.
494
00:36:29,691 -->
00:36:31,641
are quite critical thinkers.
495
00:36:31,641 -->
00:36:37,846
Um, you know, a lot of the times we're multitasking, you know, we have to think a little
bit more laterally.
496
00:36:37,846 -->
00:36:43,118
and so we, are very good problem solvers and because of that, I think that's where this
sort of,
497
00:36:43,118 -->
00:36:50,424
IMM or meds sort of process has begun because I didn't want to just do things the way it's
always been done forever.
498
00:36:50,424 -->
00:36:53,217
um And it's served us well.
499
00:36:53,217 -->
00:36:59,689
And I think that's, you know, this is a whole new career path for a pharmacist now in, in
workers' comp, because it is very specific.
500
00:36:59,689 -->
00:37:03,282
It's, it's the same as community pharmacy, same as hospital pharmacy.
501
00:37:03,282 -->
00:37:05,235
They were like the traditional roles.
502
00:37:05,235 -->
00:37:11,092
Now we've got GP pharmacists, aged care pharmacists, and now we've got insurance specific
pharmacists.
503
00:37:11,092 -->
00:37:15,618
It's just that you have to work for a provider like us to sort of enter the industry.
504
00:37:15,618 -->
00:37:27,006
But I think that's a good thing because it means that we get to screen pharmacists that
are entering this space and have an impact on how they do the job.
505
00:37:27,006 -->
00:37:28,057
Yeah, great.
506
00:37:28,057 -->
00:37:28,668
Absolutely.
507
00:37:28,668 -->
00:37:33,488
And making everybody better in terms of improving the quality for everybody.
508
00:37:33,488 -->
00:37:37,219
It's like you're upskilling pharmacists, you're upskilling insurance companies.
509
00:37:37,219 -->
00:37:43,210
Hopefully this interview today has helped people get some a little bit more knowledge and
skills so they can feel upskilled.
510
00:37:43,210 -->
00:37:47,110
So Luke, I know that there's going to be many, many people who want to go, I need to know
about this thing.
511
00:37:47,110 -->
00:37:48,430
How do I know about this thing?
512
00:37:48,430 -->
00:37:51,081
How can people find out about this thing?
513
00:37:51,081 -->
00:37:55,463
I'm a pest on LinkedIn is probably the biggest platform.
514
00:37:55,463 -->
00:38:04,716
I do like being on LinkedIn and having a voice on there, I think, because so many people
in this industry are on that platform.
515
00:38:04,716 -->
00:38:12,860
And it's somewhat professional, you know, that you don't get the roastings and comments
that you get from Facebook and Instagram and those types of platforms.
516
00:38:12,860 -->
00:38:15,109
So yeah, LinkedIn, both are.
517
00:38:15,109 -->
00:38:19,262
My personal and all meds and IMM are both on there as a business page.
518
00:38:19,262 -->
00:38:20,674
So follow along there.
519
00:38:20,674 -->
00:38:22,455
and we've got a website as well.
520
00:38:22,455 -->
00:38:29,919
So independent med management.com or imed management.com.au and all meds.ai is our risk
assessment platform.
521
00:38:29,919 -->
00:38:35,822
So if you want any further information, there's links on both those websites to get in
contact with us and book free demos.
522
00:38:35,822 -->
00:38:39,155
Or, if you want free trials and things, we can organize that as well.
523
00:38:39,155 -->
00:38:40,696
Fantastic.
524
00:38:40,696 -->
00:38:45,670
So all of that information will be in show notes, in emails to you on social.
525
00:38:45,670 -->
00:38:49,102
So if you're driving along somewhere and you go, Oh, I'm not going to remember that.
526
00:38:49,102 -->
00:38:52,846
Well, you can always come back and listen to the interview again, but it will come to you.
527
00:38:52,846 -->
00:38:54,748
just, just keep an eye out for it.
528
00:38:54,748 -->
00:38:56,919
Luke this has been a fantastic conversation.
529
00:38:56,919 -->
00:38:58,520
Uh, we interact on LinkedIn.
530
00:38:58,520 -->
00:38:59,381
So that's how I know.
531
00:38:59,381 -->
00:39:03,854
wouldn't have called you a pest, but you do like to stir the pot, which I really enjoy.
532
00:39:03,854 -->
00:39:06,742
m
533
00:39:06,742 -->
00:39:08,097
somewhat professional.
534
00:39:08,168 -->
00:39:13,222
No, you do a great you've got a really good you're exactly how you've turned up today on
LinkedIn.
535
00:39:13,222 -->
00:39:16,653
So it's not like we get this jarring like who is this person?
536
00:39:16,894 -->
00:39:22,939
So the next time I get to well, the first time we get to meet in real life, it'll be at a
cafe because I'm Jo.
537
00:39:22,939 -->
00:39:24,801
What coffee am I ordering for you?
538
00:39:24,801 -->
00:39:27,455
ah Small double shot flat white I would say.
539
00:39:27,455 -->
00:39:29,547
hello, person after my own heart.
540
00:39:29,547 -->
00:39:32,560
That's a bit better than the black.
541
00:39:32,560 -->
00:39:33,340
There we go.
542
00:39:33,340 -->
00:39:34,631
I'm loving this conversation.
543
00:39:34,631 -->
00:39:35,902
This is fantastic.
544
00:39:35,902 -->
00:39:37,173
Thank you so much, Luke.
545
00:39:37,173 -->
00:39:40,485
This has been a great conversation again to anybody listening.
546
00:39:40,485 -->
00:39:42,247
Please make sure you get onto LinkedIn.
547
00:39:42,247 -->
00:39:47,983
Find Luke, check out his websites, go subscribe, a podcast review.
548
00:39:47,983 -->
00:39:49,395
That's the review we want.
549
00:39:49,395 -->
00:39:58,463
because the more people who can listen to this podcast, the more influence people like
Luke are going to have, which means more people are going to get the type of care that
550
00:39:58,463 -->
00:39:58,854
they need.
551
00:39:58,854 -->
00:40:00,606
So go help us out that way.
552
00:40:00,606 -->
00:40:02,298
Luke, thank you very much.
553
00:40:02,281 -->
00:40:11,940
If today's conversation gave you language, reassurance, or even a quiet acknowledgement
of, my God, it's not just me, then this episode has done its job.
554
00:40:11,940 -->
00:40:22,641
The Entrepreneurial Clinician podcast exists because the future of healthcare depends on
clinicians who are supported, resourced, and able to stay in the work without losing
555
00:40:22,641 -->
00:40:23,353
themselves.
556
00:40:23,353 -->
00:40:30,188
If you would like to support the continuation of these conversations, you can do that
through Buy Me a Coffee.
557
00:40:30,188 -->
00:40:38,536
It's a simple way to help cover the real costs of producing this podcast and to keep it
accessible to clinicians all around the world.
558
00:40:38,536 -->
00:40:45,973
And if you're listening as a service provider who supports health professionals, there's
also a space for thoughtful values aligned sponsorship.
559
00:40:45,973 -->
00:40:50,327
The kind that adds to the conversation rather than interrupting it.
560
00:40:50,327 -->
00:40:56,863
For clinicians, service providers, healthcare professionals around the world, the work you
do matters.
561
00:40:56,863 -->
00:40:58,855
The way you do it matters.
562
00:40:58,855 -->
00:41:08,171
And the profession needs clinicians who are willing to think differently about
sustainability, capacity, and care for themselves and for others.
