From the Editor: The elephant in the operating room

I used an automobile analogy in one of my last editorials and there is one which applies here as well.

Almost all of us by the time we are in our 30s or 40s can drive safely. However, when we buy a new car the sales person drives with us the first few times so we may become comfortable with the new features. When it comes to driving so-called exotics like a Ferrari or Lamborghini, potential buyers (such as hospital CEO’s) will go to a special track where they will drive with an accomplished company driver before they feel safe to drive the car on their own. The company drivers know the limits of their car and they know the limits of drivers unaccustomed to advanced automobiles. Press the gas pedal too soon or push too hard on the brake pedal and the car will spin out of control with fatal results. In the operating room, press the wrong button or push too hard and the device may deploy too soon and the procedure may spin out of control also with potentially fatal results.

It seems to me the whole controversy revolves around the phrase “sales-representative” since it implies at all times their sole goal is to increase sales. Perhaps if they were simply called “representatives” there would be no issue. Yes, it may be true that in some instances the selection of a device may be based on the relationship a surgeon has with a company’s sales representative rather than the quality of the company’s device.

However, administrators are misguided when they consider excluding the sales rep from the operating room or endovascular suite will achieve cost savings. Usually the decision to select a company’s device was made many days before the procedure. If the rep was going to influence the surgeon, it would have been done prior to the surgeon entering those sacrosanct spaces.

Thus, in their never-ending onslaught on cost, administrators who restrict sales reps from the operating room may be impeding quality care. Accordingly, ‘“the elephant in the room” may not be the sales representative but rather the administrator in the office down the corridor.

Dr. Samson is a clinical professor of surgery (vascular) at Florida State University Medical School, is president, Mote Vascular Foundation, Inc., and is an attending vascular surgeon, Sarasota Vascular Specialists. Dr. Samson also considers himself a member of his proposed American College of Vascular Surgery.