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December 2008

Industry intelligence in association with star

Junior doctors have an important role to play in secondary care, but how well is the pharmaceutical industry developing lasting relationships with this group? This month, Customer Insights profiles a second year Medical Trainee.

What is your title?

Dr Helena Fotiou, CMT2 (Core Medical Trainee Year 2 or third year SHO) working at the Heart of England Trust, Birmingham.

What are the main objectives/responsibilities within your role? How/why has it grown in importance in the past few years?

The main objectives of my role are to routinely deliver good patient care in a ward setting and to provide acute care during patient admission to a medical bed in hospital. I rotate through different medical specialities on a four-monthly basis, so the content of my work will vary to some degree depending on the specialty I am in. For instance, I have been on a placement in Intensive and High Dependency Care recently and have had no clinic work and little interaction with acute admissions via A&E. As a junior member of the medical firm, I ensure all relevant information about the patient is available to my senior colleagues to direct their care. I am also responsible for ensuring the patients are appropriately monitored and that their investigations are arranged. It will generally be the junior doctor who writes the drug chart and chooses which PPI, for instance, that patient will receive during their admission. I usually spend the most time with the patients out of the medical team and will be the main interface with the patient’s family members. I am also important in the process of discharging the patient as promptly as possible as soon as they are declared medically fit to leave hospital. I have previously also been responsible for writing discharge summaries, including patients’ discharge medications to their GP.

According to a rota I will be leading the acute medical take of new patients and managing the post-take ward round with the consultant within the first few hours of a patient’s admission. Other medical specialities may require me to help in outpatient clinics and to attend multidisciplinary meetings. I also have to attend teaching sessions and I have a responsibility to lead my training and ensure my learning needs are met.

What does a typical working week look like? With whom would you expect to liaise?

My typical working week can be quite varied depending on my on-call commitments. I will be routinely on the ward and occasionally attend outpatient clinics with multidisciplinary team (MDT) meetings and teaching sessions once a week. On-call I will either be based in A&E or on the wards. I might liaise with all the members of the MDT on my ward including social workers, physios, pharmacists and Speech & Language Therapists. During on-calls I interact with A&E doctors and nurses and the occasional manager.

What and who are the major influences on the decisions you reach? How do you arrive at your priorities?

My decision-making is primarily led by patient need and is set within the context of the NHS infrastructure within my hospital and Trust. Decisions regarding a patient’s admission for treatment will be directed not only by their clinical state but also by their social circumstances, i.e. whether they live alone or in a supported environment and can seek help appropriately. Access to investigations or procedures and availability of resources impacts on the decisions I reach or those taken by my senior colleagues on a regular basis. Increasingly our workload is directed towards increasing patient turnover and managing bed provision, whether this is on the general medical or speciality wards or ITU/HDU. The patient’s overall care is primarily the responsibility of their named consultant so their decisions will overrule my own. My prescribing decisions will be influenced by what is understood to be best practice, i.e. by national or local guidelines, as well as consideration of the hospital formulary and the availability of medications. My priorities are led by patient need and safety, but must take into account the need of the hospital for service provision to the whole community.

What contact do you have with people from pharmaceutical companies?

I mainly have contact with people from the pharmaceutical industry in lunchtime departmental meetings held for training purposes. They will have provided lunch and at the end of the teaching will do their own informal presentation about their drug or drugs of interest to that particular department. They usually have some ‘freebies’ to give out, like pens and paper, memory sticks or paper weights.

How can the industry achieve greater access to people who perform your role? What kinds of information might they be able to provide you with, to help you within your role?

Junior doctors’ awareness of new research findings usually depends on their seniority and training level. They may feel that a choice of medication is formulary-led rather than an issue they can influence from the ‘shop floor’ and they are usually influenced by their senior colleagues’ opinions and preferred choice of drug. The only times junior doctors will come together as a group is when we are required to attend teaching sessions and grand rounds.

Some drug reps have spoken about drugs that were directly relevant to the subject of the teaching session and this allowed a broader discussion of a therapeutic area and prescribing decisions. These have been not only the most memorable but also the most useful meetings and, most importantly, have altered some of our prescribing choices.
Some of my colleagues arrange drug rep lunches around informal teaching sessions on subjects of our choice and invite a relevant rep to provide food and do a presentation at the end.

As junior trainees, it is our responsibility to find ways to meet our training needs, however on a day-to-day basis these can often be de-prioritised in favour of service provision. The willingness and ability of a drug rep to engage us in a wider context around a therapeutic area beyond the scope of their particular product would be more engaging and have the greatest impact on prescribing decisions, even if it may involve discussion of other drug choices. Information about their own drug but also the latest developments in that field and references to other relevant research would help us
fill our minds as well as our stomachs.

How do pharmaceutical sales professionals need to improve their communications with this group?

Seeking out a representative of the junior doctors forum of each hospital and encouraging informal teaching sessions around their products’ clinical areas would be useful, as such sessions often fall apart without the incentive of food and due to the failure of the session’s leading doctor to turn up because of work commitments. Developing a rapport with junior doctors in which they
can deliver on their own commitment to promote their product as well as support them in their training would seem a mutually beneficial way to engage this group and could lead to lasting professional relationships between these parties throughout their careers.

What would be your top five tips for medical sales professionals on how to improve relationships, and therefore productivity, with this group?

• Ensure the product is relevant to the subject of the meeting/session around which their presentation is based. Be prepared to engage with this group directly.
• Bring training tools or materials geared towards this group along with materials on the product in question.
• Come prepared to answer questions on therapeutic decisions that may include products other than your own.
• Have more visual aids available if the setting of the meeting allows.

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