You thought the pharmaceutical industry was slimy before reading this post?

You're a drug rep selling psych meds (hey, had to make the post fit this week's Grand Rounds somehow!), and you have to meet your quota. The family doc whose office you're walking up to right now, though, is 100% hardass.

You can bet that you won't even get the chance to have any face time with him - even though his secretary always cleans out your briefcase full of samples (this doc's one of the "sample-grabbers" you heard about in training), this doc will only see you if it's by accident, and even then, pretend you don't exist.

Which of the following best describes your attitude?

a) Scared stiff.
There's no way you can up sales if you can't even see the doctor.
b) Pretty nervous.
What if he's behind the counter when you come in and he yells at you?
c) Pissed off.
This is going to be a waste of an appointment.
d) Thrilled.
You know you can accomplish your objectives - probably even better - even if you only talk to the secretary.

If you answered D, you're a slimy lizard, and you'll make an ideal drug rep.

In fact, you'd make an even better one if you believe that there's a "d) thrilled" answer for every single type of doctor - from those who prefer competing drugs, to the skeptical, to the high-prescribers, to the friendly and outgoing, to the ones who won't even meet with drug reps.

That is, after all, how the drug companies train their reps to think.

Thanks to a new journal article out called "Following the Script: How Drug Reps Make Friends and Infl uence Doctors," available to anyone here at the PLoS online peer-reviewed journal, you can get an eye-opening glimpse into the mind of a pharmaceutical drug rep.

The article concludes, "Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends."

I'll admit, reading this made me a heck of a lot more wary. Even just a few months into medical school, I've already seen drug reps in action at the family practice clinic I go to for class an afternoon a week. I've seen everything including pens, patient chart notes, and Kleenex boxes supplied by drug companies, with their logo stamped thereupon (though I honestly can't remember any of those sponsoring companies...then again I haven't been prescribing very much yet). I've also gotten a couple free meals thanks to drug companies, and there are students in my class (who instill much jealousy within me) that have clinic at a group family practice office and a different drug rep each week brings lunch for all the docs and staff there.

I strongly encourage you to take a look at the article, even if it's just to browse the fascinating table explaining how a drug rep approaches each of the doctor types listed above. If, like me, you had little to no idea what's going on - or, if you're routinely visited by these reps - you need to at least give this article a glimpse.

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By the way, I proceeded to write about this again - link to Version 2, here.

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Check out Grand Rounds 3.31

Check out Grand Rounds v3.31 at Med Valley High!

Enjoy!

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Cancer Survivor, Children's Book Author, and only 14 years old

"I have Hope, Faith and Courage on my side
and Love standing guard at my back.
No Dragon in the world is a match for all that."

Somebody told me about Matthew Epp in an e-mail to our class, and I was incredibly touched by the story and had to share it with you.

When Matthew was only two years old, he was diagnosed with a rare form of cancer known as Wilm's tumor. With three recurrences throughout this life, nobody expected Matthew to survive, let alone be a thriving, energetic and inspirational 14 year old.

Matthew has overcome overwhelming adversity with the help of Hope, Faith, Courage and Love, and he has also done some incredible things in his life. He has been selected as the child representative for the Canadian Cancer Society, Saskatchewan's Children's Health and Hospital Foundation 2004 Champion Child, has met the Prime Minister, worked with the Chldren's Miracle Network telethon.

Now, he has written a children's book offering a touching story of a young boy who must undergo surgery who dreams of a magical land, and pictures himself in a fight against a viscious dragon, representing cancer.

You don't have to buy the book to be touched by the story. If you do choose to, however, and I highly recommend it, regardless of your age I can assure that you will benefit from the breathtaking story that this young man has to offer. A portion of sales goes to help fund cancer research.

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"Hit the patient" . . . ?!, and, My Dashing Clinic Partner

Doctor, to my clinic partner: "Go take the patient's pulse. And he's being uncooperative today, so if he objects, just... just... smack him."

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My family practice preceptor has been described as "an odd duck."

The description, I believe, is accurate.

Fortunately, I have had the pleasure of being accompanied to clinic by my breathtakingly beautiful and stunningly intelligent clinic partner (whom I'll refer to as "Kristine," for her privacy), who is in fact the sole reason I look forward so much to the 35-minute drive to our clinic location. My clinic afternoon is always filled with brilliant and hilarious conversation to and from our clinic, as well as a number of knowing looks behind the back of our preceptor when he is acting inept / absent-minded / odd / just plain insane. This post is a story about our preceptor acting in such a way.

Actually, I'm killing two birds here. Not only is this post about our i/a-m/o/j.p.i. preceptor (I'm getting the hang of turning everything into an abbreviation, as doctors apparently like to d0), but it will also co-feature my clinic partner Kristine. On occasion she has been known to read this blog, and has been begging for some time to be featured in a vignette herein. I am happy to finally give her the honour.

Before you think my preceptor is unfit to practice, let me just explain some things. His sense of humour is very...different, and he has known a lot of his patients for years and they have a lot of respect for him, which was surprisingly evident in every interaction they have with him. So, though you may be shocked by some of the things that you will see below (as I was), remember that in a lot of respects this is like old friends joking around and I am under the impression that the doctor knows when such antics are appropriate. That being said, if you still think it is inappropriate, well, that is your right as a human being, and I will definitely not be surprised.

Explanations and disclaimers having been issued, here, in abbreviated form, I present some gems from our time together, our meaning Kristine, me and the preceptor.

Doctor, to patient: "[Student] will now give you your immunization"
(Student = either Vitum or Kristine. Identity protected for student's privacy.)
Student: "But I have never given a needle before!"
Patient: [looking terrified, about to object, but interrupted by doctor...]
Doctor: "Aaaaaand... GO."

Students, to doctor: "Shouldn't you wear gloves while you remove these staples from a scabby infected surgical wound?"
Doctor: "Oh, that's right. Do as I say, not as I do."
We've turned our doctor into a hand-washer. We never used to see him washing his hands

Vitum, interviewing patient: "And did you experience any other pain after that?"
Patient: "No, none."
Doctor, to patient: "Tell Vitum the truth."
Patient: "What?! I am telling the truth."
Doctor: "No, you're NOT. (almost shouting) Tell him."
[Silence.]
Vitum: (shocked)
Patient: "Oh, that's right, there was this one other time..."

Vitum, trying to show off his stunning powers of observation: "Why does our preceptor have a painting titled Porcupines Mating on his wall!?"
Kristine: "It says Porcupine MOTHER"
Vitum: (to himself) "I need to wear my glasses more..."

Preceptor (to patient): "Dr. Vitum will see you now"
Vitum (to Kristine): "Did he just call me doctor?"

Preceptor (to patient): "Vitemme will see you now"
Kristine (to Vitum): "Did he just call me a female version of your name?"

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Overwhelmed much?

Finals are about six weeks away, and I'm already feeling the heat.

Let's just say that despite the slow start to the semester, last semester's finals was the most intense academic gauntlet I've ever been through, and it was on material I was familiar with, a lot of which I had seen in my undergrad. It involved being closed up in a study room, immersed in my studies, from wake to sleep, for about three straight weeks. I hate study rooms, and got through undergrad without having to use them much, so for me to do that is a feat in itself.

This semester is going to be a different story.

This semester, we have an extra five weeks of school covered in finals, all material that I have never really covered before. The weeks we have had have been much more intense and involved a lot more information than last semester. We have also had significantly more clinical skills instruction, as well as a course in pathology that we didn't have last semester.

We will have finals in:

• clinical skills
• family practice
• infectious diseases
• cardiology
• fluids electrolytes renal genitourinary
• pulmonary

as well as three extra finals:

• histology
• pathology
• anatomy

as they relate to the above finals.

Oh, and one ten-page essay. Okay, that could be worse, but have pity: it has to be about relating a medical condition with the social aspects. What, since when do patients have a social side to them?!?! This will be hard for my science-based mind to wrap itself around!!

Yep, feelin' the heat. Good thing I find most of it fascinating.

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