Dramaturgical study of meetings between general practitioners and representatives of pharmaceutical companiesCommentary: dramaturgical model gives valuable insight

Examples of performance

Scene 1

Rep: "Thank you for your time, it’s for a really quick chat about¼ " (Meeting 2)

Rep: "I know you’re busy, so I’m just going to talk about two products today¼ ." (Meeting 11)

Rep: "Nice to meet you Dr F¼ Here you go there’s one desk planner¼ Make use of that" (Meeting 3)

Rep: "Here’s two diaries¼ did you want a desk one as well?" (Meeting 1)

Scene 2

Rep: "Maybe you are aware of [product]?

GP: "No, I’m not to be honest with you."

Rep: "Well that’s fair enough, that’s good news. So hopefully I can inform you"

Scene 3

Rep: "Well just to summarise the news for today. Reduction in [the price of the drug] and some new clinical evidence for you to read in your own time [so you can] make your own judgements." (Meeting 5)

Rep: "So I don’t know if you agree with this but when I speak to hospital doctors they say that a meta-analysis of studies is probably the most stringent sort of argument that you can have really¼ so if they show [name of drug] to be very effective¼ would you use [it]? ¼ This study is by [author name], presumably he is some eminent psychiatrist."

(Meeting 10)

Rep: "I mean doctors often look at the immediate prices and think that it is really expensive, but if you looked at that more closely you would see that [rival treatment] is given twice daily ¼ so then you are talking very similar prices"

(Meeting 3)

Rep: "It’s £4.17 for 28 days so it does fit in nicely as a cheaper alternative¼ The new consultant at [hospital]— he is certainly switching patients over to [name of drug]."

(Meeting 1)

Rep: "Prof [Name] is using it. He has done a lot of talks for us¼ he does speak out nationally and internationally for us¼ He is very much in favour of using [name of drug]."

(Meeting 6)

Scene 4

Rep: "Do you accept, if you are getting similar levels of cholesterol lowering, you would expect to achieve the morbidity / mortality outcomes?"

GP: "Yeah. Well, it is always this difficulty that you are looking at intermediate outcomes. I think the advantage that you are fighting against for [the two rival products] is that they have been shown to reduce coronary events in trials, while these updates you have shown me are just these intermediate outcomes. So my mind is open about that."

(Meeting 7)

GP: "but a lot of patients of course who come out from seeing the psychiatrist now are usually on SSRIs to be honest with you."

Rep: "Hm, right. I would suggest that there would be some patients that would be inappropriate to prescribe a tricyclic— the elderly perhaps? ¼ Would you tend to use a tricyclic in the elderly?"

GP: "Umm, no, um, if they’re sleeping poorly, I use a lower dose of tricyclic, probably subtherapeutic in terms of their depression, but certainly, helping them get a good nights sleep."

(Meeting 10)

Scene 5

Rep: "I am only supposed to be talking to people who are the decision makers as to what is going on with drugs—which I gather you are?"

(Meeting 4)

Rep: "But obviously, as you just said, you are aware of [the symptoms]."

(Meeting 13)

Rep: "I think one of the reasons why a lot of doctors are using [drug name] is cost¼ there’s a lot of pressure on you isn’t there?"

(Meeting 9)

Scene 6

Rep: "Before I go I’ve got a couple of other things you might like. Would you like a paediatric stethoscope?

GP: "Thanks very much."

Rep: "It’s OK and this is the ABC of Allergy by the BMJ, so that’s quite useful¼ "

GP: "Thanks very much, yeah that’s great."

(Meeting 11)

Rep: "All right and I’ll drop in these charts in a few weeks¼ "

(Meeting 13)

Rep: "¼ and I’ll drop them back to you so that you can evaluate them yourself.

(Meeting 12)

Rep: "It may be a bit late notice, I don’t know if you have already had an invitation, it is on Wednesday afternoon at the zoo¼ Three hours PGEA and free entrance to the zoo if you so wish?"

GP: I’m sorry¼ we are already annual members."

(Meeting 1)