CEimpact Podcast

Assessing Liabilities and Risks in Pharmacy Practice

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Explore the complexities of legal liabilities and risks associated with pharmacy clinical services, such as point-of-care testing (POCT) and immunization administration. This episode will offer strategies for managing potential legal challenges, including handling adverse reactions and sensitive patient results while ensuring compliance with legal and regulatory standards. Listen to this episode and equip yourself with the knowledge to navigate these challenges and provide safe, effective care to your community.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
David Brushwood, RPh, JD
Senior Lecturer
U of Wyoming

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Identify potential legal risks and liabilities associated with various pharmacy clinical services.
2. Describe strategies to manage adverse events and patient outcomes in compliance with legal and regulatory requirements.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-295-H03-P
Initial release date: 11/18/2024
Expiration date: 11/18/2025
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and I'm really excited about our conversation today. With pharmacies expanding their clinical services, understanding the legal liabilities and risks involved is more crucial than ever. In this episode, we'll explore strategies to manage potential challenges, from handling adverse reactions during immunizations to communicating sensitive test results. Ensuring that you're equipped to provide safe clinical services to your patients that's our overall goal. It's so great to have my friend and colleague, david Brushwood, with me today to dig into this topic that unfortunately looms heavy over the heads of many pharmacists, as we are all aware, hopefully, and cautious, of the many liabilities and risks that we undertake as we practice every day. So, david, thanks so much for taking time out of your day and thanks for being here.

Speaker 2:

Hey, josh, great to be with you. Thank you so much.

Speaker 1:

So before we jump in for those learners that may be new to you, david just give us a brief background of yourself. Just tell us a little bit about yourself and what you do, and maybe kind of why you're our law expert. What's your passion there?

Speaker 2:

Oh sure. So I'm a lawyer, I'm a pharmacist. I went to University of Kansas for both of those degrees and currently I am a senior lecturer at the University of Wyoming School of Pharmacy. Also, I am a emeritus professor at the University of Florida. I really got involved in pharmacy law because having rules about expectations of pharmacists in order to meet patients' needs is something that's always excited me and I thought, well, let's try to make this more than just rules that are rules for rules sake, but rules that really guide the profession in a positive way, so that we can grow and provide richer experiences for our patients.

Speaker 1:

That's great, David, and you know I realize, as you're sitting here telling your background, I don't think I ever know which came first, your law degree or pharmacy degree.

Speaker 2:

Oh well, I went to pharmacy school first. Well, long story I wanted to go to law school got drafted after I graduated with a pre-law degree, they made me a pharmacy technician in the army and then so I went to pharmacy school, practiced pharmacy for a few years and realized, oh gee, I really wanted to go to law school. So I went and did that.

Speaker 1:

Gotcha. Okay, I just realized that I don't think I ever knew which came first. It's interesting to know. Thanks for sharing. Well, again, thanks for telling us about yourself, thanks for being here, thanks for always being our law expert and our guru. We are just always in awe of the knowledge that you have in this space, so it's exciting to have you on the podcast today. So let's review just a little bit about what are some common liabilities and risks in pharmacy practice. You know, especially in this space of adding clinical services, like what should our pharmacists, who are doing these things, who are expanding, who are trying to change the practice model because that's what needs to happen? What are some of the things to just be aware of. What are we forgetting or missing?

Speaker 2:

Yeah, well, I'm going to trip you up just a little bit here. Josh, you and I are close enough that you don't mind my doing that.

Speaker 1:

No.

Speaker 2:

I am a little concerned that the threat of liability is a daunting challenge for pharmacists and for that reason they're not expanding the practice as they could. We call it risk management. We don't call it risk elimination when we're talking about the possibility of liability.

Speaker 2:

So, for example, I've become a bit concerned about test and treat about pharmacists who say oh gee, I don't know if I want to do that. I'm afraid of the liability, and I'm trying to encourage them go ahead and accept the responsibility. The liability will work itself out. You're okay. There's a movie called 20 Feet from Stardom. I don't know if you've ever seen it.

Speaker 1:

I've heard of it. I don't think I've seen it, but I've heard of it.

Speaker 2:

Okay. Well, this is a movie about background singers who are 20 feet behind, and Bruce Springsteen is in it and he said I used to be a background singer and man, it was a comfortable place to be. And then they decided I could be a star, I could step forward.

Speaker 2:

And he says those 20 feet are tough 20 steps to make, to go out there in front and expose yourself. And I get the feeling that among some pharmacists there's a bit of stage fright about stepping forward and saying I'm going to be the prescriber, I'm going to test you, I'm going to treat you. It's me Because they say things to me like and a number of pharmacists have said, I'm very concerned about prescribing Paxlovid because there are these interactions with. There is an interaction with statins. What can I do? I need to get permission from the statin prescriber to hold the statin and I say you don't, you don't need to do that.

Speaker 2:

Prescribers all the time. No patient is going to die because for a few days they don't get their statin. They need their Paxlovid. You can go ahead, you can step up there to the front and you can say you have sought me to be your care provider. That's what I'm doing. Hold the statin for a few days. We'll avoid this drug-drug interaction. That's perfectly fine. So I don't want anything I say with you today to cause fears of liability. There are lots of rewards that come with responsibility and increased liability is not something to worry about.

Speaker 1:

I love that approach. That's fantastic and you know it makes perfect sense in the whole. What we've talked about before, even on previous episodes, is, when you're doing things as a pharmacist, be confident. You know, you have the training, you have the education, you have the knowledge. Be confident. Don't just say, hey, well, you know, maybe we should. I think, maybe this is the best route. Be confident. You know what the answer is, and that's exactly what you're saying in this is step forward, be confident and and assume the liability and the risks Because, like you said, it's not the greater issue at bay here. The greater issue at bay is not getting our patients the care that they need.

Speaker 2:

So yeah, that's absolutely right. Yeah, I mean, I've got a couple other things I'd like to talk about with you, if I may, josh, oh yeah, absolutely.

Speaker 1:

We could wrap it up right there, couldn't we, david, we just solved everything, yeah, for sure.

Speaker 2:

I do think it's important and I get emails and actual phone calls from pharmacists periodically asking me how can I do this? What should I do? We have some demanding patients and it seems to be in part due to this idea that if you think a drug will be effective for you, then you have a right to have your pharmacist provide that to you, and the pharmacist really has no discretionary decision here. It's your right. This came up during COVID with ivermectin and hydroxychloroquine, and it seems to be extending over the GLP-1s. Patients think if I have a prescription, then you must fill it, and some pharmacists are saying well, actually those are drugs that I'm saving for a different category of patient than you and I'm going to make the decision not to provide that medication to you. And patients are upset, but that's something pharmacists need to hold firm. Pharmacists need to decide who gets a drug when there's not enough drug for everybody who wants it.

Speaker 2:

And there are some standard decisions that they can make in doing that. So I wanted to reinforce that. Simply because somebody says a prescriber has prescribed it and I want it doesn't mean you must provide it.

Speaker 1:

You decide that.

Speaker 2:

That's great.

Speaker 1:

That's great, david. And if I can ask on that, you know the trepidatious pharmacist inside of me might would say, yeah, but what does that set me up for? You know like, can the patient come back and sue me because I didn't fill their prescription? You know like, I feel like that might be the question back. So how would you respond back to that?

Speaker 2:

Well, patients can sue you and they have sued and the pharmacist has won every time. You may have read in the newspaper that at the trial court level, the court refused to dismiss the case, but once it gets to the appeals court level, pharmacists have won every time. Hospitals have won every time. So that's a winner. But there are really two criteria the decision that the pharmacist makes to not provide the medication must be based on the patient's best interests, on the public's best interests. It can't be a self-serving decision, it can't be arbitrary or capricious or silly, and it has to be based on a policy. So every pharmacy, in my view, should have a policy on when it is that the pharmacy, unfortunately, must decline a medication. It's not stubbornness, it's not personality, it's not the patient, it's that these medications are necessary for people who need them and can't be provided to people who really won't benefit from them, because they're precious resources that we have in this country and they have to be preserved for the people who actually need them.

Speaker 1:

Yeah, and I think that you hit on something there that is just key, and that is you need to have a policy, and I know that there are so many, unfortunately, stores that don't have policies and procedures on things or only have it when it's, you know, officially required, like if you have an immunization service things, or only have it when it's, you know officially required, like if you have an immunization service and you must have a PNP manual, you know. But even then, is it thorough enough and you know? So any feedback there for anyone who is like oh gosh, what do you mean a policy Like? Is this like a 20 page legal document reviewed by our lawyer, or you know like, or what does that look like? What can the policy and procedures look like on that?

Speaker 2:

Yeah, the policy has to state that pharmacists have an obligation to provide medications only when they are necessary in the patient's best interest, and that policy then must be supported by evidence. That policy then must be supported by evidence evidence from APHA or ASHP or CDC or from the professional literature, that there has to be some substantive basis for that policy rather than a whimsy of the pharmacy personnel who simply don't want to do something. It's not that you don't want to do it, it's that you cannot do it Because, as a professional standard, pharmacists provide patients with medications that are necessary for the patients because the evidence supports the provision of them, and if there is no evidence, then they cannot be. It's not that you're refusing. You cannot provide that medication because there are people who really need it and to preserve a sufficient supply for those patients who really need it, we simply cannot provide it for a non-evidentiary use case of this example, if we just continue down this path with the COVID example.

Speaker 1:

So obviously nobody necessarily saw that coming. I mean, we saw it snowballing and it got to be a bigger issue, but at what point would you enact that policy? Or would you need to say we're getting a few requests on this, we probably need to make a policy on this. Is that kind of how the process should go?

Speaker 2:

Well, there should be a policy already, and that policy should certainly address opioids, for example as medications that cannot be provided under some circumstances because the potential for diversion is such that it simply cannot be done. There are other policies that would depend on state law that relate to conscientious objection. We are a profession that respects the right of some pharmacists, under some circumstances, to step away from the provision of medications, not step into the way but, step aside, while others, who are not objecting to them, provide them. So those are policies.

Speaker 2:

I mean APHA has policies like that, so it doesn't take much modification of an existing policy to cover everything. Yeah, and I think that can be done. Do an internet search. I wish I could say there is a generic one size fits all policy that every pharmacy, but you can't I mean it just? Depends on where you are, what you're doing.

Speaker 1:

I think my question was really, you know, do we have to pivot every time something new comes out, when the next hydroxychloroquine or when the next like, do we have to pivot each time? Or like what you're saying is, we should have pretty much a band-aid policy that would cover that already, like a version that would cover that instance, so that when something else creeps up, the next pandemic, the next, whatever, that's already covered, right.

Speaker 2:

I think you're right we don't know what we don't know.

Speaker 1:

That's true, so that's fair. We didn't know COVID was coming in the way that it came, so that makes perfect sense. I agree, yeah, but in general I think it's you know. Your point is that it's important to already have policies in place that could be used, you know, in other circumstances, and I think the key here is just taking the time to create those policy procedures and to make sure that everybody on staff knows them and understands them and follows them. I think that's what's important.

Speaker 2:

Yeah, and explain it to patients in a gracious, respectful, caring way. I care too much about you to be able to do this. I'm not being stubborn, I'm not being political. The pharmacists who Believe it or not. Maybe you do, maybe you don't. The pharmacists who declined to dispense ivermectin and hydroxychloroquine are accused of being political. Sure, not the patients. They're not being political at all. It's just the well you know. Politics just needs to set aside from this. This is about patients.

Speaker 1:

This is about their welfare.

Speaker 2:

This is about the public welfare.

Speaker 1:

That's about the public and that makes sense. I mean, you could, you could? I remember a similar instance when you know, the morning after pill first came out, way back in the day, when, when I was in community practice and fully, fully practicing, and I remember very similar instances where you know it became similar with, it was politicized or it was you know your beliefs, that's why you're doing it and whatnot. So I can see where you're saying that you know we need to approach it from the instance of in your best interest as a patient and protecting you. So, yeah, that's great feedback.

Speaker 1:

So, david, going back to some of those, so again you know we talked about how, as a pharmacist, being confident, embracing some of those liabilities, understanding that you know they're not going anywhere, so you can't always hide behind them and not expand your services because of that. Because we know that we're all at a critical juncture in the practice where we need to be pivoting and we need to be changing the model, and so we are going to have to embrace expanding these clinical services. So what are some of them? I guess, when people say they're concerned about liabilities and risks related to that, what are some of the things that they're concerned about, like what can you tell us that's like? This is what I mean when it's not that, when it will work itself out.

Speaker 2:

I think one concern is whether pharmacists who are expanding their practice into new opportunities feel confident that they have adequate training. And I would say give yourself the confidence you need to expand what you're doing, but stay in your lane. Don't be bullied into doing something that you don't feel fully adequate to do. On the other hand, it's your responsibility to acquire that knowledge and skill in order to fulfill your professional responsibilities. There is this saying see one, do one, teach one. You've probably heard that. I hate that.

Speaker 1:

I hate.

Speaker 2:

It's as if you see it done once, do it once and can teach it once.

Speaker 1:

And then you're the master, yeah.

Speaker 2:

It's more complicated than that.

Speaker 1:

I'm sorry.

Speaker 2:

And if there is a credential that is offered by a continuing education business or company or provider, then obtain that credential and make sure that you have the necessary background to do it. Another important aspect is to establish a relationship, to make sure that the patients understand who you are and what you do. Some patients perhaps many patients incorrectly think that back behind that counter, where the pharmacist is mysteriously doing something, that thing they're doing, that they're limited to doing, is taking pills from one bottle, putting them in another bottle and slapping a label on that, the computer is generated for them, and that that's the limit of what a pharmacist can do. And it's important, I think, if you're providing an expanded service, identify yourself by name. My name is David Brushwood. I am a pharmacist. That's what I am. I am a pharmacist. I am going to provide you with service X.

Speaker 2:

Here is what you need to know about service X, and if somebody says, well, are you qualified to do this? You can say I am absolutely qualified to do this. I am licensed to do it. I have undergone additional training in order to do it. Don't be offended, don't you know that? Some people just don't know. Actually, yeah, my wife was at a, in the waiting room at an anticoagulation clinic a few weeks ago waiting for somebody, and it's a pharmacist. Managed pharmacist staffed anticoagulation clinic and an elderly gentleman went up to the receptionist and said what's the difference between a pharmacist and a PharmD?

Speaker 2:

And the receptionist didn't know the answer to that question and my wife, who is not a pharmacist, was very tempted to say excuse me, I can explain what the difference is and why you were seeing a pharmacist here at this anti-COAG clinic, which is not an uncommon thing to have happen. Pharmacists do this around the country, but she just didn't feel it was her place to do that. And hopefully the pharmacist was able to explain. Here's who I am, here's what I do and I'm qualified to do it.

Speaker 1:

Yeah, I've heard many people in our profession say many times before and even Jen on our impact team I've heard her say numerous times before one of the things that we are not good at as a profession is telling others what we do and what you know, who we are, and really kind of I don't want to, you know, dumb it down, but like marketing ourselves and just making sure people understand like we are trained for this. We are knowledgeable individuals. We know how to do more things than just count to five and you know lick and stick, you know. So I think that it's important, like you said, to be sure that we are relaying that message to the patients, educating them on the fact that, yes, I'm absolutely capable of doing this, yes, I'm trained, yes, I'm confident in this, yes, I can do it, you know.

Speaker 2:

So I think that's really key as well, and I think it takes, you know, a little bit of effort and a little bit of practice and time to build that confidence as a pharmacist, especially if it's something new in a space that you're doing, so Sure, another thing that pharmacies pharmacists can do is conduct their own practice site assessment and sort of go through even with the checkoff list, kind of like you've seen the pilots do of an airplane.

Speaker 2:

Absolutely Before every commercial flight the captain goes through a checklist and makes sure that everything necessary to succeed with that flight is in place. And it may be that as a result of a practice site assessment on a particular day, the pharmacist in charge or another person in authority will say there is a certain service we're not able to provide today. We cannot, we are not prepared to provide immunizations today. I'm terribly sorry, but we can't do sterile compounding today. We can't. Whatever it is that ordinarily they do, they don't have the equipment, the equipment isn, they do, they don't have the equipment, the equipment isn't working, they don't have the personnel. I mean just whatever it is. But go through, don't continue to try to do these things that ordinarily you do if under some unforeseen circumstance, you're just not able to do it.

Speaker 1:

Right, because that would open up a whole you know liability risk, right, if it ever came out that you were doing this in a situation where, again, you were understaffed or you know your HEPA filter was on the brink or whatever. So that could open up an additional liability, as opposed to, just as you said, being upfront and honest and saying we're not offering the service today, I'm sorry, we can't do that, you know, whatever. So, yeah, that's great advice, david.

Speaker 2:

I mean people won't be happy. Josh, You've been in the waiting area at the airport when they announced that the flight is canceled because there is a problem with the equipment and the captain has decided, and people complain.

Speaker 1:

Of course, yeah, put me on that. With one engine, let's go anyway.

Speaker 2:

Yeah, right, okay, but in pharmacy, similarly, if we're just not able, for whatever reason, on a specific day to perform all of the services that we normally do, we're just going to have to apologize and explain that we cannot do it. People will not. Well, most people will be very understanding of that, right?

Speaker 1:

sure no, but I love that approach because I feel like it just is also normalizing us, as we have limits and there are times when we can't do something and it's okay to acknowledge that and not to push forward, to set ourselves up for additional risk or liability in that sense. So, yeah, that makes a lot of sense. That's a great analogy, david go to a different hospital.

Speaker 2:

Our ER just can't do it right now, then certainly a pharmacy is able to say I'm sorry, I wish we could, but we're getting slammed right now and it's beyond the ability for us to do it the way. We owe you to do it Right.

Speaker 1:

We owe you a level of service and we can't meet that right now or we would be putting you at potential risk because we are you know, we are understaffed or whatnot. Yeah, yeah, a lot of sense. That's great. So going back to the we have a few minutes left. So going back to the policy procedures and how that's really key. I think there's another thing that's key in this and we always hear it documentation. So can you talk, can you briefly just kind of talk about documentation and kind of the role that that plays and why it's important and why that's really key to so many different issues that occur is the lack of documentation or inadequate documentation or something like that.

Speaker 2:

Yeah, and you're absolutely right.

Speaker 2:

That's another policy and procedure matter it's important to have policies about who documents, where they document it, when they document it and how they document it. And let's not decide well, let's do it the way the physicians do it, because we want to emulate them. They do it poorly, they do something different than we do anyway. Let's develop our own strategies for deciding who it is that documents. Does the person who performs a service necessarily be the one who documents what it's done, or can ancillary personnel or assisting do the documentation? Where is it going to be documented? Well, it's going to be in a computerized record somewhere, hopefully one that IT doesn't decide to purge when they update the system, Because if IT decides, oh well, this information isn't necessary, then it's lost forever. What to document? Anything that is necessary for continuity of patient care must be documented. Nothing that isn't necessary for continuity of patient care should be documented. This woman is a real pain.

Speaker 1:

Should not be documented.

Speaker 2:

This woman is a real pain should not be documented. This patient has some concerns that I have attempted to address that should be documented. There are just a variety of ways of saying things that are respectful, that are correct that are complete that are concise, just a variety of and we have not taught that.

Speaker 2:

We have done a pretty good job, I think, of teaching, both through formal colleges pharmacy, and through continuing education, verbal communication skills. We've not done such a good job of teaching written communication skills and we need to try to do better with that.

Speaker 1:

I'm sitting here with my wheels spinning, I'm putting on my hat, education creation and I'm like, wow, we need a. You know, like, what do you document and how do you document it? I mean, just because you're exactly right, I remember an instance when I was in pharmacy school.

Speaker 1:

It was at a practice site I think it was one of my rotations and I remember there was a big, you know, I think there was a lawsuit involved because somebody put in their profile under a patient's name that this lady is crazy and obviously that's an issue on so many levels, you know. But it ended up being that it was in a, a field of like nickname or something, I can't remember, but whatever, it printed out on a label and so it actually got on a on that patient's label where they saw that underneath their name it said this lady is crazy and it was just, it was a, it was a big deal and, like you said, if you know understanding what is appropriate and professional and applicable document and where should it be documented, you know that those kinds of things could be avoided so that you know they do not become an issue or a potential lawsuit.

Speaker 2:

So Sure, absolutely.

Speaker 1:

So I, I so I. You've now given me an idea of creating a course on documentation and exactly what needs to be done and best practices and all that. So that's, that's great. Thanks, david You're welcome, Josh. Yeah, awesome, okay. So, david, anything in this space that we, that I haven't set you up to talk about today, that you really wanted to share with our learners as we're wrapping up time, yeah, there is one thing that's on my mind and it's just a recent experience that I have not had personally, but I have consulted on and it is the missing prescription or the lost prescription.

Speaker 2:

Back in the old days we all remember, a patient would go to a prescriber. They would get a piece of paper. It was their responsibility to convey that piece of paper to the pharmacy. They would bring it with them. If they lost it, it was on them for having lost it. Now, with electronic transmission, no longer do patients have the responsibility to convey that piece of paper, that order. Instead they show up at the pharmacy and they say my name is thus and such.

Speaker 2:

My doctor has transmitted a prescription here and unfortunately, at several circumstances, in several situations I'm aware of, the pharmacy has said nope, don't have a thing for you, just don't have anything. And the patient goes into their patient portal and says well, it looks like to me you do. And they say, nope, don't have anything. And they turn the patient away, the patient not really understanding this. You know you can't expect them to fully appreciate how pharmacies work. And then, lo and behold, it turns out that that electronic file got saved somewhere strange. They did have the prescription all along, or they printed out a prescription, I mean it was there. So I guess the message is try harder to find that prescription. Don't just turn somebody away and say well, don't have a thing for you.

Speaker 1:

Call the prescriber and say there's an easy solution here.

Speaker 2:

Yeah, Pick up the phone and say we may have had a miscommunication. I'm very sorry, and it's perfectly fine to say I'm very sorry about a possible communication. Can you confirm for me that there's a medication, If they've sent the order to another pharmacy? Then, you can have it transferred over to you, but don't just turn people away when you can't find them. Or if you must turn them away, get their name, get their identity If they're a stranger to you the first time they've been there get their name and contact information.

Speaker 2:

So when an hour, a day later, that prescription miraculously appears and somebody says well, what are we doing with this? You can call them. It's the pharmacy's responsibility now to maintain those prescriptions that previously patients had had the responsibility to maintain and get to the pharmacy.

Speaker 1:

That's a great point and that you know that's happened to me many times in practice and sometimes it could be something as simple as the last name was misspelled, therefore it didn't match with your profile on that patient and so it kicked it into a different queue where you know it didn't match with that patient. You created a new profile and it was, it had the wrong birth date or something, and so therefore you know it wasn't found when the patient requested it because it wasn't under their usual profile or whatnot. But yeah, I mean, you know, I think I mean your advice is raw and abrupt, but it makes sense, like just try harder, like dig deeper, make the phone call, you know, approach the situation with more than just you know turning them away. Because I think it is important and, like you said, it is now the responsibility of the pharmacist and the pharmacy team to ensure that the prescriptions are found and maintained and given to the patient.

Speaker 1:

So it's a great point because I remember the day I'll date myself, but I do remember the day when paper prescriptions ruled the world. You know, like that we didn't have. We didn't have the electronic stuff and the electronic stuff was was all new, fangled things, electronic stuff, and the electronic stuff was was all new fangled things. I do remember, you know, many of coffee stained and lots of other oddities that came in with your prescription when patients were responding.

Speaker 1:

We're bringing them to you, but but you know, I don't know Sometimes. Sometimes I long for the old days when we didn't have so many new fangled contraptions. But anyway, well, david, this is, as always, an extreme pleasure. I feel like you always just have so much information and I could just hear you tell stories and hear you tell experiences and you know, I had an interaction once with, and I feel like I'm always just sitting back ready for a great lesson. So thank you so much. What I like to always do, David, before I wrap up a session is to just really kind of hone in on the fact of. You know, this is a Game Changers podcast. We're talking about the things that are really changing the practice of pharmacy. So what here is the takeaway for our learners today? What is that game changer in this space of liability and risk and being a pharmacist in today's world of pharmacy, what's the take home for the learner?

Speaker 2:

Yeah, I think the take home is take risks. We have to take some risks, but they have to be measured risks. They have to be sensible risks on the behalf of patients. If we decide, well, we don't want our patients to have any risks whatsoever, then the only way to do that is to not give them any medication and there are benefits to these medications. But stratify the risk.

Speaker 2:

I mean there are some risks that simply are not worth taking. I mean you just cannot do it. When there is a prescription for methotrexate once daily to treat rheumatoid arthritis and the doctor says that's exactly what I want, once daily, methotrexate, that's going to kill the patient, just don't do it. Just you know you can't give the patient that medication. There are other, much smaller risks than that that are worth taking but need to be explained to the patient. But don't be daunted by the possibility of liability. It's always there, but we're a group that has each other's back on this too. I mean we can work together to develop policies and procedures that, as long as they are followed, will protect all of us from unnecessary exposure to liability.

Speaker 1:

Yeah, yeah, I think that's great feedback. What my initial thing was going to is that you know we take so many risks every day in everything that we do. Getting behind the wheel of your car, that's a risk every time you do it. You know, waking up and going down the stairs in the morning, that could be a risk. It could be the day that you slip and fall. So we can't, let you know, the idea of risks limit what we do, and I think the same is true for the profession. I love that feedback of understanding what the risk is and then making the decision as to whether or not to embrace it and or to push back. So, yeah, that's great, David. Thank you so much. As always, such a pleasure. I really appreciate your time.

Speaker 2:

Great to be with you, Josh. Thank you so much.

Speaker 1:

Yeah. So if you're a CE plan subscriber, don't forget, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom. And, as always, have a great week and keep learning and, as I always say, I cannot wait to dig into another game changing topic with you all next time. So talk soon.