Thoughts: Validating Medical Career Choices Through Impact

First published September 12, 2016

I was catching up with two medical friends yesterday over a traditional Melbourne brunch, and as you do over flat whites and mushroom burgers, we chatted about our careers and our dreams for the rest of the year and beyond.

One friend is launching an app, a new platform that could transform the future of hospital medicine, no hyperbole intended. Looking at the prototype, as a clinician, I was impressed. This person had taken the frustrations of staff across many hospitals, departments, training specialties (eg. Obstetrics and General Medicine junior doctors don’t often interact at work unless there’s a referral or they’re friends), locations, and years of operation, united those frustrations, and summarised them to create this product. I have met several others who have given up months and even years of college training time to devote themselves to their own solutions for higher-quality, high-efficiency healthcare, and the focus and determination they all demonstrate are incredibly inspiring. They don’t realise it, but they rejuvenate me, when I feel worried or anxious about my own work.

The other friend is getting their letters at the end of the year. He’d had startup aspirations for many years, but had shelved those aspirations to complete his training, and despite the long, arduous exams, he’d somehow managed to keep his other interests alive. He is still a fountain of ideas bubbling over today, and will no doubt do something incredible very soon.

Then there’s me. A very keen, slightly travel-weary but ever-inspired writer whose head simmers constantly with ideas on how to energise the medical system in Australia; how to learn from others’ experiences within and overseas; how to inspire students, junior and senior doctors and other healthcare professionals alike; how to connect with others who don’t normally interact day-to-day with our professions in hospital, bar multidisciplinary meetings;  and most of all, how to celebrate the uniqueness and creativity that every single one of us exhibits when we apply ourselves to a self-made project aimed at a greater impact. 

The three of us are happy because we’re each creating impact. The one who’s about to become a specialist, and who was the one who brought up this Impact concept, had to push aside his many ideas and that creative energy whilst knuckling down with training. The other friend and I had waited long enough- it’s an individual decision, and you know when you’re ready to take that leap.

I’m surrounded by inspiration and hope when talking to friends like these. People who can relate to thinking outside the box, and are driven by that internal fire for achieving greater impact than they could one-on-one with a patient, yet still value the sacredness of the clinician-patient interaction. (And when I say “clinician” or “healthcare professional,” I also mean physiotherapists- “physical therapists” in the States; occupational therapists; nurses; dietitians; dentists; and so forth.)

Yet, as I mentioned in my previous editorial, our conversations as healthcare workers are often restricted or self-censored as we fret over whether our projects will be recognised and validated by external medical training colleges; whether we are jeopardising our future careers by deviating from well-worn paths; and whether there will be anything external to show when we’ve given it that shot.

How can we become a more Impact-Driven profession? 

We have to show that education is also about life experience and applying that experience to a greater cause. The trials of forming and running a startup or social impact project are like a real-life, practical exam.

And you fail instantly by not trying. 

To make it easier for people transitioning from stable clinical job to startup or social impact project, the conversation has to start with you. We need to celebrate the individuality of healthcare professionals who value the interactions between clinician and patient (and their loved ones), and nourish that environment of creative thinking in medicine. And by creative, it can mean anything from brainstorming better patient flowcharts between hospital departments on a nursing unit whiteboard, to improvising novel bandages in a resource-poor setting when on a field trip or rescue mission with the Flying Doctors or other emergency services.

Or it can be through sharing stories, like me.

Would love to hear how you gain inspiration to continue your journeys when you feel discouraged, or how you rejuvenated yourself when you felt overwhelmed by opposition. feel free to share your comments below, tag us on Twitter @themedstartup, tag your photos on Instagram at @themedicalstartup, or send me an old-fashioned email via the Contactpage.

Enjoy your working day :) 

Interview with Dr Lloyd Nash, Co-Founder of Global Health Startup “Global Ideas”

First published September 2, 2016

Dr Lloyd Nash is a General Medicine Physician working between Australia and Vanuatu, who co-founded Global Ideas, a series of conferences and events where people from diverse industries unite to learn about Global Health issues, social ventures, and career pathways. Lloyd and his friends created this as they found a severe lack of opportunities for people at various stages in their studies or professional lives to explore career options in Global Health. This weekend, their fifth Global Ideas Forum will be held in Melbourne, featuring international guest speakers and small group sessions. During the year, they also host the Design Jam and Global Ideas Labs, where people brainstorm particular issues in Global Health over three hours, using human-centred design thinking.

Lloyd has successfully brought together healthcare workers, architects, graphic designers, lawyers, NGO founders, social entrepreneurs and more into a Global Health powerhouse that energises people at all levels of education to build solutions to Global Health problems. We’d been blown away by the enthusiasm at last year’s Global Ideas Forum, and got talking to Lloyd about his journey combining traditional clinical training with building his own Global Health organisation.

Dr Lloyd Nash. Photo: Supplied

How did Global Ideas begin?

It started around the board table at an AMA (Australian Medical Association) meeting in 2011. I was there as the chair of the College of Physicians’ Trainees’ committee. I was sitting with young, inspiring people who were passionate about global health, including Dr Rob Mitchell, Dr Ross Roberts-Thomson, and Dr Jake Parker, and we were lamenting the status of Global Health career opportunities.

The lament was, there’s a lot of passion and energy around medical students and campuses, lots of activity and initiatives, then people get into the early part of their careers, whether in healthcare or not, and get buried. Often they might come to Global Health at the end of their career, but there’s a sort of donut (where their Global Health opportunities are lacking). That was a frustration for us, realising there wasn’t a lack of enthusiasm about Global Health, more of a lack of pathways, opportunities and engagement.

Also, looking at my own career path, as I trained in Infectious Diseases for awhile, the Global Health models that were around were either, do an internship at the WHO, or via NGOs- volunteer in the field for two years, then we might give you a job as a program officer. It seemed both of those were very bureaucratic, unresponsive pathways, not fit for purpose, and hadn’t adapted to the 21st century realities of technology, using the skills and passion coming through from the next generation. Most people were told to go do a Master’s degree or camp in the jungle for five years, then come back and look for work. It seemed to be the wrong way to harness the energy and enthusiasm of younger people.

So we started Global Ideas with the Forum in 2012. Our mission is to create and connect the next generation of Global Health leaders. It’s a leadership capacity building project, from Education through to Action.

The structure was Learn, Share, Develop and Connect, as an educational and networking enterprise. We wanted people to learn about new initiatives, share their own ideas, any research they might have done, any social enterprises and other new initiatives they may have developed, and connect with a broad, diverse interdisciplinary community.

We ran three conferences, then had a strategic review and thought, what more do we need to be doing? We were doing well at engaging and inspiring younger people, but I wanted to do more knowledge and skills development, so we launched a couple of new programs- the Labs and Design Jam.

Labs is an extension of the Forum- Labs engages people on a more regular basis to dive deeper into issues over 3 hours. We have a Lead (facilitator), and intimate group discussions. It revolves around the Sustainable Development Goals framework, so connections between health and development, and advocating for the Sustainable Development agenda amongst the next generation of Global Health leaders. We wanted to have events like edutainment, so people can be, like, “I could go to the cinema tonight, or go to the Lab, and I could have more fun and learn more by going to the Lab.”

The Design Jam program extends that educational journey into Action. We partner with organisations doing Global Health work, Design organisations and other groups, and smash those together with our participants to help people become more aware and comfortable applying the tools of Human-Centred Design Thinking.

How can you motivate anyone to care about Global Health and see themselves as change-makers?

If you think about how to create change or develop leadership influence, think about people’s motivations and passions. We encourage people to reflect on their world view to influence others’ behaviour. To do this, you’ve got to learn about Global Health. You’ve got to develop skills to apply in the field, not just vertical skills, but a reproducible thought model that is creative, innovative, and collaborative, to apply to complex challenges in their own careers. That came screaming at us as Human-Centred Design and Design Thinking, and I use both terms interchangeably.

We want to have discussions that feel comfortable, usually taking the form of expert, but I really wanted to challenge the idea of expertise. The concept that you have to be an old professor who’s published a lot of papers, I didn’t think that was true. We wanted to promote the idea that younger people who’ve taken time to reflect and had experiences can be experts in their own right.

I ran a Lab in June on ethics and leadership, discussing Sustainable Development Goal 16- Peace and Justice- how you build societies that encourage dialogue and discussion around conflict.

So I was nominally a discussion lead, and brought a friend and colleague, Professor Paul Komesaroff, who’s a clinician and philosopher, who also led the discussion, but we’re not there to teach or preach. We facilitate connections and help the crowd, and reflect insights back to people. That’s the essence of good facilitation.

We’re creating pathways because, maybe, someone will meet someone working in Global Health, or an organisation that has opportunities through what is a pretty complex system.

How quickly did Global Ideas evolve to what it is today?

It was remarkably quick actually, our meeting was end of 2011, our first forum was held 2012, and now we’re at our fifth forum.

We were kind of powered by medical doctors in the beginning, mainly through my networks. The four of us, Jake, Rob, Ross and I sat and decided we needed a more diverse board, so we brought on Jenny Jamieson who is also another doctor; an accountant, and a lawyer; then we ran into a young doctor who was very passionate about Global Health, Natalie Wright, and literally over a coffee I said, “I have an idea to run a conference, will you help me?” and she was like, “Yes,” and she was effectively our CEO and forum convenor. We literally sat in a cafe on the back of an envelope and sketched out what a great forum would look like.

We brought in other people. Our first academic officer, was also a doctor, Aaron, a really bright guy who created a great experience for people that was grounded in Global Health with many career development angles. This became Global Cafes, sitting in small groups talking to people who’d worked in Global Health, and could reflect back to others about their leadership journeys, and people could ask how they could consider their own career pathways, educational opportunities, and opportunities for action. We had a Career Corner, and Family Time- threaded throughout the conference, in small groups where they stayed with each other during the conference to build intimate connections. Family Time has now become Reimagine Time, which still runs throughout the conference to address global health issues via human-centred design thinking.

How did you get the word out to designers and other professional groups?

Once you diversify your leadership team, you can diversify your management team, your content, and everything else. As the board evolved, it became more diverse, we brought on a designer, a business development person, and a human-centred design service designer. The board became radically diverse.

We always took a more upstream look at Global Health, in that we’re not here to just look at tech solutions for global health. We’re looking at drivers of ill health, particularly social and environmental determinants of ill health. Health is intimately connected with development and vice versa, and people felt it was very accessible and our events were not swamped in health, and that health touches all aspects of their lives.

Once you have content that’s engaging for these people they come along.

What’s your biggest tip for people wanting to do what you’re doing?

There’s a lot of ways to create impact. We identified five personas at Global Ideas, ranging from Grassroots advocacy to Entrepreneurial activities to Policy-making. You may fit into one or more personas. Start with what you’re passionate about, and how you can influence the world, and you’ll quickly identify with one or more of these personas. Once you’ve identified what you’re passionate about and what gets you out of bed in the morning, decide, how do I want to create influence? Do I need a bigger network? More education? And that’s partly planning, part serendipity. But you’ve got to know where you want to get to.
Don’t be intimidated by vertical pathways that are wound up with social status. If you want to change the world, work out how you want to change it, and make it happen.

The Global Ideas Forum 2016 kicks off tonight in Melbourne. Tickets are still available, including day and student passes, here. 

Doctors Want To Be Innovative, But They Don’t Know How

First published June 20, 2016

Since embarking on this journey, I’ve been fortunate to explore innovation in medicine and learn what makes a medical entrepreneur, by talking to people first-hand outside of hospitals and clinical environments.

From working full-time in hospitals, I know first-hand what it’s like to want to create change, but not know how to. The constraints of protocols, hierarchies, specialty college milestones, and expectations of supervisors- not to mention full-time rosters- they all exist for safety and for high-quality medical training. I value my time in that world like nothing else. It made me into the doctor and person I am today.

Yet, I had to forcibly step away in order to figure out my odd journey.

Looking up at the possibilities. Gaudi built his vision, which millions enjoy today. Credit: The Medical Startup

Medicine is a long road, signposted by those milestones I mentioned earlier. You graduate from med school. You start Internship. You score your first Resident job in the field you want to enter. You gain entry into the specialty college of your choice. You survive your first day as a Registrar. You pass your college exams. You become an Advanced Trainee. Then you’re a Fellow.

Then, one day, you finish that, and you’re finally a Consultant. (What many in the public refer to as a “specialist” or, in the case of General Practitioners, Fellows of the RACGP– fully qualified and accredited family doctors.)

It is odd if you step away.

Will people point you out for daring to be different? – Grand Canyon. Photo: The Medical Startup

It is odd if you take a break. (Okay, maternity/paternity leave, marriage, other life events, they obviously do happen.) In the recent past, not even five years ago, it may have been more acceptable to take a break for a year. But with the ferocity of job competition amongst junior and senior doctors alike in Australia, the walls are closing in on flexibility.

And now, taking a step away from training; even for just a few months; even by remaining employed but putting off an exam for a year; even if you just need a 6 month “half-gap” of a year, because you’ve not had a proper study break since you were 5 years old – even if – sorry to hear –  a tragic life event has shaken your world – it can be seen as detrimental to a person’s chance of being rehired.

And when you’re surrounded by colleagues and well-meaning friends who don’t understand, and who actually say that those who take a break, even to work on a startup, are “unambitious” or “unmotivated” – is it any wonder, then, why doctors feel isolated and stay under the radar when they come up with an idea?

And, even if a hospital or clinic is supportive (and they usually are; unfortunately, it tends to be particular influential individuals who aren’t) – you have to go a step higher, and try explain to colleges that you’re still doing valuable work in healthcare, by working on your startup- it just doesn’t fit their definition of training.

And this is why doctors find it hard to Innovate.

Leaping through the clouds- daring to dream. Photo: The Medical Startup

How can you innovate when you are feeling weighed down by all these pressures?

How can you innovate where your environment is slow to respond to change, and, despite best intentions, has trouble understanding the few (or many) employees who want to do more, but can’t articulate their feelings?

How can you innovate when you risk being penalised or even kicked out of a specialty college that you’ve worked so hard to enter?

How can the medical profession realise that a step away doesn’t equate a permanent career change, and that it is vital for the future of healthcare for motivated health professionals to gain experience building something outside of their day-to-day work environments in order to bring optimal change for their patients and colleagues? 

Entrepreneurship doesn’t suit everyone. This is not a comment on forcing everybody to become entrepreneurial. It’s about creating the supportive ecosystem for those who are motivated and capable of change, to create that good change.

We should connect our different ways of thinking, and allow ourselves to shine. Credit: The Medical Startup

Many Australian hospitals have rotations in Clinical Redesign and Innovation, or other similarly-named Medical Resident positions. A junior doctor has the opportunity, usually for 10-12 weeks (the standard duration for hospital rotations) to work on innovating within the hospital system. They are usually assigned a senior Supervisor and observe, advise, discuss, formulate, and strategise solutions and carry out these solutions during these ten weeks.

Projects are varied. They can improve the efficiency of completing discharge letters sent to the GP when patients go home. They can improve the allocations of night shift duty. They can create more structured Handover meetings at the start of each shift, so the staff finishing can “hand over” outstanding tasks and patient updates to incoming team members. These roles give junior doctors the opportunity to innovate. However, very few of these roles exist, and to be honest, I am not sure of the demand for doctors who want to rotate in these roles over Cardiology, Nephrology or other critical specialties that count towards training and clinical care. (Feel free to let me know.)

I’ve been really fortunate (and also worked hard!) to attend events where I get to meet people in the health tech space; and others who are medical entrepreneurs in non-medical fields; and I find, that non-medical people are, very graciously, applauding those of us who innovate. Those of us who choose to step away. This whole post has been stimulated by yet another Twitter comment by a non-medical entity encouraging more doctors to innovate. It’s fantastic that the non-medical community are eager to see more doctors and health professionals innovate. If they only knew how hard it was, and how much doctors risk by choosing to innovate, they might understand why there are, perhaps, fewer Australian doctors in the entrepreneurial spotlight than in other fields.

Dreaming big at Yosemite National Park. Photo: The Medical Startup

I’m going to shine this spotlight on inspiring health professionals who are doing great things with their time, to help normalise this situation, and to celebrate their wins as well as their journeys. And I challenge you, too, to be inspired, to value your time, and give your best to the world, no matter what field you’re in.

Do you agree? How can healthcare ecosystems and communities in general improve inclusion for health professionals to innovate, in and out of their workspaces? What cultural issues need to be addressed and how can they be fixed? Or do you think things are fine as they are? Feel free to comment below, or send us an email via our Contact page. 

How Co-Working Spaces Can Help You And Your Startup

First published June 2, 2016

Wondering what co-working is? We visited two major co-working spaces in Perth-  Spacecubed, and its sister space Flux, to find out.

Co-working spaces are community spaces for working on and building your startup, sole trader enterprise, or scaling business. Spacecubed just held Australia’s first Mental Health Hackathon, MindHack. Its success means another MindHack is in the works!

Co-working spaces are also, by definition, a space for working with other businesses, at various stages of a business lifecycle and from a range of different industries. Startups and sole founders can be very isolated, and co-working helps to solve this problem. Membership flexibility allows businesses and sole founders to adapt as they require, and the space is built to facilitate networking and collaboration, as well as quiet -room working spaces and longer-term office leases.

Spaces tend to offer a rotating program of activities that can help its members, for example, SEO tutorials, legal advice, games events, pitching tips, and drinks. Some of these events may be open to the wider community.

Spacecubed offers packages including mentorship and legal advice for its members. Photo: The Medical Startup

Spacecubed Marketing Manager Matt Kirk kindly took us on a tour one Wednesday, showing us the varied office spaces, desks and personalities inhabiting Spacecubed over several floors. Home to startups across a range of industries, co-working helps members cross-pollinate ideas, resources and perspectives that they wouldn’t encounter otherwise . Having neighbours who are coders, engineers, designers, or copywriters from fintech, education, photography and even space tech, helps new connections and, potentially, new startups form. Mentor programs also run from many spaces.

Spacecubed, Perth. Photo: The Medical Startup

Hot-desking options allow members to meet and greet while working in different spaces. Office space for more established companies are also available for hire. Part-time and full-time memberships are on offer, and many spaces offer one-day or even free introductory rates. Packages at most co-working spaces exist to be flexible, starting from daily rates to monthly or even yearly memberships. Spacecubed also offer a day of free co-working at partner locations across Australia, and this helps foster connections between communities across the country.

Housed in the former Reserve Bank of Australia headquarters, Spacecubed has different floors for levels of quietness during work hours. Meetings can be held in a soundproofed former bank vault. And, further down the road at Flux, businesses can use the new maker labs with 3D printer, virtual reality lab, and prototyping materials – a first for co-working in Perth. Introductory packages are on offer to coincide with Flux’s opening this month.

A peek inside a demo office at Flux Perth. Photo: The Medical Startup

The other benefit of co-working spaces tends to be location. Both Spacecubed and Flux are situated along the CBD hub of St George’s Terrace. The area’s bank facades and glass windows are punctuated by shortcuts to some of Perth’s best bars and dining areas for business meetings and post-work meetups. I snuck over to the Print Room for a meeting, chomping kale salad while my colleague had a drink, and, later, The Apple Daily Bar & Eating House for a dinner catchup. (Melburnians, think Chin Chin with less queuing and a more Malaysian twist.) Perth’s startup scene may not be as well-known as Sydney and Melbourne, but its geographical isolation, strong education institutions and quiet beauty has helped it become a major player in Australia’s startup community.

For more details and to book a free tour, visitSpacecubed‘s and Flux’s websites. 

Part 3: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 29, 2016

 We hope you’ve enjoyed Greg’s series on starting his telepsychiatry business and his journey to success! Here he talks about dealing with the process of failure, and rising from that, along with future plans for Conduit Health.

You can now view Parts 1 and 2 as well.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Can you talk more about your failure process? How did you deal with criticism and get through failure? (Greg had to resit his exams a few times before qualifying as a consultant.)

Firstly, it’s a humbling thing, and there are some good resources. You should find those consultants or colleagues who can give you meaning to your failure.A lot of people will say, “oh, you did this wrong or maybe you did this wrong.” I’m not saying there should be an external locus of blame, I’ve been through that too- “oh, the college is out of its mind failing me because everyone I know is telling me I’m ready to be a consultant, couldn’t really figure that out. But one thing I was told is, “look at this person who’s now a professor, I know during his training he failed 4-5 times,” so I guess there are some comforting things like that. But it’s also about yourself being able to apply that meaning to your failure. Otherwise you go through all this pain, and you can’t get some benefit from it. And that’s pointless, absolutely pointless except to hurt you.

Failure is just an opportunity disguised as pain. 

So I thought, “I won’t let it hurt me or fail me.” With my career, I did think, “should I be doing this?” but I felt resolved that before failing and before I was in that frame of mind, I knew this was what I wanted to do, and this shouldn’t change it. Just because some people failed or I didn’t pass an exam, I will pass eventually.

My reflection of my failure brought about so many positive opportunities.

Medical people tend to become very disillusioned when they fail. We’re not used to failing, we’re high achievers, and when we do fail, it’s a huge fall, and some people don’t recover from that. Those who fail need support, and I know myself because when I did fail, I spent endless nights on YouTube looking up motivational videos and how to get through failing and how to get meaning from that. I felt alone.

I had colleagues who also failed, so we formed a bond and pushed each other through. They’re not entrepreneurial per se, but we had some support in that we failed together.

I think people should apply some meaning about failure. It’s all too painful an experience to do for nothing. Even if you eventually don’t pass, it’s okay, as long as you did something meaningful. Even if I didn’t pass and dropped out of my training, I took meaning from it, and reflected on it.

In fact, Conduit Health is thanks to failing. Had I not failed, I’d have sailed through my training program, with this inside disgruntlement of “this is what I am”.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

One of my bosses said, “I think this will make you a better psychiatrist, and this is because you now know what it’s like to fail. Previously you had no idea what it was like to fail. You excelled and  succeeded in everything. And now you can see that when your patients fail, you can feel a bit of that.”

The medical field, I think they kind of shun people who fail. And people who do fail, don’t talk about it, because they want to be seen as brilliant, successful, and never a failure. Whereas in business, the more I look, they talk about failure with pride. They go, “I started up ten companies, and all failed before I made Google.” They talk about failure with pride, and those who don’t talk about failure and don’t own it, they’re missing that opportunity to share with people. Everyone fails at something, in one way or another everyone fails at something. And people then tend to hide it and put it in a box and not share it with anyone.

We need to change the culture and say, “it’s okay to fail, lots of people fail, but what will you do with it?”. The famous words from Edison I think were, “It’s not that I’ve found the way to make a lightbulb, I’ve only found ten-thousand ways NOT to make a lightbulb.” 

It’s about mindset change.

It’s like, “ok, I failed four times.” It’s not to say, “I failed and I’m useless,” it’s, “I’ve failed and found four different ways to not pass an exam, and I just need to find that one way to pass it.”

Reflecting on my failures in the exams, what held me back wasn’t anything to do with my knowledge. A lot of people think it’s the knowledge (that makes them fail), not knowing enough. For me, it was the anxiety levels. I went into the exam thinking, “what do the examiners want to hear?” But the time that I passed, I gave that away, I said “I don’t care what the examiners think.”

I think there could be more constructive ways in which our colleges could address failure. One way I think is to talk about it more, and to show that it’s not life or death if we fail, we can get through this, and be more supportive, be able to talk about it. 

By having the courage to say “yes I failed my exams”;  other people find doctors as quite intimidating, they’re seen as being super successful and smart, and when you can bring yourself down a bit and be humble and say “I failed”- everybody fails at something, whether it’s their driving test or something, failure is something everyone has in common, so when I bring it up, a lot of people can suddenly relate to it.

In business, that’s super important, so people are not intimidated by you, they have something to relate to you, and it builds relationships. A lot of my GPs, mental health nurses and staff, they like me for being open about it, rather than hiding it away, rather than bringing across this facade that I’m super brilliant, never failed in my life, top notch.

How do you view competition in business? Doctors have that win mentality, how do you manage that in business?

I welcome competition in business. I feel that if somebody can – if somebody else comes forth, it’s always anxiety related, like, “I must be better than them.” But what I do is look at the competitor, and ask, “did they actually evaluate? Did they actually have new ideas about improving telepsychiatry, did I do that, and if I didn’t do that, why can’t I do that? If there are no competitors, you are at risk of becoming complacent, and competitors bring excitement. So I ask, is there value-add, or do I just have to do my job?It can become about less value, more competing on price point. But I know it’s hard for other companies in this space to compete on price point.

What are your other plans for 2016?

Trying to balance. It’s tempting to focus just on private practice, but Conduit would fall by the wayside. For me, what I’m trying to do is allocate time to Conduit Health and allocate other times for private practice . I’ll try organise more talks for GPs including interstate, hosting events.

I love going out to rural communities and seeing them, they really don’t have much psychiatry services. Same with their GPs, they don’t have much support and can get very isolated without someone coming from the metropolitan areas to offer help.

We’ve received the odd referral from the Great Barrier Reef, the Northern Territory, Tasmania, but I want to increase that. In business I think this is something we do- go back to fundamentals, think “why did I start the company, what did I want to achieve?”

The more isolated rural places, I’d rather focus on them. In the semi-metropolitan places, people travel 1-2 hours, whereas in the NT there’s no psychiatrist for a few hundred k’s.

The other thing will be statistics. Looking at 2015, we’ve been collecting data about how many patients we’re seeing, the outcomes, sending surveys to patients and GPs. Being able to publish them and say “this is where psychiatry services are at, this is what we’ve done.” Entrepreneurship is 24/7. It is on my mind 24/7. Even if you’re not doing something on it, it’s on my mind. My admin staff, everything, it’s on you. It’s like having a baby, it’s 24 hours, no escaping. Something people wanting to get into business need to be aware of. It can be like medicine, it can be all-consuming.

A few years from now, I’d really like to get government involved so that I can provide telepsychiatry services to public hospitals. Public services can be quite stretched, but for a private company like mine, that’s what we can offer.

What are lessons that medical professionals and people from other industries can learn about starting in business?

Guy Kawasaki’s lesson is, it’s not about how are we doing things now and how can we do things better; it’s about, “what is the next curve?” Conduit Health is jumping on the next curve. Not just about how to improve how doctors see patients face-to-face, sure there’s a lot of work to be done there, but if you want to jump on the next curve, (you’ve got to create) innovation.

Not too many doctors by nature are entrepreneurial. A large part of that is because we get comfortable doing our daily job. See patients, make a living. Innovation and startups are a huge risk. It’s out of our comfort zone. We stop seeing patients, and suddenly your startup becomes the neediest patient you’ve ever had. 

It’s important to get this out there. It’s people like you, me, people who dare. And hopefully this will help a lot of people find, “this has been inside me, this has been in the back of my mind, but I’m too scared to do anything about it.

Thankyou for your support of The Medical Startup and Greg’s interview. You can view Parts 1 and 2 of Greg’s interview by clicking here and here. 

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please emailenquiries@conduithealth.com.au. Conduit Health is also on Facebook. 

Please note: In the medical world, “consultant” refers to a fully-qualified ie. board-certified specialist. “Registrar” is a doctor who’s a member of a training program and preparing to qualify for this certification. “Resident” is pre-registrar; “Intern” or “Houseman” is first-year out of medical training.

Highlights from the Digital Health Show, Sydney 2016

First published April 19, 2016

The Digital Health Show Conference and Expo at Sydney showcased a broad range of international digital health ideas. Presenters from medical and non-medical backgrounds shared their innovations via onstage panels and roundtable discussions. 

As Elaine Saunders of Blamey Saunders said, “Today, digital health is much more than reading off the internet or doing Telehealth.” Creating meaning through innovation, and marrying this with a viable product, generates synergy between patients’ and practitioners’ best interests.

Some themes that emerged from the Conference: 

1. Digital health should unify shared goals for both practitioners and patients. Thomas Goetz (USA), former executive editor of Wired magazine, spoke of the difference between Passive Data (eg. phone sensors for pedometers), and Active Data (voluntarily entering your weight after stepping on a scale) in health. “Active data could potentially be more meaningful,” he said. His startup, Iodine, a search engine for side-effects of prescription medications, utilises active data through its Start app. Start lets users enter improvements and side-effects they experience from their antidepressants, generating a flowsheet over time that can be shared with their doctor.

2. Digital health can improve patient compliance and education by tracking goals and milestones on apps. This personalises each patient’s therapy; and potentially improves patient outcomes, speed to recovery, and reduces relapse rates. ImAblegamifies stroke rehabilitation via smart device apps, making participants 16 times more productive; DorsaVi’s ViMove wearable sensortracks lumbar muscle movement and posture to aid rehabilitation and avoid workplace injury; TrackActive’s exercise prescription app holds an exercise database so users can recall their prescribed exercises by video or saved instructions rather than on loose paper. Clinicians appreciate the integration of these apps and devices into their workspaces, improving interactivity between clinician and patient even outside of appointments.

3. Novel technologies can be integrated smoothly into user-friendly devices. Quanticare’s Footprintsoptical sensor can be attached to walking frames to analyse a person’s gait; ResApp uses the speech recognition technology behind Siri to diagnose respiratory infection via cough; Respirio uses nanotechnology to detect the presence of Influenza A and B in twenty minutes. Quanticare was founded by a physiotherapist, and Respirio by an Emergency Department physician, showing how inspiration from the frontlines of healthcare can inspire creativity.

4. Improving workflow. More innovation and more data can create more headaches for clinicians and workplaces struggling to manage the deluge of data. Medtasker aims to solve these problems by providing a secure platform for clinician communications at hospitals, meaning that clinicians will be able to locate the patient accurately, and triage pending tasks according to urgency.

5. Integrating convenience for patients and practitioners. Dr Noel Duncan of SiSU Wellness demonstrated SiSU’s health check computer station, which has previously been positioned at Crown Casino and Priceline pharmacies. Performing blood pressure, weight, BMI and heart rate checks via ultrasonic height scanning and bioelectrical impedance, it is partnering with the Stroke Foundation to conduct free blood pressure checks at Priceline pharmacies nationwide this month.  Dr Alan Greene (USA), Paediatrician, TED speaker and Scanadu founder, began his Australian visit by diagnosing an ear infection 7000 miles away in the States via telemedicine. He estimates that 90% of his interactions with patients occur outside his office. Although the American systems of telehealth differ to Australian models, Dr Greene’s talk painted an ideal picture of where digital health is heading for patients’ and practitioners’ benefits.

Overall, the DHS was an enjoyable experience, and for a newbie to the startup world, it gave a great overview of companies and founders who are realising their visions of creating a better world through digital health. It also gave me a better idea of the workings of startups and the stages that health startups go through to be approved in Australia and the US, such as prototyping; proof of concept clinical studies; and building a great team.

Other clinicians who attended similarly had a positive experience.

Dr Akshat Saxena from CancerAid said that “it was a nice mix of professionals, and a good place to link up and see what’s going on around Digital Health.” 

Dr Andrew Yap from Medtasker agreed that “it was a great opportunity to showcase Medtasker with other emerging healthcare companies. We made some great contacts and attendees were really enthusiastic about how Medtasker could improve patient safety and hospital efficiency. We want to thank the Digital Health Show organisers for all their efforts and we’d be keen to attend again next year.”

Dr Nelson Lau, GP who attended the DHS for the first time, felt that “it was a really informative event. The main talks gave an interesting overview on some of the potential pathways that digital health will branch out to in the future, while the roundtable sessions were a great opportunity to network with peers and have more informal discussions on collaboration possibilities. The exhibition hall was an interesting place to discover and play with emerging new technologies and platforms and it’s exciting to be at the forefront of the oncoming wave that will be sweeping over healthcare as we know it.

It was impressive to see so much time devoted to Geriatrics and devices for the ageing population, which we’ve featured in a separate post here.

The Medical Startup attended the Digital Health Show with a courtesy pass.

Did you also attend the Digital Health Show? Got any comments? Leave them below. Subscribe to our mailing list for future post updates.

Innovations for Aged Care and Senior Citizens at the Digital Health Show

First published April 19, 2016

The Digital Health Show Conference and Workshophad some standout projects aimed at improving the lives of the elderly and more vulnerable in our communities. Innovation for our ageing population will help integrate our society’s communities, improving wellbeing across all age groups. Here are some highlights:

1) A/Prof Valerie Gay and Dr Peter Leijdekkers of UTS showed how their community model, Le Bon Samaritain, links elderly residents in the community with “Good Samaritan” neighbours who are alerted via smartphone app if the resident is in distress, via a Red, Yellow and Green light system. Using “tech to empower communities,” this will help engage neighbours with often isolated members of the community. From our experiences working primarily with the elderly, we’ve seen many preventable hospital admissions occur during heatwaves, floods and falls, and feel that systems like these will help improve safety in our communities.

2) Philip Goebel, Physiotherapist and co-founder of Quanticare technologies, demonstrated the Footprints sensor, that attaches to a user’s walking frame and analyses gait during everyday use. The Internet of Things Innovation World Cup Winner at Barcelona, Philip created Footprints in response to the feeling that “our healthcare system is very reactive; focusing on fall detection, rather than indicator of cause.” Footprints uses an optical sensor which analyses gait via spatio-temporal gait metrics. The data generated can assist with prescribing mobility aids and falls risk management.

3) The ePAT (Pain Assessment Tool) for Dementia uses facial recognition software assess pain accurately in dementia sufferers, who often cannot verbalise their pain. Founded by Professor Jeff Hughes, former head of Pharmacy at Curtin University, he described how, by using the inbuilt cameras on smart devices, ePAT can assess facial pain cues at the point of pain onset, as well as non-facial pain cues. The benefits for dementia sufferers and their carers, will extend to more accurate pain management in hospitals and the community, and is being looked into with pre-verbal children.

4) Eureka Connection: A/Prof Helen Hasan, Information Systems specialist from the University of Wollongong, hosted a workshop discussing Eureka Connection’s vision for bringing computers and smart devices to senior citizens. Starting with the Illawarra region of New South Wales, Helen’s passion for bringing tech literacy to seniors through home visits, community centre stations and education was reflected in the videos of seniors who were awed at sending their first email, receiving their first Skype call, and joining their first Facebook community group during a seasonal flood. As the elderly are at more risk of injury and isolation, tech education to encourage connectivity and social integration helps their wellness and physical health. Giving advice on how to set up a computer or smart device; selecting the right device for their needs, making it user-friendly by, for example, enabling large text; and helping them to reload credit and find hotspots are just some of the things this ambitious project hopes to achieve.

What are your thoughts on these projects for seniors? Comment below.

The Medical Startup attended the Digital Health Show 2016 on a courtesy pass. See our other highlights from the Digital Health Show here.

Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health: Part 1

First published April 26, 2016

 Dr Gregory Sam is a consultant psychiatrist who founded Australia’s first bulk-billing telehealth psychiatry consulting service, Conduit Health, in 2014. Focusing particularly on rural and remote communities, Greg currently runs Conduit Health along with his private practice work in the city. In this three-part interview series, Greg kindly shared his tips for success, the road to Conduit Health, mixing business with medicine, and rising from failure.

Image credit: Dr Gregory Sam

How did you get the idea for Conduit Health?

I think the idea started during my rural rotation of training in 2009. It was often a whole-day affair to see these clients, 4-5 hours’ trip each way, and that was disheartening to see people suffer so much. It’s supposed to be easy access. But they had to wait ages before seeing a psychiatrist.

So I aimed to fill that gap.

I started because I was so frustrated at the way things were.

I found so many deficiencies in rural mental health care, and thought, how do I improve things? There area lot of difficulties and shortcomings in the system. I was always into tech stuff. So I tried to think of the amalgamation of the healthcare and mental health care sectors. Telehealth was in its infancy then. So I thought, why can’t we assess the patient through telehealth conferencing?

I struggled to get through my exams, failed 3 or 4 times, and started to get a bit disillusioned about my career in general. I wasn’t sure why I wasn’t getting through. A lot of thoughts were going through my head. Is this the life for me? Should I be changing careers? A whole heap of stuff. But I thought, there’s still good things I can do in this field, whether it’s as a registrar or consultant or not. I’ve learnt a whole heap about my specialty through this. 

How long did it take you from having the idea to taking action, alongside your clinical work and studies?

Honestly, a few years. My idea has been since 2009, and it’s very tempting to get distracted by training. I was so focused on training that all these other things I could do fell by the wayside. I had the idea for a few years, but only started something solid in 2014.

I think 2014 was when overcoming all the inertia of starting a business occurred, planning and actually doing things. 

Failing my exams gave me that opportunity to start thinking outside the box. I took 3 months off work to have a break. I think that’s the best thing I did during training. I focused on badminton and other things I like doing, and started to make moves on my company. I had meetings with colleagues and friends in business, picked their brains, tried to absorb as much as I could from them, both guys and girls, to understand what it’s like to get into business. My business friends said, “it sounds like a brilliant idea, why don’t you do something about it?” So that gave me a kick to start.

When I went back to work, I left business for awhile and focused on passing exams. Once I passed, during our year of Advanced Training, I set learning goals on things like, “I want to learn more about drug and alcohol,” and other goals which I did in my day job, and also focused my energy on Conduit Health. That’s when the wheels started turning.

2015 was the launch date. Our first consult was February 2015, so 2015 has been a big year in that it’s a startup, and for most startups it’s about sustaining that growth, so 2016 is another big year. A lot of planning happens with regards to how to continue that growth, otherwise it’s too tempting to have a firework effect where it starts then fizzles up. 

Overcoming inertia is hard, but once you overcome it, things start rolling, and you can’t stop.  It’s a lot of commitment but so rewarding, more rewarding than my day job. I find treating patients rewarding, I can help them and their families as a psychiatrist. Whereas with Conduit Health, I’m helping so many more people across the country. We’ve had referrals from far and wide, from every state, and remote locations like the Kimberley and the Great Barrier Reef. I’m working with primary health networks (PHNs) across the country to expand our reach. 

How does a typical consult run?

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Either the psychiatrist dials in (from their location), or the patient (who’s hosted at their GP clinic) dials into us, then the psychiatrist introduces the consult. We need to say at the start that we’re doing it via teleconferencing, that there’s no one else in the office, and check who’s in the office. This sets the scene so the patient can understand that there are no unseen people in the room. We discuss confidentiality, unless risks in which case we need to notify particular people. It’ll go between five minutes to an hour, we state our aims, then start the diagnostic interview.

The video quality is quite good, but if there’s any lag or dropout, we disconnect and call back. We check at the start, “can you see me? Can you hear me?” We check camera position so the webcam points directly at the patient and so the patient can see us. We also make sure it’s appropriate, eg. the psychiatrist is in a quiet isolated room, not at the beach. We set rules for our psychiatrists. They use the Conduit Health backdrop. 

Sometimes a mental health care nurse will be there. We offer to GPs, if you want to be present for the whole assessment or in the last 5-10 minutes, you can. Some GPs stay for the whole interview, others come in the last 5 minutes and ask the psychiatrist, “what’s your diagnostic impression and what’s your plan?” They can get immediate feedback, (and sometimes help with scripts and so on).

We also get constant feedback from other GPs. My role is partly to ask patients and GPs, “how are you finding the process? Can we make things better for you?” Constantly evolving the company.

One benefit of Conduit is confidentiality. You don’t need to go into a psychiatric facility where everyone knows it’s a psychiatry facility, and sit in a waiting room with other mentally ill patients. Patients have said that’s a benefit, so people don’t have to know they’re seeing a psychiatrist. In a way that’s also bad. We’re not trying to promote stigma of mental health, but unfortunately this is a barrier to receiving care.

How did the name Conduit come about?

I was building a house at the time, and working with the builders, one said, “I want to dig a tunnel under your garden to create a conduit for your electrical wires to go through.” Also from my cardiothoracic surgical rotation in med school, “they harvest the conduit” in bypass surgery, and they explained what a conduit was to me. I then thought about what Conduit Health does, it takes away big distances and gaps.

The logo is a bridge, to embody bridging gaps.Suddenly, 300 kilometres to go to an appointment doesn’t matter anymore. It’s a link, a conduit, from point A to B. So patients don’t have to travel.

I don’t think telehealth will replace traditional face consults, but it can address geographical barriers.

Would you expand Conduit to non-psychiatry services?

The immediate next need would be psychology. It would be great to have psychologists who can do tests and consults. But at the start, I want to focus on psychiatry. Some companies have one of every specialty, but I want to focus (for now). If there is demand later on, for say, neuropsychology, social work, we will expand to fill the need.

What about your plans for aged care?

A big arm we’re developing in 2016 is to work with residential aged care facilities. There’s such a huge need, patients can’t often go see a psychiatrist. Aged care services are often floundering, “can we get the psychiatrist to come here?” but not many psychiatrists want to do that to see one or two patients, it’s not feasible. But we can go in and have a session there, and it’s immediate. So 2016 will be a big year for Conduit Health Aged Care branch. We want to expand to all the big aged care facilities. 

To learn more about Conduit Health, click here. 

Stay tuned for Parts II and III of Greg’s interview, in which he discusses his business inspirations, his insights on failure, and running a business as a medical professional.