In the past few years, we have witnessed a slew of scandals from the digital health and life sciences start-up community. From the damning WSJ investigation into the scandal at the once lauded biotech start-up Theranos, to smartphone apps that claim to help conditions from addiction to schizophrenia. It all sounds like practicing medicine without a license when there are no clinicians in leadership providing or the frontline teleheath care to the patients using the app or technology.
As a clinical behavioral psychologist by training, I am constantly asked by investors and consumers what my “check-list” is and what I look for – in a digital health start-up. Here is my checklist (in no particular order):
Does the Founder have a Clinical Background?
The number one thing I look for are clinicians (MDs, RNs, PhDs) in the C-suite, and preferably on the founding team. It’s difficult to create an app or program without knowing the intricacies and the actual tests inside and out. If the founder has experience treating patients – extra points!
Importance of Medical Ethics
Ok. Some of you might be thinking — do letters behind a name, a “Dr.” title, really matter when choosing which start-up founder to support? It is because medical professionals are trained in ethics. Our training and degrees dictate how we conduct ourselves professionally under a strict code of ethics.
Here is Stanford’s Code of Ethics (where I did my fellowship program):
THE STANFORD AFFIRMATION
On my admission to the Practice of Medicine
I pledge to devote my life to the service of humanity.
The care of patients will be my first consideration.
I will strive to acquire and share new knowledge with my colleagues and my patients;
I will practice my profession with conscience and dignity, and to the best of my ability and judgement.
I will approach each patient with charity, attention, humility, and commitment;
I will hold all life dear, and let knowledge, wisdom, courage, and compassion guide my therapy;
I will use my medical knowledge and skills to promote human rights, social justice, and civil liberties.
I will not permit considerations of age, disease or disability, faith, ethnic origin, gender identity, nationality, race, sexual orientation, social standing or other forms of discrimination to intervene between my duty and my patient;
I will respect the confidences with which I will be entrusted;
I will give gratitude and respect to those from whom I have learned my Science and my Art;
I will uphold the integrity of the medical profession;
I will cultivate peace in both personal conduct and political expression; I will not use my knowledge contrary to the spirit of this Affirmation.
I make these promises in witness of those who have stood here before me, and those who will come after.
Solemnly, freely, and upon my honor.
Based on the declaration of Geneva as modified by the graduating class of 1990 and revised 2008 | Stanford University School of Medicine
While there are bad apples in every profession, the majority of doctors and clinical psychologists I know take the oath very seriously. When making business decisions, this code of ethics is ingrained. We are trained to put “Patients First” above all else and consider the implications of our actions not just for our patient, but on ourselves, families, and the larger medical community. This is a very different way of thinking, and in my opinion, introduces considerations of medical ethics into business decisions.
Putting Patients First
Part of clinical training is that you are taught to always put patients first. I’ve noticed that non-medical founders usually refer to patients as “users,” in their pitches. At first glance, it might seem like semantics – but it’s not. When a medical professional speaks of their “patients,” it is with an assumption of responsibility for the welfare of those individuals and their families. This distinction returns again to the oath of responsibility and the ingrained part of the clinical education that says my patient’s needs will always come first. On more than one occasion (I’m sure my medical colleagues can relate), I’ve had to eat on the fly (granola bar, whatever is in my bag), and wish I had more time to sleep – because I chose to spend more time treating my patient. It’s a fine balance and as I’ve grown in my profession, I’ve learned to manage my time better to avoid not eating/sleeping/taking bathroom breaks but medicine is a “calling” in a way that business is not.
Empathy in a Founder
The experience of delivering a terminal diagnosis is a uniquely profound experience, that only a clinical founder would have. A case that stands out for me was a female patient in her early 40s that I diagnosed with early-onset Alzheimer’s. I remember she had two small children. She was just a few years older than me, and her husband was the kindest man. I kept my composure throughout the meetings and was the consummate rock they relied on for information and guidance about their options and next steps.
That night in the parking lot, I sat and cried for a solid 30 minutes before I drove back home. That was years ago, and I still think about her to this day. I wonder sometimes, how her family is doing, and I still feel humbled by the experience of being part of her journey to the end of her life from a terminal disease that slowly steals the mind while the body lives on. A non-medical founder has not had this humbling kind of experience – the confronting of disease and death where you are the bearer of bad news, and at the same time an instrument of hope for treatment or respite, if even for a few months.
The Business of Medicine
In the US, for better or worse, healthcare is mostly a for-profit business. Most founders care about creating shareholder value and generating a significant return for investors. These goals are central to the operations of most healthcare companies, perhaps especially digital health start-ups.
What is unique about a clinically trained founder is a worldview that has been shaped by years of education and hands-on training to consider what I call the “two exits” of digital health: 1) financial considerations and 2) lives impacted.
Clinicians, I would argue are far more likely to reject business favorable actions that put patient health or lives at risk. In short, we have learned in graduate school via rigorous ethics and educational training to put patients before profits. We are taught to always put patients first.
In closing, I want to leave you with the best analogy I’ve heard in the business world. Ben Horowitz’s statement to founders to “take care of the people, the product and the profits in that order.” This is great advice for any founder but has larger implications for a digital health founder – as individuals on a daily basis are using your product to make life-changing medical decisions – so please remember, patients must come first.