We’ve all seen it…the doctor is doing a case and wants the rep to be there to advise him on the equipment.  Sometimes, if it’s a new procedure, that’s necessary.  But should they be there during the plain old stent procedures they’ve been doing for years?

Back in the olden days when I started in the IR lab (late 1980’s), reps were non-existent in the IR lab.  Even when we were doing biliary stents using Gianturco Z-stents, and some of the first femoral artery stents using hand-crimping tools, the reps weren’t in the lab with us.  They visited us, sure.   They brought lunch, coffee, and the best Snickers® cake in Texas (Thanks, Laurie!).  But they didn’t come into the lab for every case, or even most of them.  And when I went into the Cardiac Cath lab in the early 90’s, the only reps in the cases were for implants or new technology such as distal protection and rotablator.  Even when we did the first DES in Dallas, the rep was outside the room.  So why, all of a sudden, are reps necessarily part of the procedures?

Recently, I worked in a lab where some of the doctors wouldn’t do a case without the rep present.  Mostly, it was peripheral cases; legs, below the knee, using various atherectomy devices.  I understand having them there the first couple of cases.  But in the three months I was at that hospital, one doctor needed the rep there for every case.  This rep, however, pulled only equipment needed for this particular procedure, using this particular modality.  Good for her!  But at that same hospital, a different doctor needed the rep for plain old reperfusion procedures…stents.  The doctor would ask what diameter and length he needed, and the rep would pull something out of stock.  His product, of course.   But the really bad part was when the doctor said he was finished and the rep suggested he stent one more lesion.  A lesion that I saw as 30-40%; certainly not enough to stent.  The doctor stented.  Is that appropriate?

Another hospital where I’ve worked has banished all reps from the labs.  Period.  Is that too severe?  Maybe.  Sometimes we need the reps in, especially when it’s a new procedure.  Or, when we’re new to the procedure.  But the doctor should never ask the rep how to do a simple procedure that has been around as many years as stenting has been!

My thought is that a doctor should have training on procedures, then maybe have the rep there for the first 2 or 3.  After that, if he’s not on his own, he shouldn’t be doing the procedure!  The rep’s job is to ensure the product is there, and support the physician’s use of it, not to tell the doctor how to practice medicine!

There have to be boundaries for the reps when they come into the lab.  The physicians must be aware of, and agreeable to those boundaries.  And those boundaries must be enforced by the lab managers.  Otherwise, we end up with reps practicing medicine using the physicians’ hands.  And those boundaries should extend to the techs and nurses.  But that’s a topic for another day!