Excerpts from authors article on Medical representatives, past and present
In 60’s medical representative was never a high profile position. Lot of travelling, staying away from the family and society associated stigma of wine and women with this profession. I did not and do not believe in that. It was only handful few that might indulge in some unacceptable activities and bring bad name to the profession. During that era the most respected medical representatives by the medical profession were from Sarabhai Chemicals. The representatives were sent to the field only when they had adequate product and medical knowledge. This highlights the importance of job related knowledge. “On the job” training, would start only after all the prices of products and the detail talk for the products under promotion during current cycle was by hearted. It was expected that the representative should spontaneously respond to any query on product and price. Medical representatives were expected to be knowledgeable. One must admit that in that era medical representative was a major source of latest information for the medical profession. Most of the companies operating in India were multinational companies or Indian companies with foreign collaboration. These companies would have all the latest information on new drugs and on various clinical trials conducted abroad. Medical representatives were regularly provided the latest information for further transmission to the medical fraternity. I was told by my seniors that in forties there was a trend that the medical representatives would mail postcards to the doctors informing them their travel plans and inviting them to meet at the railway stations. The representative would travel by train and doctors would await his arrival at the railway platform. The representative will come out of the first class compartment, address the assembled doctors, provide them with literature and sample during the brief halt of the train. The train would then proceed to next station and another group of doctors from that town will get audience of the representative. If such were the days then why would not a medical representative get the respect from medical profession, after all he was the harbinger of latest information.
Well trained medical representatives had better knowledge of pharmacology than many practicing doctors. This was particularly true for new products. During my days as medical representative, in interiors many doctors did not understand English, so explanation had to be in local language. Many doctors had clinical experience and but were unable to correlate indications (in English) with the symptoms. The option was to tell the indications in vernacular language or to explain them the symptoms in local language where the medicine will work. This knowledge was very essential to develop rapport with rural doctors. Due care was also needed to ensure that doctor’s ego is not hurt when he is being educated by medical representative. Knowledge was therefore one of the most essential requirements to be a good medical representative.
Travelling was very tough in those days. Public transport operated by state government or handful private operators was only available. Within the cities and towns, in absence of own transport, a cycle rickshaw had to be hired on hourly basis. For me the rickshaw puller would come to my place every day and take me around for business calls. All my daily allowance and at times even more than that would be spent on rickshaw. Doctors would meet at very odd hours. Some busy doctors would meet by midnight, so I would go for a movie, return by midnight, make the calls and return home.
In small towns and villages some rickshaw pullers or Tangawalahs were very knowledgeable about the doctor’s visit times, their potential to prescribe, their attitude etc. You alight from the bus and these chaps will rush to you, pick up your bag and take you round the town. These fellows will guide you through. They will take you from one doctor to another, while travelling they will give you commentary on what type of patients the doctors get, what he prescribes, what are his habits etc. Information on competitors was also available from these fellows, like who all visited the town during last week, what gifts were distributed, who got the orders and who were turned down etc. On one occasion I insisted to meet one doctors, but the rickshaw puller advised not to meet his, he said the doctor is SH and you will waste samples and your time. It took a while for me to understand SH is “sample hunter”, the doctor who keeps asking for lots of free samples. Unique experience indeed.
For outstation travel, in absence of any personal vehicle I had to travel by bus. The buses had upper and lower class in those days. Being a medical representative we were expected to travel by upper class. It was customary to tip ten to twenty five paise as tip to the conductor and in return the bus conductor would offer you a seat of your choice and at times even clean the seat with soiled handkerchief. For conductors, chemists, compounders and patients, we the medical representatives were known as Agent Saab. I always tried to figure out why this term Agent Saab came in usage, but even seniors in that era could not offer satisfactory explanation. The term might have come during British regime when most of the pharmaceutical companies were exporting products to India and the business was handled by the agencies, thus the term agent. Whatever may be the origin but fact was the Agent Saab commanded great respect. Patients and doctors would get up from their seats when Agent Saab would enter doctor’s clinic. Fan that was not switched on so far would start, tea or local soft drinks would be offered and doctors would pay great attention to the detailing. Doctors would ask questions, get their doubts cleared and share their clinical experiences. Very often a patient who was prescribed my company’s medicine will be called and made to vouch his experiences. Even those patients who might need the product that I detailed would be asked to come forward and the doctor would take my opinion for prescribing the medicine to those patients. To impress the waiting patients doctor would announce that Agent Saab has come from Bambai just to meet him and the appreciative looks in the patient’s eyes would be evident.
In some towns and villages in UP, I would hire a cycle and work. For neighbouring inaccessible villages, I would take a bus, keep my cycle on the top of the bus and get down couple of kilometers away from the town as buses won’t go there. Cycle down to the place and meet doctors. That was devotion to the work.
Touring in Chandrapur, Maharashtra was very tiring. I was based there covering the district and neighbouring Bhandara district. I used to travel for twenty five days in a month. Distances were large, Chandrapur was the largest district in India. By this time I had purchased a scooter. Many places I would cover on scooter. For the far off places ST was the only option and it would take six to eight hours to reach desired town. The red soil on untarred roads would drench me from head to toe. There were no proper eating places, food was very spice and hot, no good drinking water was available. It was extremely tough. In summer 1200 F temperature was not uncommon. On one such warm day I was looking for a place where I could get Coke, with great difficulty I found it with Paan shop, where few bottles were kept in bucket full of water to make them cool. There was no fridge where the bottles could be chilled. I asked the shopkeeper to open a bottle and gulped it down, and asked for another and then the third one. The surprise on the face of the shopkeeper was evident. A bottle of Coke was 70 paise, similar price as one would pay for a liter of milk and the tree bottles that I drank cost me nearly 25% of my daily allowance. Places like Sironcha, Gadchiroli, Armori, Kurkheda, were very difficult places to travel. Unfortunately these places are now known for Naxalite activities. At times I would carry my Luna (Kinetic) in a Jeep and then visit large number of small towns where the Jeep could not go. It was a fun.
I developed excellent contacts with deans of medical and dental colleges and professors of these colleges. The basis for these contacts was not money power or bribing but just the knowledge base. Even among the private practitioner I commanded respect. I could walk into their chamber without appointment and these doctors declined to take fees not only from me but even from my distant relatives. In one case a distant relative of mine was admitted to orthopedic hospital, kept in a special room for about a week, underwent the treatment. At the time of discharge when the bill was asked for, the doctor told my relative that he will take it from me. When I asked him for the bill he ridiculed me saying that my relative has already paid it. In today’s scenario this looks impossible. Hospitals will not admit the patient without advance payment. One of the top cardiologist in Nagpur, whom I knew but did not have much contact was to be called to my house to see a patient. This doctor was known to be sarcastic and whimsical. He never went for home visits but just with one telephone call, he came to my place and saw the patient. While he was examining the patient his assistant cautioned me not ask for his fees, as that would have offended him. I just thanked him for his visit. This was possible just because I was a medical representative. If all this was possible forty years back, then why not today? Well, it’s point that can be debated, but one simple answer is the medical representatives are not the same as they were in that era.
The CRM activities that we talk currently were done by me forty years back in early seventies. Organizing get together, developing personal relations/rapport, occasionally making a telephone call to important doctors was my routine. The corrupt practices that we find now for which MCI has to give directives were unheard of in seventies. Doctors were happy with few samples or a small gift. Unfortunately when pharmaceutical companies started mushrooming in India, the corrupt practices got it roots and now it has assumed huge proportion. The rapport that my generation could develop with knowledge base has turned into wealth base rapport. The values have undergone drastic change. Many doctors would treat the representative rather than representatives treating the doctors. On my day trip to Kiraoli, Fatehpur Sikri, I would be forced to have not less than fifteen cups of tea and nearly a dozen of kachories or samosas. Saying no to a doctor would hurt them thus no option but to accept their hospitality. I am sure this must have undergone a change.
The loyalty factor had a great value. Even doctors did not appreciate the representatives changing the company. There was a total devotion. On one occasion a doctor complained about large size of our B-complex caplets. I tried to reason with the doctor that swallowing is a reflex action and size of the tablet doesn’t matter. He somehow had some reservations on my statement. I took out a strip of sample containing six tablets. Took out all the tablets, put it in my mouth and gulped down. Doctor was aghast. He couldn’t believe it, but he was convinced. My region manager was a step ahead. Doctor complained of pain following our B-complex, liver extract injection. We all knew it was painful, but to demonstrate that pain was not a major issue, my region manager got himself injected by the doctor. For whole night he had hot fomentation, analgesic tablets. Next morning he walked into doctor’s chamber to show that pain was tolerable. All this was being done to get acceptance for company products and to have a lasting bond with the doctors. Who will do this today? The loyalty factor has vanished, so the commitment is lacking. The greed of the company has increased and that’s deteriorating the quality of medical representatives. There is a mad competition which has taken toll of a wonderful institution known as medical representative. I know the old times cannot return, old values are out dated but acquiring knowledge can never be out dated. Strive for knowledge, acquire knowledge, one will always command respect, wherever he or she is. It’s in tune with old saying स्वदेशे पुज्यते राजा, विद्वान सर्वत्र पुज्यते.
