Having personally undergone several trips to the emergency room (including one today for a broken acromion) I can tell you it is very difficult to keep track of everyone coming in and out of the operating room. This is especially difficult with everyone covered head to toe in matching surgical masks and scrubs, and the fact that you're most likely in a great deal of pain does not help either. Even with all my previous trips to the Operating Room (OR), I was never informed until today that sales representatives working on commission for medical device corporations are present in the OR camouflaged among the scrub cladded physicians. This was astonishing to me due to the ethical implications that arise from people working on commission, without medical degrees, advising my surgeon as to what device is best to screw my bones back into place for proper healing.
Research regarding the influence of these sales representatives on physician decision making has shown evidence that there is significant influence on physician prescribing behavior, reduced physician awareness regarding the adverse effects of prescribed drugs, and there has been very little public discussion regarding the relationship these two parties share (O’Connor, B., Pollner, F., & Fugh-Berman, A., 2016). In fact, the reason I was never informed of the possibility that sales people may be present in the OR during my procedures is because I am not able to find any law in the U.S that states this information is required to be disclosed to me. If research has shown these corporate representatives have influence over the decisions of physicians, shouldn't patients have the right to know and/or refuse these representatives' presence? In my experience, corporations look out for their shareholders, and not the little guy like me. With this in mind, the thought of sales people able to earn commission off of my injury is rather unsettling. What's interesting is that when I looked into the opinion of surgeons on this practice, I found that surgeons generally appreciate and prefer device representatives in the OR (Altieri, et al., 2017). Might this be because this takes some of the decision making off of the physician making their job easier, and could this come at the expense of the care delivered to the patient? Do you believe patients should be informed and allowed to waive the presence of these representatives during their surgery? Would this benefit or worsen long term surgical outcomes?
Citations:
1. Altieri, M. S., Yang, J., Wang, L., Yin, D., Talamini, M., & Pryor, A. D. (2017). Surgeons’ perceptions on industry relations: A survey of 822 surgeons. Surgery,162(1), 164-173. doi:10.1016/j.surg.2017.01.010
2. O’Connor, B., Pollner, F., & Fugh-Berman, A. (2016). Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives. Plos One,11(8). doi:10.1371/journal.pone.0158510
Will,
ReplyDeleteI have heard of this in the past and found it to be disturbing as well! I looked into the role of the medical device sales rep further and found in addition to being a sales rep this individual is an expert on the use of the medical device (which, yes is bizarre given they are in fact not a medical professional at all!) and provide “troubleshooting” during procedures. Most physicians believe reps benefit patient care by increasing efficiency and mitigating deficiencies among operating room personnel [1]. Without a doubt this raises ethical questions about the reliance of surgeons on device reps (and the extent to which device reps are assisting with surgical procedures and influencing physician decisions in care). Some companies require OR medical device sales reps to have surgical tech training. However, this is not common practice for most companies. Kinda scary! Get Well Soon!
O’Connor B, Pollner F, Fugh-Berman A. Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives. Plos One11, 2016.
So I actually was interviewing to be one of these reps before I was accepted to Regis. Both companies I interviewed at numerous times and I had to know someone in the business to be recommended. As much as these people do not have medical degrees, they commonly require extensive background to even apply. You must have an RN license, a biomedical engineering degree, an impressive clinical experience background, or all three. A huge thing they look for is a very clear motivation for medicine, not money. Most of these reps actually go on to medical school after working for a few years. They are also trained for 3-6 months, 40 hours a week, before they can be in an operating room alone with medical staff. Yes, they do make commission, but it's not as bad as it sounds. Typically, the hospital or specific doctor will use a company that provides great devices and good reps to support them. There is no battling it out in the OR of which rep gets the commission or anything like that! Reps are not allowed to touch patients at all in the operating room. They train on cadavers so that they know how to use all the devices, but not in an actual OR. They just make sure the equipment is set up properly for the surgeon and that nothing goes wrong. Hope this gives some insight and comfort!
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