Hitting a Nerve

Is the troll tracker crying wolf?


I’m a big believer in my state’s Prescription Monitoring Program (PMP), perhaps more commonly known as the troll tracker. The ability to quickly access a patient’s controlled prescription records across pharmacies has been enormously helpful in my everyday practice. I rely on it and check it often.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

With it I can see if my patients are getting the same drug from other prescribers, pharmacy-shopping, or carrying out other concerning activities. The database helpfully sends me emails alerting me to such conflicts, so I can take prompt action on them.

Unfortunately, the threshold for such emails has gradually crept lower, to where I now get maybe 10 a week.

A lady to whom I gave two Valium tablets to get her through a lumbar spine MRI also got 20 Percocet for the same back pain from her internist … and I get an alert email.

A long-established patient for whom I’ve been prescribing Ativan and Tramadol for years, fills them both every month … and I get an alert email every month (and I’m the only prescriber who has written for him in the last 10 years).

A patient who suffered a painful vertebral fracture, got 10 Norco in the ED, follows with up with me 5 days later, and I write her for 20 more … and I get an email.

Now, I understand what the program is trying to do – and wholeheartedly agree with it – but the problem is that the more email warnings I get the less likely I am to have time to investigate each one. It’s like the boy who cried “wolf!” In fact, it’s probably been over a year since a warning email from the PMP told me something I didn’t already know.

Granted, these emails are sent by a computer, following a rigid set of parameters to do so. The machine doesn’t know I’m aware of the situation, or keep track of case nuances, or even notice that I’m the only prescriber of all the medications involved. It just does what it’s set to do. And the warnings all make it clear that they’re just warnings, and that the treatment is still left to physician’s discretion.

Arizona currently has roughly 18,000 practicing physicians. Granted, not all of them are routinely prescribing controlled agents, but I’d guess at least two-thirds of them are. So it’s safe to assume at least 12,000 doctors here are receiving email warnings with varying degrees of frequency.

At some point, with all the other tasks and hats your average doctor goes through in a day, too many of these warnings – the vast majority of them meaningless – become part of the background noise.

There are only so many hours in a day to see patients, write notes, send prescriptions, review tests, return calls, fill out forms, and all the other things that are part of our days. Having to log into the PMP website to see what’s up every time you get an email from them, especially when the last 20 (or more) warnings that you received were meaningless, gets pushed farther and farther onto the back burner. So when a real warning shows up, it may not got noticed much at all.

Like I said, I believe in and routinely use the state PMP. But it may be time to take a second look at the criteria under which its email warning system operates.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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