Probably an all too familiar character, Dr Grumpy is the pharma rep’s most difficult customer. So how can you win him over? Self-confessed ‘grumpy’, Stephen Head, explains his resistance to sales pitches and the disadvantages of fast-acting and convenient once-daily drugs.

To say I dislike pharma sales reps would be wrong – and perhaps hardly possible.They are, after all, chosen to be attractive, personable and likeable people. They are always smartly dressed, polite and patient. And unlike colleagues, patients, NHS managers or politicians – drug reps never rub me up the wrong way.

But maybe there is the rub… I hate saying ‘no’, I love to engage in supporting win/win relationships – I do it all the time with patients – but with sales people there is always a sense of unease. In the background I have an uncomfortable feeling that if selling a product requires that much effort, perhaps it’s not that good anyway. And being a bit of a critical appraiser, the information provided by drug reps often fails to impress.

Then they give me trinkets, or even lunch, and I still have big doubts about the product.

At this point I suppose my unease amounts to a sense of guilt – meeting nice people, being treated kindly and generously by them, only to not do what they want me to do and use their product.

Sales Resistance

I’ve had the occasional exceptional relationship with drug reps, usually based on other things we had in common.With these I might open up and share my regrets and concerns. One hit the nail on the head:“You don’t like being sold to.”

He was absolutely right and it’s not just about drugs.The Internet is wonderful. No longer do I have to talk to acneiform youths in Currys to buy a TV, or have giggly schoolgirls on their weekend job asking “Can I help you?” when I am trying to sort out for myself which, if any, pair of trousers I might buy.

Underlying this is a strong conviction that if it needs selling it’s either not very good or overpriced. As a GP with the sort of income the Daily Mail keeps grousing about, I take an evil delight in finding the cooking utensil I am seeking in Poundland. And I have banned family members from using the name of a famous shopping mall nearby as though it were blasphemy – which in a sense it is (to me, “leisure shopping” is as logical as bamboo shards down your fingernails for pleasure or tooth pulling without anaesthesia for selfamusement).

Is Sales Resistance congenital or acquired? As a Yorkshireman who trained in Scotland I find it hard to say, but suspect there is a synergy between nature and nurture.

But the “anti-pharma” literature – Drugs and Therapeutics Bulletin, stuff from the National Prescribing Centre (surely an oxymoron – they usually say don’t prescribe) and the “Thought Police” (PCT pharmaceutical advisers) – all pile in to reinforce my basic antagonism to sales pitches.

Features into disbenefits

Over the years I have occasionally enjoyed myself by upsetting reps, especially if their products were not based on clear quality headto- head benefits compared to standard therapies or the opposition. But I get especially annoyed when sometimes even good products are marketed with no sense of what I need as a GP.

That marketing thing about turning features into benefits often just breaks down. A few examples might illustrate:

Example 1

A proprietary compound analgesic, with the same ingredients as cheaper generic alternatives, was heavily sold on its rapid mode of action – therapeutic plasma levels after 20 minutes.The rep seemed genuinely shocked at my negative reception of this “benefit” – I actually did detect quite marked annoyance – but she knew she’d make no sale by then.“20-minute therapeutic response”? Well that’s a complete disaster to me! If drugs work quickly then patients will want them quickly.When I’m being harassed on a Monday morning the last thing I want is people demanding immediate care so they can receive immediate benefit. I prefer slow acting drugs any day – then whether the patient is seen now, in two hours, or even tomorrow will make little difference – except it keeps me sane.

Example 2

The macrolide antibiotic that comes in three-day courses for children’s ENT and respiratory infections. Really – so how good is that? We know most of these infections are really viral (not that I am a nihilist when it comes to antibiotics in children) and really viral illnesses often drag on for much longer than three days.

So do I want hordes of snottynosed kids paraded in on Day Four: “finished the course and still not better”? No I do not. And on the same subject, a seven-day course puts my accessibility into perspective. If a child is screaming with earache, how helpful is prioritising the day when I can explain IF antibiotics are going to help? It often takes over 48 hours for them to kick-in and a whole week to complete the treatment.

Those are the kind of timescales that keep my receptionists happy and stop my lunch going cold. There are scores of products out there sold on the basis of simple once-daily dosing – either monotherapy or compounds of two or more classes of drug combined in one tablet or capsule to aid compliance. I grant you there are some busy, unworried but unwell people who want to get on with their energetic lives who might benefit from such products.

“When I’m being harassed on a Monday morning the last thing I want is people demanding immediate care so they can receive immediate benefit. I prefer slow-acting drugs any day – then whether the patient is seen now, in two hours, or even tomorrow will make little difference – except it keeps me sane”

But these kind of people don’t come to see me.The kind of people who come to see me have multiple complaints and “no life” (as in the corollary of “Get a life” – which they can’t). Eric Berne, transactional analysis guru of the 1960’s, explained how people need to structure time.

For most of the sad people who see me their only options to do this are:

1) seeing me
2) managing 45 different medications all inconveniently and confusingly packaged.

So which do you expect me to prefer?

Please don’t simplify their medication regime – it will give them “space”. For if you do, they will just get into my space – and when I say “Get out of my space” they will explain (not quite their own words) that the reduction in burdensome polypharmacy has generated new opportunities in their life – to bug me.

Marketing to ‘grumpies’

I can’t be the only judging / thinking / sensing / introvert in medicine – in fact I have assessed many colleagues on the Myers Briggs Inventory and a lot turn out like me (and they tend also to find drug reps difficult).

Perhaps it’s time to look at new ways of marketing, based on models that us ‘grumpies’ might relate to.The biggest challenge will remain cognitive – having evidence of value even a GP who shops in Poundland might accept.

Firstly, you need GOOD evidence. If your products are dicey by our standards, seek better evidence. If you can’t get it – change company. Secondly, please respect our problems. Don’t assume your sales pitch will suit UK GPs. Remember the International dimension – three-day course with return visits may be fine where GPs are paid per consultation – they’re terrible here. And finally, don’t insult us with plastic pens, post-it notes or a curry buffet before the “yawn” presentation.

A visit to your US manufacturing plant with return business class flights, five days at leisure in New York, all accommodation provided and a generous gratuity for outof- pocket expenses – that might even make Dr Grumpy smile.

And will we then prescribe your products?

Will we f***!