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One of the few advantages of no longer being on the medical register is the comforting knowledge that despite the gravity of one’s misbehaviour, either currently or in the past, one can no longer be struck off.
But the nuns once taught me that confession was good for the soul, so on the assumption that I may one day face an even higher authority, it’s time to set my conscience straight.
I confess that over a period of more than 40 years, as a junior doctor and later as a consultant, I was willingly bribed, bought and corrupted. There, I’ve said it.
Like so many other criminals before me, I started small. My villainous peers, once reformed, and usually prior to launching a book, are sometimes asked what single factor started their life of crime. A broken home, extreme poverty or drug abuse are regularly cited.
For me, there’s one simple answer: Biros.
I had a need; a young family to feed. Children at home who were as carefree in their scribbling as they were careless in their ownership of pens.
And there were those queueing up to meet that need. They were willing, they were pleasant (not necessarily good or kind, but always ‘pleasant’) and they had bags and bags of pens.
The trouble is, a good medical rep will never stop there. They would unfurl the jotters, unhinge the miniature penknives, and clank an always slightly too large mug down on the desk. Things we never knew we needed, but that we craved nonetheless.
That was how I came to find myself on a golf course one afternoon, a course I had previously spurned because of its eye-watering fees. We knew the routine. A short presentation on whichever product was being hawked, followed by the run of the course, unencumbered by guilt or further spiel.
I know – or at least I think, or perhaps I hope – that I am referring to a bygone age. The greatly increased number of clinical guidelines means doctors have less individual power when it comes to prescribing, so there is less scope to corrupt the corruptible. The GMC’s rules on gifts and hospitality appear to have become more rigidly enforced.
But we didn’t always get away with it, even back then.
As we trotted across the manicured fairway, we suddenly heard a sharp, challenging voice behind us. ‘Just who is paying for you?’ he asked. That was all; we ignored him, but it was enough to hamper the swing and trouble the conscience.
Later, I thought I’d see what the rep thought. He seemed decent enough, he had his own code of standards, presumably, and he may not have worked in the health service but he was a patient, like everyone else, and he had an interest in it running fairly.
I found him in the bar and, like a particularly clumsy ethics presentation, I stumbled my way through my observations, reflections, concerns and dilemma.
His smile remained perfectly fixed. ‘Don’t worry,’ he said. ‘It’s all tax deductible.’
Peter Docherty is a retired consultant ophthalmologist from Derby
Dear Peter - brilliant bit of confessing - its over 25 years since we last spoke but you've lost none of your insight into medical life or mischievous sense of humour - best wishes Nigel Dickson
Too true, I made a policy of only accepting hospitality from companies whose products I was already using. In other words I made the decision before accepting the hospitality so that it did not influence my decision making on which product to use. This means I missed out on a lot of free golf. Indirectly the taxpayer paid for my free lunches so I was careful not to have too many.
Still going strong in Australia, lunch and dinner meetings...with some really interesting lectures having said that...
Working in an African country adds new ethical dimensions to this issue! Drug reps provide/sponsor a lot of useful teaching which would otherwise not happen. Also at the end of the day, labour is cheap, and they know they could be easily replaced, so they beg for our support so their families can survive. That is why, at least, I give them an audience and try to enter into a good discussion to push them to know their pharmacology and their product well. On the other hand, generics which are used in the government and charitable sector can be useless, so it depends on funds and seriousness of the condition whether we insist on the better brand.
Virtually everyone took part in these or similar activities when I was a junior doctor, in the '70s. I still have a couple of old stethoscopes in first aid kits, and tourniquets for venepuncture, emblazoned with the names of long forgotten drugs. We all knew we were being bribed, but the pay-off was so small that we could disregard it at a realistic level. Hopefully, we were intelligent enough not to base our prescribing decisions on the gift of a cheap ball-point. On their side, the drug companies offered some education, whilst also funding and undertaking the development of new drugs. We also understood they were driven by hopes of great profit in these endeavours, so were not taken in by false sincerity. Further, it was fairly obvious that without them, we would still be using digoxin, aminophylline and opium as our mainstay emergency medications, if all pharmaceutical research was left to government organisations.
The problems arise not from obvious advertising by 'Big Pharma', but the undeclared funding of research and trials of products by those whom we might expect to be impartial. It's our fault if we don't scrutinise the papers and review the declaration of interests; the companies are only trying to make a profit, even if their ambitions are large. Banning free ball-points won't change anything; but widespread and healthy scepticism will.
I too collected many pens . Despite the fact that I last worked 8 years ago am still finding collections of pens as
my husband and self are trying to declutter the house . Some work some do not so they are binned !!
Dr Rosemary King former GP
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