iPLEDGE Allegiance

My pager went off Saturday night. Susan was in a panic. "I couldn't log onto the iPledge Web site!" she cried. "I called their number and waited 40 minutes, and they told me you hadn't confirmed contraceptive counseling. If I don't get the medicine Monday, I'll be locked out for a month!"

I know an emergency when I hear one. Susan had already taken isotretinoin for a month, so a 30-day holiday would not do. Springing into action, I logged onto the iPledge Web site, located Susan, and pressed the "Confirm Patient Counseling" tab to verify that I'd told her not to get pregnant. I did that at her visit Thursday, noting that the pregnancy test from Tuesday was negative. No dice. The error message read, "Not enough time has elapsed."

Not enough time? Not enough time for what?

I called the 866 number and had to wait just a few moments, listening to the grating background music, before a human being picked up. I gave her my DEA number.

"I need your date of personal significance," she said.

Other Web sites use secondary passwords you can actually recall, like your mother's maiden name. "I don't know my date of personal significance," I said.

"Would you like to guess?" she said. I guessed my birthday. Wrong.

"We can't speak to providers who don't know their date of personal significance," she said, "unless they answer the phone in their office. Are you in your office?"

"It's 10 o'clock Saturday night," I said. "I'm home."

"Then I can't help you," she said.

"For heaven's sake," I said, "if you call my office, the automated attendant will identify my name. …" Just then I found the memo in my Palm. Of course that was the significant date I'd picked: 9/11/01. Catastrophe.

Now she could help me. Only she couldn't. I stated my problem. "This patient had express registration," she said. "There's no waiting period. It must be a system problem. I'll transfer you to technical support."

Now I had my chance to spend 40 minutes listening every 60 seconds to, "Your call is important to us. Someone will be with you shortly." Eventually someone was.

"May I help you?"

I certainly hoped so.

"I'm exhausted," she said. "I've been working 12 hours, 7 days in a row. And it's busy!"

I commiserated and restated my problem. She put me on hold, then returned. "This patient had express registration," she said. "There's no waiting period. This shouldn't happen."

I agreed.

"'Not enough time has elapsed,'" she read. "What does that mean? It makes no sense!"

"Good point," I concurred.

She tried entering different dates. "Aha!" she said. "I got it to work!"

"What did you do?"

"The contraceptive counseling has to be before the pregnancy test," she said, "Otherwise the system won't take it."

"Does that mean that if my patient takes a pregnancy test Monday and I see her on Wednesday and counsel her then, the counseling doesn't count?" I asked.

"That's a medical question," she said. "I'm not authorized to answer medical questions about the actual program. I'm technical. I just know how to make the Web site work."

"Is the patient all set?" I asked.

"All set!" she said. I told her to go home and get some rest.

I hung up, pleased with another useful job under my belt.

I celebrated too soon, though. As we all know by now, iPledge drollery has degenerated to disaster. Getting Susan her medicine took 3 more days of calls and listening to, "We are experiencing a high call volume. Peak times are 9:00 a.m. until noon. Please call back another time." This message played from 9:00 a.m. to midnight, followed by disconnection. Click. You're dead.

Things will no doubt get better in time. They may expand the number of operators from four to six. Someone familiar with English will change all the "who's" on the Web site to "whose." And maybe they'll figure out a way not to require monthly counseling for males. ("Don't give your pills to pregnant women!" "Take prenatal vitamins!")

They may even improve the music. When you're on hold, that music you are hearing oompahing and sawing away in the background is Mozart's "A Musical Joke."

Please tell me, what warped bureaucrat would choose, from the whole universe of musical possibilities, Mozart's purposely annoying send-up of incompetent composers and instrumentalists?

At least we know whom the joke's on, don't we? Our patients and us.

My pager went off Saturday night. Susan was in a panic. "I couldn't log onto the iPledge Web site!" she cried. "I called their number and waited 40 minutes, and they told me you hadn't confirmed contraceptive counseling. If I don't get the medicine Monday, I'll be locked out for a month!"

I know an emergency when I hear one. Susan had already taken isotretinoin for a month, so a 30-day holiday would not do. Springing into action, I logged onto the iPledge Web site, located Susan, and pressed the "Confirm Patient Counseling" tab to verify that I'd told her not to get pregnant. I did that at her visit Thursday, noting that the pregnancy test from Tuesday was negative. No dice. The error message read, "Not enough time has elapsed."

Not enough time? Not enough time for what?

I called the 866 number and had to wait just a few moments, listening to the grating background music, before a human being picked up. I gave her my DEA number.

"I need your date of personal significance," she said.

Other Web sites use secondary passwords you can actually recall, like your mother's maiden name. "I don't know my date of personal significance," I said.

"Would you like to guess?" she said. I guessed my birthday. Wrong.

"We can't speak to providers who don't know their date of personal significance," she said, "unless they answer the phone in their office. Are you in your office?"

"It's 10 o'clock Saturday night," I said. "I'm home."

"Then I can't help you," she said.

"For heaven's sake," I said, "if you call my office, the automated attendant will identify my name. …" Just then I found the memo in my Palm. Of course that was the significant date I'd picked: 9/11/01. Catastrophe.

Now she could help me. Only she couldn't. I stated my problem. "This patient had express registration," she said. "There's no waiting period. It must be a system problem. I'll transfer you to technical support."

Now I had my chance to spend 40 minutes listening every 60 seconds to, "Your call is important to us. Someone will be with you shortly." Eventually someone was.

"May I help you?"

I certainly hoped so.

"I'm exhausted," she said. "I've been working 12 hours, 7 days in a row. And it's busy!"

I commiserated and restated my problem. She put me on hold, then returned. "This patient had express registration," she said. "There's no waiting period. This shouldn't happen."

I agreed.

"'Not enough time has elapsed,'" she read. "What does that mean? It makes no sense!"

"Good point," I concurred.

She tried entering different dates. "Aha!" she said. "I got it to work!"

"What did you do?"

"The contraceptive counseling has to be before the pregnancy test," she said, "Otherwise the system won't take it."

"Does that mean that if my patient takes a pregnancy test Monday and I see her on Wednesday and counsel her then, the counseling doesn't count?" I asked.

"That's a medical question," she said. "I'm not authorized to answer medical questions about the actual program. I'm technical. I just know how to make the Web site work."

"Is the patient all set?" I asked.

"All set!" she said. I told her to go home and get some rest.

I hung up, pleased with another useful job under my belt.

I celebrated too soon, though. As we all know by now, iPledge drollery has degenerated to disaster. Getting Susan her medicine took 3 more days of calls and listening to, "We are experiencing a high call volume. Peak times are 9:00 a.m. until noon. Please call back another time." This message played from 9:00 a.m. to midnight, followed by disconnection. Click. You're dead.

Things will no doubt get better in time. They may expand the number of operators from four to six. Someone familiar with English will change all the "who's" on the Web site to "whose." And maybe they'll figure out a way not to require monthly counseling for males. ("Don't give your pills to pregnant women!" "Take prenatal vitamins!")

They may even improve the music. When you're on hold, that music you are hearing oompahing and sawing away in the background is Mozart's "A Musical Joke."

Please tell me, what warped bureaucrat would choose, from the whole universe of musical possibilities, Mozart's purposely annoying send-up of incompetent composers and instrumentalists?

At least we know whom the joke's on, don't we? Our patients and us.

My pager went off Saturday night. Susan was in a panic. "I couldn't log onto the iPledge Web site!" she cried. "I called their number and waited 40 minutes, and they told me you hadn't confirmed contraceptive counseling. If I don't get the medicine Monday, I'll be locked out for a month!"

I know an emergency when I hear one. Susan had already taken isotretinoin for a month, so a 30-day holiday would not do. Springing into action, I logged onto the iPledge Web site, located Susan, and pressed the "Confirm Patient Counseling" tab to verify that I'd told her not to get pregnant. I did that at her visit Thursday, noting that the pregnancy test from Tuesday was negative. No dice. The error message read, "Not enough time has elapsed."

Not enough time? Not enough time for what?

I called the 866 number and had to wait just a few moments, listening to the grating background music, before a human being picked up. I gave her my DEA number.

"I need your date of personal significance," she said.

Other Web sites use secondary passwords you can actually recall, like your mother's maiden name. "I don't know my date of personal significance," I said.

"Would you like to guess?" she said. I guessed my birthday. Wrong.

"We can't speak to providers who don't know their date of personal significance," she said, "unless they answer the phone in their office. Are you in your office?"

"It's 10 o'clock Saturday night," I said. "I'm home."

"Then I can't help you," she said.

"For heaven's sake," I said, "if you call my office, the automated attendant will identify my name. …" Just then I found the memo in my Palm. Of course that was the significant date I'd picked: 9/11/01. Catastrophe.

Now she could help me. Only she couldn't. I stated my problem. "This patient had express registration," she said. "There's no waiting period. It must be a system problem. I'll transfer you to technical support."

Now I had my chance to spend 40 minutes listening every 60 seconds to, "Your call is important to us. Someone will be with you shortly." Eventually someone was.

"May I help you?"

I certainly hoped so.

"I'm exhausted," she said. "I've been working 12 hours, 7 days in a row. And it's busy!"

I commiserated and restated my problem. She put me on hold, then returned. "This patient had express registration," she said. "There's no waiting period. This shouldn't happen."

I agreed.

"'Not enough time has elapsed,'" she read. "What does that mean? It makes no sense!"

"Good point," I concurred.

She tried entering different dates. "Aha!" she said. "I got it to work!"

"What did you do?"

"The contraceptive counseling has to be before the pregnancy test," she said, "Otherwise the system won't take it."

"Does that mean that if my patient takes a pregnancy test Monday and I see her on Wednesday and counsel her then, the counseling doesn't count?" I asked.

"That's a medical question," she said. "I'm not authorized to answer medical questions about the actual program. I'm technical. I just know how to make the Web site work."

"Is the patient all set?" I asked.

"All set!" she said. I told her to go home and get some rest.

I hung up, pleased with another useful job under my belt.

I celebrated too soon, though. As we all know by now, iPledge drollery has degenerated to disaster. Getting Susan her medicine took 3 more days of calls and listening to, "We are experiencing a high call volume. Peak times are 9:00 a.m. until noon. Please call back another time." This message played from 9:00 a.m. to midnight, followed by disconnection. Click. You're dead.

Things will no doubt get better in time. They may expand the number of operators from four to six. Someone familiar with English will change all the "who's" on the Web site to "whose." And maybe they'll figure out a way not to require monthly counseling for males. ("Don't give your pills to pregnant women!" "Take prenatal vitamins!")

They may even improve the music. When you're on hold, that music you are hearing oompahing and sawing away in the background is Mozart's "A Musical Joke."

Please tell me, what warped bureaucrat would choose, from the whole universe of musical possibilities, Mozart's purposely annoying send-up of incompetent composers and instrumentalists?

At least we know whom the joke's on, don't we? Our patients and us.