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Did you ever try selling something to a Know-it-all?

A little knowledge can be dangerous, and a lot of knowledge can be even more dangerous, unless it's used wisely
Hadassah University Hospital in Ein Kerem, Jerusalem (Courtesy)
Hadassah University Hospital in Ein Kerem, Jerusalem (Courtesy)

I have had the privilege of working with many brilliant, professional and caring physicians. And I am happy to say that I have learned from all of them. I should point out that I have also had the great displeasure of working with many, far too many, substandard physicians who either were professionally or morally lacking. I also learned a great deal from them. But this second issue is for another blog post.

One physician I had worked with for many years, was practically a savant when it came to the medical literature. He was certified in multiple specialties in medicine, and was also technically highly skilled. In my mind, he was unquestionably one of the best, if not the best, physician I have ever met.

What I greatly appreciated about him was his totally unassuming nature. This was a man who could have, and perhaps should have, been the head of a medical department in one of the top university hospitals in the world. He was instead, fortunately, a resident of Israel who was far more interested in having a one-on-one relationship with patients rather than present at conferences around the world. There is a need for high skilled physicians in both worlds.

As part of his unassuming nature, he always gave people the benefit of the doubt, that they were aware of the medical literature as well as he was. I was always honored and thrilled whenever I could have an informed discussion with him. If he would remark that my professional comments were valid and even valuable, I was truly humbled and felt tremendously complemented.

Sometimes, his breadth of knowledge and nature did lead to somewhat awkward situations. In my previous place of employment, we would often have representatives from the pharmaceutical companies who would come and present their wares. Their intent of course was to get us to begin using the latest and greatest products from their companies, which often were more expensive than the existing medications on the market. Of course, if the new treatments being offered were dramatically superior to existing options, the discussion with the pharmaceutical representative was almost superfluous – we would want to have these medications available in any case. But there were many times when there was a clear attempt to convince us to begin using a costly medication that really had no clear benefit over existing items in our drug cabinet..

You will pardon me for the following statement but it is simply true. The pharmaceutical companies are well aware of the fact that there are still more male physicians in positions of authority than females. As such, of all the pharmaceutical representatives I personally met, not a single one was male. They were all female, very attractive and sometimes even questionably dressed. I will leave it to the reader to figure out why the pharmaceutical companies believed that this would be a more effective way of getting male doctors to make more purchases.

As a father of two amazing young women, and one amazing young man, I want all of my children to benefit from the same opportunities and to succeed as well as each other. But the simple fact is that medicine continues to be an “old boys club”. This is changing. But we are talking about a meeting with a pharmaceutical representative that happened many years ago.

In any case, the young lady who came to meet me and my mentor, presented a new medication that had recently come to market. In her hands, she had a number of documents including peer-reviewed published articles that supported the claim of benefits of the new medication. She spoke clearly and professionally and made her case very well. At the point that she finished, I was impressed with her knowledge, but more importantly from her perspective, the new medication.

My mentor on the other hand, with no intent of malice, began to dissect every statement she made. He quoted from memory the medical journal articles that she held in her hand and challenged the interpretation of their results. By the time he had finished, the pharmaceutical representative was stuttering, feeling clearly awkward and left with nothing to say but “please contact me if you have anymore questions”. She then left very quickly.

I felt bad for her. In some ways she was no different than a car salesman who is well aware of the positive features of the automobiles that he is selling. But when such a salesperson is faced with a diehard mechanic who knows the ins and outs of the automobiles’ workings, the salesperson can easily find himself at a loss for words and clearly incapable of making the sale. The same was true for her. Her arguments would have won over the vast majority of physicians. And I have absolutely no doubt that she had already succeeded in getting a significant number of physicians to begin using the unnecessarily expensive medication that she had presented to us. Her bad luck was that my mentor was that rare person who could truly evaluate the science behind  the advertising and then make an informed decision.

All of this is just fine when you are lucky enough to be a physician and more so to be in the presence of someone with such a knowledge base. But the average patient does not have this. The average patient relies on advertising and marketing and physician suggestions, all of which may have little to do with the actual science behind the medication or treatment. This has to change. And fortunately, due only to the expansion of  medical technology, this will change.

Even today, it is already easy enough to Google the name of a medication to learn about it. But there is a huge difference between reading a variety of articles and trying to piece them together in order to form a single, substantiated opinion, versus having someone, or something, clearly present the positives and negatives to you. There is no question in my mind that both physicians and the general public desperately needs an artificially intelligent tool that can not only read and even understand the medical literature, but formulate clear arguments for and against any medication, treatment or medical approach.

When a patient who has, say, high blood pressure reads about a new blood pressure medication on the market, it should be possible via a cell phone app or a desktop program to view an automated clear presentation that also takes into account the individual’s existing medical condition and personal knowledge. For a person in the general population, this presentation could include information related to the individual’s existing medical conditions such as diabetes and heart disease. This customized presentation could include costing information specific to the patient’s existing insurance options. Such a presentation could even include a map showing the distance to the nearest pharmacy that carries the medication.

When all is said and done, the non-physician user could truly make an informed decision about the value of this new medication. The marketing would be stripped away by such a system. This would be a perfect implementation of a system that is meant to empower patients and ultimately to dramatically reduce healthcare costs.

From a physician perspective, perhaps one of the most important things would be for such a presentation to be integrated into the electronic medical record system that the physician uses. This way, the physician could gain access to this critical information at the point of writing a prescription. And once again, the presentation would automatically be customized to the specific issues of the patient for whom the prescription is being written.

Will this spell the end of pharmaceutical representatives making in-person visits to physicians? I would like to think so. I would like to think that one would not have to sell a doctor on the idea of using any medication. The science behind any treatment should spell out its effectiveness, cost and side effect profile. And with this information, everybody could make wise choices.

This kind of change in medication selection and purchasing will actually come about in a subtle manner. Often, subtlety is a more effective way to effect change. As I have said in regards to many other medically related technological advances, I very much look forward to this new reality. In my opinion, the only solution for the upcoming medical cost apocalypse that is spoken enough so frequently in every venue, is to empower patients.

Thanks for listening

My website is at



About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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