The rose, the thorn, and the bud: Implications for health care

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I was having dinner with my grandchildren, and one of the children* led the family through rose, thorn, and bud exercises. My granddaughter asked each of us to share a “rose” (e.g., a positive in their lives), a “bud” (e.g., something they are looking forward to), and a “thorn” (e.g., something they feel stuck with or need support). This was an excellent opportunity to share what excites us, makes us anxious, and what we might look forward to.

After reflecting on the metaphor, I thought it could be applied to the healthcare profession. This blog looks at what gives us joy, what causes pain and anxiety, and what our future holds.

The rose

I often go to a surgeon’s lounge or lunchroom and hear my colleagues complain about the status of American healthcare. Many say they would not choose the medical profession in the future or wouldn’t recommend healthcare to their children or grandchildren. However, suppose we stop and think about the joy we receive from our profession. In that case, it may alleviate some of the angst and heartache many of us experience.

We receive gratification when caring for a patient who achieves a favorable outcome. Fortunately, this happens with most of our patients. We feel delighted that we are physicians when we receive a call or a lovely letter from a patient’s family after the patient dies when they express the kindness and empathy we showed to their family members. (BTW, with patient and family permission, I place these glowing letters in a scrapbook that is in my reception area for other patients to see and read.)

We receive a vicarious pleasure when we receive feedback from our patients in our office surveys. This also includes patient satisfaction scores from online reviews. We feel a sense of pride when our online reviews are four and five stars.

We feel valued when we receive calls from TV and radio stations asking us to give our opinion on a new treatment or medication. We also feel accomplished when our publications are referenced by colleagues in peer-reviewed journals.

There are many examples of the psychological rewards and joy we receive nearly every day from our patients, colleagues, and others in the community.

The thorn

The thorn is something that causes irritation and annoyance. There are situations when something or someone is a source of unhappiness. There are pain points in our practice that we must contend with.

The most common complaint among physicians is declining reimbursements and rising overhead costs. We can seldom control reimbursements, but we can control overhead costs. If reimbursements are declining and accounts receivables are increasing, then it is time to look at coding and denials. If our services are correctly coded, the reimbursements will be protected, and denials or returned claims will occur. This pain point is a red flag that must be fixed.

Another issue that is inflicting pain on nearly every practice is the electronic medical record (EMR). Doctors spend more time looking at the computer than the patients. This is a common complaint that patients have voiced and must be resolved. Today, doctors find that they can’t complete their medical records during office hours and must use 1-2 hours each evening of uncompensated time to complete their medical records. This has even been given a name, pajama time. This is a most unfortunate situation and a source of great pain for physicians, and this must be resolved. One solution is using a scribe who inputs data into the computer while the doctor can focus on the patient. Now, computer programs can digitalize the doctor and the patient’s voice and create a record without requiring the doctor to input data into the medical record.

The need for prior authorization is a source of great pain for doctors and administrative staff. Insurance companies demand prior authorization for appointments to see specialists, lab tests, imaging studies, and medications the physician prescribes. Artificial intelligence has created effective PA letters to insurance companies that can reduce the time to develop communication from 30-60 minutes for each PA to just a few minutes.

A common complaint from patients is difficulty gaining access to care. It is common for patients to wait weeks or months for their appointments. Even acute care patients cannot be accommodated in busy practices and their patients are sent to urgent care centers, emergency rooms or seek another doctor. This, too, can be addressed with technology that offers patients online scheduling. Practices can see patients early in the morning, evening, and weekend.

Another option is to leave 1-2 time slots daily for emergencies, urgencies, or new patients. These time slots are nearly always filled and help to reduce the long waits to see a physician.

The greatest pain point is being involved in a malpractice lawsuit. Practicing defensive medicine is not the answer to avoid a lawsuit. Doctors are now mandated by their employers to see more patients daily, which shortens the time they can spend with each patient. This alone increases the risk of litigation.

Another thorn is the potential for cybercriminals to hijack or hack our patient data. The healthcare profession is a target for cybercrime. Retrieving patient data is time-consuming and very costly. Efforts must be made to protect our patients’ data and avoid this ever-looming pain point.

Finally, burnout is the thorn impacting nearly 50% of all physicians. Burnout is reaching epidemic proportions, causing dissatisfaction and disappointment that many physicians are retiring early and leaving the healthcare profession. This thorn must be dealt with quickly, or we will see a greater shortage of physicians needed to care for the American population.

We will usually find that the gratification from practicing medicine (the rose) far outweighs the discomfort and pain points we must endure from our practices.

The bud

The bud represents the future and the opportunities ahead for us all. This is where new ideas have blossomed into projects and events, looking forward to how they may impact healthcare and the services that we provide our patients.

I want to share a story that leads me to discuss a bud in healthcare. I referred a patient to a large academic medical center. The patient was seen by an oncologist, and the patient spent thirty minutes completing seven pages of demographics, health insurance information, and a health questionnaire. He was sent to the radiology lab from the oncology department for an imaging study and lab testing. At each department, he filled out the same seven pages of information that was the same as at the oncology department. This patient was anxious about his diagnosis and his impending chemotherapy, and now added to this was nearly ninety minutes to fill out the same information that was indeed available on the computer in the oncology department. Suppose the patient had to participate in a survey of his experience and go online to rate the experience. In that case, you can guess what his responses would have been.

My bud is that this process can be streamlined and doesn’t have to be onerous. Let’s learn from the airline, the hotel industry, and Amazon. At Amazon, you can buy a product with just two clicks: one to check out and, finally, a second click to order the item, which will be delivered in twenty-four hours. When you order from Amazon, you receive four email messages from Amazon: 1) the moment you place an order, 2) you receive an email confirmation of your order, 3) another email shows up in your inbox to let you know your order has shipped, and 4) and finally an email is sent once the order arrives which includes a picture of the box\envelope that is at your doorstep. This is one of the many reasons that customers love Amazon. That’s an example of a bud where we can do better.

Another bud with multiple opportunities is harnessing artificial intelligence (AI). AI can reduce administrative tasks like prior authorization, writing patient education materials, writing referral letters to referring physicians and writing job descriptions to post on internet job sites.

The bud will bloom when we can check patients in with just a few clicks, like Amazon, when we can use artificial intelligence to perform mundane administrative tasks, and when we use technology to look at our patients rather than at computers.

Bottom Line: The goal of using this metaphor of the rose, the thorn, and the bud is to reflect on the practice’s accomplishments, pain points, and potential for improvement. Sometimes, we need to reflect on the joys and benefits of a medical practice. Then, we need to identify the thorns and find solutions to those pain points. And last, let’s look forward, not backward, and see all the potential in front of us and put the joy and pleasure back into our medical practices. Perhaps we can focus on patients and not on data entry into computers.

*Thank you, Shelby, for sharing this idea with GWhiz

Neil Baum is a physician in New Orleans and the author of The Business of Building and Managing a Healthcare Practice, Springer 2023