In December, ConMed Electrosurgery received FDA approval for the Altrus Tissue Fusion System.

What that means… I am about to find out! Tomorrow, Wednesday January 18th, I will be tweeting live from the national sales meeting about this exciting new growth product.

Visit my LinkedIn page for a download of the press release at http://www.linkedin.com/in/lisamcmedicalsalesrecruiter While you are there, feel free to send me an invite if you’d like to be the first to know of new ConMed Electrosurgery sales openings in your area.

Tune in at http://twitter.com/#!/MyJobScope

It should be interesting and lots of fun. Can’t wait!

I received this great question and enlisted the input of some experienced O.R. sales reps for answers.

“In the med device industry, while in the OR and working with Surgeons, what is the best approach to tell a surgeon they are making a mistake or doing something wrong without losing their business and them going ballistic on you?”

While it is not necessarily true that a surgeon will go ballistic if corrected, situations like this need to be handled tactfully, especially during moments of stress. Here are three different responses, each with useful thoughts on addressing this challenging scenario in the operating room.

The Direct Approach

It sometimes depends on which Dr you’re working with. You have to have a feel for the way they are while in the OR. I have found that the best way for me is to speak up very loudly and clearly about what I am going to tell them. Don’t be hesitant in your voice. If you know something is wrong, be very confident in the way that you speak and be very clear for them to understand. I think the more you speak up in the OR the more respect surgeons will give you.

All surgeons are different and react differently so there’s really no right or wrong way to speak to them in the OR. Over time you just have to get a feel for how to talk to them while in the OR.

The Proactive Approach

In response to your question I would agree the scenario you pose is a challenging position to be in.  I’ve personally been in that situation several times and I’ve found it is always better to be vocal with the surgeon even though it is a fine line to walk.  A bad outcome or a poor reflection of your product is not worth biting your tongue during these instances and losing a potential user.
Before the case even starts it is important to use your time wisely to educate your surgeon on proper use (surgical pearls) of your product and any pitfalls you’ve experienced with new users. Educating the staff e.g. techs, circulators is also important for set-up and understanding how product works.  It is also helpful to state that you the rep may be a little more vocal during the first few cases if necessary and ask if your input is welcome. Most doctors appreciate this proactive approach and it gives the rep an opportunity to offer product expertise and chance to differentiate yourself from the competition.  If by chance you do see a problem about to occur or misuse of your product you have already set the stage for providing input.  Soliciting feedback from the surgeon throughout case is also a good idea to make sure product is meeting expectations. If a problem does arise offer techniques that you have seen work best for other surgeons and explaining why is an effective way of not insulting intelligence or ego. Following up with the surgeon one on one after the case is also a non-threatening way of delivering a message without being confrontational.

The Diplomatic Approach

One experienced rep I spoke to told me that he will sometimes talk to the tech loud enough so that the surgeon can hear him. That way, the surgeon gets the information without the rep correcting him or her directly. When the rep is “teaching” the tech, the surgeon can draw his or her own conclusions and adjust before things get too sticky.

“If you have good rapport with the surgeon, they want you there and want you to critique, but it’s important not to be too cocky or aggressive,” the rep said.

As mentioned above, referring to the surgeons’ peers is another helpful way to deliver the message and lessens the chance the rep will be seen as presumptuous. If the surgeon begins to struggle with some part of the procedure, this rep might might calmly interject,

“A lot of people have found that they get better results in this stage of the procedure if they…”

Despite everyone’s best efforts, some cases are challenging. After a difficult procedure, the rep said he might approach the surgeon for a one-on-one conversation. He would say something like:

“Dr. So-and-So, I noticed you did (this or that), but I know you want to get the best results. Next time, you might try…”

or

“I would be doing you a disservice if I didn’t tell you this…”

With some personalities, offering suggestions can be really difficult and awkward no matter how you approach it, he admitted. Even with the most respectful phrasing, sometimes there is no getting around it.

“You have to be comfortable being uncomfortable in this job,” he said, “but if you have the patient’s best interest in mind, you’ll be okay 98% of the time.”

What do you think is the best way to head off trouble in the O.R.?

“The difference between a smart man and a wise man is that a smart man knows what to say, a wise man knows whether or not to say it.”  ~Frank M. Garafola

It is sometimes hard to explain to those from outside the medical device industry the role that a surgical sales representative plays in the operating room.

I used to say that the rep was like the quarterback, but I now think it would be better to say that the sales rep is like the coach, calling plays from the sidelines. The surgeon is like the quarterback, executing the plays. The first assist or surgical tech is like the center, and the instruments are like the football being passed to the surgeon-quarterback.

Okay, it’s easy to get carried away with this sports analogy, but the pieces seem to fit together well. Then again, maybe that’s just because the last time I was truly an expert on football was when I was in second grade and Terry Bradshaw was the quarterback for the Steelers.

When something goes wrong in the O.R., it is the surgeon and the sales rep who need to figure out how to set things straight, just like a quarterback and the coach might confer about plays or strategies to regain control of a game.

Like a coach, a sales rep needs to remain calm under pressure. He or she needs to have alternative plays and needs to be able to think clearly and respond quickly, especially when everything does not go as planned.  If a sales representative is able to handle the pressure, then he or she can gain respect of both the surgeon and the surgical team.

It would be hard to imagine a coach walking away from a team after one bad game, and yet there are sales representatives who are tempted to throw in the towel after a bad case. Some reps try to duck the surgeon’s frustration rather than analyzing what went wrong. No doubt, facing an upset, frustrated surgeon after a less than optimal case is not a whole lot of fun.

One rep I interviewed recently described a difficult case with a surgeon who was using his plating system for the first time. The surgeon disliked the instrumentation and had many complaints.  Rather than heading for the hills, the rep analyzed how the case could be improved the next time. Over the next few cases, the rep swapped out instruments and refined the set to best meet the surgeon’s needs.

“I kept trying to take his objections away,” he said. After dialing in the instrumentation and identifying a particular plate that suited the surgeon’s needs perfectly, the cases began to go smoothly. When the surgeon’s patients began having great results, it was like the team had mastered the play and was scoring every time.

I admire this rep’s tenacity. Working through challenging cases to win a surgeon’s respect and trust is tough, but it is definitely a winning strategy. If a sales representative and surgeon work well together to solve problems in the operating room, in the end it’s the patients who are the biggest winners.

What do you think of this analogy? Is there a better one?

“If any thing goes bad, I did it. If anything goes semi-good, we did it. If anything goes really good, then you did it. That’s all it takes to get people to win football games for you.” ~ Paul Bear Bryant

Today I spoke with a candidate who went on a ride-along last week as part of the interview process. From the way he described it to me, I think it may have been the perfect ride-along. He got to see a good rep in action and four surgeries in one day of the same product.

Here are a few things he shared with me about his experience:

1. Although product was the same for all four cases (actually it was our new SRS system, so more than a single item), every surgery was different. In fact, he said the anatomy of each patient’s shoulder appeared different, probably in part due to the individual variations of the injuries, but also because no one’s anatomy is “textbook”.

2. Because of these differences, each surgical procedure was unique. Each case called for some variation in the technique and instruments used for the repairs.

3. The rep played a crucial role in having different instruments and solutions ready for the surgeon and his team. The candidate commented that the rep “seemed part of the (surgical) team”.

The reason I think it may have been a perfect ride-along, is because his observations highlight the learning curve inherent in becoming a successful surgical implant rep. He saw just how much surgical technique can vary from case to case, and how important it is for a rep to be on their game. Developing this level of skill as a sales rep takes study, dedication and what I like to call “time in the saddle”. Being able to problem-solve in the operating room, while remaining confident and calm, is the hallmark of a seasoned rep who is an asset to his or her customers.