Glad it's over

I had the colonoscopy today (Tuesday so I guess yesterday). The Doctor and Nurses were great. This was the Gastro Doc that showed extensive interest in and knowledge of Pacemakers/ ICD's and the importance of having a rep present for the programming instead of a magnet.

The NP in my Cardio's office made the arrangement for the rep. to be there. The Gastro Doc and I were very grateful.

The rep showed up...not the rep I thought was coming but not the "don't wanna do my job" rep so that was fine. He checked my device and turned off the defib. So far so good.

And then it began....He asked the Anesthesiologist if they have a magnet. He said, yea, somewhere. The rep said they could just use the magnet to turn the defib. back on.

I'm lucky they had that conversation in front of me or he would have been gone.....and then what?

I had to explain (yet again) that I had problems in the past and we need him to use the programmer when the procedure is over to check the device and reactivate the defib. Ok, so he's staying. I guess it wouldn't be a procedure or surgery for me if there wasn't some extra pacemaker rep stress.....part of my "new normal".

They wheel me into the procedure room and the Doc is there, we exchange a few laughs and then he tells me the rep called him and asked the Doc if he really needed him??. The Doc replied "Yea, I think they want you here".

So I just don't get it. They must be given an allotted time for these procedures or surgeries. Aren't they expected to stay for the full procedure or is "magnet and go" in 4 minutes the new way? And, if the Cardio's office says they want them there, why do they think they can call and try to get out of it? I am very disillusioned by this whole process now.

Can anyone enlighten me? PacerRep?

BTW: The procedure went well and electrocautery was not necessary so great report. Just glad it's over.

Grateful Heart

13 Comments

Thanks Don,

by Moner - 2013-12-11 02:12:22

Hi Don,

Thanks for your reply, my hospital I go to operates in the same fashion.

Moner
>^..^<

US Tech Reps

by donr - 2013-12-11 02:12:30

The PM Mfgr's Reps we have are Tech types; trained by the mfgrs & are not sales people. They perform the same function that your Govt employee tech personnel do.

They are experts on their company's devices & are continually updated on tech issues. This is significant because the hospitals do not have to spring for the money to send employees out for continual training. The cost of this service is reflected in the capital cost of the device to the hosp or Dr. who implants it.

They answer to their company only for making their rounds & meeting scheduled visits to assigned hosp's & Cardios. They respond only to the medics they support when it comes to settings of the devices. No conflict of interest.
W/our decentralized system of care, the Reps ride a circuit visiting the various Cardios & Hosp's on a fixed schedule. They also are on call to support hospital ER's during other than normal business hours.

F'rinstance, the Medtronic Rep hits our Cardio's office every Tuesday & checks PM's all day for the Cardio. After he/she checks it, the Cardio comes in & we have a joint conference among the three of us. Usually we have time for discussion w/ the Rep before the Cardio comes in, giving us a chance to review our download report & ask questions. I get checked by the Rep once per year & once per year by the Cardio's own staff. He has several nurses who are trained to check them. Also, once per yr, the Cardio's EP comes in to check up on me.

Dunno about the Mfgr's Reps being cut back, but the hosp staffs are being mowed down like weeds right now in anticipation of changes coming in another two weeks.

The Reps are people just like those who work in hosps, so you have all the problems of quality personnel.

All the Reps that I have dealt with here in Atlanta have been top notch quality. They make NO changes to a PM's operating parameters unless approved by the Cardios they are involved with as a support rep. Every hosp does NOT have experienced PM people on their staffs so in emergencies, the PM Mfgr's reps are available to interrogate PM/ICD's & offer tech advice to whoever happens to be handling a patient.

It is a different system, yes, but it works w/i the boundaries of human personality & capability.

Don

Thanks Don

by IAN MC - 2013-12-11 03:12:54

I appreciate that the system must work to some extent or your country wouldn't use it. Nevertheless , if I lived in the US and was about to have a PM implant, I would ask the cardiologist the following questions :-

I) Am I right in thinking that the PM manufacturer's rep will be making the decisions re a large part of my cardiac care in the future ?

ii) What exactly is his or her level of training ?

iii) Does this after-sales service which you receive influence your choice of PM , or do you choose the make and model which is right for me ?

iv) If the PM reps are all called to a 5 day sales conference in Florida,which is totally out of your control, where does that leave me ?

v) Do you have any control over the availability of your rep ?

vi ) How do you appraise the performance of your PM rep - if he is no good at his job what would you do ?

vii ) If the PM manufacturer decided to suddenly wind up this after-sales function because it is not economically viable ( which they could do at any time ) what contingency plans do you have ?

viii ) Do you agree that the sole reason which PM manufacturers have for providing this service is to SELL more of their own brand of pacemaker , and it is nothing to do with my best interests ?

I could go on and on, Don, but I think you know where I am coming from ?

Ian

Yes, thank you Don

by Grateful Heart - 2013-12-11 03:12:59

Something is definitely lacking in my area regarding the reps.

Don, Moner.....anyone.......When you guys have any surgery, do your reps "magnet and go" or do they standby until post surgery to recheck settings, etc. without you or the Doc having to tell them to do so again and again?

I have read a few reports why programming should be used and not magnets.

I'm at my wit's end.

Grateful Heart

PM Reps - observations

by SaraTB - 2013-12-11 08:12:19

Hi Ian, as you know, I'm a Brit resident in the US. All my PM experience has been in the US system (so far!).

For what it's worth, the set-up at my EP practice is that he and my nurse practitioner do all the set-up and tuning and monitoring. The Rep. only comes in at their request, for example when they were having difficulty getting my second PM programmed the way I needed it: the Rep. knew a bit more about some of the 'deeper' programming options and was able to offer some more specialist knowledge. This was done as a team discussion with the EP, NP and myself. Final decision is with the EP, the Rep can only 'propose' alterations. Well, I suppose the final decision was mine, since I had to tell them whether it worked or not.

When I had my replacement PM, my EP discussed all the manufacturers at length with me - he wanted it to be a joint decision and he was clear that the had no bias.
My NP had recently gone for training with Biotronik, and we discussed that as well as the others, although they didn't yet know what the Mfg. service was like.

My first PM was Medtronic, the replacement Boston Scientific - I met the Reps from both, when additional tuning advice was requested, and they were equally supportive and knowledgeable.

This spring, after I called a conference to adjust the programming after some issues, the regular guy wasn't available, so his supervisor drove 3 hours to come in his place. He said they always provide cover when needed.

I wonder whether it's more economical for the NHS to train their specialists intensively, because essentially it's a full-time programming clinic centralised at a hospital, whereas in the US system it's usually just one element within a cardiology practice, in private medical offices (bit like seeing a specialist in the UK, as a private patient and not at the hospital).

One day, I hope to move back to the UK, and it'll be interesting to see how the NHS handles it once I re-qualify for eligibility.



Grateful Heart - I don't have an ICD, so perhaps programming isn't such an issue for me, but I am 100% paced. The decision was taken when I had my colonoscopy that they wouldn't need to have the Rep. available - I was however treated in the main surgical part of the hospital, so they could call in an EP if necessary, instead of the out-patient suite. Sorry you have to go through this anxiety.

I'm glad it's over, also...

by donr - 2013-12-11 08:12:22

Congrats on being the PFH again (Patient From Hell).

As usual, you did a great job of being a lump on the OR table.

I'll quote our Veterinarian for you "You have to be your own gatekeeper" through all this.

Enjoy the peace of mind that follows a successful peocedure.

Don

staff reductions?

by BillMFl - 2013-12-11 09:12:19

I know that in my area the Medtronic reps are very stressed out because of staffing cut backs and increased workloads.

More on Tech Reps in the US

by donr - 2013-12-11 10:12:46

Ian, et al: If we are lucky, Pacer Rep will stumble by & talk in depth from first person knowledge about this issue. But till he comes by - here's the scoop as I understand it from 10 yrs dealing w/ all levels of PMery. I'll address Ian's questions in order;

Ian: I appreciate that the system must work to some extent or your country wouldn't use it. Nevertheless , if I lived in the US and was about to have a PM implant, I would ask the cardiologist the following questions :-

Don: Yep, it works & everyone seems comfortable w/ it - except perhaps Grateful Heart after her several debacles. Remember that we have 200+ yrs of a different social & education structure than our principal progenitors, the Brits. Our judges & trial lawyers no longer wear powdered wigs & our soldiers no longer wear Bear hats - but we manage. Were it not for Rumpole of the Bailey, I'd feel scared to death facing a Brit court, so I can understand why you would have the questions you ask & the concerns that generate them. I'll never forget the time I was in a hosp & my pulmonary specialists' Physicians Asst came to see me to drain a pleural cavity. He was a former MD from the Ukraine. He could not get licensed in the US except as a PA.. Turned out that he was darned good at what he did & we had a grand old time as he grubbed around inside my body - joking all the time about him graduating from the KGB med school in Kiev.

Ian: I) Am I right in thinking that the PM manufacturer's rep will be making the decisions re a large part of my cardiac care in the future ?

Don: The only decisions he/she will have to do with will be concerning the direction he/she faces the PM interrogator while working in the absence of the Surgeon. All decisions will be made by the cardio/EP. Specific technical/design/operational programming & algorithms MAY be discussed w/the Rep if the Cardio so chooses. The Rep will be judicious about interjecting advice into conversations w/ "The Great Man" during any interaction. The level of involvement really depends upon the size of the ego of the surgeon. If it's the size of a Spitfire V-12 engine, the Rep keeps his mouth shut. If that ego is more like a lawnmower engine, he will probably volunteer more input.

Ian: ii) What exactly is his or her level of training ?

Don: Depends upon the mfgr. All the Reps I have met have had BS degrees in engineering -plus a whole slug of training at the Company's facilities, followed by intern training following around w/ a seasoned Rep. I have participated in the training of at least three intern level Reps. Takes at least a year for them to become qualified. The Mfgr has a lot at stake here because these Reps are the face that the Dr's see & deal with on a daily basis. If they are technically deficient, the company looks like a fool. The types of questions I've heard asked are "Far Out, Baby!" To put them in perspective they are the sorts of questions Frank would ask - or answer. KAG, the retired electrical engineer from Arizona has sat w/ a pair of them & vetted them very thoroughly. KAG is an experienced engineer with digital devices & programming from aerospace applications.

IAN: iii) Does this after-sales service which you receive influence your choice of PM , or do you choose the make and model which is right for me ?

Don: Ian, that's a darned good question! I'll betcha it depends on the Cardio/EP. You read what SaraTB wrote about choice. My Cardio leans toward Medtronic. He has more experience w/ that one. BUT he has ONE Sorin (Hi, Inga!) in his practice. I have had two Medtronics, they were adequate for my situation & have performed well for me. We've read bot situations here. But that is a question that is fair game to ask. I have not - but I surely would, now that I am an old hand at it.

Ian: iv) If the PM reps are all called to a 5 day sales conference in Florida,which is totally out of your control, where does that leave me ?

Don: In the presence of a fill in Rep of equal capability or better. I've had substitute Reps come in when our regular rep was gone on vacation or ill. In Atlanta, there is a network of Medtronic Reps that cover for one another.

Remember that these Reps are NOT sales weenies or marketing slime. They are TECH Reps. But ALL company employees have a responsibility to sell the company. After all, it's their livelihood. (Before anyone in sales or marketing gets their nose out of joint, I came out of marketing & was darned good at it. AND that's what I called them to their faces on a daily basis. You decide if I wore a smile.)

IAN: v) Do you have any control over the availability of your rep ?

Don: I cannot answer that beyond noting that the Mfgrs have a responsibility to keep the geographical areas covered w/ Tech support. Probably depends on the agreement w/ the hosps, cardios, EP's supported. In my experience, when one is needed, one shows up - be it in a hosp or Casrdio's office. Remember that the cost of the Reps' support is buried in the cost to buy the PM, so it is a contractural requirement that has to be met. Dunno how it is in the UK, but here, PM business is as cutthroat as a pirate's convention. Any Mfgr that falls down on tech support is going to lose sales.

Ian: vi ) How do you appraise the performance of your PM rep - if he is no good at his job what would you do ?

Don: Who knows? Only the company employing the Rep. Probably they would fire (Sack) his/her butt immediately. See my last comment. Serious complaints in our medical community go a long way. The Dr's can tell when a complaint is real or bogus. Our Cardio sacked his NEW head nurse based on patient complaints. The first one just raised his awareness of the situation. A few more & he concluded that she was spreading hate & dissention through the community, so she was GONE.

Ian: vii ) If the PM manufacturer decided to suddenly wind up this after-sales function because it is not economically viable ( which they could do at any time ) what contingency plans do you have ?

Don: Again a good question. Ask them. We will find out starting in about two weeks when Obamacare kicks in. We are seeing precursor waves of it already.

IAN: viii ) Do you agree that the sole reason which PM manufacturers have for providing this service is to SELL more of their own brand of pacemaker , and it is nothing to do with my best interests ?

Don: Of course that's my reason for providing the service. BUT!!!!! if I do not wind up serving the best interest of the patients, I will lose them, because they will go elsewhere. To quote Gordon Gekko from the Wall Street Flick, "Greed is Good." That has happened to many companies in the US. Dunno about in the UK. Studebaker, Packard, Kaiser-Frasier, more than one steel mfgr, several drug co's, several food processor companies all have disappeared from sight for this very reason - the list is as long as a basketball player's arms. The marketplace is a very vicious, unforgiving enviroonment

Ian: I could go on and on, Don, but I think you know where I am coming from ?

Don: Yes, a general mistrust of big business after working in it for a career & experiencing its strengths & weaknesses.

My answers come from a general mistrust of big Govt, after working in it for a career & experiencing its strengths & weaknesses.

I have also spent the past 25+yrs working in the business community & see a lot of aspects of each that can either be superior or inferior to the other environment. They both have their place in the scheme of things.

Don

Grateful Heart

by IAN MC - 2013-12-11 12:12:41

I'm glad your procedure went well ; you must be too !

I'm fascinated by the system you have in the US where manufacturer's reps are involved in patient care ; and particularly as you seem to have had bad experiences with your system .

Here in the UK all PM care is done by highly trained cardio-physiologists who are employed by the hospital and reps aren't allowed anywhere near patients.

Who exactly do your reps report to ? Do they report to
the cardiologist,or to someone else in the hospital, or do they report to a line manager in their PM company ???

There must be the potential to have a conflict in interest where the rep's boss wants him in place A and your cardiologist wants him in place B . The staff reductions issue which Bill raises must compound this potential for problems. Still , Im glad that your story had a happy ending !

Best wishes

Ian

Sara / Don

by IAN MC - 2013-12-12 09:12:22

Hi Sara :
Always good to hear from a Brit in the States
When you do mange to escape, and return to civilisation some aspects of the NHS may make you want to get on the next plane back to the US ; our A& E for example ( or ER as you call it ) is really almost at breaking point BUT our cardiology services seem to be excellent.

We have an extra layer of staffing in the cardiology teams,compared to the US, these are known as cardio physiologists , these people have a 3 year intensive training in pacemakers and related electrical heart problems and are responsible for all changes to PM settings . I believe that they sometimes also assist the EP with ablations. They are very knowledgeable guys ( and gals ) and I imagine that their training in heart disease is far more extensive than that of your PM reps whilst their knowledge of different makes of PM is continually being updated..

They are part of the hospital, part of the cardiologist's team and are not tied in any way to individual PM manufacturers

You mention the relative economics of the two systems; difficult to compare really but as Don says , with your system the cost of the rep after-sales service is probably factored into the huge prices that you pay for the PM relative to here.

But it sounds as though the treatment that you receive from your EP's office is excellent and that is all that matters.

Don It is a shame if Grateful Heart is the only person in the US who is not altogether happy with your PM rep system; but I suspect not ! ( don't get me wrong some people probably are not happy with our system; it all comes down to the calibre of the individual giving the treatment at the end of the day )

I, too, hope that Pacer Rep chimes in; it could be interesting to get his angle on it . Interestingly in his previous posts he never revealed who he worked for, i.e. who pays his mortgage but I did detect a certain amount of commercial bias in some of his replies re makes of PM. This , I guess, is what makes me uneasy with your system . I don't want someone with a strong commercial bias involved in my healthcare. Once you have commercial bias objectivity disappears IMHO !

Cheers

Ian

Ian: Response ...

by donr - 2013-12-13 12:12:14

...tomorrow. Too late tonight.

Don

More on PM Mfgr's Reps

by donr - 2013-12-14 01:12:06

Let me put my Bottom Line Up Front (BLUF). There is no such thing as a free lunch.

Any product or service must be paid for by someone. Ian & his Brit fellow citizens pay for the tech support they get through taxes. In the US, we pay via our insurance premiums or cash on the barrel head. We are about to learn if the Gummint or private sector does a better job at it. The promises from our Gummint were that everything would be cheaper, higher quality & universally available from a Gummint assumption of responsibility of healthcare. Currently, that does not look too promising on either front. But that is for another debate.

I do not know what the UK does as far as Mfgr's TECHNICAL support for their products is concerned, but in the US, our Mfgrs have always (defined as during my lifetime of 77 yrs) had a corps of technical (as opposed to sales) Reps in the field for liaison between the users & the Mfgrs.

During WW-II, my father was an aircraft engine Tech Rep for Curtiss-Wright, who Mfg large radial engines (18 cylinder) used in B-29 bombers. He knew all about the guts of those engines & spent several yrs at the aircraft plant here in Atlanta GA. If there was a problem w/ an engine, they called on him. There was a whole network of these experts at the plant, so there was 24/7 support available. The internet was not in existence then, & long distance phone service was difficult, at best, so he had to know what was going on inside those monsters.

BUT - he knew ONLY the details of the Curtiss-Wright engines - NOT the Pratt & Whitney engines of the same size. Yes, he was heavily biased toward his company's machine. He was the guy at the plant who was expected to know everything - the company kept him informed of the constant changes in the machine & it was his job to take that knowledge to the airplane mfgr. The cost for his services was included in what the Gummint paid the mfgr for each engine. Call it a "Push" system for knowledge & support. They were expected to provide a functioning, reliable engine & this was their way of doing it. It worked & did so very well - eventually after the bugs were all worked out of the design.

The same sort of support was established for any sort of complex electro-mechanical device.

IN The US such a TECHNICAL support system came out of WW-II for just about all complicated systems. W/ the advent of complex medical devices & computers the same systems of support were created. IBM, Sperry, NCR, HP - you name it, the mfgrs created systems of experts on THEIR systems to visit users & assist them in using, maintaining & understanding their products. These field teams were in constant contact w/ the home organization & ensured that information flowed BOTH directions.

Problems are most often found in the field with users. Having a Mfgr's Rep right there meant that eyes & ears were available where the problems were found. Whereas the users were responsible for day to day repair & maintenance, the Mfgr's Reps performed modifications & training on the spot on a daily basis & were available 24/7. Again, I reinforce that these Tech Reps have nothing to do w/ sales - the decision to buy a certain product was already made by the user.

I have been involved now w/ three organizations that use field support Tech Reps. I worked for one in the factory automation business. Their system used Tech Reps who were part of the sales organization, & Ian is completely correct - not a good system. The Reps were too interested in selling & their tech advice was biased toward that. In at least two situations, I had to step in & correct situations that verged on violating US Gummint procurement law. I was NOT popular w/i that division of the company, but I literally kept people out of jail. This reinforces my contention that Tech support must have NO association w/ selling. Enough said about a corrupted Tech Rep system.

On to organizational systems where it worked effectively & I have first person association w/ them.

First, General Electric Company manufactured a line of large scale digital computers during the 1960's. I taught at a university that owned two of them. GE had a Tech rep who was available 24/7 for support for those computers & all their peripheral devices. This relieved the university of the requirement to keep someone current on the really esoteric aspects of the machinery. I recall seeing the Rep in the center performing mods to the computers at all hours of the night & on weekends. His contribution to selling consisted of being a high quality technician that kept the reliability of the computers high. He maintained a small office in the center, but serviced several other GE computer owners/lessors in the geographical area.

Medical devices: I host a pair of hearing aids (EH???! Would you repeat that, please?) and am quite badly impaired (Not too far from being deaf w/o them). They are provided by the US Veterans Administration Hosp system. I see an experienced audiologist for support. Not unlike my PM. My particular set is manufactured by Phonak in Switzerland, & are bought under a negotiated contract for many thousands of sets annually. Additionally, just like for PM's, there are several other major mfgrs who sell HA's. Siemens, Beltone, Starkey, ad nauseum! The audiologists are trained by the mfgrs, under the sales contract. If you think a PM has a lot of parameters that are adjustable, try getting into HA programming. For those of us profoundly impaired, the HA is a rather powerful digital computer that does real time signal processing & gain control. Mine have at least 5 optional programs to match HA output to hearing loss as a function of frequency.

In addition to Phonak, the VA can buy several other Mfgr's devices for vets w/ diverse needs. But you can bet that there is a bias toward the Phonak devices, since that is where the major contract is. What device you get depends solely upon the decision of your audiologist, hence whatever biases they have determine your fate. NO organization is w/o preferences (Biases), regardless of how they are organized & to what technical level they are staffed.

Now - granted a HA host will not die if their aids croak on them, but the support can be just as big a pain as for a PM. The sales decision is already made in this case. But - there is no system of Tech Reps that visit the centralized VA hosp clinics to assist the audiologists. There are always questions/problems that come up w/ individuals & their aids. My audiologist calls Phonak at least once a year baseds on a problem I have that requires more in depth tech knowledge than she has.

MY VA hosp has at least 20 staff audiologists. To send them away for training would bust the budget. That is a problem w/ any large, centralized care facility that takes total responsibility for tech support of a system - the battle of the budget. Something always loses or gets short-changed. By relying on the Mfgr's Tech Reps, the cost is shifted to the Mfgr & reflected in the price of the device. The more devices that absorb the cost of tech support, the less the cost per unit. In the case of Phonak HA's, it's a telephone consult.

Medtronic - ah, here's where it all started! The US has, at least till now, a decentralized system of PM/ICD care. Generally speaking, the care is handled by independent Cardiology practices, as opposed to large scale clinics in centrally located hospitals. Hospitals provide separately managed & staffed OR's & support facilities that the independent cardios use. Yes, there are large scale hosp clinics - Mayo, Cleveland, Emory, Johns Hopkins, Baylor, etc, but the majority of the care is at private practices. Also, all major Medical Colleges support PM/ICD clinics at their associated "Teaching Hospital."

We are seeing a current move of hospitals to "Buy out" individual practices & move their operations under the control of the hosp. The main motivation is the onerous records & information collection requirements being placed on the individuals. Our Cardio sold his practice (& soul) to a major hospital. He did it because the admin cost & efforts he had to expend drove him to distraction & away from his primary love, treating patients.

Since the individual practices can decide what Mfgr's PM's to implant, you find quite a mix of brands, each w/ its own tech support structure, sending out sales reps to all the practices. Each is vying to sell to every Cardio. Part of the sales effort is to convince the Cardios that they provide superior Tech Support from the SOURCE - the Mfgr. If that ever slips, regardless of how good the product is, the mfgr is toast!

Here's the bottom line (again) - "There is no such thing as a free lunch." Whether you get tech support from the mfgr or your local staff, it must be paid for. The Tech Support system developed in the US works fine. The quality depends solely on the people involved - you have a bum, a lazy layabout, & the support sucks. You have smart, well motivated, dedicated people, it is superb. People are people, regardless of who they work for. The Gummint & large hosps get just as many duds as the private sector. Generally speaking, the larger the organization, the more difficult it is to give a dud the sack. I've seen it in cardiology. Grateful Heart has, also.

My experience has been that it is easier & cheaper in the long run to get the Tech support from the Mfgr as part of the device purchase price than to pay for it through training programs. When part of the device cost, it is detailed, current & interactive - the Reps on site take your problems & questions back to the Mfgr & get answers immediately.

Pacer Rep has described some of his OR experience assisting surgeons. He is right there; can advise based upon info as current as it can get because he is constantly talking w/ the mfgr. He is NOT a decision maker, he is an assistant & information source. Information currency is not necessarily an asset that a hosp staff member can bring into the OR. The Tech Rep is inundated w/ info from his home office. You can be sure that it gets to him. The company's life depends on it.

Aother Medtronic product: They also make a "PM" for incontinence. Urologists plant them. My wife has one, so we have seen the interaction between her Plumber & the Medtronic Tech Rep for bladder PM's. Matt (the Medtronic Tech Rep) knows all there is to know about their operation & setup & follow on adjustment. He attends every implant procedure she does. He brings the device & sets it up as necessary. After the procedure, he provides an hour long seminar for the new host, explaining all the adjustments & programs it has in it. We have two phone numbers - The Plumber & the Medtronic Rep. Either is available for questions - her for medical issues & Matt for purely technical questions. Now Wife's plumber would not be allowing Matt to talk to her patients were he not competent in his field of expertise. She is the Dr. held responsible for the patient's well being.

Your concern about commercial bias on the part of Pacer Rep - what do you expect from a man who represents only one Mfgr? He is NOT trained on any other devices, so he does not know them, nor should we expect him to be able to answer questions about them.

I suspect Boxxed is a multi-Mfgr man. As best I can figure him out, he works for a big cardio group in the Mid-West & supports them on all or several makes of device. From him I hope for zero bias. From Pacer Rep, I expect it big time. How successful would he be if he went around talking trash about the product he supports? Not very. Depends on who pays the Rep's mortgage, as Ian said.

Again, I dunno how it works in the UK, but the reputation of a Cardio gets around very fast here in the US. Ditto for the reputation of a hosp. There are web sites w/ all sorts of info & ratings on MD's & health care organizations. It is quite easy to vet a provider.

Don



Reps

by IAN MC - 2013-12-15 07:12:44

Don , I suspect that these posts are only of interest to you & I , apologies to our loyal readers if that is the case.

I should have come clean about my background . I started off as a research chemist working for a large UK Pharmaceutical company. I had a complete career switch in my mid forties and moved over to the commercial side . For my last 7 years I was national sales manager with a team of 96 reps ( all science graduates ) and 10 field sales managers. I tell you this only to reveal that I know a bit about reps.

I also had a small team, of supposedly non-selling reps who called an asthma clinics and helped practice nurses and GPs correctly use peak flow meters, inhalers etc. I say "supposedly" because , boy, did they knock competitors products if Drs raised them !!

My concern with your system revolves around a little scenario :-

Your cardiologist is working alongside Joe, the local Medtronic rep . He has known Joe for years , Joe is reliable and knowledgeable, his patients love him. ( this really is a sales manager's dream ; having a rep who has infiltrated into the customer's working life )

Believe it or not, the cardiologist does occasionally ask Joe about competitors' products because he respects Joe ( also like most medics , he is quite naive about big business ) " Joe, I hear that Sorin have just launched a new PM , does it offer any advantages ? "

How do you think Joe will answer , he won't give a glowing report on it , that's for sure !!!!

and if I happen to be a patient who would really benefit from features on the new Sorin PM , I end up being the loser . That is why it is ethically preferable for non-commercial people to be involved in patient healthcare .

I rest my case

Ian

You know you're wired when...

Your favorite poem is “Ode to a Cardiac Node”.

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