The 'Rep' is much maligned

MEDICAL MATTERS: Like Harry Potter's wizarding world, the medical world has its own terminology.

"Reps" have nothing to do with agriculture (although I have been asked to fill out reps forms by elderly farmers).

In doctorspeak they refer to pharmaceutical representatives. These are either lackeys of evil drug companies sent to bribe and befuddle doctors or ladies and gentlemen of the road, bringing science and conviviality to the far-flung outposts, depending on your point of view.

I tend to have mixed feelings about reps, tending to hate the sin and love the sinner. In other words, although I am not too fond of large multinationals, many of whom have dreadful environmental and ethical records, I like to see a rep enter the consulting room.

Firstly, let me say that I do not like reps simply because they give me biros. After more years in medicine than are probably good for me the excitement of receiving a free biro is now but a distant memory. I'm not that cheap.

The reason I like reps is because they are only secondary to psychiatric nurses as good listeners. I have honed many of my favourite anecdotes on reps. I imagine weary old reps say to eager young reps outside my door: "He'll then tell you the one about the professor and the urine sample. Laugh like blazes and think about the company car and it'll soon be over."

Like Mike Murphy, who could oscillate from the arts show to Winning Streak with the same breezy charm, a good rep will mix it whichever way you like. If the doctor wants to chat about the state of the roads, the rep will oblige.

If, on the other hand the doctor wants an in-depth discussion about the pharmaceutical profile covering the drug's side-effects, half-life and efficacy, the rep will also oblige. They have not been given that 05 Passat for nothing.

Drug reps tend to fall into two categories: the Old Stager and the Bright Young Thing. The Old Stager has his (he is invariably male) code. If he sees another rep in the waiting room, he will not enter until the next session. He will refrain from denigrating the opposition's product. He treats doctors with old world courtesy, no matter what he thinks of them in private. I suspect, although I have no proof, that all these Old Stagers regularly meet up in Athlone to have a right laugh at us and to jeeringly recite the story about the professor and the urine sample en masse.

The Bright Young Thing is beautifully groomed. She (for it is usually she) has a degree in biochemistry or marketing. She explains her product with the aid of flow charts and brightly coloured diagrams, using terminology that the doctor may struggle to follow.

A susceptible young GP friend of mine once, on seeing "rep" on his appointment screen swooped on one of these Bright Young Things in the waiting room. She had the expensive suit, the tan, the gleaming smile and was quite the most fetching rep he had ever seen. He whisked her off to the kitchen, made her a coffee and offered her a cigarette. She angrily declined, explaining that she was a barrister who had come for a pregnancy test. As my crushed friend led her back to the waiting room a grizzled Old Stager emerged from the bathroom.

The relationship between pharmaceutical companies and doctors is rather like that between recording companies and musicians. At some stage each will need the other, but there is a degree of wariness on both sides underneath the bonhomie.

Doctors in training are made aware that the cost of hospitality is ultimately borne by the consumer. GPs who are influenced by reps tend to prescribe more expensive medication. Trainee GPs are taught to spot any degree of spin and are rigorously trained to prescribe.

And yet many of our patients who cannot afford medical cards have been glad of the free samples from drug companies and many of the reps keep us informed about generic products which are made in Ireland and are cheaper varieties of the main brands.

Reps also, famously, sponsor meetings. We all have to keep up to date. On weekday nights throughout the winter, GPs all over Ireland gather in hotels to attend lectures and talks. Medical students may be devastated to learn that it doesn't stop when you leave college. Many of these meetings have been sponsored by drug companies. You would be waiting for a long time for the Government to do it.

So the next time you are in a doctor's waiting room and you see a well-dressed stranger with a briefcase, be aware that both sides have thought about the issues involved and the relationship is not as straightforward as you might think.

Dr Pat Harrold is a general practitioner, in Nenagh, Co Tipperary.