As far as your doctor.. is this your PCP or a GI specialist? Any GI specialists who thinks you MAY need one will probably go ahead.. my insurance doesn't require referrals for specialists.. so I just went straight to a GI... I had an EGD endoscopy.. and I did it without sedation... the sedation though is usually demerol... so you aren't completely out.. but not really there either... as far as going without sedation.. it's not too bad if you can just concentrate on breathing and drooling... it's a tad uncomfortable.. but not painful... the most uncomfortable thing was when they blow air into your stomach to inflate it... you then belch the air out in a gag... I have a horrible gag reflex and did just fine.. all the nurses and my doctor were quite amazed I did it without sedation...