Disruption in Healthcare: Beyond Buzzwords | Marwah Younis, PharmD, MBA, Agate Medcare

Speech to text:

Mike: [00:00:00] Marwa, for those that haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Marwah: I am Marwa Younis, I'm a pharmacist from Canada, and today we're gonna talk about disruption in the healthcare system.

Mike: I had a listener, she wrote to me a few days ago and she said, we listened to you up here in Canada. You need some more Canadians on this show. And I said, well, we've had a couple and, so here you are now Marwa. That was just by chance. It was the same week that someone had reached out to me about that.

Marwah: Let's see. Yeah, and we've got plenty of great, amazing disruptive pharmacists here if you need, more for me to recommend,

Mike: Marwa Unfortunately we live with the Detroit Lions and every year, you know, is rebuilding and disruption and things like that. It's because they suck the year before.

 You know? So you gotta throw those words around.

 Do some people use it as an excuse for the term disruption?

Marwah: So the term disruption, I had a really amazing prof in the MBA and she had this term called innovation theater. So it's basically saying you're being innovative, saying you're being disruptive for the sake of saying it, for the sake of, sending out, like, virtue signaling that, you're doing something different when really it's just you're not really allocating enough budget, you're not doing anything.

You're just kind of shuffling some people around and giving them some cool titles and Yeah, blowing it up all over the internet to say, yeah, we're committed to disruption and innovation in the healthcare space.

But in the end, you're not doing anything any different.

Mike: Who is your favorite customer 

Marwah: I am kind of a little passionate about startups just because it's exciting to see the ideas they have, where they want to disrupt, and just how they're solving problems

in an interesting way. 

Mike: It's not really a company that's disrupting so much, but somebody perhaps that left that company and they're gonna disrupt on their own.

Marwah: Yeah, I mean, that's my passion on the side. But what I actually, I love your question because my favorite company to support Disrupt is a bigger organization. So not necessarily a startup, because startups are so resource hungry, a bigger organization that's doing something different. So I started my own pharmacy back in the day, back in 2008.

And when we went in, we had this idea to disrupt the world of the developmental disabilities and mental health sector here in Canada. And it was just an underserved sector. but it was just so ripe , for disruption, like ripe for somebody coming in and saying, okay, we're gonna build an end-to-end solution to help you do what you're doing 

So. Any organization that's just, that's ripe for that I prefer a little bit of a bigger organization that can, that still has some resources, has its hand in everything, but also has the leadership that is excited and hungry to make changes in the healthcare system.

Mike: What size might that be? I don't want to corner you, but are we talking to 10 people? 50, a hundred, a thousand? What kind of company would be cool to come in and say we're gonna disrupt it? 

Marwah: Yeah. I would say, I mean, I'm talking to a company right now and there are probably about 10,000 employees.

Mike: I went too low. 

Marwah: Yeah, but I don't want anything too big. Like I'm not gonna go to a hospital and try to disrupt a hospital because there's such a large incumbent that you can't disrupt, you can't change and you can't charge the health system as a whole because it's all like policy reform and so much red tape.

Mike: It's turning the Titanic around, but not even being able to get in the engine room or

whatever.

Marwah: exactly. Yeah. So it's not as much about size. For me it's more about, almost like company culture. How much red tape do you need to go through to actually make any changes? How big of a player are you in like the existing system or I specifically, focus on the healthcare system, but how big of a player that, you can make some of those changes 

Mike: Marwa, I'm gonna play devil's advocate here.

Marwah: Okay.

Mike: You've got a company that needs disruption. That means they haven't done anything. They're just sitting on their hands, they haven't disrupted enough. And now you want a company that you're gonna go in and they're gonna accept disruption. It seems like two separate ends. What am I missing there?

Marwah: I think what you're thinking is disruption is going on and telling a company everything that they're doing wrong and that they need to change it. And so yeah, you can't, I think it would be really difficult to go into a company and tell them that you have to go into an organization that probably has new leadership or a leader that's saying, you know what, the way we're going, it's not future-proofed.

 We can't continue to function like this. and the leader, the leadership has to make that decision. And often, especially one organization that I'm talking to, often that leader comes in, leadership changes. They all come in with a change, uh, [00:05:00] management, a disruption attitude that the culture has to have already kind of shifted and changed for them to come out and say, okay, we need support in doing what we want.

This Disruption, this innovation. 

Mike: It's kind of in their blood, but you're kind of, organizing it, kind of bringing them along, new ideas and things like that. But they're already ready to go, it seems.

Marwah: Yeah, either that or like the pandemic, I was able to support an organization during then, and it was the pandemic forcing the organization to be like, oh wait, we can't continue doing what we're doing. We need to disrupt everything. And that's when things are also really ripe for disruption and innovation.

Mike: I have a brother and he owns a branding company and I always joke with him. I say that the companies bring him in, and these are high paid executives. I say they bring him in. As a scapegoat so they can say, well, we brought Tim in and it must have been a bad idea. we failed.

Maybe in picking the right person, we're gonna pick another person this time. I joke with him that he's the kind of person that people can point to instead of using the skills that are already in the system. Do you ever feel they're bringing you in to, maybe,they got some inner bickering going on or, they don't think someone's doing something right, so they kind of bring you in like, let's have marwood. Do it so we don't have to say what's on our mind.

Marwah: It's interesting that you say that because I do feel like I have been put in these situations once or twice, but it's not so much as inner bickering. I feel like oftentimes, oftentimes people don't, they have an idea, they maybe don't trust exactly what they're thinking and they need to bring outside, subject matter expertise for the organization or even for the leadership to say, oh, okay, maybe, it's kind of similar, like, if I tell my kids, Anything, they will just roll their eyes at me.

But if one of their friends comes in, or if an outsider, or if another mom comes in and tells 'em something, then all of a sudden, or if their teacher tells 'em something, then all of a sudden, oh, it's gold. Right? So I ha I do get put in those positions and I actually don't shy away from them just because I am the kind of person who, I do speak for what I believe is true, and I will, I'm not gonna say I will fight, but I will stand up for what I believe is right.

So during the pandemic, I did a lot of that. I was the one who was having the hard conversations with public health, with some of our others, like health regions and health teams, to be able to say, no, we can't do it. This is the way that it's done. And even the change management conversations with some of the leadership that was in the organization that was with.

So really, I don't shy away from that. And I don't know, it's I think in some ways it fuels me a little

Mike: For a number of years, I was in Kiwanis, which is a service club, kind of like Rotary Club, things like that. And every week we had a speaker, and the speaker would talk for like 20 minutes or something like that, but we had a rule that once a month, the speaker had to come from over a hundred miles away.

know, because then they become like, instead of Joe Schmoe around the corner, it's, Joseph Schmoe from, a hundred miles away. They're the expert that they brought in, might be the same damn guy that just lives a hundred miles away. But when you're further away, when you come in, you're a new blood, new name, people just kind of perk up a little bit.

And I can see a company doing that for both my brother and you. It's kind of a new face symbolizing new ideas, new blood kind of stuff.

Marwah: Yeah, absolutely. I think it's a little bit of that, but also I'm a huge believer that if you wanna disrupt, innovate, you do need to look at somebody outside of your circle. when you're in an organization, when you're doing something, you're so completely, you're so. Come, it's everything that, you're so inside of it that it's so hard to pull yourself out and see more of a bigger picture, a bird's eye view.

While when you bring somebody in from the outside, sometimes they can look at things and, have a little bit of question, a little bit of nudging. So why are you doing it this way? Oh, did you know that over here we have done it this way? Like, do you think that this would work? So it's more about giving that, like, bringing in a different perspective.

While it can be the same person, we're still pharmacists, we're still doing this, we're still doing that. MBA doesn't matter. same titles, but the experience maybe brings in this fresh set of eyes to look at things differently, 

Mike: my wife, I'm sure got sick of this a long time ago, and I haven't done it real lately, but I used to always, whenever we would go to a store, because I was in retail and pharmacy and so on, every time we went somewhere, I'm like, look at that.

Why is that sign there? It's blocking this and looking at the pain on this, and who wouldn't let that carpet get like that? That kind of stuff. One part I realized that I'm not doing it so [00:10:00] much is I'm like, you know the term of, mind your business, mine your own business.

And it's like, maybe that guy has less anxiety than I do. That guy or gal who owns a business, they don't worry about those kinds of things. They're making plenty of money and that's the way they want to do it. But I had the ideas that I would love to like, and nobody would, well, I shouldn't say nobody would pay me for this.

I never tried it, but I would like to go around to a business and just spend, this is alluding to the second eye. YouI would like to go around to a business, spend 20 minutes there, give them a list of 10 things I think they could change. And here is the idea. Mawa. It would be between, we know they have, secret shoppers, 

right? And we've got business consultants. So you got secret shoppers on The transaction, and then you've got people that know the depths of it. But I would like to go in, spend 20 minutes and give them a list of 10 things. That to your point, you don't see in your own business, the carpet gets dirty gradually, you don't see it, and the annoying music or this looks old or, why are you opening at this hour instead of this hour?

Just like 10 quick things. The point is I think we can all use that in our business, A set of fresh eyes.

Marwah: Yeah, absolutely. And that's what consulting really is, I mean, the kind of consulting I enjoy doing is all about you coming in and you're giving those. Little pieces of advice almost where you're like, why are you doing it this way? Have you considered this? Have you thought of this? And I believe that you can probably do it.

I mean, specifically just going, it's so funny cuz I do the exact same thing. I do it in a lot of different stores. I come from a customer service background. I've worked retail all my life. So I walk into a store and I'm like, why did this person not say hi to me already? Why does this look like this?

Why does this look like that? So it's exactly, you have that critical eye where you're walking around and yeah, it's mine your own business. But because you have been a business owner for so long, because you've tried so many different things, you have this critical eye of, and because you expect things at a certain level, I believe.

And so that's why I'm exactly where you are. That's, I walk into every store and I think the same things like why is this, why is the lineup so long? Why is a pharmacist not engaged in any store? I'm like that.

Mike: Thinking back to your time when you owned the pharmacy, what kind of skills are you bringing from there? I know you guys had 35, 40 employees, but what kind of skills do you bring from there that you might talk to somebody who has 10,000 employees and they may not know that you're just thinking about your three employees of your pharmacy, but what are some skills that don't die?

they're across from 30 people up to 10,000 people. What are some similarities that you pull from there that make sense everywhere?

Marwah: That's a great question. So, you're absolutely right. And sometimes I wonder about myself. But when you do have conversations with people who are even in larger organizations, you realize that everybody has the same problems or is working on the same problems.

So, for example, if I talk to somebody who is the VP of talent in HR, some of the biggest things are culture.

How do you change culture? What is change management? How do you implement it? Everybody's all about digital transformation right now? How do you implement that kind of change? How do you support people through their career? How do you build job satisfaction? How do you retain people?

Those are all things that I worried about in my 40 to 50. Person, store, and those are all things that I loved and I valued and I read about, because that was really big for me, my team, somebody who's working on this strategy. So, we're always, if you're somebody who's really involved in your business, I was always working about the future.

How am I future proofing my organization? How am I staying ahead of the game? How am I making sure that I'm looking at different avenues for my business lines, looking at operations. How, so that's a completely different other side. So anybody who's working in operations, you're looking at how do you stay lean, how do you become efficient, how do you reduce error?

are big things. And then, healthcare, that's a whole other line of business. focusing on quality, focusing on risk, focusing on, making sure. That you're implementing best practices, so, so many things that you are looking at, especially at a small healthcare organizations that can easily be transferable to any size of healthcare organization or any type of 

organization, really taking away even the healthcare background.

Mike: One of my children is a freshman in high school and her backpack was in my car. Leaving in dad's car and then in [00:15:00] case I go somewhere for the night, they have an excuse why they can't do their homework. But I'm smarter than that.

So I went to grab her backpack. And this thing, it had to be 30, 30 pounds. And it kind of upset me because. This is a freshman in high school, and if anybody, you should be talking about the wonders of digital, the wonders of computers would be this age and to have everything on a pad, PDFs on the screen and all the grading and all this stuff.

And it bothered me that she's got a 30 pound backpack. I mean, it might be full of rocks for all I know. Maybe she was just doing that to look studious in front of her parents, but I don't think so. I think it was full of books, and it upsets me that they haven't transferred this idea yet to somebody that age who's blooming in the technology world.

When you talk about digital transformation, am I on target ? Something like that goes from old school to new school.

Marwah: Yeah, absolutely. So it's exactly like that. You would be surprised, and I still am surprised how many organizations are still doing a lot of things just on paper. So medication administration or even HR things or even just. Clocking in and clocking out, basic things that are just on paper.

And there it comes from that basic digital transformation where they're bringing in an HR solution or when you're looking at hospitals and they're bringing in different types like electronic health records or electronic medication administration records. So taking that, all that stuff that we've been doing on paper that you can do nothing with because you can't, collect data, you can't collect insights from that.

Putting it, digitizing it, digitalizing it. And then from that, not only is it a lot more standardized, you're reducing error, but also you're able to pull out data, 

you pull out insights. You don't use that for something rather than just on paper that's just gonna be, thrown out or been stored somewhere and never used again.

Mike: I bet there's bigger companies on paper than I would even realize. I try to do everything digital and I think, alright, the only people that don't do digital are people that have fewer employees than I do. That's just my mindset. Everybody's growing and bigger. But I bet there's a lot of 'em that you're like, why the hell are you paper still?

Marwah: Yeah, you would be surprised.

I

yeah, you would. I have a friend who's a project manager and she's doing a large digital transformation for a very large, Toronto based organization. there's others as well. And you would,it is shocking to me. Like, it was shocking to me to find out that everything they were doing before was on paper in this day and time, and now is the time that they're transforming it and putting it, digitizing it.

Mike: Well, I know , there's a few reasons why people don't do it. they don't have either the skills or, but I think two reasons is one is,Sally, Sally's not gonna go for this. She's been doing it for 20 years kind of thing, and who's gonna tell Sally , just because of the change.

Everybody's afraid of Sally. And I think the other thing is, What is going on in Sally's mind is both change, but also thinking about her future. Like, am I gonna get replaced by a spreadsheet and now even AI kind of thing. I can see why people are hesitant about change, but it's time to stand up to Sally.

Marwah: Yeah, absolutely. I think that is one of the hardest parts. I mean, when you look at, okay, just being empathetic to Sally, she's been working for 30 years doing things a certain way. She's been doing it so well, there's a lot of fear and now you're introducing this new thing that she has to learn.

What if she doesn't do it? Well, what if she makes an error? What if it's, I can definitely be empathetic to that feeling, but it is, it's a, that's why there's so much stress on change management. And how do you support people who are, what's the word that they call it? the, not the deters.

So there's a name for it. The people who absolutely will put their foot down. It is the hill, they will die on that. They will not take this on. Right.

Mike: Yeah. My team, we were adopting some new software for some delivery stuff. And one of my guys asked, well, what if you know, so-and-so's not on board? It's like I said, what would you say if we hired somebody And they came in and instead of a register, they wanted to have their old paperboy, coin thing on their belt.

 Mario, you're too young for that. Do you remember that?

Marwah: What I don't think I do.

Mike: It went on your belt, and when you were a paperboy, when you collected from people, you had to go around once a month and get the, $8 for somebody, or more like $3 for their monthly fee for getting the newspaper.

And when you had to give 'em change back, you'd go [00:20:00] click on your belt, and it had the metal, there were four rows for quarters, dimes, nickels, and pennies. click, and the stuff would come out.

Marwah: My point to my team member was, you're not gonna allow someone to come in here and say they don't want to use a cash register.

Mike: We're just gonna do it out of a cup. 

But we've all had to make those changes. But these are kind of like cash registers for everybody. Everybody had to make that change through time.

Marwah: Yeah, absolutely. I mean, when you're in a bigger organization, you're dealing with hundreds of people that are possibly like that, and then it becomes too much like a decision of how you're gonna support them. How do you support them through it, or do people just decide that's something they're not going to take on and it's time for retirement, which I've seen happen as well.

Mike: Let's say someone's running this company. You could get advice from the friend that says, well just do it. Just go in there and tell 'em we're doing this and it's the future, and they don't like it.

they're gone. It's like, fine. But when you wake up, next week and you got 30% of your staff that has quit now it's your problem. So it's not just kowtowing to people, it's trying to. do it in a way that overall, positivity comes out of it. Not a positive attitude, just don't make it worse for yourself as an owner.

 Try to make it better as a whole.

Marwah: Yeah, absolutely. And I'm a big believer in getting in and. Trying to understand where, why people make certain decisions or why people refuse to do certain things. There can be many, and I feel that they are, that is the group that we can learn the most

from, because usually it's people who have been in the organization for a really long time.

Usually it's people who have so much insight that we are not aware of. So sitting down and actually giving them respect by saying, well, what is it that is, deterring you from using this? Why is it difficult? And I think the biggest thing, the most important thing is bringing them into the conversation.

Because whenever you do such a big change, it doesn't start from, okay, we're implementing this change. It comes from, it starts from way before that where you're including people in the conversation and including them in the decision making process.

Because you are gaining insights from them as well as you are, gaining that support at the same time.

So it's valuable, it's valuable insights that you would be losing on by just going in and saying, this is how we're gonna do it. We're doing it. This is the time. take it or leave it kind of thing.

Mike: That's where I can see you and people of your sort. I can see such value there because when change is knocking at the door, instead of dealing with somewhat objective concerns of employees, let's say, having that middle person is so valuable because you take some of the emotion out of it, where without that middle person, Sally might have a good.

Objection, but you don't even get to the point of that because Sally's been passive aggressive all these years, or she never wants to try something or she starts crying that information is so important about change. It's just we bosses don't want to hear it sometimes because it sounds like just nagging again.

 It's good information. It's just a pain in the ass to hear it sometimes from that person with that kind of temperament.

Marwah: A lot of the decisions come from top down, right? So a lot of leadership makes decisions. What I found in my career is that there tends to be a very huge disconnect from the top to the people who are actually going to be implementing on the front lines and. Like, just like you said, the information is very valuable, but sometimes bridging that gap is being a person who is on the front lines.

So during the pandemic, I was working in an organization and I was one of the people who went in and I did the testing for outbreak situations. I wanted to go in, I wanted to be in the homes, I wanted to understand what the barriers were. I wanted to also show them that, look, I'm here. I'm with you.

I'm not scared. So it is, and then through being with them, being on the front lines, understanding the barriers, understanding what they were dealing with, that helped me make better recommendations, better decisions as part of the leadership team as

well. So being able to bridge that gap is really important 

Mike: I'm gonna say, I'm gonna throw a number. I'm gonna say 80% of the listeners of the show, when they make a decision, they might not be living the decision. But they're probably with an earshot of it, or at least an email away from, here's this not working well, but I imagine, I've never been there Marvel, but I imagine in these bigger companies you got, and I know it happens in the chain pharmacies, you got people way up there making decisions for people on the front line, and [00:25:00] I bet those disconnects are even hard to imagine sometimes.

Marwah: Yeah, absolutely. I think one of the biggest things and the most important things for me, like that's really a part of. Any decision that you make, anything in an organization, when you see the people who are going to be impacted by your decisions as even, looking at a different company, doing something else as your customers, And one of the, one of the strategies I use is that, whenever I'm in a position that way, I'm putting myself in my customer's shoes. I am them. I become them. Use their language, feel their feelings. That is the time when you have that empathy that you're able to make decisions. And when you are making the decisions, you're thinking, okay, how will that impact

the front lines? How will that impact my customer? And then knowing and feeling and being in their shoes, you're thinking, okay, how will that impact me? And I feel that decisions made from that mindset are just better decisions and they tend to have a more positive impact and people will feel when you are making decisions with them in mind.

Mike: We've certainly seen a change with Covid and with. Work from home and what do you call that when it's blended? What do you call that? The part work 

part home part. And we've seen the hybrid. How has that changed, do you think, the dynamics of what you might have told somebody a year ago to what you might tell them now or I'm saying pre covid and post covid. I know a lot of people say, I'm gonna work from home.

Well fine when the supply and demand is in your favor. But when there's enough workers and it's like, all right, bye. Who wants to come and sit at this test for three to five days? Has it changed much?

Marwah: I think the way I see it, I know that a lot of people, especially, people in my kind of network are looking for positions or have positions that are, have the flexibility to almost completely work from home with maybe one or two days maximum to have to go into the office. And, when you're running a pharmacy, actually my pharmacy, we do have positions that allow technicians to be working from home because they're just completely virtual positions, data entry positions, whatever it may be.

I think it's important to have that flexibility, to have that balance. I completely understand from an employer perspective, worrying about how much work people are doing because I've also heard people say, they just sit around and they move the mouse.

Mike: Yeah. Well, some people are getting like three or four jobs, especially with chat G p T coming out now, they're doing a job in 10 hours that takes 'em 40, and they're picking up three more jobs.

Marwah: Honestly, I've actually also heard, and I felt it, that working from home for certain people in certain positions, like I've been in this position, you are working much harder. Like my schedule was packed with barely one or two minutes in between calls to be able to get up and get a sip of water.

While I would imagine if I was in an office, I'd be walking around, having a chat between meetings. Nobody would be trying to book me that much. And back to back like that, I feel like in some cases it's becoming almost too efficient to the level of possible burnout , where I just saw a post on LinkedIn saying that, recommending that instead of booking one hour meetings take 50 minute meetings, so people have a 10 minute break in between.

And when you think about how crazy that is, if I was in the office, I'd be walking around, hanging out. So there's, I feel like there's an argument that we could be made for both.

Mike: That is so true. Marwa, I think it's even deeper than, well, my computer's there, so I can go over and work anytime. And so I think I'm too much dedicated to work and so on, but it's deeper than that even. walls have come down.

Don't think physically about it. Just think emotionally about it. Even your emotions. Forget about the work. Your emotions have now come into your house more than they have before. So instead of you being at an office, having it out with one of your contemporaries about a problem, now you're at home and you're doing the same thing.

And let's say it goes sideways, Now not only does your family hear it? and your Labrador, but the walls of themself now have this competitive spirit of business that you've brought into the atoms in your room. It's weird to combine those.

And I've done it my whole life here. Most owners have of course, but it's a weird thing to combine 'em where if you haven't done it before, strange things can happen.

Marwah: Yeah, actually that's a good point. It's kind of like when you think about how we were trained to support sleep hygiene, right? they say to support sleep hygiene. Your bedroom is where you sleep. That's it. You don't have your [00:30:00] TV in there. You don't have this because you walk into your bedroom, you go to bed, your brain thinks I'm going to sleep.

And we've lost that. You're right, we've lost it. In terms of the business of work, of that dilatation of, I'm home to do, when I'm home, I do this, I focus on my family, I do that, but now be, now there's this huge blur between home and work and business, and I find that my laptop is literally open at all times on my dinner table.

Always open to my email just in case, open to LinkedIn, open to whatever research I'm working on. We're used to stopping at five and leaving the office and coming home, and then you get that break. It's almost that removal from the business, from the office space.

Now you don't have that. You turn it off, you turn around like I'm making, I'm clicking dinner in between, having meals. There's, you've, you are absolutely right. it's all there. It's, we've lost that. We've lost that segregation like nothing. No, nowhere is holy Now, 

nowhere is protected. 

Mike: And just seeing the computer there can do that. not getting onto it, just knowing it's part of work now.

Marwah: Yeah, I think you're right. I just saw it the other day. Every time I looked at my laptop just open on the dinner table, I would get a bit of anxiety. So the other day I was like, I should just start packing it away. So it's little things that we can do similar to, when we talk about sleep hygiene, like, what are little things that we can do to be able to start creating that, that perception of a difference, like, alienation between home and office and having an office space, a dedicated office space.

You're right, like I, there's a lot of theories out there and to be able to do that.

Mike: You talk about your bedroom , and that's for sleep and so on. My dear wife, when we were dating, she gave me the idea of brushing my teeth in the morning and at bedtime. I never learned that as a kid. We just brushed our teeth in the morning.

And she also thought it probably wasn't smart of me to bring a stack of Oreos into bed too. I did that for a long time. I'd bring Oreos in, I'd go to bed, I'd have these black teeth and stuff like that. I would just fall asleep with that in my mouth. And this wasn't when we were married, we were dating, so I never brought it into our bedroom, but it was just like, sure, you have a stack of Oreos when you don't brush your teeth at night, it can get exciting.

Marwah: You can do cool things with that if you don't have to put that spearmint taste into your mouth, Ah, that's so funny. Yeah, I'm surprised. Your teeth are so nice.

Like, you know, right now.

Mike: they're pretty good. and my wife, she's got soft teeth. unfortunately. it's just your genetics and mine. I never had that problem. And so, it worked for me. It worked for me Marla, tell me.

The coolest week you could have if your business went exactly like you wanted it to go, what would be a really cool week for you? Let's say three to five years out? What kind of clients would it be? Would you be traveling for work and talking on the stage?

Would you be doing anything on tv? Do you like that forward presence? Would it be, having your nose into a database? be a really cool week for you in time?

Marwah: I love this question. so when I envision the time, my friends call me the conference queen cuz I love going to conferences. I love traveling. I love going to conferences specifically, and specifically, I. Healthcare, health tech, healthcare, innovation conferences, because there's so much talk about the future of healthcare, so many great ideas.

You're meeting and mingling with people who have all of these amazing ideas of how to change healthcare and just cool and innovative ways of how to solve problems and people you can get excited about solving problems with and people who are passionate about these problems. So for me, if I picture, like five years down the line, what is the most exciting thing for me to be doing?

And one of the biggest things that I'm very passionate about is the future of pharmacy and how we are going to be, since we're talking about disruption, how are we going to disrupt the way. Pharmacists work. How are we going to disrupt the way pharmacies are viewed in the community? How are we going to disrupt the way that pharmacies are, affecting the community?

How are they a bigger part of primary care? I would love to be doing this here in Canada, but also overseas. I feel like there's so much opportunity to be doing something. Cool like this in other countries as well. maybe start with a proof of concept here. I have some ideas that I'm working on.

Be working with a fantastic team, a team that I respect, a team that has very complimentary skills, and be traveling. And maybe we've implemented it here, we've implemented it overseas and now they're bringing me in too as a thought leader. And so for me, I envision traveling through leadership, but also continuing to work on really cool disruptive ideas that are actually like, I'm the kind of person who wants to work on a problem that I can see, being solved or, being completed within the next few years.

I don't wanna go back to policy reform [00:35:00] and work on something that I probably won't see the fruits of my labor for another 10 to 20 years. I wanna see it in the next two to five years maximum.

Mike: Sometimes I peter out on things if I have an idea and I can't even find out the results until tomorrow. we, owners, we like to,dabble and see the results like now. So yeah, that policy stuff goes on for years and then you think it's gonna change and then someone comes in and votes, something like that.

How many people do you like to speak to live?

Marwah: Oh, that's, many people do I like to speak 

to 

Mike: What kind of crowd is your favorite size? Is it three people? Is it one person? Is it 500? What do you like the best?

Marwah: I have to say, I don't know. I don't have a preference. I mean, I feel like you can have different results. So when I'm speaking one-on-one with somebody, it's a lot different. you're getting their energy, you're going with their energy. You're talking about really personal, intimate things.

 I think about when I used to give little, motivational speeches to my pharmacy staff, I used to love that too. Used to be a lot more candid. I've done speeches to much bigger rooms, and that's really nerve wracking and that probably requires a lot more preparation.

and it's still exciting because it's something bigger. it's something that you can say, I did this. And, maybe it's a little bit of an ego, but it's just, it's so powerful to be, to say that, I was brought on to speak to this many people and this many people actually wanna hear me speak.

It's kind of exciting too, so 

I don't have a preference. 

Mike: You've gotta like it cuz it kind of disrupts your day and your week because you're prepping for it. You're a little bit nervous the night before. You've put some other things to the side because you're thinking about it and so on. So, it's fun, but it's kind of a pain sometimes.

Marwah: It is fun. I mean, just this podcast, I was pretty sure I couldn't sleep last night. I woke up in the middle of the night. There's not much to prepare, but it's still, your mind is going, how is it going to be received? What questions are we gonna talk about? How is it going to flow?

So, I mean, there's so much that's beyond your control whenever you think of those certain things. But I think the one thing, I guess that, I mean with everything that is just like this one day, one event, so much beyond your control is just enjoying that process, that journey of getting there and just kind of, just preparing as much as you can and just enjoying it.

Just trying to be in the moment, live in the moment.

Mike: It was John Lennon who said, life is what happens when you're busy making other plans,

Marwah: Yeah, absolutely. It's true. When you think about any, when we set goals and we say, in two years I'm gonna do this, or on my birthday I'm gonna do this, or my wedding day, this is what it's gonna look like the most important, what I've learned. So this is not something that I'm saying I'm gonna always be wi, I've always been wise with, but what I've learned is the most important part is actually the journey of getting there and what you gain in that process.

Within that journey. There's so many lessons learned, there's so much to learn about yourself and enjoyment and people that you're doing it with. That is actually a lot more valuable than just that one goal and event at the end.

Mike: I have a tendency to probably be anxious if I had to go down any of the crazy columns. Anxiety would probably be there. And I think anxiety is because you want something to go a certain way, and you're fighting to make it go that way.

The problem is, how do I know what's good for me? I don't think I wanna go to prison. That's one. and I was almost there. Long story short, I had a family member that was trying to send me to prison. And, it was a big legal thing to, boy, 18 years ago now.

seems like yesterday, but I had a. A chance of, a lot of things happening, losing business, losing my license. all crazy things in this person's mind. But I had a chance of it happening if for some reason the judge was skewed or something like that. The one thing I said that I didn't want to happen was prison.

Marwah: But now that I think about it, I don't know. My life could be a lot better if I went to prison. you? No, seriously, Mario. You just don't know. You don't know the people you're gonna meet. what kind of peacefulness you're gonna seem, you think the Richie riches have it all together.

Mike: their suicide rate is up there probably as much as anybody else. You just don't know what your path is. So there's no reason to. Fret too much about it. Here's another one, Marla.

Marwah: Mm-hmm.

Mike: I don't think I want to be like 85 and be a greeter at Lowe's. Do you know Lowe's

Marwah: Yes. Yeah.

Mike: Why am I thinking that? I have a pharmacy degree.

Why would I think I'm gonna be a greeter at Lowe's? There's nothing wrong with that. I just picture I should be doing something else when I'm 85 than being a greeter at Lowe's.

Marwah: So why would that even like come into

your 

Mike: don't [00:40:00] know. Why would that come into my mind? 

Marwah: That's interesting. 

Mike: you know, people talk about, um, 

I don't have it. You hear it? The imposter syndrome.

Marwah: Now you're speaking my language. 

Okay. 

Mike: Maybe I'd have to be there cuz I don't feel like I'm a pharmacist and they'd say to me, Well, not at Lowe's. Lowe's isn't a pharmacy, maybe Target or something. They'd say, Hey, do you wanna work in the pharmacy? It's like, no, I'll just be a greeter.

Why? I don't know. I hate it, but I just think that's where I should end up.

Marwah: It's funny that you say that sometimes when, and I've talked to other friends about that when we're just really tired and really sick of doing really difficult things you think of like, what is the job? Like even I just start thinking, it would be, and I've done it before, just going in and working as a frontline pharmacist and I remember how like fresh that was and how, I would just worry about the prescriptions that were coming in and just worked as a, although I know it's really difficult as well, like, there's people getting mad or whatever, but at least at five o'clock or six o'clock I got to go home and not worry about anything.

Right. So there's certain levels where you're thinking that it's funny that you say that cuz what. What gets me really kind of like feeling, that feeling of like fear and claustrophobic is actually being stuck in the same position, doing the same thing for like 10 to 15

years. 

Just that, like, having the thought of that actually makes me wanna take a deep breath.

Mike: Well, Marwa, again, I'll throw this number out, 80% of the people listening to this, they're doing just that. And I thought the same way. The listeners know I was gone for about five years, from 2015 to 20. If somebody said I had to come back and be in the store as much as I am now,

I'm not the type that, thinks about killing myself, but just figuratively, I'd have to kill myself , to not do that. But I guess you make it work. This is why I do the podcast , it's a blessing instead of a curse, But 80% of the people here listening are doing that.

Marwah: Yeah. And I wonder to what level are people doing the same thing? Like when I had my pharmacy for about 15 years now, 

Mike: You still have it? 

Marwah: We still, yeah, I still have it. I just have kind of stepped away, kind of runs itself, so I don't have to do any very much to it. But when I think about the journey, almost every two years, something drastic has changed.

So either the team has grown, we've brought on more customers, we've rebranded, I've decided on a different strategy. I've actually moved locations three times or two times, sorry. And as we got bigger, we moved larger locations. And so while I think about it. I had it for that many years. I have found a way to make it different throughout those and in between I had two kids and your life changes.

So it's really, although I know that some people are completely satisfied with being in the same job with that security, and that's a completely different personality, and it it

doesn't mean that I look down on people like that. I think it's, they find joy in a lot of different things.

I find joy and passion in what I'm doing in my profession, what I'm doing in my career. It's a huge part of like what excites me, what 

wakes me up in the morning, the point you made about, sometimes being on the front line. There were times when one of my pharmacists was gone and I had to work on the front line. And those were kind of peaceful times for me because I gave myself a little grace that I wasn't gonna think of the future of the business during those weeks.

Mike: I couldn't put it off for a long time, but for a week I could just be a pharmacist and not think about those things. There's an author I like, a book I like called Getting Things Done by David Allen, and it's not really getting things done, it's really. Packaging stuff. So you have room to dream outside of that.

But he talked about one time when he had the most peace in his life was when he was on a sailboat. A storm came up, he woke up and he knew his boat was gonna crash into the rocks if he didn't do something. So he's out there, fighting for his boat, fighting for his life, basically.

And he looks up at the full moon up there. And he said he had this great peace inside of him because he knew at that moment even though it was only gonna last for maybe 10 minutes, he knew at that moment that's exactly where he was supposed to be in this universe at that point, saving himself and his wife and his boat, and.

Not a lot of us have that. Not a lot of us know exactly where we should be, and those moments are few and far between. So sometimes just being in the firing line of stuff, you're like, at least for today, I'm peaceful amongst this storm. I'm peaceful because this is where I am right now.

Marwah: Yeah, it's an interesting thing that you're bringing up because one of the things that I've been kind of going through for the past couple years have been through, I've been going through this process of exploration. It's almost like, some days I call it like a mid-career crisis [00:45:00] or still trying to figure out what I wanna be when I grow up.

When you mentioned that term, not many of us know what we should be doing or are confident in where we are. And in that process, when I first started it, I was saying, I was pivoting in my career and it is kind of a bit of, I have to admit, it was a bit shameful. I thought, like, I've been a pharmacist for over 15 years.

How am I at this point in my career and not knowing where I want to go? Because I've always, while running my farms, I've always just known, I've known what I wanted. I've always had a goal, I've always had a vision of how I'm gonna do it, and I always was just very determined. So now I'm in this place where I'm like, It was after I finished my base also to like give it some context.

I was like, I can do anything? What will I do? The interesting part is as I started talking to people that I thought had everything figured out, had all the biggest positions, they were all kind of in the same place. it's really interesting that you're there. I'm kind of still trying to figure out where I wanna be, when I grow up, and these are people, they're not young people, like forties, fifties, And still in that process. And actually, in the beginning I was a bit ashamed of it. Now I realize it's kind of exciting, I feel like if I'm ever in this place where I'm like, okay, well this is it. I will just. I think I will get really scared and really bored, but the fact that I'm continuously thinking, oh, there's more I can do, there's more I can do, it's kind of exciting to me.

And it goes back to your term of like, you feel like you're kind of in that anxious bracket. Sometimes I wonder, because they say there's very little difference between the feeling of anxiety and excitement, 

and really it's like the perception of the outcome. I think in the end, I can't remember what the difference is, but sometimes I have to stop myself and I'm like, am I anxious or am I excited?

Most of the time I'm very excited. I'm very excited, but a little bit of the excitement is the anxiety of like, oh, is it gonna happen? Is it not? 

Mike: Well, if you think about our human evolution, think way back you might have been happy in the cave with your little clan, you found some berries or something like that. But you do that for. 20 days in a row sitting in the cave, eating berries, there's more out there. And I think we as humans, we're just pushed for more.

 I think it's a natural thing that you have that, uneasiness sometimes because it's what made us who we are as humans,

Marwah: Yeah, I think there's two, I mean, there's many types of humans, but when you really think about it, there's the people who are content with being in the cave. It's safe, it's stable, don't go out there, you don't know what's out there. And then there's the people that are like, but what if it's more exciting?

But I can't handle being here anymore. And it's, I was just talking to a friend about making a big career change after being in one position for 20 years. And all the people in her close circle are saying, are you crazy what we do? That you're in a stable career? While she was just at a point where she was not fulfilled, she wasn't happy.

And some people would prefer that, just the stability and that. Makes them more happy. So it really is like understanding the type of person you are. And I'm the kind who's always like, well, I wanna know what's out there. I need to know what's next.

Mike: I mentioned my one brother has a branding company and his group of friends, they were all kind of in sales kind of thing, business stuff. One friend went back to pharmacy school. He's like, I wanna know what I'm doing during the day, during the week. I don't want to be taking work home. That was his answer to the other side of things of having too much disorder in life.

Marwah: Yeah, I can see that.

Mike: Marwa, tell me about your M B A journey. Was there a gap between your pharm D and that?

Marwah: Yeah. So I'm actually, I originally have a Bachelor of Pharmacy. I graduated in 2006, 

Mike: 2006 

 You entered at nine, 

Marwah: I'm not as young as you think I 

1. Yeah. No. 

Mike: Okay.

Marwah: Yeah. So, in 2006 I had my bachelor's degree. I went back to get my pharm d when they started, they built this new program at University of Toronto, pharmD for pharmacists. I did it part-time because I was still running my pharmacy, so I got that in 2018. Then I had one

year. 

Mike: How long was that program?

Marwah: So if you did it full-time, you could finish it in two years. I did it in four years. As part-time 

Mike: That's like eight years later. Between your 

BS and your pharm 

Marwah: Pretty much. Yeah, I started in 2015, 

Mike: What was the impetus for that? 

Marwah: I was in a place where I just felt that I didn't wanna close any doors. So it's funny, at the time people were like, why are you gonna switch careers? I was running my pharmacy, I was in community pharmacy.

They were like, are you gonna go to the hospital? At the time it was like, if you're gonna get your pharm d it's cuz you wanna be more clinical and you wanna get into hospital. I just decided that there's going to be new grads, that they're gonna be graduating with an entry level pharm d and I'm gonna have 10, 15 years more experience yet I'm gonna be looked at as just a bachelor.

And I didn't know at that time what more I wanted to do in my life. And I was always about continuing education. Like when I graduated, I went back to do my. Diabetes educator, respiratory educator, board certified, geriatric pharmacist. I always just wanted to, speaking to [00:50:00] your imposter syndrome. Actually, I read somewhere that healthcare professionals have a very specific type of imposter syndrome.

And I heard you talking about it in another one of your episodes, but we don't believe that we can do anything without having that extra degree of schooling.

Mike: Yes, for sure. 

Marwah: so after finishing my pharm d I liked it. I decided I wasn't gonna be more clinical, had about a year, and I decided I actually enjoyed the business and the strategy side of healthcare. And while I remember my dad at the time, he was like, why would you do that? You've already been running your own business.

And I'm like, because I want to. And then I went in. It was a very interesting program, actually, very specific to healthcare providers. It's a global Executive MBA for healthcare and life science executives. 

Mike: And that was how many years after your pharm d

Marwah: just a year

after finishing my farm year. 

Mike: 

you had the schooling in your blood then.

Marwah: i, you know what?

Once you're in it, it's really hard to get back into school. And my thinking was once you're in it, once you had, like, I had this regimen, I even, I even went on mat leave during my pharm d and I had a daughter, but I continued, I didn't take a break, I just continued with my courses 

because once you come out of it, it's so hard to get back

Mike: All right. So you got your mba. Did you have an inkling of something outside of the pharmacy or when was that seed planted to say that we're sitting here now versus you being in the direction of being in your pharmacy right now?

Marwah: There was a point where I had realized that I've taken my pharmacy as far as I can take it. I had bigger dreams than I would've taken it, maybe nationally, probably. But there got to a point where I was like, I want more from life. And I don't know if that's a specific imposter syndrome for healthcare providers, but I think it's also a female thing where I knew I wanted to be in the business side.

I knew I wanted to be an executive. And I don't know if other females feel that way. I think they do, but it's. We feel the need to have extra certifications to prove the same type of skills and expertise as. Maybe our male

counterparts.and so while, other, there's lots of other pharm Ds out there, being execs being, I felt like I needed the MBA just to prove that I knew 

what I was doing on the business side.

And to be honest, I think it gave me a lot more than that as well. Like I realized that we are like, as healthcare providers in the community, pharmacists, we've been running our own businesses. And for me doing the mba, one thing it did for me is it gave me that validation of like, actually I kind of know a thing or two about running a business.

The other thing it gave me was that like a lexicon, that language was able to communicate with other business people on the same, kind of, on the same level. To be able to, to explain the things I've done in a business way 

rather than,

I did this thing because I felt like this is what we needed to do.

I 

needed to be able to phrase it and frame it in a way that makes sense 

Mike: As I kind of prepped for the show, I was browsing through some of your, I guess I l All right, here's the thing. I want to hear somebody's voice before they're on the show. because you know what it is like. People, you've heard their voice, and then you see their face.

People do that with me. I've got a face for audio, and they're like, oh, I've been listening to that old fart. I just like to see it. But we were talking to somebody. I just watched it this morning, and I was impressed in just one sentence

and I thought, oh, well, she kind of knows her stuff.

Marwah: Wow. 

It was something about, benchmark, this kind of stuff. And I thought, well, Mars got it, I am gonna say that's the best compliment. Thank you. Only because I actually don't consider myself very eloquent. And those are some of the things, actually, even in my MBA admission interview, the director of the program said, what was one of your weaknesses? And I said, I don't know. I just don't know how to speak with big words like other people do.

And the funny thing is, I was speaking to somebody else and they had actually defined that as accessible language. So I find sometimes, when you're speaking to academics or speaking to people who are really into what they're doing, and they use the really big, just words to make themselves feel and sound really smart, what that person defined the way I speak is accessible language.

And I think it comes from me, a community pharmacist where we're trained to speak with lay language. So thank you. Thank you for that.

Mike: Marwa In the pharmacy, I speak to the customer. 

I'll never use a big word to them, but when I'm outside of there, I use the biggest obscure words I can think of. I love it. makes you look better. It makes other people look kind of small ,

my son, I do that.

I, Iuse the biggest words I can with him just to make him say, oh, dad, that was another one. I gotta look that up. I love doing it. [00:55:00] People say, don't do it. I'm like, screw it. all day. I'm dumbing stuff down. Actually, I'm not dumbing it down. That's all I know, but I'm pretending to dumb it down. And here's a secret Marwa, even on the show here, because I edit a lot, I use the biggest word that comes to my mind and then I rephrase it if I'm not sure what the word is, if I'm not sure I nailed it.

I rephrase it so then I can use either one.

 I had a guest on some shows ago, and I was talking about how oil changes places. They do better than us pharmacists because we don't track stuff like that.

Or they put all this stuff down, they checked this, we did this. I don't think they do it, but at least they put it all on there. And then I said, those oil people, they go down into the gallows of the oil place to find all this information and then I thought to myself, I'm not sure if that's right.

So then I said, in the same sentence I said they go down underneath where the car is dropping all the oil. I looked it up later. Gallows doesn't mean like a dungeon kind of thing. It means what they build to hang people. Did you know that

Marwah: Absolutely not. I would probably write that down and look it up later.

Mike: The gallows are what they build with the platform and they hang people on it. It's not down below. It kind of sounds like that though.

Like in the gallows it sounds like that, but that's not it. So anyways, I use the absolute, biggest words I can.

Marwah: I do love that. Cuz then you

know you're building up other people's vocabulary. I would 

just write that down and make a mental note for me to look it up later.

Mike: It's pompous. People like me would talk about people like that.

Ah, guy's kind of an ass. Why is he doing that? But. But for the few percent of people that think that's kind of a cool word, boy, Mike must know his stuff. It's worth it. It's worth being called an ass by 97% of the people. If 3% of the people say, boy, he, that was pretty sharp of him. Marow talking about letters after your name.

it's important, because I'll read a book and if I read a business book from you, I wanna see B afterwards. There's a lot of self-help books, and it's got, Charlie Smith and you're like, what are his credentials? and I don't think the credentials make the book better.

It's just, the person's been through the ringer and,I don't like, I don't, there's a book out. I doubt I'm gonna have her on this show. I don't even know who the hell she is, but I think it's called, You Can Be a Badass.

Marwah: Ooh,

Mike: You ever 

heard that 

book before?

Marwah: No. 

Mike: It's, something like, you can be a badass and I'm looking at it and the lady has zero credentials.

Marwah: Wow.

Mike: She's probably done YouTube stuff. She's probably grown some kind of a practice or something like that. But I still like to see the credentials.

Yeah, absolutely. You're right. I mean, when you think about it, it's a bit of virtue signaling. So, sure. 

Why not though? 

Marwah: That's the society that we live in. That's what we wanna see.

Mike: I'd rather see a virtue signaling of somebody who made it,

Marwah: Yes.

Mike: or at least knows bigger words than somebody who has a glass straw or something because they don't want plastic. something like that. 

Alright. Marwa, what advice would you have for a pharmacist who is in those four walls and is listening and says, it is time to disrupt my life. It's time to make some changes, especially in this day and age with technology where everybody can have their own TV studio and everybody can talk to anybody in the world.

What advice do you have for someone like that?

Marwah: So one of the biggest things that I actually got out of my M B A, it started off with a conversation that I had with this partner at a major consulting firm, doctor by trade. We were part of the MBAs. We were allowed to, we were able to have conversations with people like that.

And I asked her what advice she gives me about healthcare to be successful as a healthcare executive? And one thing she said to me, Was, you need to forget you're a pharmacist. And me being a young pharmacist with a chip on my shoulder, I'm like, she's saying that cuz she's a doctor and she doesn't have respect for me.

And, but what I realize, and this is what I learned, is we as pharmacists have so much skill and so much transferable skills part from like our profession and having to go through all of that, but also very specific skills like mine are partnerships, networking,forging relationships outside of everything I know about healthcare, outside of how I know to be, like stress on quality improvement.

We have so much [01:00:00] outside of who like our little title as a pharmacist and to start looking out there and start looking at positions that we can have transferable skills, right? You see doctors doing that a lot. A lot of other professionals are engineers doing that. A lot. Even lawyers are doing that now.

So, It's trying to get your head space out of the fact that you're just a pharmacist and you are nothing more beyond those four walls of a dispensary that there's so much skill and looking for. And I've seen, this is actually what brought me to your podcast. I was just looking for a podcast that showcased pharmacy and pharmacist in a completely different light.

What are other pharmacists doing? That's really cool. I was listening to one podcast from here the other day about this team of doctors and pharmacists building innovative care delivery models. I've listened to some pharmacists doing really cool things on pharmacogenomics and precision medicine and doing blogs and doing training and consulting and also being executive coaches and career coaches.

There is so much that we can do as pharmacists 

that I feel like it's just trying to get yourself out of that head space of, I am only 

this title within these four walls.

Mike: I'm actually a little jealous sometimes of people that don't have a degree, and I shouldn't say a degree total, because you want 'em to be able to write a book still, but they don't have that pharmacy degree.

Cuz it would force me in these last five, 10 years of my career to do something different. And I know I would,

Marwah: It would force me out of what I'm doing. There's some peacefulness in that, but with the degree you do feel it's part of you, you have to use it.

Mike: And if you go out on your own and make that decision for yourself, you can kind of feel like you failed maybe. But if somebody takes your degree from you, then you have no choice. You go out and do it.

Marwah: A very interesting perspective I get a lot of people telling me like, why don't you go off and do your own thing? Why don't you do a clothing line? You know, everybody's into doing clothing lines and all of that. And I'm actually a huge believer in, but for me, I am really passionate. I mean, at least for now, about what I'm doing.

And I'm not, I'm not really a frontline pharmacist. I'm doing some interesting things in the healthcare system. I get to work with really, you know, exciting people doing that kind of stuff. So I'm not, I don't feel oftentimes I don't feel like I'm using my pharmacy degree often. although the other day I've been, the past few months, I've been doing a few shifts here and there just to keep up.

We have to do that to keep up our license.

And it was kind of cool to be back there. It was just so like, like you said, like my mind was kind of free, but at the same time, it's funny that you feel that you making the choice to leave your degree behind is harder, bigger of a failure than somebody taking you away from you.

Mike: There's some peacefulness of saying, well, I gotta do something 

Marwah: Mm-hmm. 

Mike: Of making the wrong choice, you're just making a choice.

Marwah: So I have a theory about the people, the personalities that get picked to be pharmacists versus doctors. So I keep having this theory. Is it nature versus nurture? So I feel like, cuz I remember this as I was trying, I was in like a pre-med program, like a life sciences degree. And I remember going in, I was like, pharmacy just seemed like it was more of a very.

Straightforward. I just needed to know, like some people think we're just the drug experts. We actually know everything we do. We know the disease, like the disease, how to diagnose. We know how to differentiate. We know all of that cuz you need to know that to know what drugs. But then the doctor makes the risky decision.

They're the ones who make the diagnosis based on, oh, it could be this, it could be that, okay, but I'm gonna go with this. Once we get the diagnosis, we can easily say, okay, first line based on your, based on any side effects, based on the medication that you have. So we get a more straightforward decision.

And it's funny, it's that you are unable to make that decision. And I, it's part of the personality of a pharmacist. And I think that's, that is part of life, the nature of us, the nature of our profession. And then we go into the nurture part where, I don't know what your pharmacy, like program was like, but there's a specific lab that we have in pharmacy school that we're not allowed to call back to the doctor to verify a prescription more than once, or else we get marks off.

So it's then that nature of being like, okay, don't make any big decisions. 

Mike: Interesting. 

Marwah: Sure Yeah.

Mike: But Marvel. What I found out though, I used to always say the same thing, like, people go into pharmacies and you always have a babysitter, that's a doctor and so on.

Marwah: Yeah.

Mike: doctors and judges, when I was in the time that I thought I was gonna go to prison, the doctors and judges are not artists.

They don't have a lot of leeway. They both have to narrow it down. They have to use previous

Marwah: Experience.

Mike: experiences or research, and they don't just wing it. I mean, judge Judy does, but I mean, the rest of 'em, when they're talking, they're like, okay, paragraph such and such because of this, such and such versus such [01:05:00] and such.

I mean, it's not art. It's not art to do art, you kind of make your own business, or I'm not talking Picasso Art. I'm talking about the art of decisions of do we do this or that. That's not with a law degree or an MD degree that's on your own somewhere.

because even though pharmacists kind of answer to that, they're in the same position too.

Marwah: Absolutely. I think it's that, when you make these decisions, It comes from a lot of experience. Yes, we have a lot of experience, but there will always be like a tiny bit of like, gray area that you have to, you could be going either

way 

and I think it's your experience that helps you have more conviction to make one decision or another.

But I do feel like some pharmacists, because I struggle with that, with a lot of pharmacists that I employ, 

they just refuse to make a decision if there's any amount of gray area,

Mike: Anything.

Marwah: any amount. While I kind of feel I'm on the team of pharmacists, I need to be able to trust their clinical judgment.

There's always gonna be a tiny bit of gray area and you need to be able to, you document, you make sure that you have all like, the research, the information that you need, and then in the end you make the best clinical decision based on the best information that you

Mike: Well, I got into trouble when I was home during those five years, I had someone else who was the pharmacist in Charge Arch. That wasn't a great thing because part of the issue is I didn't communicate well enough with her, but I kind of just say that, part of the thing was, Because they didn't have any skin in the game business wise. They didn't have efficiency in the game. Everything became a triple count, a triple audit of the controls customers waiting because they had to count this by hand to triple check this and that.

It's a bad situation when the people in charge medically don't have skin in the game. You can say it's a double check, but for a small business it can be trouble. what you're saying about making those decisions and you throw finances in that too, and people say, well, you should divide those.

It's like, well in a fairytale world, but this pharmacy is only here because I have an owner here who deals with finances. So you don't get to separate that.

Marwah: Yeah. I mean, they have skin in the game just from their license, 

 And that's all they see. So I think it's a little bit of a lack of confidence. Sure, they don't have skin in the game, the business side, and they don't maybe get that. But I think it's more of a lack of confidence that it comes at that point where it's just such a fear of like anything coming on your license that you need to be triple, quadruple 

checked before making a decision.

Mike: I think part of their problem was they knew that I had the chance to go to prison and there's no way in hell they wanted to be in my cell with me. I think that's what it was.

Marwah: I shouldn't have been working with you then.

Mike: That's right. Hey, Marwa, what kind of person would you like to reach out to you after hearing this? What would be a cool email to get from somebody?

Marwah: I would love to hear from people who are looking to do really cool things and wanna bring me in as maybe a, not necessarily, I don't see myself as a subject matter expert, but somebody who just thinks outside the box. I love new ways of delivering service, of delivering care of what we're doing to disrupt pharmacy.

and anyone that wants to chat about where their career is going, anyone that feels, they're kind of like where I'm at, where I'm like, I'm in an exploratory place and if they wanna hear about me, and I'd love to hear about them. I love hearing people's journeys, their stories. That's probably the most exciting thing for me, and that's why I love going to conferences.

Mike: Well, Marwa golly, great having you on. I got another Canadian down. I didn't even have to try to figure out any accents or anything, or not maybe figure 'em out, but at least kind of chuckle about 'em, 

but thanks for being on, and opening that up. It's so cool to see. As you mentioned, part of the reason you got in here listening was because of the different faces and backgrounds and things like that, and thank you for being a part of that.

Marwah: Yeah, absolutely. Thank you so much for having me, Mike. It's funny that you say that about accents cuz this morning I was thinking, I really hope I don't go on saying this after every sentence.

Mike: it. My best friend is from, er, upper Michigan. It's like watching, I don't know what show, like Fargo or something like that. 

Marwah: Like those two moose that were on one of the Disney ones, 

Yes. 

Mike: What was that called?

Golden Bear. what was the name of that

Bear

One 

brother Bear. That was it. Yeah, he's like that. So, no, you're, no, we're close. No, nowhere close. Nowhere close. right, 

Marwah: Thank you. 

Mike: forward to keeping in touch.

Marwah: Thank you. Me too, Mike.

Have a great day. Bye.