Question from Dr. Y, C. “I spend long hours at the clinic and then a harrowing day at wards before clinics again. Imagine when after clinics I have a queue of thirty odd med reps, vying for my attention. I spend an additional forty minutes listening and honestly most of the time just shaking my head without processing anything. Is this exercise even worth it?”

I love this question. Depending on where you are and how you were trained is affects how you see med reps.  If you were taught to be suspicious of them or see them as guys who will force you to sell more drugs etc, then that’s probably why you feel this way about them.

When I went to AU, med reps were introduced to us as soon as we were in clinics. So third year and up. We had already started dealing with them as medical students. What came across to us from our residents was that they were part of our education. The pharma companies do contribute significantly to medicine.

So let me tell you first what med reps are responsible for OTHER than selling medicines.

-Educating you about new molecules or changes in molecules.

-Creating brand awareness

-Giving you therapeutic insight into something that was not known before

-Highlighting a current gap in treatment and a new treatment that could fill it

-Teaching you how to prescribe and dose/ bio-availability

Let’s be honest. There are thousands of drugs out there. No doctor can keep up with every changing molecule or drug composition. It’s just not possible. Most pharma companies look to the market for post marketing adverse effect reporting/ surveillance. If there is a new development, strategy, side effect or better dosing technique, who better than the pharma companies to actually disseminate this information. With this background let me explain my own strategy of dealing with med reps.

1.Build Trust

This is a symbiotic relationship. You need med reps to keep you abreast of the changing molecules. They need you to chase sales. As an addendum to this, don’t trust them fully. Once a particular composition piques your interest don’t blindly trust everything they have to say. Sometimes data can be fuzzed and the lines do get blurred. So make a written note, go home and as part of your daily medical reading, glance through the evidence supporting what your med reps says.

2. Find the Passionate One

In every group of med reps, there will be a handful who are really passionate about the job they do. They’re not just pushing numbers or chasing a target. They know the market, they understand where their product stands, they know the pros and cons and they will say so. This is the guy who’ll give this drug to his own mother. Spot these guys and build a relationship with them. Allot a day or time when they can come in separately and pitch.  This is mutually beneficial. The med reps then repays you by providing your practice with beneficial news, or drug discounts or even future developments about new products. He may also invest more time in learning and studying your market to get you the best deal.

3. Take notes

You won’t remember everything, as rep after rep rattles on. Active listening will get you to learn more. So write down somethings that interest you. For me sometimes it may not be the molecule, it may be the way it’s pronounced or if the dosing is less, I’m quick to jot it down. Some times it’s just the way the drug’s packaged that attracts my interest.

4. Treat it like a CME

If you’re going to sit wondering what your wife’s cooking for dinner while the med rep is flipping his chart, then this whole exercise is fruitless. You might as well pack his and your bags and simply go home.  This is an opportunity to soak up as much information as you can. Ask questions. If your rep goes on and on about bio-availability  when it’s not much different from the competitors, you jump in and ask the tough questions, “But what’s the cost?” Once you ask questions and show interest, they will tailor their presentation to your needs. For me cost is the most thing for my patients. It’s the first thing I want to know, because my patients are not swimming in money. Now med reps with a more expensive drug don’t waste my time showing me what I will never prescribe to my patients.

5. Don’t get greedy

The AMA is quite strict about this. They’ve banned all sorts of gifts from pharma. If its a medical textbook or stationary, it’s fine. But don’t accept anything other than that. Once you do, there’s always payback.

6. Encourage free samples

And don’t take them home.I like free samples before I can prescribe. Because it helps me test out the drug in a small sample group before taking it further to a wider market. Don’t take them home and give it to your relatives. Let me explain, samples for new compositions or updated molecules are to help with the post marketing surveillance. If you’re aunt swallows up all the samples, how are you going to know if the side effects (if any) are applicable to a larger group or simply a one off event.

7. Don’t dress them down

If you’ve had a particularly difficult day at the wards, then it’s pretty easy to spew venom on the med reps. But if you  remotely feel there is chance of this happening, simply postpone their visit for another day. Tell them what happened and why you can’t see them. They will appreciate it.  Remember they’re doing their job like everyone else. They’re not hired to be your punching bag.

8. No one can force you to make a sale

Always remember that you prescribe what you think is best as long as you’ve not accepted extravagant gifts or perks from pharma. Let me warn you that pharma companies have tie ups with pharmacies and vendors to study your prescribing habits. They pay to get this data. They will tailor their marketing program and train their med reps better to convince you their drugs are superior. NO ONE can force you to prescribe an inferior drug.

How do you deal with med reps? Do you have a strategy?