From Stillwater-Ponca City (OK) Ostomy Outlook June 1996:

ET Nurses & Sales Reps

Editor's note: In keeping with the Internet theme of this newsletter, I decided to reproduce the following postings from the Internet newsgroup <>. Sandy Kinghorn is a sales rep from an ostomy supply manufacturer, and frequently posts articles to the newsgroup. If some of the language seems harshly critical, keep in mind that discussion on Internet newsgroups tends to be very frank.

In a previous posting, W.T. Powers had suggested to a still earlier letter writer:

My advice would be to find a new ET. A good one can be an excellent ally while a bad one is a font of misinformation. Also speak to the surgeon who did the original procedure. I've had two ET's. The second told me that most only recommend the brands that the hospital uses or parrot what the salesmen tell them.

Here is Sandy Kinghorn's response:

I just HAVE to comment on this since I am one of those big bad "salesmen." I am also a nurse with Crohn's disease, so perhaps that puts me in a unique position of being able to see the issue from many sides. As much as it pains me, tpowers is right about some ET's and/or hospitals. There are many reasons why a particular hospital may put a person in a specific appliance. The following is the list, pretty much in order, of why they choose what they use.

1. What's on contract. This means, what's the cheapest, what does my hospital's buying group want me to buy, what product do I get rebates, kickbacks, etc. on. Obviously this has absolutely NOTHING to do with what is best for the patient.

2. What product can be used on the greatest number of patients. Ostomies and stomas come in many shapes and sizes, but a hospital can't stock something for everyone, it's too cost prohibitive. So what they do is try to select one or two sizes and/or styles that will suffice for most people. They do that for inventory control, but that means that what they put on you in the hospital may or may not be the best thing for you personally.

3. We use what we've always used because it's too hard to change. This is the one that bugs me the most, because when they say this, they're really saying, I'm just too lazy to care whether I'm doing the right thing for my patients.

The industry changes quite frequently with new technology, new styles and a multitude of improvements. Ostomates today have more pouching choices than they've ever had before, but most are still using 10+ year old technology. The hard fact is that about 90% of ostomates continue to wear what the hospital put them in, whether it's the right thing for them or not. The best way to keep everyone honest, is to be smart consumers. Don't let anyone but you make your pouching choices. Demand information in the hospital and after. If you attend UOA meetings, go when the manufacturers reps come and ask for samples. Keep yourself up to date. When you get samples from different companies, put them side by side on the table and really examine them. Look at the barrier material. It should be a uniform color and shape. the hole in the middle should be centered. The backing paper should be centered. Does the barrier look well made, or does it look like it should have been a factory reject? Feel the thickness of the pouch material. Some manufacturers use 4 layers of pouch film, some use only two. You can feel the difference. A thicker pouch material is better at holding odor in. Check the seams on the pouches. Are they uniform? Are they any jagged edges or areas that appear thin? Crinkle the pouch material in your hand. Is it noisy? If it's a two piece, do the pouch and barrier lock together, or can you pull them apart easily. If they don't lock together, you run the risk of having an accidental pop-off of the pouch.

4. I see all the reps and evaluate new products so I can be sure to provide my patients with the best pouching system for their individual needs. Wouldn't it be wonderful if every hospital made their product choices this way? Then we could all feel confident that we had the right pouching. I love it when I visit hospitals who care like this. It makes me feel like I'm spending my time well when I'm with them.

5. I have a good relationship with the rep from X company and I know that they will support me and help me get "special" things for me and/or my patients. If they're talking about the rep that buys them the biggest gifts and/or goodies, it's obviously not a good thing. If it's educational (booklets, videos nurse and patient educational programs, etc.), special pouch samples to handle individual patient needs, then it's not so bad to have that kind of relationship with a sales rep. I still don't think it should be the only reason, but often it does make a difference.

6. We don't have an ET, (or our ET isn't so good) so we just wing it. You'll know it if you had this experience. You woke up with some bag hanging off your belly and no one EVER came in your room to talk to you about it, or they just tossed a booklet at you, or they acted like they didn't have a clue what to tell you.

7. I'm so smart that I already know everything there is to know. I don't need to see any salespeople and I'm going to use my pet product until the day I die. This one gets me worked up. Salespeople are the ET nurse's primary source of industry news. Even if the company the sales person represents doesn't have something that the ET needs, the information is good to have. Someday an ostomate may walk in needing that very product. If the ET doesn't know it exists, well, obviously the ostomate won't know about it either. This type of ET is, fortunately, not the norm. They are out there, though, and often work in very reputable hospitals. They have such an ego problem that they can't do justice for their patients. They aren't in it to help people, they're in it to stroke their own pathetic egos.

So, there's my list. Now, I have to add my disclaimer, since I've already admitted that I work for one of the companies that manufactures ostomy appliances. This is my personal opinion only. I make these statements to represent my own personal opinion, and not the opinions of my company. I'm not suggesting that the company agrees with me or that they don't agree.


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