There is one question no pharmaceutical rep should never ask me, at least if they want to get a second question. It is this:
“Doctor, how do you approach the patient with…” fill in the blank; whatever clinical scenario you choose does not matter.
Here would be the parallel for a musician. Lets say you are a mandolin player, and you finish a set with your bluegrass band. A member of the audience approaches you after the show. “I enjoyed that. Could you show me how to play that little guitar in an hour?”
The answer is, “Well buy a quality instrument, find a good instructor, play at least an hour a day for a year, then come back. After that you will have a start on it. But no, I can’t tell you anything in an hour.”
The same is true in medicine. Unless the rep is prepared to go to school and invest a hundred hours a week for a few years in basic science before they get to interview the first patient, and then more years of hundred hour weeks to explore every nuance of patient history before they prescribe the first medication and then, well…. the best thing to do is not ask such a question. Because the answer is, “First you take an history and then you do an examination, and…. oh well, never mind.” Anything less is like asking a pilot to take off an airplane without going through a pre-flight check list. (Another approach to life I do not recommend.)
At best it indicates some marketing guru made them do it. Reps do some good in this world, and I want to hear about their products. However, I have no interest to try and explain how to be a doctor in a superficial response.
I am reminded of the great golf teacher, Harvey Penick. He was the famous instructor from Austin, Texas. He taught Ben Crenshaw and Tom Kite, so he knew a little about the game. So the story goes (paraphrased) his son-in-law wanted to learn to play golf. The young man was a fine athlete; a three letter kind of guy who was an All-American in basketball.
“Mr. Penick,” he said. (no one called him Harvey) “I want to learn to play golf. Can you give me some lessons?”
“Sure. I’ll send some clubs. Next time I’m there I’ll show you a few things.”
Mr. Penick shipped him out a set of clubs.
After a few months Mr. Penick went to visit. The son-in-law greeted him with great enthusiasm. “I sure am glad to see you.” Months had gone by and it had been a terrible go of it. “This game is giving me a fit.” Like all beginners the hooks, slices, and tops far outnumbered the sporadic solid strikes of the ball. ” Why did you wait so long for the first lesson?”
Mr. Penick smiled. “This is the second lesson. You have already had the first. In golf, a great athlete must be humbled before they are ready for the teacher. Now we are ready to start.”
I feel the same way about some of these reps. They are young, smart, educated, good-looking, and pop society hip, but hopelessly unsophisticated about medicine. I can no more give them a sound bite approach to lipid management than I can teach them to play the mandolin in an hour, or golf either one. It also holds true in writing, a fact I have begun to learn over the last nine years. Each discipline takes years to even get started.
Mr. Penick died a very old and wise man. He charged five dollars for lessons, but to everyone who knew him he was a very rich man. He understood things about life most people never know while here on Earth. He even came close to understanding golf, which is near impossible. I wish I had the privilege to know him, but at least I got to learn from his ‘Little Red Book.’ I am glad he left it behind.
Maybe I need to teach some of the drug reps how to play golf. I’d start by making them memorize Mr. Penick first.