So, I'm pleased to introduce the next part of our program. And we call this, we call this program A Day in the Life of a Gastroenterologist, and really the goal is for you to learn about what is being a gastroenterologist all about, because you are going to be interacting in the field with GI docs, a lot of GI docs. On the slide right now, you can see essentially a poll question. I'm going to take a show of hands in a second about what you would like to hear about. Our panel will be, is convening up at the front. I do want to introduce Dr. Taseef Ali. Taseef, just to raise your hand, he hasn't had a chance to be at the podium yet. And Taseef is in community practice and really focuses his practice on inflammatory bowel disease, but he has a very large practice that deals with being an inflammatory bowel disease biologic agents, and obviously you guys want to know a little bit about biologic agents. We're going to focus tomorrow's session on the day in the life. Some of that will be about how to navigate biologics, but today we really want to give you an idea of what it's like to be in general gastroenterology practice. So look at the slide being projected now. What would you guys like to hear about? I'm going to walk through this and I'd like to see a show of hands. Would you like to hear about changes in GI practice settings and resources being sought by gastroenterologists? Show of hands. Okay. Would you like to hear about optimizing working relationships between GI physicians and pharmaceutical or medical device companies? All right. I figured that was going to be popular. Do you want to hear about trends within endoscopy and GI procedures? Okay. And types of GI patient disease states being evaluated and managed by gastroenterologists? Okay, good. So it looks like we're going B and D first. All right. So for, and by the way, you can ask questions too. So if you want to stimulate, feed off of what we're talking about up here, feel free to raise your hand and I'll recognize you and you can pose a question to our panel. So for the panelist, what would be a key piece of advice you would give our attendees in terms of the do's and don'ts of interacting with you or any other of your colleagues in the field? And you are going to hear some brutally honest answers. Okay. We don't want to hold any punches here. We want to let you guys know what it's like to be in the real world. So Karen, I'll start with you. What are some of the do's and don'ts that you would give in terms of advice? I think it's because you don't get to really hear this kind of conversation from us normally. Can I ask how many of you are like experts and you've been doing this for a while? And how many are kind of new to this? Not very many. Just a couple. Okay. So as, you know, in my practice, we all have different practice settings, but I'm more akin to a private practitioner. I work all day, every day clinical, so I'm not in a lab or doing research. I spend more than 50% of my day doing procedures and, you know, we're scheduled every 30 minutes, boom, boom, boom, boom, turnaround, rapid, we got to get the patient, get them out. And then in the middle, I might have 15 minutes for, you know, eat lunch or grab a power bar or something. There's almost never time to go to the bathroom, okay? I just want you to get a picture of what our day is like. And then I start in the office and I start seeing patients and mine are booked every 15 minutes the whole afternoon. So where's the time to have a conversation with a pharmaceutical rep? There really isn't any easy time. So I really appreciate when the reps that I see respect that time and maybe give me what I would call sound bites. You know, I don't have time for the whole deal that you've been taught to say to every doctor by your trainers, right? There's just most of the time in reality, there's not that much time unless you've gotten lucky to have an appointment where you're really sitting down and talking to them. So come up with, what do you want to tell me today that I should know about your drug? I have a coupon, I'm going to give it to your nurse, we have a home service that can help get your patient started, I'm going to give it to your nurse. Remember, our medical assistants and our nurses do the bulk of the work on getting patients set up for drugs and prescribing what I tell them to do. So their education is also really important and you will get probably a little more opportunity to spend time with them in the office as opposed to the doctor. So don't be disappointed that you don't get to give us your whole spiel, but we value you, we want to learn about your product. Personally, I find when a new drug is coming out, like this drug will be to us, I like those drug company-sponsored educational seminars. I don't even really want to go to dinner, I want to sit on my sofa and have it Webexed into me and I will listen to it while I'm at home having a glass of wine and eating dinner, and I can punch in and give questions. So everybody's different and you'll hear what they like, but I think that's the best advice I could give you if you're working with a really busy clinician, is soundbites, right? Fasif, what about you? What are some of the do's and don'ts of interacting? Yeah, I'll also try to focus on don'ts first. So the first thing is, as Dr. Karan was telling you about, that know your physician. I'm in a hospital-based practice, I'm an employed physician, so there's a lot of restrictions that come from a system, hospital system also. So be aware of that, how you can have engagement with your physicians and with the staff. There may be some rules and policies set up, just like in academic institutions. There are different environments now, which we probably will discuss later, but if you are coming to a hospital-based practices, not only in endoscopy, but in clinics, there may be some policies how you can have engagement with the physicians. There are different types of physicians, physicians who may be very well versed with the product, with how this drug works, so don't waste your time explaining to them. Be very respectful of the time. Just it was mentioned that you may want to just ask the physician, what do you want to know from me? What type of help or resources you want from us? I think that's a very good opening relationship and kind of like the discussion point, because you may be telling us for five minutes things that we may be hearing but not listening. So just be aware of that. Know a point of contact in the practice who can then engage you, can schedule your visits. Just don't try to sneak in. That's the worst thing you can do. I've seen that happening where reps or representatives would just sneak into the clinic, endoscopy. That's a big no-no. Do not do that. Please make sure that you were expected at the right time and then be mindful of the time of a physician also. I think the key thing is to make sure that your engagement is meaningful. It's bringing something to the physician. You're just not there to just reiterate everything that you know about the drug, because there are different levels of physicians. Physicians who may know everything and they may just want to ask you about coupons, about some resources, and there may be physicians who would like to ask, how does this drug work? So just be aware of that. Steve, how about from your practice in terms of your experience with industry representatives, both pharmaceutical and device? So do's. I'll talk about do's rather than don'ts. So do know the mechanism of action of the drug you're touting and be able to say that succinctly and rather quickly and do have one go-to slide, the graph. Like in IBD, here's mucosal healing at eight weeks. It's probably going to be the same for your medication as well. Here's histologic remission at 12 weeks. Here's endoscopic remission at eight weeks. Be able to do that. Do be aware that in clinical medicine, the burden of prior authorization right now on physician practices is becoming an overwhelming problem and is going to reach ahead soon. Do be aware that sometimes we have to write letters of medical necessity. If I'm booked from 6.30 till 12 in my endoscopy center and in my office from 1 to 5.30 with patients every 15 minutes and going home to try to be with my family but then realize I have to spend two more hours doing electronic medical records to sign the notes that I created that day and that is the reality of what we do every day, I don't have the time to do a prior authorization. I don't have the time to do a letter of medical necessity. It's a huge, huge problem. Just be aware of that huge problem that physician practices have. If you're in an employed relationship or in a university setting, perhaps you're not seeing that hit your bottom line as overhead but in my practice, I see that bottom line and I understand it completely and it's a big problem. The other thing is just from EOE, just for you guys, the majority of the patients I meet are actually in the middle of the night at 12 a.m., at 2 a.m., at 3 a.m., at 4 a.m. My first encounter is when they have an esophageal foreign body or a food bolus and it's not an insignificant number of people and that is a drain because you're coming into the office and I would post call and I still have a full docket of patients but I had to go into the ER at 2 a.m. last night to deal with an esophageal food bolus. When I started my practice, actually, I would go in to take care of variceal bleeders and man varices all the time and now I'm actually going in to take out food boluses a lot of the time so it's kind of weird. I'll stop there. Great. Thanks, Steve. John, you know, John is in a more, he's at Mayo Clinic, a little more academic facility so John, maybe there's some differences in terms of the dynamic of the working relationship, the do's and don'ts in your center. Thanks for introducing that point, Bill. That's a really, I think, a very important point is the differences in the way that practices are structured and what gastroenterologists do. So for example, not earlier in my career but at this point in my career, 100% of my clinical work is procedural work. So actually, most of my contact with marketing and sales professionals is with devices rather than with pharmaceuticals. But I think that the bottom line is that you're a marketing and sales expert and so you're an expert in content and messaging and helping clinicians to understand what the usefulness of your product is. So I need you to carry that expertise and provide it in a concise fashion. And also know the literature, the data that's there, the evidence that's there to back up what you're going to be messaging. Because ultimately, I'm going to look at your messaging and if it rings true for me too, I need to be able to provide that messaging to my patient in a clinically accurate, precise and relevant way. So I think, number one, the content, knowing your content and being able to distill that and provide that message to me in a professional way is incredibly important. The other thing is understanding your audience. So I'm clearly not the right physician to come to with a lot of highly specialized pharmaceutical agents. But if I'm in a rush, I might forget to mention to you, oh, hey, it's actually Dr. Carpenter that you might want to talk to because he knows more about that. Ask me. If I'm in a rush, I might not mention that. But if you say, hey, are you the right person or should I talk to someone else who knows more about this or sees more of these patients, I might be elated to tell you who that is and that physician might be elated to receive you. So know your audience. One of my – I have two asks. One is understand that while you are a marketing and sales expert and have a lot of knowledge and skill in that area, I think it's different when your product has its relevance in treating sick people or keeping people well. My car means a lot to me. I couldn't get to work without it. So I appreciate a marketing and sales expert with automobiles or when I'm buying my house to put a roof over my kid's head or whatever, then I appreciate a real estate marketing and salesperson's expertise. I think it's a little bit different when your product is life or death and health and so forth. One of my asks is please also think of yourself as a healthcare professional. You're sales and marketing, so you're a messaging expert. But what is the product that you're representing ultimately end up doing? Think about the significance and impact of that and please roll that into how you feel as a professional. The second thing is I don't need to see you or talk to you for a long time because I can't. But please don't ignore me. Don't hit me once with a message and then not seek me out for a year. Then I might think that you don't think that I matter or that I'm important. My wife and I work 120 miles apart from each other every day all day long, but it's not like we stay out of touch. We text each other or whatever during the day and that's how one maintains a relationship. We all know that that's how it works. Well, relationships are relationships regardless of what kind of relationship. With a professional relationship like you would have with me, just reach out. It's easy these days, email, text, or whatever. Hey, anything I can help you with? Need something from me? Can I do something for you? Can I provide you with some information? Five seconds, 10 seconds every so often is way better as a tactic than expecting an hour once a year or something like that. It can't happen as my colleagues just mentioned to you. Our schedules don't work that way, but you can keep it up. I know it's more effortful for you, but reasonably frequent, short touch points and touch bases, they'll do the trick. Thank you. Very insightful. We've heard, don't take it personally if people are busy. Run into the endoscopy lab, run into clinic, dealing with after hours work. Don't take it personally if your provider you're calling on is very busy. Before we get off the topic of interacting with healthcare professionals, I want to just maybe ask our panelists, and you guys can ask questions or expand upon this. Obviously during the pandemic, there was very restricted access for industry professionals in various medical settings. Has it opened up completely now at your centers? What's the dynamic like in your centers? Karen? Yeah, it's opened up pretty well at our endoscopy center. I think it's back to the way it always used to be. They come in usually for breakfast or lunchtime, and they catch us when we're going in and out to get a cup of coffee or something. That's pretty open for us. Hospital has always been a little restrictive, a little more difficult, but we're seeing reps back up in the office in our coffee room. They bring in some little things and catch us there. I think it's pretty close. Mike is here. Mike, is it the same? My local person, is it back to baseline? Are you up there? Oh, okay. Well, you can tell us later, but I think it's about back to what it was. In our practice, we actually have now evolved into a hybrid. We are actually doing both because we found sometimes these virtual meetings, especially education to the staff. It's very hard to get the staff at one time. Sometimes they are spread out. They may be taking lunch breaks at different times, whether it's an endoscopy area or in the clinic. It has actually opened up a door where they can just sit at their desk and can just hear you virtually learning about a product, how it works. I would just add a few other things that I was just thinking and making some points here that I thought was very useful. Number one, make sure that you know the structure of the clinic. There may be some point of contacts that want to have that specific information. You can't just go and drop coupons at the front desk or to any person. That doesn't work anymore. In my practice, I know who I need to go to, like, hey, this drug is not working. Do you have ... What should we do? That is a point of contact. Yeah, Dr. Ali, we have some coupons, or I can help you with ... Make sure you know that. That really helps. The virtual things have really helped us having more interaction and engagement with the staff. They are more open to ask questions because they are at their desk. They have time to ask those questions freely. That has really helped us. In Savannah, or for Georgia for that matter, we're back to more or less to where we were pre-pandemic. During meetings, evening things, I do believe that the virtual ones work very well. I see these advertisements or whatever come across and go, that would be great. I would love to hear what they have to say about that medication for this disease, and I'll sign up for it, and I'll RSVP. Sure enough, half the time, or maybe 60% of the time, I can't make it virtually. Sometimes, I have it on virtually, and I'm being constantly interrupted by whoever, and then sometimes I have it on virtually, and I'm completely distracted because I'm entering orders for something else that's going on in my practice somewhere else. Just recognize that your virtual audience might be distracted, and if they're not there, it wasn't because they didn't want to be there. It's because they probably signed up because they wanted to, but we are constantly pulled in different directions. Can I interject? On one other note like that, I've done the same thing where I wanted to do it, and then I didn't get ... I don't know if there's a restriction about this, but I wish you would record them, and then give us something, a handout with a link that says if you missed it and you want to see it, it was a really good one, here's how you can get on and look at it, because I probably would do that if it was something that was important to me. I've never had a company offer that option, so maybe there's a reason not to do it, but I would appreciate it. That's an excellent point, and further, you can move quickly through things that are self-evident perhaps to you that might not be to others, and then get to, if you will, the meat of the conversation quicker, and it'd be more efficient. I think you're right about that virtual thing where you could get it when you want it on demand. Yeah. John, do you have anything to add to that? Very similar to Taseef's experience. It's kind of hybrid for us. We're not back to the good old days, so to speak, but it is somewhat relaxed, and we do make use of Zoom and other technologies to bridge the gap. I think that's fair to say. It's pretty scripted at Mayo Clinic where I work, because it's a hospital organization. What I've found that the marketing and sales professionals that I'm in contact with do is they realize that it's a changing process, so they will contact me or some other physician and say, hey, what's the deal? What's going on? What's the access like? We'll let them know, so ask. Any questions from the audience before we shift off of the topic of industry reps interacting with healthcare providers? Question in the back. If you could push. There's a little microphone that you could push, because we're trying to record this. Can we assume that you know when things are new and who do you get your influence like your peers? Do you talk to your peers about it with something new? How do we gauge that if you could just answer? Yeah so the question for the other room just so they can hear us is do you read up on journals and if you get new information do you interact with peers to share that information? I'll take that to begin with maybe y'all can dovetail off of it. So an emerging problem in our profession at least I see it this way is that we have multiple organizations so we have an organization called the AGA and one called the ASGE we're here and there's one called the ACG and so there are dues required that you pay annually to be a member of these three organizations and I still do that and I'm a fellow of each one of the organizations and I like to I enjoy that. I have found that a lot of my colleagues are choosing one organization as opposed to multiple. Each one of these organizations has a journal so the AGA actually has two journals the gastroenterology and the clinical gastroenterology journal. The ASGE has one called gastrointestinal endoscopy it's dynamite for techniques and then the ACG has what's called the red journal which is the American Journal of Gastroenterology and so then you live life and all the catalogs come into the house and all the you know you know whatever architectural digest or whatever people and then and your journals show up and there's this big stack and I worry about the trees but there's this big stack of things and there's a huge stack by my bed that my wife complains about and I read these journals but I think I can't put a percentage on it I'll pass the panel here about what percentage of your colleagues do you think actually stay up to date with their journals and reading their journals just kind of a guesstimate so I don't I don't think it I'm not sure it's greater than 50% I don't can't put a number on it but the person that you're gonna be speaking to may be someone who's reading all their journals but it may be somebody who's not reading all their journals and I could go on about maintenance of certification and maintaining your expertise but it's beyond the scope of our conversation here but if you have a PDF of an article like the guidelines for the management of eosinophilic esophagitis and you are able to give that well I love stuff like that when I get like a guideline handed to me from a legitimate source that's awesome and or a key article you know demonstrating the benefit of your product that was published in a reputable journal I find that to be very useful and enticing and makes me want to use the medication and lastly some people in my practice are ones that would adopt medications early and use them early the minute they come out I've been more sloth like in my attitude towards things and I'll let things be out for a year or two before I just jump on that bandwagon because I do have some concerns about patient safety I know that your your products probably very safe but we've been around for long enough to have medicines come out and then after a while realize like well maybe it wasn't quite as safe as we thought and in fact some of the medications get taken off the market and I've lived practice long enough to see that actually happen so I'll stop right there and let you guys kind of dovetail on that yeah I think I think some of the dynamics that play out in your question really gets to the changing landscape of medical education and I know to see if it's ready to pipe in on that so I'll let him go ahead and make a comment yeah because I I do a little bit differently and you'll find this also a very common thing is the use of social media a lot of physicians including me the way I get information every day is through social media and so I have my Twitter handle IBD tweets you may know that because I I do that all the time where I I use social media for my own information so every morning I look at all the journals and their table of contents anything that is released recently I learned about so physicians learn through self learning through journals but then you will also find out especially with industry that there's KOLs right the key opinion leaders so sometimes in community we look for what is the key opinion leader stance is on this product or how they are practicing and that's when we go to symposiums we go to our annual meetings we look forward to hear from our experts in the field like how they are implementing this new knowledge in the practice like from bench to bedside thing but then there's a new concept that have evolved over the last few years called DOLs digital opinion leaders and their opinion actually is very impactful so just be aware of that that there are different ways that we are getting information these days in terms of social media and this new concept of DOLs and I think it's also a generational change you know those of us that have gray hairs learn differently than the younger generation learns and what they expect out of education and learning and picking up new knowledge is very different than than us seasoned faculty members or gastroenterologist okay I want to change if there's no other questions on the relationship I want to change to the what's the you know the the types of disease states and other experiences what is for the panelists what is the maybe the couple of the greatest things about your job the best things about your job and what are a couple of things that are not so great you'd like to see different in your experience as a gastroenterologist so Karen you're smiling and laughing so I'll start with you. I think the greatest thing about what we do is is endoscopy frankly it's the most fascinating it's like the magic school bus if you remember that cartoon you know going through the body and able to do all sorts of things it's changed dramatically since I was in training to where we're doing things we never would have dreamed of doing an extra luminal endoscopy and and all the things we do now with EUS and I just love doing therapeutic interventions I like seeing something fixing it and the patient wakes up and I say you're fixed and and they are and they're very happy I also you know interestingly enough that I do a fair amount of general GI and I like IBD I like seeing patients who again it's a fixable problem I like problems that I can can fix and they have a chronic disease but there's so many options with that disease to make them well and and they're suddenly feeling better than they have in a long time so that's very rewarding to see patients that you have something to treat them with and I suppose that'll be similar to this drug you know it's the first time we will have had something perhaps with a lasting effect you know that will treat a disease that some patients have ongoing symptoms from and that that's very rewarding for the doctor to be able to do that what do I not like I don't know let's I'll pass this somebody else I could spend too much time on that so just like as you said that I take care of IBD patients and that's my passion I all my clinic staff know that they are my babies so don't hurt my babies and take care of good care of them so I have a team so it's not just a physician it's my staff and I just take great passion educating my staff also how to take care of these patients with chronic illnesses and then it's a it's just a very joyous moment when you see a young kid who is now in remission after having a very bad disease course and suffering so for me that's that's the the best part of my life is taking care of these chronic illnesses the worst part is taking care of the frustrations of prior authorizations and step therapy and I guess that we will discuss tomorrow also about these biologics and new drugs and step therapies and how it hurts and once again if you're on social media I have a hashtag called respect my prescription so if you type hashtag respect my prescription you will see all the different for the last five years every time I get a denial every time I get a stupid thing that you need to use NSAIDs before stepping up to treat Crohn's disease I actually call out to those spares and see like how they're doing so so that's the most frustrating part in my career Steve the best parts of your job and what are some of the things you wish yeah this is the best parts what Dr. Woods mentioned was the fact that we can see the disease that we're treating so in IBD you can see mucosal healing and you can get the satisfaction that you're getting the outcome I assume we'll probably have something similar with your drug and secondly things I really to reiterate this to say it a little differently it's frustrating to know that there's a therapy that will make a patient better and you and you prescribe that therapy and to be not allowed to do so and that's incredibly frustrating and to tell a patient there's this medicine that's available too bad you can't have it it makes you feel bad and then in this that's it's a huge there it gets into the economics of medicine and beyond the scope of our conversation but that to me is very frustrating and I think for your medication it might be the kind of thing you know because a lot of young people have are gonna have this disorder and you know all of a sudden you don't know you have it and one day you're eating a piece of steak and all of a sudden it gets stuck and you go see the doctor and he says oh you've got this disorder called eosinophilic esophagitis and oh you mean I actually need medication now I didn't know I needed insurance I was young and happy go lucky and I do see people thrust into that situation so I just like prescribing something and being told I can't prescribe it and but our jobs are even though I don't like being on call and waking up in the middle of night I I still love what I do a lot and I don't want to retire and I want to keep doing it because it's fun I just need to get that work-life balance going I haven't gotten that yet I'm working on that so John anything to add in terms of what's great what's the greatest part of your job and what would you like to see changed in the practice of gastroenterology I think the greatest part of my job is I have 100% work-life balance just kidding that's the biggest bunch of BS I know I'm never gonna achieve it so I've quit trying you know I don't know what the balance is you do the best you can and keep on moving I mean for me the best part I think actually is I enjoy that communication with the patient and trying to help them understand what's going on because in my mind even if you can't cure the condition you might be able to control it and even if your control isn't perfect if the patient just understands what's going on a little better that gives them the feeling that they have some control and that can make a huge difference so I think understanding is control even in the most frustrating of circumstances and that means you need to be an exceptional communicator at distilling the message and trying to explain something in a way that it is understandable and that needs to be tailored to every single patient and I enjoy that challenge every day the other thing that I enjoy is my work for the most part aside from communication is procedural work and there is a manual dexterity and a skill involved with that I learned something new every day which is saying a lot for someone in their 50s right I go home every day feeling like I learned something still that's a big deal because it keeps it from getting old and there's something athletic about doing something with your hands and you know your hand-eye coordination and this and that and I do kind of enjoy that but the biggest thing as you walk out of there every day feeling like you probably did at least a little bit of good for maybe one or two people a lot of people don't get that their work every day I hope you get that you can and you probably do if you don't find it because that makes a huge difference frustration I don't know that I experience as much of that because I work in a large bureaucracy where there are professionals who enjoy some of those administrative challenges that get paid handsomely to do it and I don't have to do it and so you know I don't have some of those paperwork challenges and so on and so forth there are some frustrations from staffing you know there's never enough people around to do all the heavy lifting that's got to get done and stuff like that or you know there's always this or that breaking down but I think I just have tried to sort of get less frustrated about that stuff and just say well it is what it is and it's just work and get the job done and get through the day regardless and somehow it all works out and you feel like you did your best or did the best you could get something good done for somebody at the end of the day so I want to be clear do think do things break down at the Mayo Clinic I'm glad you asked me that because the reason why I brought up breakdown was what's today Tuesday so yesterday was Monday I walk in on Monday morning and understand the procedures that I do every day require a scope but they also require a live x-ray machine called a fluoroscope and I walk in to do the room huddle at 7 in the morning and the x-ray technologist says hey just so you know our fluoroscopes not working and biomed is here and I could see that you know the machine closet was open and they've got a bunch of stuff torn up in there and they're not sure whether they're gonna be able to get this thing fixed today or if they're gonna need a part so they're getting a power supply brought over an extra one from our hospital down the street three-quarters of a mile west of where I was and long story short they couldn't fix it and the part wasn't going to be overnight until today which wasn't going to help yesterday so we're trying to figure out a way in this room with a big fixed machine to cram a portable fluoroscopy machine in there well you know we all figured out a way to do it and thankfully one of the patients canceled and one of the two hour cases didn't turn out to be as tough as it could have been and we finished on time and I got to the airport in time and my flight was delayed anyway you know so the bottom line is it all kind of works out but yes stuff breaks down you know and the process breaks down and you know or the administrators out with kovat or whatever but so yeah we've got our problems everybody does but you know you're gonna jump up and down and get all pissed off about it or are you just gonna say all right well you know we'll do what we can here and you know that crown thing that says you know hold your chin up and whatever be calm what I you know I guess I'm trying to do a bit of that well so in the interest of time we are going to have to move on to our didactics I hope you've learned a little bit about the general aspects of gastroenterology

gastroenterologist

panel discussion

industry professionals

GI practice settings

endoscopy procedures

chronic illnesses

communication

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