What looks good on paper, often sucks in real life. Good idea: A system to prevent pregnant women from taking Accutane. Poor implementation:

The system, called iPledge, requires female patients to take pregnancy tests and birth control. But doctors say that is inconvenient, cumbersome and sometimes impossible to manage.

Dr. Kathleen Carney-Godley, a dermatologist from East Greenwich, R.I., said that she tried to enter her patients into the system from home one Sunday but could not because she did not have her patients’ Social Security numbers.

Her partner tried to enter a patient into the system, failed, called for help, was put on hold and had time enough to excise a cancerous skin lesion in another patient before being able to talk to an operator, Dr. Carney-Godley said.

Other doctors complained of nonsensical instructions from the system – like requiring pregnancy tests for male patients – and long waits on the phone.

“I’m concerned that the regulation has gone so overboard that an important drug will not be available because dermatologists won’t bother to prescribe it,” Dr. Carney-Godley said.