This Is How I Would Replace Myself With A Robot

I am sorry pharmacy

The story of Damocles is an interesting one. For those who don’t know Damocles was flattering king Dionysius about how amazing his life is. So, Dionysius asked Damocles if he would like to switch spots at the dinner table to experience a little bit of his amazing life. Damocles jumped at the opportunity and sat in the king's chair. He was mesmerized by all the riches and bounties. But the king had something else in mind. He had a sword hanging over Damocles’ head held there with a single strand of a horse's tail. He wanted him to realize that all this excess and riches could be gone at any time even for someone as powerful as him. This caused great anxiety for Damocles. He was not able to enjoy the bounties because of the imminent danger. So, he asked to leave the seat. He realized that Dionysius’ life was more than just what he saw from the outside.

Now, why am I telling this story?

It is because pharmacy is at the king's chair with a sword hanging over its head. During school, we are told all these amazing things we can do with our degrees. We would be doing disease management working shoulder-to-shoulder with doctors in the clinic. We would even have our own schedule!

But when we graduate, we are greeted with tedious tasks and busy work.

For those that do not know I am a pharmacist. I graduated in 2012 from pharmacy school and then did one year of residency afterward. After failing to match for the second year of residency I was able to get an amazing job at a top academic institution in their cancer center. To say that I was happy is an understatement.

As I progressed through my career, I would think to myself why am I doing this? Not being a pharmacist, but all the tedious tasks that I knew could be automated. The more I thought about it the more I was like I think a computer can do most of my job!

This Hurts Me More Than It Hurts You

The following is what some would call self-sabotage. I am going to show you how many parts of a pharmacist’s job can be automated.

Filling

If I was a big corporation that's business was based around a pharmacy in the back of the store, I would move all chronic medications to a remote filling site. All medications could be filled with a robot so you would need minimal technicians and pharmacists. All they would need to do is fill the machines with the right medications and the robot could handle the rest.

The same filling robot could be deployed in hospitals. I worked at a hospital when there was a robot that would dispense medications more than 12 years ago!

The great thing about robots is that they can fill medications all day. They don’t need breaks. Their concentration is never off. You could even have these at the main pharmacies with the most popular medications.

The same can be done with medications in hospitals. There are even robots that make intravenous (IV) medications.

Checking

We are not far off from computers taking over this part as well. Every medication has a unique identifier on it. You can have a computer scan the medication and make sure the unique identifier matches the medication that is being dispensed.

I can tell you with great certainty that every prescription is not re-counted by the pharmacist when checking. Narcotics probably, but not everything else. There just isn't time. After the computer has verified it is the right medication it can either count the medications again or simply weigh the bottle and see if the right amount of medication is in the bottle.

Dispensing

Have you ever gone to Home Depot, Lowes, or even some Amazon mailboxes where there is a wall of locked boxes with a screen? You go to the screen and either scan a barcode or type in your unique alphanumeric code and then one of the doors opens up and voila your merchandise is sitting right there. No need to wait in line. Quick in and out. Well, that can be easily done with refills of your medications.

One caveat to this is in some states you need to be counseled by a pharmacist. But I could see this being worked around with a question asking the patient if they want to speak to the pharmacist. If they say no, then they proceed to their pickup. If they say yes, then a pharmacist could show up on the screen and start talking to the patient. Or they could be directed to go to the pharmacist at the counter.

Another popular way of dispensing that is already happening now is mail order. This is when your prescription is mailed directly out to you.

Dosing

Let's look at the sacred clinical side. One place I could easily see automation is with the dosing of renally adjusted medications. Almost every hospital has guidelines and algorithms that all pharmacists follow. You could easily have that algorithm automatically dose the medications and schedule labs based on the parameters set in your protocol. Anything that is an outlier could be reviewed by pharmacists.

Interventions

This is already being automated. Gone are the days of having to memorize what interacts with what. Now almost every EHR or pharmacy-related software has a drug-drug integration checker. I would say this is already automated. The major ones or the more nuanced interactions are the ones we need to intervene on.

Also, as a side note. Someone having a stomachache is NOT a drug allergy! It is an adverse event! Can we please for the love of all that is holy have a separate place to document adverse events?

Insurance Issues

I am joking. This is not our job, and it never should have been.

👏 WE 👏 DID 👏 NOT 👏 GO 👏 TO 👏 SCHOOL 👏 FOR 👏THIS! 👏

If you have a driver's license, are you supposed to be a mechanic as well? I didn’t think so.

Reconciling

This is not to say what a pharmacist does is not important. It is quite the opposite. What we do is vital to the medical ecosystem, but we are burdened with all these tasks that can be easily taken off our plates. This is saying that we are not practicing at the top of our licenses, and that to me is a big problem.

We went to school to manage disease states. We are experts in medications. We were taught how to counsel patients properly and be able to figure out why someone is not adherent to their medications.

The first thing that needs to happen is that every single pharmacy organization needs to come together and lobby for prescriber status for pharmacists. Then we can start getting paid for the clinical services we all thought we were going to be doing when we graduated.

Some great steps are being taken in pharmacogenomics (PGx), remote patient monitoring (RPM), medication therapy management (MTM), and the list goes on and on. All of these initiatives can and should be led by pharmacists. There is so much more than just retail and clinical pharmacy that we can do.

We should be part of this technology revolution that could help the profession out of the shackles it’s put itself in. If you are a company in the space, you would be hard-pressed to find someone better than a pharmacist leading your team.

I am sick and tired of talking about how much money I saved the system. I want to talk about how much money I saved the patient. How many patients I was able to help. I want pharmacy to be looked at as a revenue generator, not the black hole it is currently seen as.

Even if we get replaced by robots, we will still need to intervene in the things that fall outside of the parameters set for the algorithms.

We can do more! And we should be doing more!

So yes, this is how to replace me with robots so I can do the things that I was meant to do!

Thank you so much for your support! Please do not hesitate to reach out if you have any questions or leave a comment.

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I hope you have a great day!

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