"I can't keep my socks together through the dryer. You can imagine trying to get 100 pans or 300 pans of instruments all set up correctly," says orthopedic surgeon Michael Christie of Nashville, who specializes in new hips.

I have developed medical devices in a university setting and I have developed developed medical devices in industry. And not like bone screws, either. Atrial defibrillators. Artificial skin. Surgical ultrasound. More than that, I'm at the surgical supply store a few times a year. And outside of specialized, investigational devices, the proliferation of instrumentation and specialized fixtures is driven by the device industry. Full stop.

Obviously you want all the best tools available. But at the end of the day Medtronic's recommended set of forceps isn't likely to radically alter the outcome from the surgeon's chosen set of forceps. Of course, if Medtronic says that the only way to do the procedure is with their chosen set of forceps and the doctor deviates, well of course that's going to come up in court. Even if this one goes well, 300 procedures from now when the lawsuits start flying Medtronic will hang that surgeon out to dry for using the wrong forceps "against advice" and the jury won't feel comfortable disbelieving a medical expert.

And the doctor and the rep both know it.

Reps need to stay the fuck out of the operating room because they aren't responsible for patient care. If a medical device is so complicated that a rep needs to be there, the FDA will never approve it anyway. It's been a while but I could tell you two or three ways to insert a pacemaker lead into a human heart but we both know I shouldn't pretend I have any expertise.

And I helped design the damn thing. Reps just sell shit.