Drug rep's take on doctors

[Louisville04]

Here is an interesting blog about how a pharmaceutical rep views doctors:

http://featuresblogs.chicagotribune.com/features_julieshealthclub/2007/04/how_to_manipula.html

If you’re a doctor who is friendly and outgoing: You’ll get free samples, not because it’s the drug reps' job but because he likes you so much. “When the time is ripe, I lean on my “friendship” to leverage more patients to my drugs…say, because it’ll help me meet quota or it will impress my manager or it’s crucial for my career.”

If you’re skeptical and favor evidence over charm: The drug rep will approach you respectfully, supply you with reprints from medical literature and woo you as a teacher. “Armed with the articles…I play dumb and have the doc explain to me the significance of my article…Humility is a common approach to physicians who pride themselves on practicing evidence-based medicine.”

If you’re a mercenary doc: The drug rep will try to buy you out by closely “associating your resource expenditure with an expectation." For example: “So, doc, you’ll choose Drug X for the next 5 patients who are depressed and with low energy? Oh, and don’t forget dinner at Nobu next month. I’d love to meet your wife.”

If you refuse to see a rep: You’ll be assaulted by proxy. Your drug rep will lavish food and attention on your office staff, hoping they pass on unfiltered messages to you. “It’s a victory for me just to learn from the staff about which drugs are preferred and why. Goodwill from the staff provides me with critical information, access and an advocate for me and my drug when I’m not there.”

If you’re a thought leader: Drug reps will want to groom you for the speaking circuit. They’ll carefully watch for telltale signs of your allegiance, including how you handle questions that criticize their product and how your prescribing habits fluctuated. “Subtle and tactful spokespersons (are) the ideal candidates.”

If you prefer a competing drug: The drug rep will try to figure out why you’re using another drug as opposed to his and then turn into a nuisance. “Our intent is to engage in discourse but also to wear down the doc until he or she simply agrees to try the product for specific instances.”

If you acquiesce: Your rep has your prescribing patterns detailed in his computer and will know if you’re lying. “Gifts are used to enhance guilt and social pressure. Reps know that gifts create a subconscious obligation to reciprocate…Of course, most of these doctors think themselves immune to such influence. This is an illusion reps try to maintain.”

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[McDoctor]

Are you suggesting that the Boniva rep isn't buying me lunch for my dazzling smile and razor sharp wit?

That's just crazy.

 

[deleted87716]

http://forums.studentdoctor.net/attachment.php?attachmentid=6982&d=1159643783

 

[ajce9]

The best way to not get influenced by drug reps is to not let them in you office.

Instruct your staff to not give any information to the drug reps.

when a rep walks in you office have a protocol in place where one person in your office meets them and then takes their card and whatever they have to give them. Then instruct that staff member to simply reply NO to any request to any type of meeting or face to face interaction. Have your staff shake their hand and say "have a good day". then silence and strong eye contact.

Once the rep is gone. Through away the card and the material they gave you.

do your own research on medication and studies.

If the rep or reps return, and they will, repeat the whole process.
Instruct you staff to not smile at them or give them any recognition. If you show any weakness you have opened the door for them to exploit you.

Remember: Silence and long pauses in negotiation is the greatest intimidator.

 

[Red Beard]

But it must be nice to have the samples available to give out.

 

[ajce9]

But it must be nice to have the samples available to give out.

Not if I have to sell out to a bunch of salesmen. If they want to leave samples I'll take it. I won't talk to them. If their drug is good then I will use it and they have nothing to worry about. If its not good, then its a mute point.

 

[Playmakur42]

I'm a non-trad applicant who has been in sales (not pharma) for about 5 years now, so I'll voice my opinion for any who care to hear it.

Sales, like any profession, has people from all locations of the moral compass. Some of the "best" salesmen I have seen in my career have used all of the manipulative tactics (plus more) listed above. Some of the best have always done what's best for the client, including selling products that earn lower commissions, no matter what. It is often very difficult to tell the good from the bad in the field.

Despite all of the negative connotations with sales reps, they carry one thing that is vital to your patients; information. They are the conduit between physicians and the new technology developed in the industry. Take the information they give you with a grain of salt, but definitely read it. As for the free lunches for your staff- it's a nice perk for your office staff. If you can accept it and still remain objective then enjoy it - it's all part of the pharm companies marketing budget.

FYI, you as a purchaser control how the sales rep "sells" to you. If you prefer the interaction to be quick and impersonal, tell the rep.

 

[iatrosB]

Despite all of the negative connotations with sales reps, they carry one thing that is vital to your patients; information. They are the conduit between physicians and the new technology developed in the industry.

I do not agree with this. In fact, if they were the conduit of info for a physician, I would question that physician's training. As was said before, physicians need to do their own research based on objective data...salesmen/women hardly present objective data.

Tabula rasa

 

[Playmakur42]

salesmen/women hardly present objective data.

This comment is a non sequitur. It is a gross overgeneralization.

Most medical sales people (drugs/devices) play the role of educator. They provide subjective opinions of their products, along with objective 3rd party clinical trials/info and references of happy clients to support their subjective opinions. Their job is to introduce their product to the physician. Any physician worth his salt will then research the product on his own and discuss it with his peers before using/prescribing it.

Someday when you're in practice you'll understand how helpful a sales rep can be, either as an orthopedic surgeon using a new bone drill under the tutelage of the companies rep, as a general surgeon searching for a stronger mesh/suture to repair a hernia of a patient with a tracheotomy who coughs violently when coming out of anesthesia, or as a family physician searching for the correct antibiotic to treat an unusual infection.

You are entitled to your own opinion. As for me, I would want to see what every salesperson has to offer. I wouldn't want to miss out on new technology that could potentially benefit a patient.

Ego Narro Verum

 

[dry dre]

You are entitled to your own opinion. As for me, I would want to see what every salesperson has to offer. I wouldn't want to miss out on new technology that could potentially benefit a patient.

Just how many "new" technologies have been presented in the past decade? How many "new" drugs? I'm not talking about a penicillin with a new side chain, the R-enantiomer of your racemic drug that is about to fall off patent, or a "new drill" that both places and removes locking screws.

Any physician who is getting the introduction to a new drug or implant in person from a rep, well...

 

[McDoctor]

This comment is a non sequitur. It is a gross overgeneralization.

Most medical sales people (drugs/devices) play the role of educator. They provide subjective opinions of their products, along with objective 3rd party clinical trials/info and references of happy clients to support their subjective opinions. Their job is to introduce their product to the physician. Any physician worth his salt will then research the product on his own and discuss it with his peers before using/prescribing it.

Someday when you're in practice you'll understand how helpful a sales rep can be, either as an orthopedic surgeon using a new bone drill under the tutelage of the companies rep, as a general surgeon searching for a stronger mesh/suture to repair a hernia of a patient with a tracheotomy who coughs violently when coming out of anesthesia, or as a family physician searching for the correct antibiotic to treat an unusual infection.

You are entitled to your own opinion. As for me, I would want to see what every salesperson has to offer. I wouldn't want to miss out on new technology that could potentially benefit a patient.

Ego Narro Verum

I think there is a difference between medical devices and pharmaceuticals. Obviously, there are more technical questions arising with the former. especially if you are talking about surgical instruments. It helps to have someone show you the ON/OFF switch, at the very least.

I think alot of vitriol directed at big pharm would be better served aimed at the FDA. Pharm companies have a responsibility to their shareholders. The FDA has a responsibility to the public. The recent controversies with Vioxx, Celebrex, Zelnorm, and most recently Ketek represent failures of appropriate scrutiny on the FDA's part.

There's nothing wrong with examining materials presented by a pharm rep, as long as it is done with the warranted skepticism. But I wouldn't call them educators. They are salesmen. There is no shame in that, in a capitalist system.

 

[Playmakur42]

Any physician who is getting the introduction to a new drug or implant in person from a rep, well...

If a representative of the company doesn't introduce the new product, then who does? Philanthropist Martians? Dancing monkeys with cymbals? A Habadasherie store manager on his day off?

You clearly don't understand the sales process, how the companies go to market, or how business gets done in general.

Let me EDUCATE you a bit.

The rep contacts the purchasing department and goes through the necessary red tape to be certain his company qualifies to do business with the hospital. At that point, the rep often meets with some type of "business manager", whose title varies from hospital to hospital. Sometimes that person decides, sometimes they disseminate the info to a board, and other times they are kind enough to give the doctors a choice as to what types of products they use (this is when you see the rep "auditioning" his product). Some decision makers cares about the bells and whistles of the products, others care about how well the company services the hospital, while others only care about the cost if it meets their minimum specs. As you can see, each situation is different which is why they need to employ a salesperson, rather than do a mass distribution of sales flyers saying, "Buy our Bone Drill 5000 Model". The companies also do educational seminars and trade shows, which of course are run by the reps.

So, maybe the doctor isn't introduced to the product directly from a rep, but you better believe there is a rep behind the scenes moving the purchasing process forward.

As for pharmaceuticals, the company usually hires a young, fit, attractive girl to get the doctors attention or a young, attractive man to get the female office staffs attention. They usually just drop off lunch and copies of the clinical trials and go to the gym by 3pm. This difference in the sales process explains why device reps make 3x as much money as pharm reps - one is a pure sales job, while the other is more general marketing.

 

[Playmakur42]

I'm really glad that I agree with your post, because your avatar and quotes are awesome.

I think there is a difference between medical devices and pharmaceuticals.

You're absolutely correct. I outlined the difference in the last paragraph of my last post. It's like comparing a 3rd year med student to an attending in skill level.

The FDA has a responsibility to the public.

The FDA is the first and best line of defense. Next, the individual physician needs to research what he's prescribing. Finally, the pharma companies should try their best to provide safe drugs to protect both their customers and shareholders.

There's nothing wrong with examining materials presented by a pharm rep, as long as it is done with the warranted skepticism.

I agree 100%.

They are salesmen, not educators.

The two are not mutually exclusive. A saleperson can teach you something that you previously did not know.

 

[ajce9]

Salesman/woman do not educate the doctors. They educate the doctors to their product.

There is a huge difference here.

Doctors educate themselves by reading research and by reading research that has been analyzed by their peers.

Then they make the choice to pick one drug over the other. AND, even then because of the deceptive practices of pharmaceutical industry they still end up making mistakes due to the lies that are put forth in the studies the pharmaceutical industry sells the FDA and other physicians.

Salesman act as a mouthpiece. If a doctor is expecting the salesman to bring to his/her office new technology that doctor is doing a great injustice to his patients.

If I go to purchase a car somewhere and I walk in without first reading all there is to know about that car and allow some salesman to convince me to buy that car. SHAME ON ME.

It is the same with pharmaceuticals. If the pharmaceutical industry really wanted to help people they would get rid of salespeople and focous on spending money developing drugs for conditions that are not the so called "lifestyle" drugs.

There is 10 x more money spent on research for antidepressent that there is for saaay, spinal cord injury or a real cure for diabetes. Instead, they spend time re-inventing drugs for diseases where there is already 10 others similar medications available.

Don't ever insult us by stating that salesman are educators to doctors.

I don't care how successful a drug rep is. And who cares how he got there.

I don't let them in my office if I can help it and I don't need a free lunch.

NOTHING IN LIFE IS FREE.

 

[Playmakur42]

Salesman/woman do not educate the doctors. They educate the doctors to their product. Don't ever insult us by stating that salesman are educators to doctors.

ed·u·cate (ěj'ə-kāt') Pronunciation Key

To provide with knowledge or training in a particular area or for a particular purpose: To provide with information; inform:

Educate has more than one definition, one of which fits perfectly into the context of my argument. And, yes, some salespeople DO educate Dr.'s whether you like to admit it or not. I've seen the device rep "educate" the surgeon on which of their products to use for a particular case - he consistently used 1 product, but another fit better for the case.

You seem to have a bone to pick w/ pharmaceutical reps in particular. If you took the time to read the last paragraph of my 2nd to last post, you would have seen where I stand in regards to pharma reps. I understand why you won't let them in your office - they stop by weekly to tell you about drugs you already educated yourself about. If your unpleasant demeanor on an anonymous internet forum transcends into your real life, I could easily see how they would annoy you.

If I go to purchase a car somewhere and I walk in without first reading all there is to know about that car and allow some salesman to convince me to buy that car. SHAME ON ME.

any rational human would agree with this statement.

I don't care how successful a drug rep is. And who cares how he got there. I don't let them in my office if I can help it and I don't need a free lunch.

Maybe someday when I have my own office I'll feel the same way. Today, I don't have experience dealing with PHARMA REPS to form an opinion either way. Based on your replies, I'm guessing you've seen pharma reps lie first hand (since you stated that was what they did in your reply)?

 

[sophiejane]

Not if I have to sell out to a bunch of salesmen. If they want to leave samples I'll take it. I won't talk to them. If their drug is good then I will use it and they have nothing to worry about. If its not good, then its a mute point.

I am very much against the way the pharm industry works, and at one time I was super anti-drug reps, to the point of not accepting their lunches.

Then I spent 4 months in a rural health clinic where the docs are very friendly with reps, and there are at least 3-4 of them calling nearly every day.

At first I thought it was ridiculous, then I started to notice how much poor patients rely on those samples. I know, I know--they aren't supposed to, but when Medicaid only pays for 3 scripts a month and you HAVE to get Mrs. Jones' BP down and know she won't be able to afford the meds, it's really nice to go into a well-stocked closet and send her home with a month of drugs she needs.

When you view it from that perspective, at least for me, it's a little easier to swallow the brief encounters with reps (most, especially once they know you are less than a minute long). We had reps who literally just came by to shoot the breeze about fishing or whatever and stock the sample closet.

I don't have to go to every dinner or allow them to sap valuable time from patients, but if they provide something my patients need and can't get otherwise, I will put up with the BS.

Somebody else can save the world from drug reps.

 

[justwondering]

sophie, thats a good pt, but what happens after the pt has finished those samples that uve given them? arent the docs now stuck trying to decide whether to switch to something less expensive or to ask the pt to buy that drug himself? or is it possible to have all ur indigent pts get their daily meds from the reps? this is an honest question because i've wondered how i'd deal with reps when i will possibly have many pts in the future who cant afford meds.

 

[sophiejane]

sophie, thats a good pt, but what happens after the pt has finished those samples that uve given them? arent the docs now stuck trying to decide whether to switch to something less expensive or to ask the pt to buy that drug himself? or is it possible to have all ur indigent pts get their daily meds from the reps? this is an honest question because i've wondered how i'd deal with reps when i will possibly have many pts in the future who cant afford meds.

Take this with a grain of salt, because I'm merely an incoming first year resident, but from what I've seen, you don't have to lock a patient into using an expensive newer drug by giving them samples. For example, Zyrtec is crazy-expensive, but few people have to take it year-round. If a month of Zyrtec in the peak of allergy season can save your patient some suffering and $80, so be it. Some patients may already be on a newer BP drug, because that's what works best--so they need a new script for some new ailment, and have used up their Rxs for the month on Medicaid, you get tehm through until the next month with samples.

I know we had patients who would come in for refills and we'd stock them up with samples as well, just to save them a few bucks.

I know the pharm industry doesn't intend the drugs to be used like this--it's more a bait-and-hook kind of setup, but if we have to endure their pitches, at least our patients can benefit.

 

[danielmd06]

The key is to understand why drug reps are doing what they do, and why drug companies do what they do. Nothing in life is free, as a previous poster pointed out. Like casinos, these corporations and people wouldn't do something that lost them money in the long term. Understand this up front.

Use your intelligence. You got to medical school and became a doctor. You're not dumb. And there's no reason why some good cannot come out of this little series of mind games that pharmaceutical companies want to play.

I don't think we should be afraid to take advantage of free samples for our patients. I also don't feel in the least bit guilty about free lunches, free dinners, all those pens, penlights, and reflex hammers. But I understand why these salespeople are wooing me and mine. Influence me? Not on their lives. I'll read the literature that is so readily accessible to all of us on the internet. I'll rely on my overly expensive education and lengthy training. I'll consult with my peers and teachers. Then I'll make a decision in the best interest of the patient.

The drug reps are just dust in the wind.

These perks, toys, and foibles are being used as leverage against us and our patients. Caveat emptor.

 

[ajce9]

ed·u·cate (ěj'ə-kāt') Pronunciation Key

To provide with knowledge or training in a particular area or for a particular purpose: To provide with information; inform:

Educate has more than one definition, one of which fits perfectly into the context of my argument. And, yes, some salespeople DO educate Dr.'s whether you like to admit it or not. I've seen the device rep "educate" the surgeon on which of their products to use for a particular case - he consistently used 1 product, but another fit better for the case.

You seem to have a bone to pick w/ pharmaceutical reps in particular. If you took the time to read the last paragraph of my 2nd to last post, you would have seen where I stand in regards to pharma reps. I understand why you won't let them in your office - they stop by weekly to tell you about drugs you already educated yourself about. If your unpleasant demeanor on an anonymous internet forum transcends into your real life, I could easily see how they would annoy you.


any rational human would agree with this statement.


Maybe someday when I have my own office I'll feel the same way. Today, I don't have experience dealing with PHARMA REPS to form an opinion either way. Based on your replies, I'm guessing you've seen pharma reps lie first hand (since you stated that was what they did in your reply)?

I save my unpleasant demeanor for those who come to my office like leaches and bottom feeders. As for the rest, I'm mostly pleasant.

AND, when you do have your own office then you can comment on my choice not letting the reps in from more realistic and less idealistic point.

But I'm not in here to argue with you. I simply don't see any way that an informed Physician can be truly educated by a rep.

 

[ajce9]

Take this with a grain of salt, because I'm merely an incoming first year resident, but from what I've seen, you don't have to lock a patient into using an expensive newer drug by giving them samples. For example, Zyrtec is crazy-expensive, but few people have to take it year-round. If a month of Zyrtec in the peak of allergy season can save your patient some suffering and $80, so be it. Some patients may already be on a newer BP drug, because that's what works best--so they need a new script for some new ailment, and have used up their Rxs for the month on Medicaid, you get tehm through until the next month with samples.

I know we had patients who would come in for refills and we'd stock them up with samples as well, just to save them a few bucks.

I know the pharm industry doesn't intend the drugs to be used like this--it's more a bait-and-hook kind of setup, but if we have to endure their pitches, at least our patients can benefit.

Your right the samples do help those in need. But think about it. If they really cared and if they had real confidence in their medicine they would drop it off and not bother the doctor with it.

A ture act of charity does not need to be publisized. They don't need to jump up and down and say hay look at me, look at me.

 

[ajce9]

When different reps come in and are pimping the same class of drugs do the following.

Let your staff take their material and if they insist on talking to you tell them this and walk away.

And smile doing it so your demeaner is not smeared.

Tell them that there are several drugs in this class that do nearly the same thing. Tell them that you perscribe based on which insurance company you patients have and which one the company has approved. If there is no such thing then tell them that you go with the least expensive and if it works for your patient and it achieves it's goal with the least problems then thats it. If not you will try another drug and adjust the meds based on that.

Tell them you appreciate the love (i mean the "education material") and you will take a look at it later.


Oh if your single and she is cute, they usually are because they try to get you through sex appeal so you can associate the meds with T&A, so make sure and ask the rep. out but don't look too desperate.

 

[ajce9]

sophie, thats a good pt, but what happens after the pt has finished those samples that uve given them? arent the docs now stuck trying to decide whether to switch to something less expensive or to ask the pt to buy that drug himself? or is it possible to have all ur indigent pts get their daily meds from the reps? this is an honest question because i've wondered how i'd deal with reps when i will possibly have many pts in the future who cant afford meds.

That is an excellent question. It falls under a deeper, larger issue of the health of healthcare.

 

[sophiejane]

When different reps come in and are pimping the same class of drugs do the following.

Let your staff take their material and if they insist on talking to you tell them this and walk away.

And smile doing it so your demeanor is not smeared.

Tell them that there are several drugs in this class that do nearly the same thing. Tell them that you perscribe based on which insurance company you patients have and which one the company has approved. If there is no such thing then tell them that you go with the least expensive and if it works for your patient and it achieves it's goal with the least problems then thats it. If not you will try another drug and adjust the meds based on that.

Tell them you appreciate the love (i mean the "education material") and you will take a look at it later.

Saying all of this will likely take more time than listening to their little speech. Often, they are one-line sound bytes. It's easy to smile and nod and take their pamphlets, and won't take up the valuable time of your staff either (your staff's time is your time, after all, and the reps aren't interested in talking to staff, they want to talk to you. If you aren't receiving them, they will stop calling. That's fine if you don't want to have any free drugs to give your patients). Then, as I believe the majority of physicians do, just make your own decisions about treatment.

Oh if your single and she is cute, they usually are because they try to get you through sex appeal so you can associate the meds with T&A, so make sure and ask the rep. out but don't look too desperate.

With my male preceptor in a male-dominated physician group, we saw a LOT of drug reps and there were equal numbers of women and men. Quite a few of the women were pregnant, older, or simply looked like real women, not Barbies. The vast majority were married.

 

[sophiejane]

Your right the samples do help those in need. But think about it. If they really cared and if they had real confidence in their medicine they would drop it off and not bother the doctor with it.

This has nothing to do with confidence. The reps want to get their drug name seared into your brain so it comes into mind when you see a patient who might benefit from it. In talking with them, most will readily admit this, and don't believe that their drug is right for everyone.

Look, we live in a capitalist society. People want to make money and sell products. I am much more interested in banning drug ads to the public than I am banning drug reps. Their relentless ads on television, radio, magazines, etc. do more damage than their calling on you in clinic. Patients will come in and demand drug X because they saw it on TV and it really worked for that depressed lady, etc.

 

[iatrosB]

At least this thread has kept the forum somewhat alive. This place is dead! I think the fourth years are buzzed and the second years are lost in board prep. Kent is probably on a beach somewhere, Faeb is lost to the world...I can't keep the forum alive by myself!

 

[Static Line]

At least this thread has kept the forum somewhat alive. This place is dead! I think the fourth years are buzzed and the second years are lost in board prep. Kent is probably on a beach somewhere, Faeb is lost to the world...I can't keep the forum alive by myself!

Yep--Bored prep for me

 

[iatrosB]

Yep--Bored prep for me

at least with FM, all we have to do is pass

no pressure (yeah right )

 

[Static Line]

at least with FM, all we have to do is pass

no pressure (yeah right )

True if your taking the USMLE-At least you have a solid number to shoot for that says you passed, and the beanheads at NBME can't take it away from you.

Taking the COMLEX is another monster altogether. If you are too close to the passing border, after the NBOME gets through scaling the exam, even if you really passed it one can get scaled down and fail it. They love the perfect bell shaped curve and COMLEX takers may reap for it. So I am shooting for much more than pass and don't want to be anywhere near the bottom 10%

 

[deleted87716]

Kent is probably on a beach somewhere

I wish...I just got back from a conference in a landlocked state in the midwest. Not a beach in sight, and it rained practically the whole time. Had some good steaks, though.

 

[iatrosB]

I wish...I just got back from a conference in a landlocked state in the midwest. Not a beach in sight, and it rained practically the whole time. Had some good steaks, though.

You call it hell, I call it home