Clozapine Registry Website-PSF updates

[whopper]

The Clozapine registry now requires physicians type in if the patient meets the criteria of Benign Ethnic Neuropenia (every month which I think is a waste of time. What you change race since the last time I saw you?), but also requires you check off if you're monitoring the patient, etc.


So a patient of mine stopped showing to my office. I'm confident he just moved to a new area and got a new doctor but he never confirmed this with me. So because he stopped showing up I checked off I'm no longer "monitoring" him and checked off the "discontinue patient" option.

I get a message a few minutes later in my e-mail telling me what a bad doctor I am and that I'm non-compliant with monitoring this patient. WTF? He stopped seeing me so how can I monitor him?

What I figure is they wanted me to check off I'm monitoring him but then discontinue him as a patient. Yeah but no one explained this to me and the website sure as heck doesn't. So I called them and they put me on hold for 2 hours and I'm giving up.

I figure nothing significant is going to happen but that website is saying I'm "noncompliant."

---

Members don't see this ad.

 

[deleted1100659]

The Clozapine registry now requires physicians type in if the patient meets the criteria of Benign Ethnic Neuropenia (every month which I think is a waste of time. What you change race since the last time I saw you?), but also requires you check off if you're monitoring the patient, etc.


So a patient of mine stopped showing to my office. I'm confident he just moved to a new area and got a new doctor but he never confirmed this with me. So because he stopped showing up I checked off I'm no longer "monitoring" him and checked off the "discontinue patient" option.

I get a message a few minutes later in my e-mail telling me what a bad doctor I am and that I'm non-compliant with monitoring this patient. WTF? He stopped seeing me so how can I monitor him?

What I figure is they wanted me to check off I'm monitoring him but then discontinue him as a patient. Yeah but no one explained this to me and the website sure as heck doesn't. So I called them and they put me on hold for 2 hours and I'm giving up.

I figure nothing significant is going to happen but that website is saying I'm "noncompliant."

So, something similar happened to me not too long ago and I was pissed. I have been doing the PSF for a while, the requirement went into affect a while back, theres only two things technically you have to check before submitting, that you're monitoring the patient as recommended, and that the patient didnt have an adverse outcome, and youre able to submit the form without issue.

Now, the confusing part. Even if the patient has been missing ANCs, you do not put no for "are you monitoring as required". I put no, because they missed ANCs, and got the same letter, lol. When I called they explained that what it means is if you're going by the suggested guidelines, not if the patient is coming or not to monitoring. So its confusing. So if a patient should be on monthly monitoring and for some reason you are ordering CBC every 6 mo then youd put no.

but dont put too much thought into the letter, its not a big deal.

 

[comp1]

And there are all of these articles on how we need to prescribe more clozapine and why won't doctors consider it more...

 

[whopper]

I know one of the doctors that headed the academic movement to prescribe it more. I was having lunch with him while I was still a professor. My time was limited, I was leaving that place of work, and I didn't have the heart to be full frontal honest.

The real reason why I don't prescribe Clozapine that often isn't cause it's Clozapine. It's cause most of the time I can't get the patient to be compliant with labs. You can tell me all you want that Clozapine is the best thing ever. If I can't get that patient to do the labs it's not happening. No room for argument, no ifs buts or ands, no way around it, nothing. Case closed. Period. Nuff Said. Nada. Nothing!

A problem, and this is why I didn't open that pandora's box, was because as an academic physician he wasn't used to the reality of working with a lab where half the time you can't get the orders in a timely manner. He's in a hospital where if he orders a stat-lab lab he gets it in an hour.

I didn't want to go through the ego-tearing, "you're naïve to how this works outside in real practice" dressing down.

And if he was going to respond I was going to respond back. " If I can't get that patient to do the labs it's not happening. No room for argument, no ifs buts or ands, no way around it, nothing. Case closed. Period. Nuff Said. Nada. Nothing!"

But but but

Then I'd have to respond back, " If I can't get that patient to do the labs it's not happening. No room for argument, no ifs buts or ands, no way around it, nothing. Case closed. Period. Nuff Said. Nada. Nothing!"

Yeah but...

Then I'd respond back.." If I can't get that patient to do the labs it's not happening. No room for argument, no ifs buts or ands, no way around it, nothing. Case closed. Period. Nuff Said. Nada. Nothing!"

 

[deleted1100659]

The sad part is it, it really is a great medication that works wonders.

But chances are if you're using it, its someone who is very sick. Whats the odds that they have a stable caregiver who will faithfully take them to get their ANC drawn weekly? And not have major medical problems that increase the risk of prescribing? Very small subset of patients it can be used for in reality, but for those patients heck of a great medication.

Reporting the ANC weekly to me is a freaking hastle, because I never know when the lab comes in, and have to remember when each person is due so I have given up starting people on it and just keep the ones I have on their maintenance dose. Too hard to be a one man army in a community health setting where half the patient population would be a clozapine canidate (assuming they had a caregiver and medically were fine for it)

 

[whopper]

I've already had a handful of patients on Clozapine who weren't compliant with the labs and they or their family had an emotional meltdown when I told them the only way they're going to get it is if they go to the ER to get stat labs drawn. Family members and patients have threatened to sue me, screamed at my assistant or I, told me that they knew I could prescribe "for real if you wanted to" despite that I told them over 10 times I couldn't.

I had to call the police on one of them. "I know you can prescribe it and this lab rule is something you're just making up!"

that's why I don't prescribe Clozapine often.

Richard Roma: "Eff you and eff your effing attitude that I can prescribe this effing medication as if labs are not an effing issue you effing a-hole!"

 

[deleted1100659]

I've already had a handful of patients on Clozapine who weren't compliant with the labs and they or their family had an emotional meltdown when I told them the only way they're going to get it is if they go to the ER to get stat labs drawn. Family members and patients have threatened to sue me, screamed at my assistant or I, told me that they knew I could prescribe "for real if you wanted to" despite that I told them over 10 times I couldn't.

I had to call the police on one of them. "I know you can prescribe it and this lab rule is something you're just making up!"

that's why I don't prescribe Clozapine often.

Richard Roma: "Eff you and eff your effing attitude that I can prescribe this effing medication as if labs are not an effing issue you effing a-hole!"

Yes what drives me absolutely crazy is that often times we are viewed as the bad guy in this scenario. What they don't understand is the pharmacy wont even fill it without an ANC regardless if we prescribe it.

When people yell at me or family members, I explain to them that they are welcome to seek out all the other affordable board certified psychiatrists in their area. Suddenly, they become more understanding. I dont listen to people yelling at me, lol. We worked too hard to take disrespect.

 

[whopper]

I got a policy. Explain something very nicely 3x. Give the patient time to digest this information. If they still are trying to bully you into doing something you're not allowed to do....
"Get another doctor." Maybe someone that is willing to break the law. I'm not willing to break the law."

Or

"If you ask me to break the law that is called conspiracy to commit a crime. I will not break the law. Either get another doctor or I will report this to the police that you engaging in conspiracy to commit a crime. It is not a HIPAA violation because I want you off my premises and you still continue to ask me to do something in violation of several federal regulations. I told you several times I will not break the law and you are still asking me to do so."

I write a termination letter and send it out and never take that patient back.

 

[mistafab]

Impossible to get someone clozapine without worthless paperwork and frivolous labs.

Easy to buy a gun OTC at any local Walmart.

 

[Mad Jack]

I generally don't prescribe clozapine in my current workplace, but got a nonadherance letter for giving a patient a two week supply as part of their ER discharge meds while they were awaiting seeing their psychiatrist. They lived in a residential and I knew that they were adherent and I only did the discharge, the med was ordered by a different physician in the hospital. We had labs as we do on all ER patients so I knew the ANC was fine. So I guess my only option would be to sign up for REMS, enroll myself, transfer the patient to me as a provider despite the fact that I'd only seen them once prior to discharge, then prescribe the medication?