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Scott Webb: It can be a little nerve-wracking to see any doctor for the first time. And maybe that's especially true for seeing a gastroenterologist for the first time due to the personal nature of why we often see them. And joining me today to help us prepare for our first visit with a gastroenterologist is Dr. Jennifer Nayor. She's a gastroenterologist with Concord Gastroenterology Associates.

This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. And Dr. Nayor, thanks for your time. We're talking about that first visit to see a gastroenterologist. So what should we bring to that first appointment?

Dr. Jennifer Nayor: I find it very helpful when patients bring old records to their appointments with me. So I wish that we lived in a world where all of our medical record systems were intertwined and I could easily go in and access information, but unfortunately that's not always the case. And so when patients come really well prepared for an appointment, they'll often bring records from their recent blood test results, prior endoscopy or colonoscopy results, imaging results like ultrasounds or CAT scans. If patients are coming from another gastroenterologist or even their primary care doctor who saw them for this issue, bringing clinic notes from those visits can be really helpful so I can get a sense of what other doctors have been thinking about. So records are super important.

The other thing that's great to bring to a gastroenterology visit and actually any visit when you're going to see a doctor are your medications. And so it's great if you have a written down list with the medications and the dosages, but if you don't have a list, bringing the actual pill bottles in themselves can be really helpful, so we can appropriately reconcile the medications that you're taking. I have some patients who come in and they say, "Well, I take that little blue pill twice a day" and they don't know what the name is. And that's not as helpful as having the actual name of the medicine so we can know exactly what patients are taking.

So those are two physical things to bring. I think the other thing that's really important that patients bring are their notes and their questions for me. So when patients come in, if they're organized in what they want to get across to me, a timeline of symptoms that's really important or really helpful. And also, any questions that they have, so that two minutes after the appointment's done, they don't go back and think, "Oh, I wish I would have asked the doctor that when I was in there." So I think if patients come with those things in mind, that really helps the visit go smoothly.

Scott Webb: Yeah, those are great tips. And yeah, it would be difficult for you. As good as you are, it would be difficult for you if someone was describing the pill for you to try to figure out which one. So bring the list or bring the, you know, the pill bottles, bring your questions. That's all good stuff. And, doctor, will the gastroenterologists use any equipment or anything that might be uncomfortable during my first visit? We'll there definitely be a physical exam?

Dr. Jennifer Nayor: So I typically do a physical exam on any patient who I'm meeting for the first time. And I'm a gastroenterologist, but I'm also an internal medicine doctor, so I examine the patient head to toe. So I will examine heart, examine lungs, in addition to doing an abdominal exam and other GI things. Similar to when you go to your primary doctor, the exam is similar.

Often, when patients are coming in with rectal complaints, like rectal or anal pain, blood from the rectum, itching or discomfort in the perianal area, I will often do a rectal exam in addition to an exam that you would have when you go to other types of doctors. And that often can make patients feel uncomfortable. I always have another person in the room with me when I'm doing a rectal exam, just so that patients can feel comfortable. And I always tell patients everything that I'm doing at the time that I do a rectal exam so that they know what the steps are that are involved and it makes them feel a little bit more at ease.

Scott Webb: Yeah, that sounds good, doctor. And when we come in to see you or most GI doctors, will we always see the gastroenterologist the first time we come or might we only see the nurse the first time?

Dr. Jennifer Nayor: So I can tell you what happens in my practice. Of course, different gastroenterology practices function differently. So in our group at Emerson Hospital, all of the providers here are gastroenterologists. So it's all doctors who the patients will come in to see. There are other practices where there are nurse practitioners or physician's assistants, so other what we call mid-level providers, who assist the doctors in seeing patients.

So it depends on where you go. I do think that when you're scheduling an appointment, it's important to ask who you're going to be seeing, so that you can feel comfortable with the person who the appointment had been set up with.

Scott Webb: How much time should I budget for that first visit?

Dr. Jennifer Nayor: So different practices allot different amounts of time for visits. I would say the first visit ranges-- so somewhere between 30 to 40 minutes is probably a typical first visit. Some visits are shorter and are about 15 minutes. It depends on what you're coming in for, you know, how many questions you have for the doctor, if there are a lot of old records that need to be reviewed. I tell patients they should be prepared to be in our clinic for about 20 to 40 minutes, so that we can do a full evaluation.

Scott Webb: So, doctor, what if I'm nervous about the appointment? We know that these are kind of personal things. There can be some anxiety. What can you tell me to have me be just a little less nervous and a little less anxious as I come to see you or any gastroenterologist?

Dr. Jennifer Nayor: So I think gastroenterology visits, in particular, bring on a lot of anxiety and nervousness in patients. Patients don't always feel comfortable talking about GI issues. So we're talking about things like bowel movements or poops and farts and burps, and we're talking about diarrhea and things that kind of naturally give people the giggles when they have to talk about these things. And so I think it's important to just tell the symptoms like they are. Anything that you were experiencing, the doctor needs to hear.

I see gastroenterology patients all day and it's something that I'm used to. I don't really think those things are anything to be anxious or nervous about because that's why you're coming to see me. I think keeping a list of symptoms and reasons that you're coming to see the doctor is another way to just organize your thoughts before you come in for the visit so that you don't need to be so anxious about getting the story right when you're in front of the doctor and making sure you're getting in all the details. I do think coming prepared just helps with that anxiety.

Scott Webb: Yeah, definitely. And, you know, regarding COVID-19 and this time of virtual visits and telehealth and telemedicine, I'm wondering, are people doing their first initial sort of consult virtually? Or do you like to meet with them the first time in office and then maybe move to that, as you build a relationship with patients?

Dr. Jennifer Nayor: So in the world of COVID-19, we are doing virtual visits in addition to in-office visits. I do both for new patients. So I will sometimes see patients in the office, but there are some conditions where doing a virtual visit is fine to start. Whenever I talk to someone on a virtual visit, usually with a video chat, but sometimes even by phone for a visit, I will tell them, "We're going to start with this. We're going to start with doing a virtual visit. But if for any reason we need to meet each other face-to-face in the office or if there's something that I need to see on an exam, we can always convert the visit over to an office visit and do face-to-face stuff for an exam if necessary."

So I think, we're living in tough times and with COVID, a lot of people don't want to go out of the house. I think that coming to a hospital is very safe right now, especially at Emerson Hospital. We have a lot of protocols in place to keep patients and doctors safe. But for some people, it just makes them more nervous and I think starting with a telehealth visit is fine, just with the understanding that at some point you might need to come into the clinic if need be.

Scott Webb: And, doctor, as we wrap up here today and great to talk with you, what else do we want people to know about that first appointment with a gastroenterologist? Whether it's the type of questions they should bring, what they can expect, anything else we want people to know?

Dr. Jennifer Nayor: I think I want people to know that coming to a gastroenterologist should not be something that makes you anxious. You're coming to get help and our job is to provide the help that you need. So just think about it like any other visit, think about it as you’re there to get your questions answered and to feel better. And that's what we want for you.

Scott Webb: Yeah, that's great. And a great way to wrap up. And I I've really enjoyed speaking with you. You're direct and to the point. We hope that everybody will reach out, not worry about being anxious or nervous or COVID or anything else. And thank you so much for your time.

Dr. Jennifer Nayor: Thanks for having me.

Visit EmersonGI.org or call Concord Gastroenterology Associates at (978) 287-3835 for more information or to make an appointment. And thanks for listening to Emerson's Health Works Here, podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple podcasts, Google podcasts, Spotify, or wherever podcasts can be heard.