The Doctor is In

Author: Jonathan Sackier

The receptionist enters my office; “Dr. Sackier, there’s an invisible man in the waiting room.”  My response to this old chestnut? “Tell him I can’t see him” Cue rim shot. But here’s the real joke, if he is a medical device or pharmaceutical rep, in many places throughout the USA (check out Massachusetts), I cannot see him.  Literally.  Even when laws, guidelines or hospital policy allow it, time constraints impose. So our invisible man (or woman) pops the scientific paper “How best to use the machine that goes ping”(impossible for someone of my vintage to not be a Python aficionado) into a four-color tri-fold, attaches a post-it note asking me to review and call him. Nothing wrong with that is there? Most reasonable souls would assume the poor fella’s just trying to do his job, but according to FDA guidance on the distribution of reprints, there is plenty wrong. What is going on here? I truly believe that people are inherently good; we wake up, look in the mirror and think “I’m a nice bloke, my family loves me and I am going to try really hard to do good work for my employer today.” But because some people and corporations have abused the system (not going to mention names, just use Google, sit back and gasp) decrees have been introduced to stop our imaginary rep, truly throwing the baby out with the bath water. Last time I checked murder was illegal, yet bad people still kill, even in Massachusetts. So what’s the deal here? Okay, laws alone do not change behaviors, and those who contravene them should be prosecuted, merely assessing a fine is often viewed as a cost of doing business. Look at some of the names you pulled from your Google search.  It takes two to tango, the company prepared to push the boundary and the doctor willing to play along. But let’s put this into perspective, the overwhelming majority of doctors, reps and companies are honest, ethical and decent. But even they can run afoul of the system. So what to do about it? First, training is critical – I am constantly astonished when talking to industry insiders about their failure to explore the best ways to access the medical profession. It is not just about feet on the street. Secondly, use tools that help ensure compliance is not inadvertently breached – very often it is an act of omission, not commission, that leads to an error – “honestly, I did not know I was not supposed to….” You fill in the blanks. As a surgeon I relied on reps to show me which way to hold up the doohickey or how to prescribe Improveyourlotalol. I – and most importantly, my patients – need reps. They are just trying to earn an honest living. Let’s help each other do a good day’s work and not assume the worst. And don’t kill anyone, even if they live in Boston.

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