Insights into the doctor/rep relationship!

This article by West Midlands doctor Dr Steve Curtis about drug reps and the medical profession was written for a British medical journal. It was rejected by the editors on the grounds that publication might offend the pharmaceutical industry.

In times of crisis, the aggrieved will always seek solace in their friends. The God-fearing have the clergy, Woody Allen had his analyst and your average warring couple has the marriage guidance service. But for the desperate junior doctors of this world, no official institution has ever offered real comfort and when the chips are down, there’s only one man you can truly rely on.

If you find yourself friendless, he will be your friend. If you find yourself lonely, you need not be alone. Unknown to the public and largely ignored by the General Medical Council, depressed young doctors everywhere have sought comfort in their local drug rep.

Drug reps are a carefully selected subsection of the population whose sole purpose in life is to flatter and entertain doctors. In the course of this crusade, the drug rep himself has only one objective; to persuade his audience to prescribe products.

As a junior house officer, there were only eight pharmaceutical products that I could actually spell and at the time I tended to keep this sort of information to myself. None of these tablets seemed to have an active rep in our area although there was always at least one idiot out there who believed he could teach me a ninth. What with my own desperate attention span and the general pressures of the job, no medic was ever going to let himself be educated for free and the reps knew it. Distraction of this kind has never come cheap and even the best drug rep requires a generous expense account.

Reps get paid by commission and in their business, the only order form that matters is the prescription pad. That being the case, as a clinician, how can I be sure that my prescribing practice is not being affected by the offer of a few beers and a quick curry? Personally, I’ve always solved this one by not paying any attention to anything they say. However, not all doctors find this as easy as me and for many, polite attention is impossible to avoid.

Because in essence, a drug rep is about as good a friend as a junior doctor can realistically hope for. He will organise parties and hand over free pamphlets on key exam topics. In an inter-hospital soccer match he is the only man on the field ever likely to offer you a pass. He will remember to call you by your first name, even when everybody else has forgotten it and he will never sneer, bleat, or use coarse abbreviations. He will laugh at your jokes, even when you didn’t realise you’d actually told one and no matter how badly you lose it by the bar, he will always buy you another pint.

And from time to time, the physician will return the favour, nodding through his promotional lecture and not passing comment when a rep lets slip that he doesn’t really know anything about physiology, pharmacology, surgery or medicine.

But what am I saying? Why do I keep saying “he”? There’s nothing to stop your favourite drug rep being a “she”.

And on that note, no account of the drug rep phenomenon could be complete without the story of my good friend Greg and the Diprivac sales rep. In the course of my first house job, The Diprivac sales rep was a legend in her own catchment area. Her career was in its infancy and yet such was the speed with which junior doctors rush through training that there was nobody around who had been there long enough to remember her coming.

Except for one man: Greg.

Greg, a rather unobtrusive registrar in anaesthetics had been side-tracked in our DGH for as long as anybody could remember. He had a tendency to feel the strain of it all a bit more than the rest of us and occasionally the indiscreet would question whether he was really suited to this game at all.

But by all accounts, Greg was a good egg even if he did have the odd weakness and by the time I met him, Greg had been obsessed with the Diprivac sales rep girl for the past 18 months.
Blonde, seemingly frozen forever in her early twenties, the Diprivac sales rep was indeed a woman to remember. She often got a mention in local medical circles, but few of her clientele were as besotted with her as Greg, who had assembled at least six different coloured T-shirts in his wardrobe, all of them perfectly ironed and all with the word “DIPRIVAC” stencilled across the chest.

“How d’ya get so many?” I once asked him, glancing at the bulging shelf.

“She gave them to me.” He responded, as if speaking from a distance. Momentarily lost for words, I hesitated by the wardrobe door and said, rather stupidly, “I must get one.”

“Well you won’t find it easy,” added Greg, suddenly returning to the present. “’Specially if it’s in blue. She had to bring that one over from Sweden. Just for me.”

As well as the T-shirts, Greg also had a couple of DIPRIVAC pens. Both of them were red and Greg’s firebrand consultant had forbidden him from writing in red, since: “It doesn’t photocopy.” But Greg had kept them anyway. Greg knew the doses of Diprivac from memory and could quote them to people in polite conversation.

He had once written the word, “DIPRIVAC” on a drug chart whilst the rep was watching and afterwards had strolled over to her and asked her if he’d spelt it properly. When she had gone, he crossed it off. One of the pharmacists had told him it was too expensive and in any case, he had no idea what it did.

He once told me: “Can you imagine how you’d feel if you woke up in the morning and she was there?”

Greg had a way of making people feel uncomfortable.

I tried to encourage him to develop a Gwyneth Paltrow fixation in the hope this might function as a counterweight, but this didn’t work either and one night, in the bar, he confessed to some sort of Freudian problem related to her height and hair colour.

“I’ve always had this thing about above average height blondes,” he told me. “I’ve had therapy for it but it doesn’t seem to do any good. Maybe I’ll just have to move out of the area.”

And in the end, that’s what he did, picking up a senior registrar post in the North-west and leaving his hang ups behind him. More than anything, his memories of an entire two-year stint in his life were dominated by one unobtainable woman and a pharmaceutical product he never even prescribed.

And yet, in her small way, that same woman had helped Greg through a painful and difficult period in his life in a way that nobody else could and he was grateful for it. I guess we all were.

Source