Dr. Reddy: And so it’s important to bring in whatever records that you may have had from previous physician encounters. So printing out records and bringing it with you is really important. Bringing in any other testing that you may have had, any other relevant testing, such as blood work, such as imaging studies, such as CAT scans or MRIs, any other audiologic or hearing testing.
Dr. Undavia: Hey guys, welcome to NJNT’s podcast, We Nose Noses. I’m Dr. Samir Undavia, and with me I have Dr. Reddy. Dr. Smith is missing in action today. Today we wanted to talk to you about how you would prepare for a visit with us. So first, as ear, nose, and throat physicians, we deal basically with everything from here to here. So, ear, nose, and throat is a misnomer, but it’s really anything to do with the head and the neck. Most often, we, people do lump their symptoms into ears, noses, or throat, and many times they’re all related. So what I wanted to start with was ask Dr. Reddy, basically, what are the things that you see most often with the ear in the general public, kids and adults?
Dr. Reddy: Sure, so we see kids and adults of all ages, and ear complaints are very common. Some of the most common complaints we get is ear pain, for example, and hearing loss or drainage from the ears. Sometimes we get issues with the outside of the ears or the inner part of the ears. When we see those patients, a lot of times the most important thing that we look for is the history. So what brought you to that point? What have you tried in the past? Have you seen any other doctors or urgent cares? And yeah, and then if we need to order any other additional testing, we order it in our office. Do you want to go over common nose complaints, Dr. Undavia?
Dr. Undavia: Sure, I did want to just bring up for the ear, timing is also important, right, Dr. Reddy? How long it’s been there, when it started, does it come and go, does it… you know, time of day even, those things can matter. But yeah, let’s talk about the nose. For the nose, we deal with things that have to do with breathing, so breathing problems. We deal with things that have to do with the sinuses, so sinus pressure, headaches, infections. And when it comes to the breathing problems, we kind of want to know when has it started, what makes it better, what makes it worse, what types of things you’ve tried, and whether you’ve seen any other physicians for this. Other things that not only we want to know, but your insurance company wants to know if we need to order testing, is how long have you tried the things you’ve tried in the past? Have you seen other physicians it, what makes it worse, what makes it better. Those are the main things. If you have any other associated symptoms with your neck or your ears or your chest, those are the main things.
Dr. Reddy: Yep. So the other thing is when we see, yeah, so when we see just broadly speaking, when we see a new patient in our office, many times these patients have seen multiple other doctors or were their second or third opinion from an ear, nose and throat perspective. And so it’s important to bring in whatever records that you may have had from previous physician encounters. So printing out records and bringing it with you is really important. Bringing in any other testing that you may have had, any other relevant testing, such as blood work, such as imaging studies, such as CAT scans or MRIs, any other audiologic or hearing testing. And that’s all important.
Dr. Undavia: I was going to say the report is good, but the imaging, the actual study with the disk or a login over the internet would be very helpful. Those are actually incredibly important.
Dr. Reddy: Yeah, what a lot of people don’t realize is that if you have an imaging study done somewhere outside of our network, then we may not have direct access to the actual images. And so bringing an actual hard CD to you to the office and we can just load it up into our computer system and take a look is really helpful. Anything you want to add, Dr. Undavia?
Dr. Undavia: Not for the nose so much. What about the throat, Dr. Reddy?
Dr. Reddy: So, you know, if you have any images, for example, sometimes we have patients that have had procedures done in their throat and they even have images of that, that would be helpful. If you’ve had surgeries done on your nose, throat, or ears, and you have the operative reports available, that’s really helpful as well. But otherwise, you know, when we’re seeing patients with throat complaints, the most common complaints that we get is either trouble with your voice, or trouble with your swallowing. And the first thing we typically do is we get a history, just like Dr. Undavia was going over, but then we also take a look at your voice box and your throat. Do you wanna go over how we do that and what we’re looking for?
Dr. Undavia: Yeah, yeah. So. Well, from the ear perspective, we’re always, even when we’re just chatting with you, we are looking over the external features of your neck and face and ears to see if we notice anything out of the ordinary. But for the ears, we use something called an otoscope. It has a speculum and it has a little magnifier with a light, and we can look into your canal. We can look at your eardrum and look beyond your eardrum to see if we see anything off on that exam. For the nose, there’s two parts. rhinoscopy where we use a speculum and just kind of look in your nose with that flashlight and that gets us to see the front part of the nose but really the nose is a huge structure and goes from here all the way to the back of the ear. So in order to do that we use something called a nasopharynx scope. It looks like a little spaghetti stick that can move and we can see on both sides and we can see all the way to the back and that is incredibly, incredibly helpful for symptoms of all three. areas. So that part is a little uncomfortable. It’s typically about 10 seconds. We get a really good view and in most cases we can get our answer of what we need just from that alone. For the throat, we like to look in the mouth but also use that same camera through the nose because the nose connects to the back of the mouth in the back. And we can look all the way down to your vocal cords and a little bit beyond that with our camera. itself. Again, that’s about 10 to 15 seconds. We might have you say some letters or some words while we do that. Those are the main endoscopic or exams that we do minimally invasive. And then we’ll also feel your neck and your cheeks to make sure we don’t feel anything there, depending on what your symptoms are.
Dr. Reddy: Yep, so some of our patients who have never been scoped before in the office are a little scared and anxious before the procedure. But the vast majority of patients can tolerate these procedures very, very well. Usually, actually, we sometimes put a little bit of lubrication on there to make it more comfortable. Sometimes, we use a little nasal spray to also make it more comfortable. But the entire exam itself is generally under a minute long. And we’re very careful in the way that we examine the nose and throat because since we do this on a daily basis, and we’ve probably done it thousands of times at this point, we’re very careful in the way that we maneuver the camera on your nose to… cause the least amount of discomfort possible. So if you’ve ever had, for example, a COVID swab done, and a lot of people have bad experiences with COVID swabs where someone is basically blindly putting a swab in your nose and going all the way back. And that’s actually much, tends to be much more uncomfortable than the scope exam that we’re doing in the office because we’re doing it under direct visualization and we’re able to really kind of watch all those little soft spots in those areas that might be uncomfortable.
Dr. Undavia: Dr. Reddy, do you want to go over what kind of other information you might want to have when you meet your patient for the first time? Like past medical history?
Dr. Reddy: Yeah, so the other things, you know, when all of our new patients, they come in and we have them fill out an electronic intake form on an iPad. And that’s important because you’re putting a lot of your past medical history, which may be relevant to your presenting problem. So things like, do you have a history of diabetes, for example, or history of hypertension? And That’s all potentially relevant information for us, not only for your presenting condition, but the way that we may optimally treat this in the future. We also ask about past surgical history, any relevant family history, any allergies to medications, and any other symptoms that may not be related to the ear directly related to the ear, nose, and throat. So for example, any skin issues, any GI issues, GU issues, which is genitourinary issues, extremity issues, etc.
Dr. Undavia: Yeah, the classic example is somebody that comes into the office and says, I feel like something’s stuck in my throat. And you can’t really gather from the history that anything’s going on. But when you look at their past medical history, they may have had an ulcer in their stomach or something like that. It can point you in the right direction to treat those patients. So past medical history, other surgeries, other medications can be incredibly, incredibly helpful. How long does the visit typically take, like the whole visit?
Dr. Reddy: So the first visit initial encounter takes a bit longer. On average, it’s approximately a half an hour where we’re actually sitting face to face and talking and you’re being examined. But you should budget another 15 minutes or so prior to the visit for you to be able to fill out all the information. And then another 15 minutes or so after the visit just for… coordinating next steps and next care. So overall for a new patient generally we recommend budgeting about an hour as long as there’s no additional wait time. And then for follow-ups typically it’s much shorter we usually say about a half an hour or so total.
Dr. Undavia: We, I did want to let everybody know that we do Telemed visits because a significant part of our population, our second and third opinion patients are coming from all over for us. So we offer Telemed. And we have a really neat Telemed system. We have two ways to do it. One is through our electronic medical record system. And we send you a link. You put your name in so long as you have an account with that electronic medical record, should have. And you just log on. We see each other face to face. The other way is through Doximity. Also, text you a link. You click on it, put your name on there, and then we’ll see each other face to face. Some patients don’t like using that. They want to do the telephone phone call. Also, fine, so long as it’s a follow-up and we’re just going over some information. The nice thing is if we see each other in person once and we do our exam and we need to order other additional information, we can always order that and do that remotely so that you don’t have to drive in for that visit. Typically we do our Telemeds at the end of the day for seeing the patients that we have in the office.
Dr. Reddy: Yeah, so the other thing I wanted to just quickly go over was if we order any additional tests is what the authorization process looks like afterwards. So let’s say a common thing that we see is if you’re coming with us with sinus issues, after we examine you, oftentimes we have to order a CAT scan of your nose and your sinuses. And for that to happen, oftentimes insurance companies need an authorization. And so we generally start the authorization process, our staff does, and then we get an authorization number. Once we get that authorization number, then you can schedule the imaging study with that number, and it should all go through your insurance. And then we typically schedule a follow-up to go over the results. Anything else, Dr. Undavia?
Dr. Undavia: We are fully paperless, so we don’t actually ever need to print anything out and have you sign it. We do everything electronically. Information that we wanna share with you with surgery, we send to your portal, your prescriptions, narcotics, regular prescriptions, everything that we need to send, we can do electronically. Which is nice, patients have access to us and we have IntraMail where patients can reach us. Yeah, it’s been nice.
Dr. Reddy: Yeah and that’s a lot to do with Dr. Smith’s efforts to making us go paperless. If you guys ever want to play a prank on him, you make sure you come with a wad of paper just thick and just shove it in Dr. Smith’s face and he’ll run away.
Dr. Undavia: I think we covered everything we needed to today Dr. Reddy.
Dr. Reddy: But anyways. So I think that’s all we have for today’s episode. If you want to get more information about our practice, please visit our website at njent.com. Otherwise, if you enjoyed this episode, hit the like and subscribe button. And if you need to reach us by phone, you can call us at 609-710-NOES. That’s 6673. Take care.