title: Salespeople in the Surgical Suite: Relationships between Surgeons and Medical Device Representatives.
abstract: BACKGROUND
  Industry payments to surgeons have received public attention, but little is known about the relationships between surgeons and medical device representatives. Medical device representatives ("device reps") have become an integral part of operating room personnel. The effect of their presence on patient care deserves discussion.
  
  
  METHODS
  We conducted a qualitative, ethnographic study to explore relationships between surgeons and medical device representatives, and characterize industry involvement in the training of surgeons. We used group and individual open-ended interviews to gain insight into the beliefs, values, and perspectives of surgeons and device reps. We conducted two focus groups, one with ear, nose, and throat surgeons, and one with hospital-based attending orthopedic surgeons. We also conducted individual interviews with three former or current medical device representatives, a director of a surgical residency program at an academic medical center, and a medical assistant for a multi-physician orthopedic practice.
  
  
  RESULTS
  While surgeons view themselves as indisputably in charge, device reps work hard to make themselves unobtrusively indispensable in order to establish and maintain influence, and to imbue the products they provide with personalized services that foster a surgeon's loyalty to the reps and their companies. Surgeons view industry-funded training opportunities as a necessary service. Device reps and some surgeons believe that reps benefit patient care, by increasing efficiency and mitigating deficiencies among operating room personnel (including the surgeons themselves).
  
  
  CONCLUSIONS
  Our study raises ethical questions about the reliance of surgeons on device reps and device companies for education and surgical assistance and practical concerns regarding existing levels of competence among OR personnel.
authors.affiliation: Alpert School of Medicine, Brown University, Providence, Rhode Island, United States of America.
authors.forename: Bonnie
authors.initials: B
authors.lastname: O'Connor
authors.affiliation: Retired Journalist, Takoma Park, Maryland, United States of America.
authors.forename: Fran
authors.initials: F
authors.lastname: Pollner
authors.affiliation: Georgetown University Medical Center, Washington, District of Columbia, United States of America.
authors.forename: Adriane
authors.initials: A
authors.lastname: Fugh-Berman
mesh_terms: D016265:Conflict of Interest; D017144:Focus Groups; D006801:Humans; D019637:Orthopedic Procedures / Q000941:ethics / Q000295:instrumentation; D036301:Qualitative Research; D066231:Surgeons / Q000941:ethics*; D013525:Surgical Instruments / Q000941:ethics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires