Doctor Against Medical Advice (True Story)

A Doctor Against Medical Advice is a True Story that happened in 1986 when I was working as a medical representative. I used to meet at least 300 different doctors, including at least 120 hospitals and visit about 100 medical stores every month to advertise the medicines of our company. And I met this Doctor against medical advice and medical business, whose advice skyrocketed my business sales figures through the roof, way beyond my wildest dreams.

The Doctor looked at me and said, “Do you know, it is neither your doctor, nor the medicines which the doctor prescribes, that cures you, son.”

I was puzzled to hear that and asked, “Doctor, I did not quite understand what you actually mean with that sentence.”

Before we proceed any further, here the background of this true story that opened my eyes.

I was absolutely new to this job of a Medical Representative. The job involves going with a pamphlet in hand, which has all the benefits and a few side effects of all medicine manufactured by my company. One medicine is advertised per page.

My job involved going to a doctor, take out my pamphlet from my leather bag, place it on the doctor's table, start opening each page and give the Doctor advice on each medicine manufactured by my pharma company and for which disease is it. Some Doctors patiently listen to me, some say next, next, next, as he already remembers that medicine and doesn't want to waste his time on that.

Also I carry some sample medicines with me to give to the doctor's I visit. These sample medicines have it clearly written on them that these are not for sale. But doctors who have their own clinics, sell these sample medicines to poor illiterate people for making money.

When I started the job as a fresher, no one gave me directions how to go about convincing the doctors to prescribe my company medicines. I started on my own. I was trained in human body and how each organ functions. So, I was a delight for some doctors who wanted to have some discussions.

As a medical representative my job was to tell the doctor all the good effects of my company medicines but say nothing about its side effects. But, I am supposed to tell the doctor, all the side effects of other rival companies who make the same medicines, so that my medicine sales gets boosted.

I had three full districts under me almost 100 km apart from each other and all the places in between where I used to visit doctors and I was expected to visit a minimum of 300 doctors every month, if not more.

To make things more uncomfortable for the medical representative, the medicine company even demands a quarterly visit plan with my 300 doctors with date, time and the doctor’s address and send it to the company before the quarter commences.

Some companies want a post card to be sent after you finish work daily for proof that the medical representative had visited that place on the planned day. During the quarterly meetings they would take out the post cards which were posted a few days after the planned date, because the medical representative did not visit that place on the planned day. 

Some medical reps were too smart. They won't go some places as planned. They hand over the post card to a fellow medical rep who is going to that place on that day requesting him to post the card from that place that day.  Fortunately, my company did not expect me to send any post card. So I had to luxury not go to a place on the planned day. But, I was sincere and never skipped a single place in my plan.

The plan for visit to various places in next quarter had to be sent in this quarter. Once the quarterly plan has been sent to the company, the medical representative will have to stick to that plan because a senior may do a surprise check to see if the medical representative is following his own plan or not, by landing up at one of the doctor’s address or a hospital on the date and time the medical representative has sent to the company.

Visiting Doctor in a Non Existing Train

The medical representative job involved a lot of travelling daily. The company pays First Class Railway fare for travelling to all places when going to meet doctors at any place as per plan and no train tickets are to be forwarded to the company as proof of train travel. Obviously, the medicine company pays all the expenses if proper bills are submitted for the travel expenses.

As I said I was sincere, I used to send my train travel details in my expense statement. There were no trains to certain places, so I travelled in a bus to those places. Some trains did not have a first class coach, so I travelled in second class

Once sent my first expense statement and my senior sent it back saying that I have to travel only by train in First Class to all places. I called him up and told him, “Sir, those few places are not connected by a railway line at all. So, I took a bus to see the doctors in those places.”

My senior on the other end said, “Son, don’t worry, your predecessor has already laid a railway line years ago and they have been travelling by train in First Class ticket to see the doctors. Please put First Class train fare to those places instead of the bus fare you have indicated and send your expense statement back to me. I will approve it.”

I was always sincere and did not want to do a fraud. But, the company never asks for any travel tickets by train. So, I too started travelling to places where no railway line existed, by train on the railway tracks which never existed except in my expense statement, created by my predecessors, and that too on a first class ticket. Expenses are tax free.

Doctor Against Medical Advice

It is neither the doctor, nor the medicines that cure a patients disease. An old highly regarded doctor said this to me. I thought for a while, "Is this doctor against medical advice?" Most of the doctor’s private clinic and hospitals I visited had 80% - 90% of very poor farmers as their patients. Getting my costly medicines prescribed to such patients was very difficult.

I had at least 5 medical representative friends whose companies were also making the same medicines with same chemical compounds as my company. But, under different brand names, sold at entirely different price ranges.

Then, there were generic medicines with the chemists, which were the same chemical compounds which were dirt cheap. These generic medicines neither had any glittering wrappers on them nor did they undergo any quality check. In fact, they did not have even an expiry date on them.

I always wanted to know how the doctor decides on which brand of medicine to prescribe to which patient. That day, I was visiting a doctor whose private clinic had rich, high profile patients visiting very frequently. There were at least a dozen medical reps waiting. My turn to go in was the last as I was the last to come there.

I went in and shook hands with the doctor. He asked me to sit as usual. I took out my Medicine Pamphlet, reminded him of all our medicines for his specialization, that he can prescribe and increase my company medicine sales.

Then, I asked, “Doctor, I have a doubt. How do you decide to give which medicine to give to a patient. I came now with medicine A, B, C and D. Another medical representative will request you to prescribe his company medicines A, D, E and F. So many medical representatives come to you everyday requesting you to prescribe their medicines some of which have common compounds in them like in my case, medicines A and D are same. How do you decide which which medicine to prescribe and in that which brand to prescribe to patient?”

The doctor was impressed with my question. The doctor said, “Son, when a patient comes to me with an ailment, I already know which medicine to give. But, in that medicine which brand to prescribe depends on the patient.”

I looked at him with a blank space and said, “I didn’t quite understand that statement. How can a patient ask you which brand of medicine do they want. Do they have any knowledge of medicines?”

The doctor replied, “When a poor patient comes to me and I prescribe your medium priced medicine, the patient will not buy that medicine because he doesn’t have that much money with him. Even if he has, he will buy one day’s medicine against the five days I prescribe because he is short of money.”

“Now imagine, a middle class patient comes with an ailment and I write a high cost brand of the same medicine which costs four times the price of your brand, do you think he will buy that brand? He will find it difficult to afford the high cost brand. The poor patient will ask the chemist what to do and the smart chemist will replace that high cost brand with your medium priced brand. I should not let that happen. So I write your brand to that patient. This actually happens in case of some long term medicines which a poor patient will have to take twice a day for say six months to one year, like in ulcer treatment. They just can not afford it."

“Now imagine that the patient is rich and I prescribe him your medium priced medicine. Do you think the rich patient will buy the medicine?”

I thought for a while and said, “Doctor, I don’t find any reason why should he not buy that medicine.”

The doctor smiled and said, “There is something called patient psychology. A rich patient came to me because I am popular and I have a good reputation as a doctor. Secondly, when he looks at the medicine price, he would feel that he won’t get will with this low cost medicine. He might think poor of the doctor who prescribed the medicine. He has a lot of money and wants to spend money.”

The doctor continued after a pause, “I have experienced during my career, that almost all really rich patients feel, that they cannot get well with low priced medicine. They need to take medicines whose cost is proportionate to their riches. If I prescribe your medicine brand of medium price, he might go to another doctor, who might prescribe a very high priced brand of the same medicine, which I had prescribed. And they get well in both cases. But he did not try the lower priced medicine and will continue to think that it was the costly medicine that cured his disease.”

I sat there looking at him amazed with the new knowledge I had gained.

The doctor said without looking at me, “I hope you got your answer and I also hope you will use it to your advantage. I am not a Doctor against medical advice. But this is a universal truth that applies to anything and everything you sell under the Sun to any human being. Believe it.”

I thanked the doctor and left his room thinking over what I had learned that day.

That night, I sat and carefully categorized and prioritized my hospital list, chemist list and my doctors list based on their locations (cities, villages or remote areas), because that decides whether they are getting rich patients, middle class or poor farmers which in turn will affect the sales of my company medicines and achieve my target sales.

I also started spending more time sitting with every medical store close to each of my potential doctors to ensure that my medicine brand prescribed by the doctor does not get replaced by the chemist with another brand.

My area monthly sales figures started sky rocketing from the very next month onwards, like a miracle.

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