Friday, February 19, 2010

The other side of the sample case

Drug reps get a bad rap, though I often try to stand up for them. Certainly, some are ill-mannered, but I like most.

And today, I like them, or at least sympathize with them, even more.

As my regular readers know, I have a few side jobs outside of my regular practice. Most involve research and consulting, but occasionally a drug company will ask me to do a speaking gig about their product (if you have a problem with me doing this, sorry).

So yesterday, I got to be a drug rep (sort-of) for one hour. I was asked to accompany a guy named Mike, who's a nice rep, to give a brief talk & answer questions during a lunch he was hosting at Large & Soulless Internal Medicine, P.C.

And guess what I found (as if I didn't already know): A LOT OF OTHER DOCTORS ARE ASSES!

Now, I know that doesn't come as a surprise to many of you (especially the nurses), but I was a bit stunned to see it from a drug rep's view.

During my hour in that office's break room, I encountered 5 physicians. Keep in mind that this was a scheduled event for the physicians' day, NOT a drop-in.

Physician #1:

Dr. Rushed: "HelloI'mDoctorRushedwhatproductdoyouhave?"

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side, and..."

Dr. Rushed: "Goodtomeetyoudoyouknowmyhusbandhe'sacardiologistonthewestside?"

Dr. Grumpy: "Yes, I..."

Dr. Rushed: "Goodtomeetyouthankyouforlunch." (Grabs sandwich, runs out of room).

Physician #2:

Dr. Rood: "Yeah, what?" (grabs sandwich, stuffs in mouth)

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side, and..."

Dr. Rood: (still chewing) "mmf yourf a doctor? You came to my office dreffed like that?"

Dr. Grumpy: "Yes, I just came from my office."

Dr. Rood: "Whatever. I don't talk to you drug people, anyway" (leaves)

Physician #3:

Dr. Unseen: (loud voice outside breakroom) "It's a rep? I don't want to see a fucking rep! I hate reps! They're all sleazy. I'll just wait till they leave, then go get something to eat."

Physician #4:

Dr. Whine: "Okay, so what is this?"

Mike: "I carry Limpeter, an FDA approved treatment for Neuropriapism, and this is Dr. Grumpy. He's a neurologist out on the west side.."

Dr. Whine: "I used to not treat Neuropriapism. But now I do."

Mike: "Well, several studies have shown the efficacy of Limpeter for..."

Dr. Whine: "Mr. Grumpy, do you treat this?"

Dr. Grumpy: "Yes, I..."

Dr. Whine: "I'm sorry, did you say you're a PA?"

Dr. Grumpy: "No, I'm a doctor, a neurologist, and I use Limpeter in my practice for..."

Dr. Whine: "You know, Dr. Newmom, who works here, sort of, treats a lot of Neuropriapism patients. But she took a month off to have a baby, which is pretty damn unreasonable of her if you ask me, and so all her fucking Neuropriapism patients are seeing me now, so I could use this."

Dr. Grumpy: "Well, in several studies..."

Dr. Whine: "Don't you think that's ridiculous to take a whole month off to have a kid? I mean, it's not like she was in labor for the whole damn time, or had a C-section. I could see a 3-day weekend, but not a whole month."

Mike: "I..."

Dr. Whine: "Do either of you guys know anything about computerized chart systems? Our practice just switched to FubarMED, and I can't get it to work."

Dr. Grumpy: "No, I use..."

Dr. Whine: "Thank you for lunch." (grabs sandwich, walks out)

Physician #5:

Dr. Magnon was a guy who kept sticking his head in the breakroom. He'd yell "I'll be back in a minute! I have a question for you guys!" Then disappear, stick his head back in 5 minutes later and yell the same thing, and did this repeatedly. Mike hadn't gotten to talk to Dr. Magnon before, so we waited for him.

Finally, after 40 minutes, Dr. Magnon runs in.

Mike: "Hi, Dr. Magnon, I'm here with Dr. Grumpy and..."

Dr. Magnon: "Hey, do you guys know where the nearest gas station is?"

Mike: (whips out iPhone) "Sure, hang on... here it is, 1 block south and right around the corner."

Dr. Magnon: "Thank you." (grabs a sandwich, runs out. Through the window Mike and I watch him walk to his car and drive off).

When I got back to my office I told Dr. Pissy that I had no idea how benign he and I were until today.


Cheryl said...

Well, at least you got paid for your time. . .

Anonymous said...

I was going to make a "nudge-nudge, wink-wink" comment about Neuropriapism, until I looked up the end of the word (to make sure I knew what the heck I was talking about), and saw several references to how painful it was.

Guess that's going to put a damper on our jokes from those Enzyte commercials... "If you get an erection that last more than 4 hours..." we usually finish with "consult a PRO-fessional."

Grumpy, M.D. said...

Obviously, I made up both the disease, and the drug, to preserve anonymity. But I tried to make them funny.

Lynn said...

I'm a Social Worker and yes I work with several Dr. just like the ones you wrote about. Wish they were more like you.
And about Reps...they do have good pens! lol

StorytellERdoc said...

Great post, funnier than hell. I always laugh that most docs are on a pedestal...rare to find a doc who is a good person first...except in the ER! :) Enjoy your day, bud.

TheLittleFlower said...

I commend you for this post. It is amazing that even though this was a scheduled meeting, the doctors still treated the drug rep like crap. There has to be a better way to update docs on new medications/indications.

donna said...

OMG! I am speachless! At least that
end of the gene pool is all in one
office! And they have patients?
Just amazing! you should get paid
double and so should Mike, for having
to go to such a soul sucking place!
Don't you wish there was a drug called
fuckitall?! My word ver. is revers
How appropriate, you just saw them!

danielle said...

Well, I am sure if you spoke to their patients, you would find these docs are just as rude to them as they were to you. If you are going to eat the FREE food, you ought to at least listen to the spiel politely! And I agree, the best pens come from the reps!! In the hosp tho, they have to filter down to us from the NICER docs!

Grumpy, M.D. said...

Sorry, gang. Pens, post-it notes, and all other "non-educational" drug rep gifts were banned on 1-1-08. We dont' get them anymore.

DreamingTree said...

I hope those tools don't round at the hospital. The nurses would probably place laxative laced chocolates in the dictation room. Bwahaha...

Jadzia said...

I think I used to work for the "why can't she just take a 3 day weekend" guy. He wouldn't be a JD/MD, would he?

: )

ERP said...

I always try to be nice to both the reps and the docs (doing what you do) when then come with lunch to us (it ain't very often though these days). However, then I find that if I am nice, I get trapped. All the other rude people just blow out of there and I am stuck trying to extricate myself after 15 minutes since I am the only one that will listen to their spiel.

Anonymous said...

I'm at fault, I admit it. Next time, I'll quit it with the snobbery already. Here I was mentally sneering at reps saying anything to get a sale as I'd given them a blanket discriminatory attitude that the majority only knew enough to sound like they knew what they were talking about.

On further reflection, I guess that probably isn't true in many of the encounters at this little hospital here in the middle of nowhere. The last two encounters with drug reps just highlighted some of the points Dr. G. attempted to get across.

The first was a drug rep for a chemo drug company for a product which just extended its indication to renal cell cancer.

Boy, that woman knew every oncologist in the state, the poop on institutions going under, the latest FDA rules, drug preparation, reimbursement, etc. plus she knew mechanisms of action, adverse side-effects, and drug comparisons.

FDA has new guidelines... about what reps can show or tell or bring practitioners, and even standardardized package inserts. Yes, she brought lunch. (No pens.)

The next rep was extremely knowledgeable about product, disease state, and I've learned a lot in previous encounters overhearing him talk, but he always stops to talk with the tech at the front desk always chats her up (no appointments) to begin. His spiel going on & on about volume discount breakpoints and prices. I am only staff, and it's irritating that he spends so much time talking with someone who has no idea of what he's talking about nor any influence on buying decisions.

Now, I realize he probably feels lucky to talk with anyone since he didn't have an appointment, nor free lunches, etc.

The last lunch & learn speaker was with a MD in solo practice. The lunch was terrible, and I'd heard his talk 4-5 yrs ago, and I had to go make a chemo in the middle of it. I think he appreciated that I ran back after finishing the chemo to ask a question I'd thought about from earlier.

At another recent lunch & learn, the MD I knew from his daughter was in my own first grader's class, but I'm sure he didn't know me--as I was working 50 miles out of town. I really appreciated his professionalism and honesty. It was a talk on a permutation of the innovator drug patent i.e. going from brand name to off-patent, so company came up with new 'XL' formulation. I'd heard the talk at another facility by a different MD and had been mentally refuting the claims and previous MD assertions, but this MD presented the drug mechanism of action, and use in his practice, as well as compared to other agents, as well as gave other related answers, that I'd been interested in for some time, then when the bottom line came up, introduced different company-sponsored patient assistance programs, and stated unequivocally 'if your patient has to pay cash, he won't be able to afford this drug'.

Right now I'm looking for the rep that provides the standard pocket references on such and such topic ... I guess most clinicians make enough money to already have PDAs and don't deal with hard-copy references.

Anyway, no more sneering, promise. (At least for Lent.)

nRT said...

In my hospital, if there is free food, medical people act as if they haven't eaten a week. I don't ever eat lecture food. So many people touch the food and then put it back. Yuck.
Can't wait for the I Hate Call T shirts. Not to be bossy but could you make them in long and short sleeves?
Thanks in advance

Grumpy, M.D. said...

nRt- I doubt I can do a long sleeve under the basic cafepress set-up, but I'll see.

Anonymous said...

Bwahahahaha -- you got treated poorly by docs? Imagine that! Not implying that you of all people deserved it. However, imagine being a chronically ill person who deals with these critters all the time!

Sara said...

Oh my, i can't believe it was a scheduled visit too.

Also, re: the "non-educational" gifts being banned on 1/1/08. Do you mean just your practice w/ that specific drug or everywhere?

Anonymous said...

Poster @ 2:13--the gifts were banned industry-wide. Now if you want pens, Post-its, or other swag, you have to hit up the Home Health or DME representatives :-)

I've probably been guilty of being Dr. Rushed. I appreciate when the drug reps bring lunch, but I don't always have time to sit and listen to a long spiel (there's always paperwork to catch up on!) I always figured that all the drug rep really wanted was my name on the sign-in sheet to justify the expenses for the meal. I'll try to give them more of my time in the future.

Anonymous said...

our clinic controls reps very carefully. this is the only way to keep them from pushing out of control behaviors. remember- the reps are using us for their benefit. big pharma is part of the problem in health care, and happy to buy a few lunches. a rep brought sandwiches today. i heard they were good, but nurse perfect warned me that the rep wanted to talk to me specifically, uninvited. i snuck to the elevator and away, gratefully hungry.

Anonymous said...

It's hard out there for a pimp :)


Classof65 said...

I going to forward your post to my daughter. She's been hoping for a pharmaceutical drug rep job for years -- before she could even spell pharmaceutical!

C. Chen said...

I'd like to see Dr. Whine push a baby out of a hole the size of his mouth. Then he can complain of his partner taking time off to have a baby.

Truthfully, I don't trust drug reps, but it's an all or nothing thing for me. I don't listen to their spiel, I don't eat their food.

Joann said...

I stopped going to one dr. because the drug reps got more of his time then his patients got. NO exaggeration!!

I'm not blaming the reps, I understand they need time too, I stopped going to the dr. because he would schedule the reps in between every patient, so I was in the waiting room for hours.... he needed ONE day a week (at LEAST) JUST for the reps visits. That Dr. is no longer has his practice here.

Lindsay said...

I'd like to thank Physician #4, Dr. Whine, for knowing that PAs exist in this world!


your PA in training

Cheri said...

As a drug rep, I can tell you this isn't always standard treatment but certainly happens 50% of the time. I guess we have become a bit like used car salesman. Interesting to note most of us really don't lie, cheat or steal. We just want to provide education and hope that it results in a few prescriptions for the appropriate patients. I love your blog. My personal favorite is the marketing survey about intercourse with drug reps. He, he, he!

Don said...

Unfortunately, this kind of behavior is also common in the engineering field, or at least that has been my experience as a contract worker. Various companies will sponsor seminars to display their latest new software/hardware toys, invite people to attend, offer free food and give spiels or have tables with food and (soft) drinks available. Too many of us tend to just clean out the snacks and ignore the salespeople, not even making eye contact.
I used to do this, but being diabetic, I try to listen to the reps and watch the demos, which are often very cool.
BTW, 2 things to note: Pepsi seems to be the beverage of choice, especially diet; the reps give out lots of presents, including pens and calendars.

Outrider said...

I'm going to CE this week, which means I'll see a whole pack of pharmaceutical reps in full cry. I always try to listen to the ones who sell products I use. Good grief, it only takes five minutes to be polite and munch a cookie.

rxBambi said...

I'm glad you finally realized that you guys are asses!

Hahaha just kidding. But not really.

Being a pharmacist I have to deal with doctors fairly often. When I come across a doc that treats me as an important member of the team I always refer patients to him. When I get treated like a moron for not being able to read his crappy handwriting or needing to verify something, well... I won't say I steer patients *away* ... but I don't give glowing reviews.

Granted I'm speaking mainly of GPs which are a dime a dozen around here. If it were a specialist I'd be more concerned with his ability than with the way he treats me... but I'd remember it if someone asked my opinion....

Unknown said...

wow, now I know why the reps like me so much. Seriously, I feel bad when they show up and I'm packed with patients or running late and always apologize and they act like I shouldn't apologize at all. The things they go through!
I'm honestly shocked.

Also: I've been reading your blog since yesterday (backwards), that's the reason why I'm only commenting now. I'm a psychiatrist in Brazil and you wouldn't believe how often I think you're seeing my patients. People are all the same, huh? Thanks for the great blog!

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