Are physicians and medical device reps too buddy-buddy?

Researchers examined the ethical implications surrounding the close-knit relationships physicians and medical device representative develop in the operating room in a new study published in the journal Plos One.

The qualitative study, sponsored by Georgetown University in Washington, D.C., included two separate focus groups — one with ear, nose and throat surgeons and one comprised of hospital-based attending orthopedic surgeons.

Researchers also conducted individual interviews with three medical device representatives, a director of a surgical residency program at an academic medical center, and a medical assistant at a multi-physician orthopedic practice.

The surgeons indicated that device representatives are a fixture in the OR during orthopedic procedures, as they ensure all necessary devices and instruments are available and ready to use prior to the start of the surgery. They also provide surgeons with technical advice regarding the instruments during the procedure if asked.

Most surgeons valued the representatives they chose to work with and said they improved efficiency within the OR. Some surgeons said they were uncomfortable with certain aspects of the device representative's role in the OR, yet still defended their own personal relationships with them.

Researchers discovered that device reps work hard to make themselves indispensable to surgeons to maintain their influence and offer personalized services along with the devices to foster a sense of loyalty. They viewed surgeons as potential clients and some even admitted a sense of guilt regarding specific sales practices.

One rep said, "I often felt like I’m driving up the costs of the healthcare system…We used to sell an implant that has 99 percent survivorship at 15 years, which is great, right? We were told to not ever market it to anybody…If a doctor asked for it by name, we would give it to him. We want to market the newer, the better technology. I'm not certain I ever thought the newer technology was better. There certainly wasn't data on it…I was uncomfortable with those sorts of things."

The researchers believe more studies are needed to fully understand the potential issues and pitfalls of excessive industry influence on physicians and their treatment decisions regarding implanted medical devices.

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