Telling detail: A cautionary tale

I glanced out toward the waiting room and did a double take. It was full of smartly dressed, well-groomed, healthy-looking young people. Where was the usual motley crowd of the sick and ailing? Where were the wheezers and sneezers? Had our practice become one of neurotic fitness freaks who dressed up formally to come to the doctor?

No. By coincidence, half a dozen drug representatives had arrived at about the same time and were all waiting to promote their wares. They certainly smartened up the waiting room, but they took up space, made me feel guilty for keeping them waiting and pestered the nurses. I contemplated offering appointments to the reps or perhaps seeing them at lunchtime. That did not appeal though; there does not seem to be enough time to schedule patients, never mind several drug reps a day.

Detail people - or pharmaceutical representatives - there is an array of them out there. Well-trained and intelligent, they are on the march into your office, and hopefully onto your prescription pad. Whether they are a time-consuming distraction or a great help depends.

Cast of characters

It's a busy morning in the office, and Mr. Very Serious is hovering around. I am dashing from exam room to exam room and notice that he is sitting quietly with that earnest expression on his face. Something about his body language makes him noticeable even though he seems to be staring into space and not moving. He can see that I am busy, and he only needs a quick signature for the drug samples he is leaving.

"Morning," I say, approaching him with my pen at the ready.

"Good morning doctor," he says obsequiously. And then those dreaded words. "I have something I want to share with you." He then opens up glossy brochures with charts and graphs and comparisons of his company's blood pressure drug with some of his chief rivals. I have heard it all before, but this is his job, so I give him a few minutes. I am conscious of several charts of waiting patients being put out. He is almost done, I think, my mind well away from his drone. But he carries on. Just before I am about to excuse myself and walk away, he stops.

"Thank you doctor." He almost bows, he is so respectful. How could I be rude to him? He is just doing his job.

Later, Mr. Jolly One breezes in. He is friendly and full of energy.

"How is the family? Done much traveling lately? How was that CD I left with you?"

All I want to do is sign his form and get on with seeing my patients. But he chats on - not the boring recital of his drug's clinical trials and lack of side effects, but social stuff. It is hard to put him down without being rude. Eventually he produces his palm-held electronic device and I use his plastic imitation of a pen to make a squirrely dyslexic imitation of a signature.

Then there is sweet Ms. Once Aweek. She turns up, recites her stuff about a bestselling antibiotic, I sign her form and she leaves.

The reps can be a great source of information and a help with samples and handouts for the practice, but there is a price to pay and that is to be the object of their sales effort. For they are salespeople. Their ultimate raison d'etre is to sell more of the company's drugs, and our cost is our time.

After a few visits, Mr. Very Serious was getting on my nerves. He was taking up too much time - and his presentations were so boring! I took him aside before he started to "share something with me" and told him that I would prefer he left his brochures with me so that I could read them in my own time. I also told him that I thought his drug was an excellent one, so he did not have to sell it to me in such a persistent manner.

At his next visit, he still insisted that he had something to share with me.

"Great," I said. "Leave the brochure with my nurse."

I saw two more patients before realizing that he was still waiting for me to sign for samples. He is not so keen on "sharing" now. And we get along much better.

I really like Mr. Jolly One, and in a non-busy office setting, his chatty friendliness would be very acceptable.

"Look, I'm pushed for time," I told him. "Let me just sign your slip. I've got to get back to the patients."

To his credit, he took the hint and now checks to see what the patient load is before socializing.

I asked Ms. Once Aweek why she felt she had to tell me about her drug every week.

"I've been prescribing it for years, you don't have to keep pushing it."

"It's my manager," she grumbled. "The rule is that I have to visit you once every week."

Now she shows her face and I sign her forms. She or I mention her drug once by name, she smiles, and she leaves. The whole encounter takes seconds.

There is Lemme Show, with his charts and statistics, and all the latest journal mentions of his product. This is a drug with a number of superior rivals that are safer and less expensive. I feel sorry for Lemme Show. He is never going to persuade me to prescribe his drug. I nod and try not to disagree with him, for to do so would produce more figures and graphs and journal excerpts. I should just tell him I suppose that he is just wasting his – and my - time, but I haven't the heart.

Ms. Putdown Theothers also has her study reports and her abstracts. Not to show me how good her product is, but to demonstrate how inferior are her rivals. I told her once that the reps of those drugs said exactly the same about her product but it didn't work. She produced more facts and figures. I mentioned that I would respond more positively to a less negative approach to her sales technique. She didn't change though, this is her way of doing things, and she doesn't take a whole lot of time.

Mr. Pushy Guy barges into the samples closet, moves them around, puts his stuff in the front and pushes the rival drugs to the back. He interrupts me as I am writing in my charts. He puts things down on my nurse's desk. Or rather, he used to. My nurse put him firmly in his place. He now has to wait out of the way until we are ready for him. He is not allowed into the samples closet - neither are other reps, although the rule is broken for some of the more friendly ones whom my nurse allows a little leeway.

Useful information

Do we need to spend any time at all seeing drug reps? Would we be any the worse off if we just said "no"? I think yes is the answer to both.

In today's information-saturated society, it is hard enough to keep ahead of our patients in medical news. Television advertisements as well as those informative magazines emblazoned with exhortations to take this for your running nose or that for your overactive bladder or underactive colon. The reps help to keep us in touch with what the latest pill is and what it does. They also stimulate us to keep up-to-date with guidelines, side effects and even basic physiology, as we all hate to appear ignorant of such things. Not all information is vital, however, and sometimes we need to filter the good from the useless.

The reps bring in all sorts of materials that can clutter up the office. The scribble pads and pens we find very useful, and the patient handouts that some companies provide are truly helpful. Some things I wish they would not leave though - gimmicky little dolls, coffee cups, calendars, diaries - those things that seem useful at the time but that I already have several times over.

Perhaps the most welcome things the reps bring to the office are the invitations to their evening programs, which are usually in a nice restaurant and usually feature an excellent speaker. I find the presentations interesting and informative, and I meet colleagues in a pleasant social setting. It is a great way to keep up-to-date with the latest in the various specialties we doctors generalize in.

Yes, the drug reps are part of our lives unless we close the door on them altogether, and whether they are a bane or a blessing depends on how we react to them. The clever, polite reps never seem to be obtrusive. They are always around and are always helpful but never get in the way. There are some who are great salespeople, I suppose, and who can get on my nerves. I don't like pushy people, and I don't like sneaky people. Ms. Justa Minute was charming and seemingly considerate. "I just need a quick signature," she would say. "I know you're busy." And, as I sign, she would bring out her brochures and start her presentation. And then another one, and another. Sneaky!

I was ready for her the next time: After my "quick signature," I reminded her that that was what she had requested and that it was all I had time for.

Mr. Too Thelimit was more obvious. He would waylay me and start into a standard presentation as if reading from a script.

"I'm sorry," I said one day. "I'm running behind. Let me just sign your form, and you can leave some information."

And he just carried on as if he hadn't heard me. I repeated what I said.

"Oh, of course," he said. "I just want to tell you..."

I didn't wait around to find out what he had to tell me. Most reps are sensitive to time constraints and office routine and are anxious not to be obtrusive. Those who are impertinent, I tell firmly what is not acceptable. If they persist in what is objectionable, I inform them that I do not have time to see them.

We have gotten to know some drug reps well over the years. They sometimes bring lunch to the office in exchange for a quick mention of their products. We socialize with them at evening meetings, we learn something of their own lives. They keep us in touch with what is happening in other offices in the area. They are the current that keeps the information stream flowing.

So when a new young face appeared last week, and a handful of brochures was produced and I heard, "I'd like to share something with you," I held up my hand, rested it gently on his shoulder, and said, "First, let me share something with you."

He might as well learn the easy way. PR