Top 10 Detailing Pitfalls

February 1, 2002
Christopher E. McCarthy, MD, FACP

Christopher E. McCarthy, MD, FACP is a St. Louis–based primary care physician and author of “Pharmaceutical Marketing and the World of Primary Care.”

Pharmaceutical Executive

Pharmaceutical Executive, Pharmaceutical Executive-02-01-2002,

Competition for physicians' time has become so intense that some medical groups have severely restricted or banned reps altogether. Part of that strained relationship can be traced back to some of the sales techniques used by aggressive pharma salespeople. Physicians have become wary of being "sold" and often do not trust the information reps provide. Many doctors no longer feel that sales reps help provide better care for patients. Rather, physicians often come away feeling as though they just had an encounter with a used car dealer. To improve their relationships with medical professionals, pharma sales reps should avoid ten

Competition for physicians' time has become so intense that some medical groups have severely restricted or banned reps altogether. Part of that strained relationship can be traced back to some of the sales techniques used by aggressive pharma salespeople. Physicians have become wary of being "sold" and often do not trust the information reps provide. Many doctors no longer feel that sales reps help provide better care for patients. Rather, physicians often come away feeling as though they just had an encounter with a used car dealer. To improve their relationships with medical professionals, pharma sales reps should avoid ten common pitfalls.

1. Asking For a Commitment

The presentation is over and the rep has given useful and practical information. Suddenly he asks the doctor to commit to prescribing the drug to her next ten patients. The doctor responds with a pained look. Why? Because there is whole host of factors that influence which drugs she prescribes. Her choice now is either to lie to the rep or spend time explaining why she cannot agree to his request. Also, the dynamic of their relationship is no longer professional because the request could be interpreted as a personal "favor." That may have undesirable consequences, especially if the rep and the doctor are opposite sexes. If the sales person has done a good job, the product will sell itself. Asking for commitment is unnecessary.

2. Probing Questions

There is a hierarchy in medical school, from the professor to the chief resident, on down to the lowly third-year medical student. One common way to maintain that pecking order is through a process known as "pimping," in which one medical professional asks another a question that he knows the answer to and the other probably does not. When the second person fails to provide the information, the first demonstrates how smart he is. Pharma reps frequently make the mistake of trying to open a conversation by asking a "probing question" designed to let them make a point about their product. Instead it smacks of pimping.

Salespeople should avoid that approach. They may not get the answer they seek, and the conversation may stray, allowing the physician to make a mental exit or take the conversation in a different direction. Good reps never allow the doctor to take control of the interaction. Rather, they should control the information being presented and deliver it in a concise, orderly format. If they want to make a point about symptoms, side effects, or costs, they should simply make it.

3. PDR Nitpicking

The Physicians Desk Reference has become a common battleground in pharmaceutical marketing. Reps often pull out the package insert of their competitor's product and start tearing it apart. But physicians like to feel that they know everything the PDR says about a drug that they prescribe, and, to them, the reps' behavior looks like nitpicking. Salespeople must be careful about quoting PDR obscure facts or statistics. If the information has no clinical relevance, reps will seem desperate for ammunition to use against their competition. They should use the PDR only when it points out a significant clinical difference between their drug and the competition's.

4. Cytochrome P450

Today there is a tremendous amount of interest in potential drug-drug interactions. Fortunately for patients, most such occurrences are subclinical in nature and have no relevance to the care of the average patient. Reps should not try to dazzle doctors by citing all of a particular product's effects on the cytochrome system. They can skip the charts with the different classifications. They are overwhelming and confusing. If the interaction has the potential for adverse consequences, then they should remind physicians time and again. But reps should never use that as the strongest selling point unless it is a huge issue in prescribing the product.

5. Too Much Information

The amount of information doctors can absorb at one time about any medication is limited. When reps bombard them with all sorts of clinically irrelevant facts and figures, the main message gets lost. Reps should emphasize only five or six important points. That doesn't mean they don't need a complete understanding of the therapy; they just don't need to tell physicians everything about it every time they visit.

Doctors have a database stored in their minds, consisting of efficacy, cost, side effects, drug interactions, monitoring, safety, dosages, formulary coverage, and sample availability. Reps should be sure that MDs' databases contain all the important information. If not, they are unlikely to prescribe that particular therapy.

6. Spin Doctor

If damaging information about the company's product has just come out, or is about to, sales reps should visit physicians as soon as possible and tell them. Doctors don't want to learn from their patients that the product they just prescribed is about to be pulled from the market.

Physicians are the industry's ultimate sales force. They are the ones who must convince patients to take a particular prescription. Their reputations with patients suffer greatly every time damaging information about a drug is revealed. Companies cannot expect doctors to continue to prescribe a therapy if the company and its reps are not honest and upfront about it. The company may lose some sales, but it will not lose its credibility. Once that happens, physicians will have a difficult time believing anything the rep or the company has to say.

7. No More Toys

Pharma companies spend a lot of money developing little "reminders" to help physicians remember their products' names. Some-pens, pads, and anatomical models-are helpful. But all the silly dolls and other cute little toys that reps leave behind don't sell pharmaceuticals. Physicians are embarrassed to take them, especially when they know that some of the costs patients bear help pay for those toys. Patients see the toys, and they know that is where some of their hard earned money is going. Companies should not expect their reps to use toys as a selling tool. They only distract doctors from the real information and make reps look silly.

8. Not Knowing the Product

Physicians expect reps to know everything about their products. If they don't, it diminishes their credibility. Doctors need reps to be an instant resource for questions about new medications. If the rep has to ask the research department to send the information, chances are the physician will never read it. Salespeople should read everything they can about their products, for both approved and non-approved indications. They must be familiar with the latest articles in the commonly read medical journals. If they don't know what journals to study, they can ask their physicians.

9. Not Knowing the Disease

The world of medicine is changing at an ever-increasing pace. Pharma reps must know what the latest models are for the diseases their drugs treat. If they want to be regarded as professionals who can help physicians do their job, they must be well versed in their field. The information is readily available. If their company can't provide it, reps can check with local physicians to find out where they can access the latest information about relevant diseases. Otherwise, they come across as glorified salespeople.

10. Unnecessary Manipulation

The last interaction that occurs between physicians and pharma representatives is the "close." That moment can make or break the entire sales call. It is critical that reps do not suddenly change the dynamic of the visit from that of two professionals discussing therapeutic treatments to that of a salesperson-consumer interaction. They must remember that physicians are not the ones using their medications, nor do they stand to gain financially from prescribing a particular product.

If anything, in certain insurance arrangements, using a product may actually cost physicians money. Doctors are not just another target; they are professionals trying to decide how to best care for their patients. It is important that reps never ask physicians to restate something they have said or to sign a prescription pad with the name of a therapy on it. They must not try to force physicians to agree with everything they just said, and they must not ask doctors to commit to prescribing their product. It makes physicians uncomfortable and smacks of manipulation. Insurance companies, patients, and pharmacy benefit managers manipulate physicians all day long. Reps should not add themselves to that list.

Better Relationships

Pharmaceutical salespeople can be a tremendous aid to practicing physicians if they so choose. Behaving in a professional manor and knowing their products and the relevant diseases will benefit both parties. In the days ahead, physicians and the pharma industry will have to depend on each other more and more. They need each other and have reached a critical time in their relationship. Both parties must make their interactions beneficial to keep the relationship healthy.

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