#432: What clinicians really want, and need, from Healthtech with Lawrie Kidd from DrDoctor

0:00Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology. and I'm your host James Someru.

0:11Laurie, welcome to Health Tech Podcast mate, how you doing? Yeah good, I'm excited to be here, it's an honour. Yeah, it should be fun, it should be fun. I'm also a little bit, I was going to say in awe but I don't know what the right term is. Like Daffid from Concentric came on this podcast and he said an amazing phrase to me which is that when you leave medicine you freeze your seniority at the point at which you have left and so now where I find myself is on a podcast with a consultant anesthetist and now I feel like you're my boss and I feel a little bit scared of you so imagine me to I'm going to be a little bit subservient I think in this podcast and ask you like oh is this is it okay if I ask this you're the first person who I interact with in any other environment who's subservient to me so that's great um well get ready for it because as I say my seniority definitely uh definitely froze when i left medicine as sho slash uh a week as a registrar or whatever i did um but never did the exams so again well never did part two of the exams so i've always got that hanging over me that the consultants when i left were like it's always there you can always do that i wouldn't recommend it but uh oh i spectacularly failed the uh the in fact no i didn't spectacularly fail it i just about failed the oski but i did spectacularly fail the viva first time around because i passed the mcq's first time and thought oh this is this is fine this this will be absolutely a walk in the park obviously it was not the anesthetic exams famously what are they the most difficult do you think if you're if you ask an ethius they're always going to say yes aren't they yeah of course they are thank you I only asked you to validate it for me.

1:54No, it's, I mean, yeah, I mean, it's definitely a monathon, but like the exams are grim and you're like, yeah, I've got so much sympathy for residents out there who are juggling really brutal on-call rotors, you know, rotating hospitals, often have got young families who've got serious clinical commitments. And on the side, their hobbies include revising for exams, which take about four hours of revision a night. like you know it's it's absolutely grueling um especially when you're learning the pressure that gas is stored outside the hospital and how it's piped in like yeah there's those moments where you're like hold on a minute is is my time better spent doing something different probably but do i want to pass this exam absolutely and it feels like a ticket to freedom doesn't it like once you have passed that i imagine i wouldn't know the feeling but if you have passed the frca i imagine that must feel like oh now i just have to do my day job surely that's fine yeah i mean funnily enough that kind of you my experience of going through training was like i don't know it felt quite hard work it was quite a quite a grueling process and um and you have these hurdles and you can you can only see the kind of the next one you've got in front of you um and so you know it might be an exam or it might be in a project or it might be in a job interview or whatever it was and then you you kind of there's this this kind of um nice little lull afterwards and then the next thing kind of rears up on the horizon um and that's kind of i guess that's kind of the nature of life but my my kind of like slightly um kind of alternative portfolio career only got established once i got over what felt like the final the final hurdle which is when i got a consultant job and that until then it was absolutely relentless just going from one project to another to you know doing some research doing a big qi project you know constantly being involved in stuff whether it was exams or whether it was stuff or just sometimes just kind of trying to keep the wheels attached to my life um with a wife who's also juggling similar commitments and stuff like that so yeah um it's uh yeah it's i've got a huge amount of sympathy for um trainees coming through the system because it is it is hard it's really hard well i'm looking forward to getting interested in because you you have put a portfolio career together working at doctor doctor as well as doing lots of other things with conferences and a bit of entrepreneurship yourself it sounds like and yeah there's there's a lot for us to get into and i guess that would be my first question as to the pressure that clinicians face at the moment seems enormous.

4:37Clinically, there are strikes going on. Practically, there are health tech things happening, AI scribes, that might take some of that admin pressure away. But I'm really interested because we don't have many, you know, practicing clinicians on here, frankly. And you see health tech from two different sides you see it from the side of working in it and you see it from the side of uh having it done to you i imagine as a clinician and so just orientate us a bit like what where where are you in in life and all those different things give us the rundown of of who are you who are you and what are you up to um and yeah just let us know what the practical reality is on the ground floor i think it's a nice place for us to start yeah so my um i kind of always introduce myself as a consultant neufelist first um uh so two and a bit days a week i work at gloucestershire hospitals so it's a split site um trust is massive it's really busy it's um it's a very exciting and interesting place to work and it's uh if anyone's looking for a job it's a brilliant place in terms of loads of interesting stuff going on and it's um and fundamentally like a really really nice bunch of colleagues which is the best thing um and i always you know if your list finishes early and you sit in the coffee room and suddenly you look at your watch and you see it's like quarter past six because you've just been having a good chat with your mates yeah that's that's golden um lovely so i'm incredibly lucky to do that and that's um kind of front and foremost of kind of what i identify with really is that clinical role what that actually involves is um probably kind of 70 ish percent of my time is giving anesthetics um and then the rest of my time I'm in pre-assessment clinic.

6:23So I do a little bit of outpatients and predominantly kind of, yeah, kind of, yeah, putting people to sleep for operations, which is, you know, you know this, it's an amazing job. It's a huge privilege. And one of the things I absolutely love about it is you are interacting with people at a stage where pretty much everyone's terrified. So no one really wants to be there. I think the only people who are excited to have an operation are people having boob jobs and people having a kidney transplant like genuinely like pretty much everyone else is like there for some kind of misfortune um and what you can be is you you kind of the whole point of a cct and anesthetics is that you you can come out being able to do the technical skills but what you can do and i remember like so clearly um as a trainee as a junior trainee um working in exeter there was a consultant who just held the patient's hand just as they were going off to sleep and was just super kind just super empathetic towards them and that's always kind of stayed with me in terms of the fact that you can do so much technically but actually what patients remember is whether or not you are kind and compassionate towards them so that is that's kind of front and foremost of of uh what i try and do i try and deliver kind of good clinical care then when i'm not doing that i've got a couple of other roles um the kind of the biggest one is with doctor doctor so i've been there for a few years now um on i was on the kind of clinical transformation side of stuff um and now i've moved into the product side and clinical product lead um and that's uh brilliant i can talk about that all day um but it's a really really interesting we shall and we shall hopefully not all day um but uh then um but yeah it's uh it's a really really interesting um and uh kind of sometimes challenging um uh but really eye-opening space to be in then the kind of other kind of form roles i've got i've got a couple of non-executive director roles um which are um yeah really insightful really eye-opening um one's for a big research foundation um and one's for a um a kind of community diagnostics provider in the southwest um that gives me a totally different perspective um and then when i'm not doing those things i'm um yeah dad to two little girls and husband and you know juggling other stuff and yeah lots of other um things going on that's amazing man um i think for a lot of people that uh you know if you just said that to me when i was an f1 f2 i would say this guy's living the dream that this guy is absolutely like I would have probably find like thought there's actually a role model and I did struggle for that quite a lot in my clinical training of who's got the career balance the life balance etc etc that that I would want and so congratulations to you for getting all that together like it I imagine what most people come on here and say is that oh it can always look like well thought out and all these things but it's you know you're just rolling from one thing to the next and bumbling this career together but how has it felt for you putting that together because have there been like clear paths to that did you have anyone to look up to uh so the last question is easiest to know um and i've kind of looked for role models and i first started kind of dipping my toe in this kind of world i yeah i did reach out to a few people and um i think most people who are doing it are pretty busy um and don't have the bandwidth necessarily to do that um i i certainly remember a few people um like colleagues at work not not so much but kind of other specialties who have made slight a handful who have made slightly uh derogatory and derisory comments about my attention not being um on my clinical work which is a really interesting thing um i've always had a lot of people be you know reaching out to me being very curious wanting to know wanting some advice and you know um so it's definitely in the minority but um it's been a it's been a a mixed reception um which is interesting because i think if i was for example i'm like becoming a postgraduate dean of medical school or something more typical i don't think people would be um asking these questions um so there's some interesting dynamics in terms of perceptions of industry and um and how the kind of health tech world is viewed is that hard to handle being so clinical you know two and a half days a week you're in the hospital a lot um i mean because i do quite a lot of out of hours and on call commitments it's um it kind of it adds up pretty quickly i i've got some kind of red lines in terms of what i want to do and what i'm not prepared to do clinically i don't want to do any less clinical work because i will one i enjoy it too i i think that kind of that relevance that clinical relevance can be lost very quickly um and also i don't want to d-skill um yeah i'm at a stage of my um my career where i'm still learning stuff all the time and um i yeah it's a it's a degree of craft um and i don't want to lose that um attention to detail and that um uh and those skills and already i'm you know you can't be good at everything um yeah and there's um yeah i'm aware i i was chatting to someone who's a surgeon who's really i mean she's she's brilliant um she's the chair of the nps foundation which i'm a non-executive director for um really interesting lady but she's no longer actually operating um because she she felt her kind of her her kind of technical hands-on skills were degrading by not being kind of being full-time so i i do think i do think it's a really interesting challenge um for people who to maintain their skills um yeah knowledge and stuff where do you think that comes from that opinion of industry and the desire to sort of neg you for it like what what i imagine it's different things in different people but that it does seem like a fundamental like the individual level i think there's so many because i have the dms there are so many people wanting to explore health tech for various reasons some are being pulled into it some are just trying to find a port in the storm and being pushed away and be interesting to talk about your perception of what's going on the ground floor there But I'm interested as to what that perception is and where that comes from as to the animosity towards industry and health tech.

12:45Because is that the same as how people would view a part time role in pharma, perhaps? Or is that how they're perceiving health tech? Or yeah, you tell me. I think it's people who don't fully understand and appreciate what's involved and what's going on behind the scenes. Is it the expectation that a doctor remains pure clinical and anything else is reductive of their status or whatever? Is it that? I think a lot of people historically has been a vacation and people have kind of felt that kind of deep resonance with what they're doing and people will go above and beyond and be very happy with that.

13:26And I think for various reasons, and I'm not going to get into the goods or the bads or the stuff, but there's been a lot of loss of that for some people of that vocational aspect. And it's become a little bit more transactional. and i think there's a kind of wave of people who have um in first commas suffered the contracting position for the residents for example who feel very differently about how to interact with their employee and sorry the employer and and what they do and how they do it um that's not to say that he that i mean i don't think i've ever met one of the trainees or residents coming through who are not incredibly hard-working driven and patient but i think i think there has been a slight slight change in that and that's kind of feeding up the ranks um i think the i think i think industry is viewed with a lot of skepticism um because i i think people think that they're constantly either being sold stuff or you know being taken advantage of or being capitalized and i think the the there's such a kind of such a bad track record of kind of good procurement decisions and good like you know the right stuff being bought or drugs being slightly missold or evidence for something um whilst it's in vogue and then suddenly actually more data becomes available and you know it was actually shown to cause harm and you know there's so many kind of narratives involved yeah i think that i think anything other than kind of pure clinical is kind of not pure um and i was speaking to someone a couple weeks ago really really interesting guy who'd done a lot of stuff at a very high level in industry.

15:04He said some of his former colleagues just refused to talk to him, just completely blanked him. Wow. Which probably says more about them than him. But that's pretty sad, actually, if that's how people view it. And I do think it is predominantly a lack of insight into actually what what industry um however whether whether whether it's pharma whether it's health tech whether it's med tech you know all the different allied specialties that are kind of surrounding health care which i think most people don't know about i was at an event quite recently on um i was at an event quite recently on a panel and someone the panel was you know four people that have left medicine doing different things and venture capital start-up land um one person was clinical but was pursuing a start-up themselves as an entrepreneur and someone someone put their hand up at this event and and basically said like i'll give the person on the end a pass because they're still clinical but basically you lot are making the world a worse place um and it was you know I had that sort of heart sink moment that that stomach drops out of you moment of of going like whoa okay that is not what I'm used to and I was very aware that I was in a bubble almost of the the positivity health tech bubble where we can sort of laugh and joke and it almost do you know what it almost felt like and I don't know how substantiated this is the the vibe was like we weren't suffering enough and in order to in order to be virtuous about what we were doing we we just weren't suffering whereas all clinicians are suffering and therefore and it was it was a very you know I did a lot of soul searching after that and reflection on it of like whoa okay I need to change my demeanor a lot if I'm speaking to this audience and I need to have more empathy and I need to connect with more people like yourself you know to learn more about what's going on on the ground floor here because I'm starting to get a little bit disconnected and you know that's the sort of work I did on myself I can also appreciate you know the phraseology and all the rest of it if you've said a chat afterwards of like look that's you know it's quite an extreme view but at the same time like I'm still thinking okay the kindness compassion empathy we need to understand each other and that's broadly my thesis anyway with this podcast and everything else that I do is I need to increase the flow of information so that everyone understands each other a bit more because things like that wouldn't actually happen because a few things would have been different but yeah it is interesting to me that I think the ground floor you know on of healthcare is very different not very different but I think it is it's definitely moved on and is different to when I was there but I'm interested in your take on that I'm interested in what's what what is it like on the ground floor for clinicians right now and this is the health tech podcast so definitely talking about it from a tech perspective is interesting because we have on one hand the hope from things like ambient scribes that are finally reaching the ground floor and individual clinicians very much resonating with the messaging that they're putting out of this is actually going to tangibly change you know the way that you practice and he's going to take something off your plates there's some hope there but at the same time I'm seeing strikes and clearly I'm getting all the dms of people wanting to explore health tech because they're looking for a port in the storm so I'm really interested in your view of you know you're a consultant an anesthetist you oversee a lot of people in that hospital a lot of juniors and training all that sorts of things so what what is it like right now honestly it's and this isn't meant to be like a monothon but it is quite like it is quite hard i think it's um expectations and the pressures and the scrutiny is huge um and that's not that's not necessarily a bad thing i think standards could you just expect just just expand on that slightly for me so expectations pressures scrutiny of what and from whom let's take a someone who's referred with a potential cancer diagnosis yes um they will be um they'll be kind of essentially fast-tracked through um on a on a pathway with very very clear the standards at which point diagnoses should either be made or not made um and a treatment plan should be implemented and um and you know there's loads of stuff um loads of kind of standards and guidelines around this the surgeons will be under huge amount of pressure to um operate on those patients and they will be juggling both their cancer lists and their um their non-cancer work their benign work so they'll be under a huge amount of pressure to populate their list to fill their lists um to do the work plus on the side they're doing all their kind of admin and clinic and clinics and stuff like that then the patients will come and have their operation now actually staffing those those lists is incredibly difficult and that's across the board.

19:59So there's not enough bums on seats. So in our trust, we don't have enough consultancies for the work we do. We don't have enough ODPs and theatre assistants and scrub staff. So we're always kind of robbing Peter to pay for Paul in terms of trying to backfill rotors and so forth. And then there's the outcomes in terms of how patients do length of stay, complications and so forth, whether the curative rates, the resection rates are good enough or not good enough. so every step every single step of the way um the team are under pressure and under scrutiny and those those um so for example if a if a list is underfilled in theater then the surgeon will be criticized for um for uh under filling if the list finishes early then theater utilize a different team will be worried about theater utilization and not maximizing the capacity of theater if the patient's cancelled on the day of surgery then someone else is asking a question as to why why that happens these are all legitimate questions because actually you don't want patients cancelled on the day of surgery you don't want this uh the list being underutilized if we can't provide staff then that patient gets cancelled um and then that patient then gets bumped onto another list and that bumps another patient further down the road so you've got all these kind of contributing factors which are all these are all data points and different people care about different things and actually it's um uh there's just tons of scrutiny and and um i think the scrutiny is good but it is absolutely relentless and everyone's seeing it through their lens so for example we've got a task and finish group to do with their surgery cancellations um that's not all that we care about but that's their their purpose so that is the only thing that they're they're looking at they're not looking at the other stuff they're not looking at the referral to treatment targets they're not looking at the resection rates they're not looking at the um you know they're not looking at this the screen the national screening programs it's it's really hard and you've got people who are um just being pushed um really hard and you've got a handful of people who are you've got a tiny minority of people who are giving a lot of people a bad name in terms of getting in the system and so forth but actually what you've got is you're a ton of people working incredibly hard um in in what are fundamentally trying circumstances um yeah and you know the the reality of trying to kind of try and log onto a computer and taking 15 20 minutes um the other day it took me three computers before i could actually log on um and it's crazy that this is still the case it's honestly and then you've got um yeah you've got the kind of ai scribe teams out there selling solutions which people want it make sense to them um but there's so many so many barriers just doing simple stuff just in basic stuff um and at every at every stage things are just made a little bit difficult not out of malice um but just out of either legacy systems or um systems which aren't fit for purpose or um uh all the kind of problems that people know and one of the one of the challenges i have when i'm working with Dr.

23:10Doctor is I'm selling dreams, I'm selling visions, I'm saying look this is how we reimagine our patients, this is how we reimagine patient pathways, doing stuff end to end is really I mean I love it because it's kind of I find it inspiring because you've got this huge problem and we're kind of helping to kind of dream up and make solutions but sometimes people just can't get their head around the fact that you know what if I try and print a letter and I can't it takes me 45 minutes to actually find the printer that's connected to give it to that patient and it's a it's a very actually printing letters probably like the worst example but like you know i had someone who was um who sits in clinic and she was saying i phone patients i then have to write the uh the blood form by hand and then put it in envelope write the patient's address on the envelope and send it out and that's the reality that's what like hundreds of um nhs consultants are doing entrusts all around the country that's the kind of stuff that we're dealing with so a lot of the amazing solutions which are out there are so far from the reality from the kind of you know lots of people talk about lived reality but the lived reality of frontline clinicians is like in terms of it and tech it's it's pretty um it's pretty miserable and what people want isn't actually um you know that much they just want stuff that works it's so difficult isn't it because there's i've i've remembered this ever since i've been a clinician and those early days of trying to solve these these real ground floor problems that don't need to stand upon much tech that there's so much that falls between the cracks because the way that the health tech world seems to have emerged and evolved is we're on this venture funding model this you know borrowed from silicon valley vibe of have a deep tech idea raise a load of money and then because you've raised a load of money you now need a load of scale in a cookie cutter fashion to keep costs low margin high exit value high and we need to copy and paste this into absolutely everywhere in the UK the US and blah blah blah and then we'll get an exit and we can return our VC 100x and that seems to be the the route to innovation at least that's how the health tech world definitely seemed in in when I got into it in in the earlier days of that that was the blueprint and that was the model you left you left to be a founder because you had an idea you went to go and raise money and that was the thing and that leapfrogs and jumps over the it takes three computers to log in and that's x amount of minutes and when you add that up it causes a big problem all of that just gets absorbed into the sort of that's what we squeeze our staff to just get done no matter what and it seems like for me we've never seemed to in my opinion because well clearly because it hasn't been solved the business model has never emerged in my opinion to actually solve so many of these things that that squeeze staff because happier staff doesn't add dollars anywhere onto a p &l or pounds anywhere onto a p &l and that was always to me seems like a fundamental flaw in the way that we're doing things because we're not doing a staff survey and then financially penalizing a hospital because what hospital needs more financial penalizing or if why don't we have a fund that financially incentivizes amazing staff experience and actually put that together and can the government find a billion quid to stick onto that and actually you know that can create some processes that start sending things around i don't know what it is but that business model's just never emerged for me and and and it's always been a struggle because whenever we talk about deep tech it always seems that we're pushing i've talked about this on here a few times but that we're pushing the technology frontier but the adoption frontier is rigid and it remains exactly where it was a long time ago which is not anywhere near the tech frontier we talk about quantum we talk about llms because of all this stuff we can talk about hosing data into places that are pumping out sass products that are completely unique to this hospital we can talk about all of that fine but the adoption frontier isn't there yet it can't be adopted and it and it sits on this bedrock of exactly the problems that you've just talked about and that's this kind of dichotomy that i end up living in in my own head where i'm even in my career it plays out you know i'm on here talking about all these weird and wonderful um deep tech solutions when at the back of my mind i i lived that reality and i and i and i'm just sort of in the back of my mind hoping it's changing it sounds like it's not it depends i mean the you're talking talking then about kind of staff survey and things and um in the kind of sustainability world people talk about the triple bottom line in terms of how to kind of calculate benefits um in terms of the kind of environment it's to do with the environment i can't remember the third thing but you um is but essentially the cost of something and the environmental cost and then the human cost right and so you might have something that's dirt cheap but actually if it's if it's kind of produced in kind of sweat factories in the developing world country then that's not okay yeah you know when we're kind of think about uh kind of designing products and implementing products and kind of going to market with stuff with doctor doctor it's really frustrating and slightly demoralizing to think that actually all these things which can make a huge difference for staff experience yeah that's not going to sign a that's not going to make a a um cfo sign of the line things to do with patient experience and kind of quality of care it's it's incredibly woolly thing and actually you know the things of like consistency and you people get it with the nhs app which is you know really kind of a really exciting thing that's being done one of the big drivers is that is this kind of consistent front doors is consistent patient experience and like people are getting that is that going to actually get people to sign on the dotted line for a um contract no it's not like yeah the different trusts of certain access policies for example and that can be a lever so every every trust every team has got his agenda and different things and it's kind of like whack-a-mole you know you know different things pop up and you've got to fix that so at the moment um maternity is a very non-reasonably either a very hot topic um in certain trusts so gloucestershire being one of them is um being subject to one of the um the baroness amos review um so there's a huge amount of scrutiny on um even more scrutiny on our maternity services and sorry just give some context on that what's the review what what is she looking at so she is looking at um uh there's 10 trusts in total without um that outliers in terms of certain maternity results and in a bad way and so uh what she's doing is she's looking very closely to try and work out what's going on and to try and then uh kind of promote some changes okay let's go down that path is our hospital our maternity services are amazing this incredibly committed dynamic people working there um at the same time as this going on what didn't make the headlines was that the cqc um reviewed maternity services and gloucester was also one of the three which was felt to be overperforming so on one metric we're overperforming on another metric we're underperforming.

31:00So we're under intense scrutiny, which people listen to, but they kind of ignore the good news. So it's incredibly challenging. When we talked earlier about the kind of the challenge and the scrutiny, it's absolutely relentless. And this is with the kind of, you know, the headcount freezes with the challenges with the ICBs and NHS England, you know, all the implementation, all the stuff that kind of really supports change. And yeah, I mean, it's probably pressure cooker is too strong a word but it's an incredibly pressurized environment even without that scrutiny with really high stakes stuff and then you've got a huge amount of external scrutiny additional scrutiny coming in um which uh which makes it incredibly tough for people yeah um and this kind of this there's a danger to kind of implement knee-jerk solutions and earlier you talked about um stuff being done to people yeah um so it's very easy uh for or someone to say, right, let's do this.

31:57Here's a solution. Let's use it. Anyone who's done any change management stuff knows that actually is like, that's not the way to do it. Can I tell you a story on that, that you'll appreciate being an anesthetist. So when I was training, one of the consultants just took it upon himself in one of the theatres to run, I guess, a pilot for, do you remember, you know, we've got the stickers for the syringes, for the different drugs, different colours, blah, blah. have you ever dealt with the ones with the barcodes i haven't no and a system where basically you would scan and it would do it would do inventory but it would also do like utilization and it would yeah yeah in theory it would then link to epr and like all that all that sort of stuff um and the the theory of course was that this was going to be amazing of course it's going to work and it's going to be great and it was just it was just quite interesting to watch just how big the gulf was between the theory and the practice of all of the unknown unknowns as to why this wouldn't work it was enormous like it was just enormous like just just so many things that you can completely imagine because as soon as you like in theory yeah you stick a you stick for people that don't know when you've done aesthetic drugs like you draw all the different drugs up and they've got different they're different types of drugs and they've got different colors and they've got different names and so you put these stickers on and like blah blah it just helps us all you know not deliver the wrong drug at the wrong time or draw the wrong one up etc etc so but adding this barcode meant that it would have all these extra features but goodness me as soon as you miss what scanning one bar the whole system is down so that's just number one and then there's the mislabeling and then there's the forgetting to do blah blah blah and then you give less than what's on the thing like it was just so enormous but yeah that was um that that was the one that i lived through anyway and it's um and we've got a similar thing for for the kit that we use and so our anesthetic assistants um spend a significant proportion of their time scanning stuff that you've used so they can be ordered now i'm not saying like inventory control and stuff isn't important but actually that's not why people go into these professions like they didn't want to work on the checkout they basically that's basically what they've done they've been they've they're now working the checkout in sainsbury's um so it's um it's incredibly i actually found it quite satisfying i'm just gonna say it i did actually find it quite satisfying and i was probably one of the more i was more of the closer to 100 utilization of the tech than anyone else but maybe maybe yeah yeah anyway i there's a couple of things i feel really strongly about one is about um the kind of the need for bums on seats so you the current way healthcare is delivered you need enough people like i talked earlier about you know doing enough operations and all these targets and challenges we haven't got enough staff and you need people to be in the job working delivering the care you need residents to be learning how to do the job understanding stuff learning the system so that they can then be the consultants delivering from you know senior led care of the future and I'm going to kind of try not to like kind of stick it to you but I think it I think if everyone does what you do then suddenly there's no there's no healthcare I agree I think I agree well that's a fact it's it's impossible to deny you you need you need people you know who are actually there doing the job delivering the care whatever whatever that is are you doing you know doing the operations speak to people in clinic you know holding people's hands yeah wiping their bums whatever it is you need a certain amount of kind of people there and so i always feel slightly well first of all i feel sad when i hear people are leaving because i think there's a there's a damning indictment of the system and the problems of the system when people have had enough when they've invested so much time and effort and huge amount of kind of personal and some of this financial resource to get to where they got and they're just going to come turn their back on that yeah now there's the kind of the sunk cost fallacy and i think it's much harder for someone like me who's been kicking around and in hospitals for you know i can't remember how long it is now but you know a long time as opposed to someone who's only done a couple of years so um that's there there is that but i i think it is genuinely saddens me because i i think actually what it's saying is the system has let you down the system isn't supportive enough it's not open to kind of entrepreneurship entrepreneurship or um new ideas or innovation or whatever it is um or it's just it's just too hard you know there's no let up and um i think there's a huge amount of kind of um well-being resource out there which is brilliant but i don't necessarily think it is it's kind of you know first aid last right safety first first aid last and i think um you know people having burnouts and needing to go to kind of um uh kind of professional support units and so forth is is grim and what we should be doing is trying to trying to make people's lives better.

37:03And some of that is just the nature of the job. And I think a degree of resilience needs to be built just by exposure. So I can think of a handful of situations that have properly stayed with me that have been incredibly hard. I wouldn't say they've made me stronger, but they've kind of, yeah, certain things, and I think anyone from a clinical background, this will probably resonate with me. We can all point to them, yeah. certain things where you just kind of yeah you kind of will never forget i remember for example pushing a patient um away from their family to go and have their organs donated wow um like the the kind of the the the howls of grief from the family like oh never forget stuff like that which is you know no amount of training no amount of stuff will ever help you with but this is stuff that you kind of absorb and you and when you're absorbing that as well as the kind of the daily crapness you know the fact that the you know you yeah let's use the computer use the computer logging as an example like yeah um and it's it's kind of some big cuts and i think you're kind of geared up for that but it's the it's the smaller cuts which i think really kind of i would agree and i've got a couple of things to say on this um the the the resilience and the strength that you gain from an experience like that i think is different to a lot of what does drive people out you know myself included is to is to um in fact a lot of people more so than me I wouldn't say this was a driving factor to me leaving so I was more pulled out than pushed out if that makes any sense I was more pulled out by what I wanted to do rather than being pushed out by what I didn't I know that's not the case for many but there's a lot of how people treat each other in medicine and there's a lot of friendly fire and there's a there's a lot of i don't think we need to be so unkind to each other and the hostility that people will find trying to sell a scan to a radiologist or get a get a cardiology review or get all these there's a there's a lot of hostility built into the way that we treat each other and actually you know i can point to you know a few more than a few of these types of things where it really made me question like is this an environment that i want to be part of because it keeps coming up the way my you know training program directors treated me when i wanted to take a fellowship year to do the national medical actors clinical fellowship and i had to resign it like people you hear these things about people having to resign reg numbers to take a fellowship within the nhl like it's but it was it was bizarre how there was all this friendly fire and it didn't feel like we were kind and compassionate to each other you know and and that that always frustrated me I think also from what you've said of you know the sadness of having people leave and the system letting people down and all the rest of it a couple of things on that I I used to talk about leaving as if it was a flex I used to talk about leaving as like yeah I left like I I did the thing I left blah blah I've grown up a lot since saying that and I point a lot more I can point a lot more in my own mind to the luck that I had in leaving actually the timing the the bizarre collection of things that happened that allowed me to leave a single whatsapp message put in a whatsapp group of fellows advertising a job that I ended up getting had that have not been the case I honestly could still be an anaesthetist there are there's so much luck involved to me leaving at the time i did as well as you know you you can create your own luck and put yourself in the right places and all the rest of it i acknowledge that i'm not trying to humble brag here but like there's that i used to call it a flex i i very much don't anymore i don't think it's this amazing thing that i left i think it is just the fact that i left and i apply my skill i can see the areas where that's good and it benefits healthcare overall but I can also see you know it left a gap and if everyone does it it's not a good thing I can appreciate that I would also say this is why I truly believe people like you are so important because if I'd have seen you in your portfolio career of what you can do doing both it would have inspired me to do the same and I think that is a great answer I don't think it has to be this all or nothing that piles loads of risk on the individual and also the system ends up worse off because someone has left I don't think that has to be the case I think there are so many entrepreneurial medics there are so many medics interested in technology there are so many medics interested in computer science engineering and frankly art and design and all these other things that can contribute when you open the conversation of medicine and and medicine and is so powerful because we've seen the health tech and biotech worlds exist i mean biotech obviously historically but the health tech world more recently evolving into this fully fledged industry where you can be a medic that is interested in tech but has skill in art and design and you can be a you can be in brand you can be in marketing you can be in you can be in all these things that we do and that can add significant value but you can also be a clinician with the other half of your time and that's an in the medicine and thing is super interesting to me because it just wasn't available because if I'd have had you know a potential training mechanism where it was part-time training in this and then part-time to do this and that's the stuff that used to light me up and I was just doing what I could to find those opportunities it just so happened that for me the easiest thing was to leave at that point but I can completely see not that I loved medicine but loved it as a hobby you know if I could do medicine at a couple of days a week and i like it i can see that path and i'm not saying that i would have been great at it you know doing it that way but i uh medicine and is the is is is i i think in this next iteration of of education and training and how that relates to health tech and frankly the evolution of the health tech industry as a whole and gaining empathy for what clinicians go through for what patients go through and for what the tech world needs to deliver i think increasing the communication in all of those fields by medic and i think is it is very interesting to me and i'm sure that plan has holes but yeah that's where that's where i sit on all of that stuff yeah it's interesting you you talk about the kind of i don't know what it's like to kind of leave um i'm probably if i'm honest i'm probably not brave enough to leave um i um i don't know whether i could um i don't think i would um i think i i my the kind of patient stuff really matters to me um and some of that i think is to the kind of um the sunk cost both for me but also kind of my parents and sacrifices they made i think there's there's lots of kind of layers and context to it um but i think um there is a danger that it can be viewed with kind of shame or or kind of people can i have some shame now like like genuinely like especially in those conversations where that person heckles and then reminds you of like uh but i don't i don't think it i don't think it should be i i think there's there's danger with what i'm saying and saying like you know we need bumps on seats we need people to do this definitely yeah that i'm by i know for a fact that you know the clinician founders i know who are who are making a go who are having the big impact they they could not do that um if they stayed in their clinical job yeah there comes an inflection there comes a tipping point yeah absolutely correct and i think um if you want to achieve um if you want to achieve scaled impact i think there does come that point where you go you know what i can't just do this as side hustle this needs to become the reality my my kind of pathetic entrepreneurial side hustle, which is running conferences and stuff.

45:37Don't call it that, come on. No, no, no. But like running conferences and stuff, so like any anesthetic psychogenethodists out there, you know, I run a conference for you. And there's plenty of those. There's plenty of those. What a bizarre quirk of the world that is. The lycra-claddenethodists of the UK. Yeah, that kind of stuff is truly just a kind of little distraction. It's a fun little pet project. um but i think you know setting up a you know for yourself like marketing communications agency is like something proper like setting up you know some of the ai scribe founders for example like um like uh like like dong doing amazing stuff like you could not do that with um alongside a clinical career and you shouldn't because you'll end up doing a bad thing of of two things so i think that i don't think there should be shame um i think it's just a shame that so many people feel like they're being pushed out due to this um this the influence environment which is bad one of the most positive things that has happened in the last few years in terms of um postgraduate training i think is um the fact you can go less than full-time without needing an excuse wow so it used to be that you had you could only go less than full-time if you had child care or caring responsibilities and a couple years ago nhs england um i'm sorry health education england um trialed this in i think it was emergency medicine where the burnout rate was just horrendous and funnily enough loads of people said yeah i want to go like less than full-time and they had fewer people quitting and now anyone can go less than full-time if they want to um now from a kind of staffing perspective and running running rotors that creates challenges but let's just kind of park that because like i think that actually if you have if you have fewer people quitting and burning out then you'll still have more kind of bodies on the rotor so i think it's important to kind of see the big picture um but that's amazing because it enables people to have a have a bit of stability a bit of you know develop a proper interest outside of work um you know the change fatigue that people undergo in healthcare is in is absolutely relentless so i i wrote a 5 000 word essay on this my um for a pg cert i did years ago um talking about change fatigue and the fact that you're constantly changing hospitals you're changing teams you're changing sub-specialties each hostel has got its own own codes to get into the changing rooms and they change every few months as well, different logins, different passwords each trust you move from to has got a different kind of crisis point so we talked about the kind of whack-a-mole there's different fires which are burning hotter in each different one, you're adapting to that each individual list you're doing, you're working with a different team, you're working with different consultants it's absolutely relentless it's just cognitive load left, right and centre Even just being the new person has cognitive load attached to it.

48:27And anyone who's still a new job will say that the first couple of months is really hard. Well, imagine doing that every four to six months constantly. It's really, really tiring. And if you're doing that whilst doing exams, whilst with young kids, whilst commuting long hours, commuting whilst working nights and all those stuff, it's not a surprise. Then bloody health tech companies messaging you asking you for free consultancy. Honestly. honestly yeah so yeah separate separate kind of words um i think the um uh the the kind of portfolio reality is important to kind of um kind of be transparent about as well though because i would i would love someone to take my hand and say look this is how you should do it and and kind of this is what i've done um as far as i'm aware there's not a whole bunch of people like me um and it's uh it's a kind of slightly uh slightly lonely place i think if i'm honest in terms of i go to conferences and i meet people and there's some really really wonderful people um with clinical backgrounds working in and around health tech and it is amazing actually i really really um like the kind of the ecosystem um but I think most people are so busy and it's so relentless that actually people haven't necessarily got the time to carve out to to kind of do that kind of formal mentorship type thing and and I think the the other reality is I've got four calendars that work off possibly five actually I've got five six email addresses that I have to monitor in terms of juggling stuff plus kind of whatsapps and communities and linkedins and other stuff um i hear you on that stuff yeah and like today i thought was a day off and just before this call started i had a message telling me that i was supposed to be working later this afternoon and had like a child care fail and i've been scrambling to try and um sort out child care for my kids to be picked up from school so that so that's that's kind of the that's the reality of i think a portfolio career in my hands it might be that it might be that my admin skills aren't good enough um it might be that the kind of you know the firewalls on the different email accounts in different organizations would allow some more transmissibility but you know it's um that that's not the kind of rules i'm playing in at the moment and um it's uh it's incredibly it's incredibly context shifting is hard um but what it does given me personally is an amazing insight into um for example what do you what does a frontline clinician want from a outpatient's hybrid healthcare solution for example with the doctor's stuff yeah what does you know on the on the industry side what what you what what are the questions that people want to ask when i'm speaking to designers i can i can say actually i know someone who's really motivated into this let me introduce you and have that conversation and see what the uh you know this whole kind of process of co-design to make stuff work my board my board roles mean i appreciate what it's like for an exec team to report in and to kind of have those constructed dialogues and to have that challenge and to work out actually okay what does what does business development look like from a from a board level if you've got a big research agenda what does that look like in terms of kind of staying true to yourself and how do you how do you kind to keep yourself on that on that um uh kind of mission mission-led um approach it's it's brilliant and i it consumes a huge amount of me um and i would probably be i don't know not not bored but i'd be quite frustrated i think if i was doing less um but i tiptoe pretty close to being burnt out some of the time um and that's not i'm not saying that as a badge of honor at all i'm saying how do you manage that how do you manage that out of interest do you can you spot when you're getting close to the line and do you have any techniques and processes to to claw yourself back um i've got a few things i do i ask this very selfishly by the way because i'm like okay interesting i can learn something yeah so i i i do a lot of exercise do a lot of sport um and so of you know going to the gym and blitzing myself for an hour is a really good way of just kind of decompressing um at the moment i'm uh jumping in a frozen pond in the garden uh every day in january which is hellish but wow that's a that's a fun thing to do like just in terms of taking yourself into a different different space i've heard for the mental resilience as well doing something you really don't want to do every day it just helps build that muscle i tell you james the amount that I don't want to do it each day.

53:13I cannot describe it. Joe's really funny. I actually saw a Joe Rogan click the other day and he obviously does it. And he was saying that a lot of people will congratulate him for doing it every day. And he has the same response every time, which is that every day I almost don't. I have no idea how close I am to not doing it every single day. It's really hard. But I think there's also kind of, like i know when i'm being a kind of particularly grumpy dad or a particularly grumpy husband or particularly short um i know when i'm tired i think there's certain things when i can't really be bothered to do stuff um so like if i can't really be bothered to like separate the recycling that is a sign that like you know just just just yeah just little signs that i i get um sometimes i will um yeah i'll just kind of make a list and i'll just as i'm writing the list i'm feeling overwhelmed and then i'll just like okay right now i've got i've got a lot on i think that the nature the nature of life is its peaks and troughs and you know the kind of the relative trough of kind of christmas and like you know we're in early january now having this conversation um things at the moment are actually in a really nice kind of low level bubbling a long way um it'll pick up and then it'll kind of as it comes to a kind of kind of year end like as a bridge as april for example all the contracts will need to be signed and all the budgets will need to be spent and things will kick off and stuff and then it will settle down a little bit and then it will it fluctuate and that's and that's okay um but i i don't know there's um i remember a couple years ago doing a um the kind of time management course and it was is brilliant um and the one thing i kind of took away from it was um i need to color code my calendar and then i went to went to all the kind of it people with the different people i work with and said look can we amalgamate all these into one calendar and they all said no i was like okay well i tried there was one actionable thing that yeah tangibly changed my life it can't be done awesome um so um i yeah so i i i love what i do um but it's hard and it takes a string and um uh and so i would um yeah wholeheartedly encourage people to do stuff that they find energizing um because and there's different bits of what i do that i find energizing so there's some stuff that i do in different kind of stuff in different roles i do that i just do right you not everything can be exciting not everything can be fun um you can't spend your whole you can't spend your whole life in a in a kind of icy pond right um you know that's like like bad for you um you need the kind of you need the mundane you need some stuff where you go oh right this is um you know important but maybe it doesn't float my boat a really good example is clinical safety okay i um i don't get that excited by it it's really important i work closely with a great cso in um i'm dr doctor and he does like more than 90 % of the low carrying on that and that's brilliant because that kind of frees that off off my um off my plate but that is something which is like yeah i'm glad it's not my everything but it's a part of my kind of part of my portfolio that is important is important to keep up to date and support to be involved in these processes and stuff like that um if i just did that i'd go nuts but occasionally dipping my toe into it is is good if i just did kind of um high stakes pitches and presentations and public speaking and events and running conferences and all this other stuff i would be absolutely exhausted um and that's also not sustainable so there's different you know it's finding a finding a bit of a mix and and actually they're kind of this maybe but kind of the my training years prepped me for this because because no week is the same um in terms of not you know my my job plan has got quite a lot of flexibility in it and variety in it um my clinical work my my diary changes constantly at doctor doctor with you know short minute um last so um short notice calls with um with nhs clients and stuff and different teams will kind of drop in ask me stuff and it's um it's incredibly varied um and that's really good but it is a kind of slightly relentless um kind of pace of change in context shifting yeah which is why you've got those canaries in the coal mine and you have a plan to do something about it which i think is so important and just the self-awareness to know that stuff to just stay not burnt out and because you're right putting a portfolio career together can look great varieties of spice of life etc but you know it's never it's never just that percentage there's always a few extra percent and then there's the channel shift and then there's all the rest of it that can creep up on you and end up hurting you before i let you go clinical product lead at dr doctor what is clinical product and why do you like it oh i love that question um i'm seeing loads by the way about product and particularly clinical i'm actually seeing quite a lot and for me it's great because it's almost like a i'm seeing that it's a real tangible one for me seeing how the health tech industry has grown that there are niches within niches now i mean to even say the word health tech what 13 years ago would have been like what do you mean digital health or like health it or all that sort of stuff and in that sort of 13 years that i've been doing this stuff broadly um god it's come such a long way and now we've got a whole sub stack like louise is louise rick's on clinical products like yeah like the the there's a whole sub stack on it now and there's hundreds of people on that and they're all doing clinical products.

58:45I'm like, wow, this is awesome. Yeah, talk to me about it. So what is clinical product? My understanding of it is that it's about the kind of design, the implementation, the safety and the advocacy of safe and robust clinically focused products. So for example, they might be kind of admin adjuncts. They might be kind of pure clinical engage clinical tools um but it's about bundling that together and making sure that they're kind of the right structures are in place around those so that when they are deployed they are deployed and they make sense they work for everyone not just someone sitting in procurement but actually the frontline user and that's the staff and the patient and the team who are then you know the admin team working with them and the back office staff and so forth and is tying all that together.

59:45Is it product management with a clinical lean? It probably is. But I think it's kind of tying all those things together. And I think the advocacy is really important as well because it's making sure that none of those voices in the room get ignored. So I remember doing a workshop and people talked about all these different stakeholders. It was a kind of change management 101, like stakeholder mapping, all this stuff. And I was like, well, what about the patient, right? And they're like, oh yeah, this is the person that's actually going to be using this stuff. So it's those kind of advocacy that I think is really important.

1:00:29And so yeah, so that's what it means to me. Why do I like it? I like it because if you get it right can you build the right stuff then it's not only easy or not easy is the wrong word it's not only implementable but it can be scalable and that has huge ramifications in terms of impact and doing good the um the kind of this kind of supply demand problem that healthcare's got at the moment is massive it's really damaging it's damaging for patients it's damaging for staff it's damaging for the economy is so many things but if you can get that right if you can do these little tweaks if you can improve things along the way um you can make a huge difference i gave me a talk um in december about um kind of some of the some of the stuff we've done with with cancer pathways and you know we're not inventing new drugs we're not kind of harnessing robots to do loads of amazing surgeries we're not kind of you know pressing control v with a whole bunch of surgeons and kind of all that kind of stuff, what we're doing is we're taking the whole pathway and doing things incrementally at each point.

1:01:43And one of my immense frustrations and sadnesses is that the adoption and scaling of solutions, and just for the record, it's not just about DocuDoctor. This is about all kind of health tech solutions out there. The trust which you've got the most bandwidth, be that financial or be that kind of headspace or infrastructure, infrastructurally robust enough or digitally mature enough or whatever, they're the ones that are already further on their journey and they're the ones who are able to kind of get the highest return on investment. If you've got an under-forming trust who has got really bad architecture, bad infrastructure, they haven't got the headcount, they haven't got the skills, they haven't got the resources, they yeah they will tip and people talk about health inequalities and you know people think it's just about you know the kind of the headline health inequality things but what about actually at a trust level yes um you know i um i i you know dr october got a huge footprint across country like the the number of kind of patient logins we have each day is astonishing the number of staff logins we have each minute is blows me away um but it's con it's you know there's a danger that it can concentrate again around various centers where this stuff is being rolled out and used at scale whereas the trusts who really need the help are the ones who aren't there who haven't got the you haven't got this enormous kind of innovation infrastructure built around them um who haven't got um you know let's say university hospital status and the funding associated with that as an example um and that that's something which i think is is something i really struggle with um and that's that kind of inequity of um inequity of implementation and rollout is what happens as that gap keeps widening because can it it can't keep widening indefinitely and you end up with these terrible places and do the amazing places end up increasing the population and swallowing more regions up and those battles disappear what's the actual end of that yeah it's interesting because i think the icb changes might point a little bit towards that don't they so the fact that you've got these mergers so so maybe the kind of bigger more more robust icbs will uh what you're seeing is those absorbing the kind of slightly more precarious ones um i don't know i think there's anyone who's been through a kind of a takeover however whatever that phrase looks like will tell you that actually you know it's not always an easy process um it needs to be handled very carefully um i've worked in some hospitals and some trusts which have been an amalgamation of of services and things and it's not easy um in some places it's been handled incredibly well um and in some places it hasn't um uh i've yeah gloucestershire is a brilliant trust you've got gloucester hospital you've got chelton hospital i've got a handful of colleagues who refuse to cross the m5 um and go from one side of the county to the other um despite the fact that it's been one trust now for i mean like years um that they're the exceptions rather raw and you've just kind of got to accept that but um i think uh these kind of amalgamations are yeah they take their toll and it's it's more more change there's more upheaval and i posted something on linkedin a little while ago about um kind of just kind of doffing my hat to all the people in nhs england and in the icbs who have had their jobs threatened but who've carried on going to work delivering and yeah try and try and do a really good job and and the number of people who kind of reached out to me kind of personally in the in the comments and stuff who have said actually this is you know the the the relentless change the relentless kind of um landscape shifting is really hard and yeah there's like there is a place for kind of innovate or die there is a place for kind of you know um constant evolution improvement but i do really feel for people who just need a bit of stability and um just need to kind of just focus on doing the job for a bit and just get used to kind of what the what the landscape looks like because what we've seen for the last is fell late for the last kind of year is yeah there's been decision fatigue no sorry not decision fatigue decision inertia because no one no one's known who's gonna have the budgets no one's known whether they've got a job no one wants to be held accountable for a bad decision and that's going to make their kind of their job be scrutinized and so forth um and that's hard from a kind of you know from a health tech perspective from the you know from the industry side in terms of trying to kind of sell stuff and try and get stuff out there and try and get stuff used but also you know we talked about kind of compassion and stuff for um uh for people in the public sector well imagine what it's like for them people who are scared to kind of make decisions who people who who don't know if they're gonna have a job and all that stuff it's it's just it's brutal it's really brutal yeah and it's funny like i've really enjoyed this conversation i think it's been amazing having you on i'd love to i'd love to get you back on to talk about more stuff i i i feel you're you have such you have such an amazing view of this space and an ability to very eloquently articulate so many of these problems and i i I believe that you also probably have quite a lot of solutions in mind, not least the fact that more kindness, more compassion, teaching that in leadership and management as well.

1:07:17And I just wonder, first of all, do you have any aspirations of leadership within the health system to enact greater change or is your interest in technology with the likes of Dr. Doctor and I have a word to say on them before we finish but Tom Whitscher being one of the people that one of the very first people I ever spoke to in in health tech many years ago but do you have any ambitions at that kind of level and what is their value in teaching a different style of leadership I believe you are aren't you actually isn't it one of your courses yeah yeah so we I'm uh I'm running something it's an experiment it's like a kind of immersive two-day um kind of i suppose like kind of fast track change management leadership right um change management as well so it's like the implementation of stuff retreat sounds too strong but the idea is it's kind of uh yeah it's like kind of two days really kind of intensive just kind of thinking about this stuff and teaching stuff like how to you know you know what does a what are the different levers that need to be pulled for different people in order to make stuff happen.

1:08:28For clinicians, is this? Yeah, for clinicians. Yeah. It's kind of showing people that the, you know, you spend kind of, I think, yeah, seven years postgraduate training to become a consultant anesthetist. You get spat out at the top and then someone says, write a business case and you've got the same amount of experience writing business cases as an F1 in their first week a lot of the time. There's a whole language that people don't know how to speak. There's a whole different approach. um i don't think you can be all things to all people i think sometimes you need people who are kind of clinically focused and you need some people who can you know they kind of um the kind of management here who can really can navigate this this kind of world um yeah so so we're trying to kind of work together um with some brilliant people we've got amazing faculty um who are going to try and help kind of nurture this group of people through um so i think there is a space for this kind of um you know um yeah teaching different ways of of doing things i think the fact it's so hard to navigate is it should should also be a little kind of um uh warnings warning sign um if i think about some of the things that i've kind of verticom has achieved as a consultant and just how hard it's been and these are things which have been like totally legitimate safety uh patient safety concerns and the amount of time and how slow the kind of wheels of change move um and then if you kind of shine the light on um kind of health tech startups and you think about the kind of capital that they're burning through whilst all this kind of these slow processes happen and the the impact on on that you know people have this kind of runway where they've got maybe six months of money left and they need contracts signed and they need to go live and they and actually if the you know if the chair's off for a for a board that um it doesn't happen and then it's postponed and then it doesn't make it on the agenda the following month and then actually the agenda is backed up so something else is a problem you know this is a reality yeah it's reality practical reality 100 um but it's incredibly difficult um to implement change and that's from within from from outside it's it's incredibly difficult i think all those kind of all those layers of um of skepticism and cynicism about um industry and i you know it's it's kind of work I suppose the ideal state is when you're working with rather than kind of working against or seeing seeing yourselves as kind of different sides of them of the the solution so when you're a development partner that is amazing when you're properly spending time with teams embedded when you those kind of connections are real so I remember going on site with one of the she's left now she's gone um to canada sierra shout out to you if you're listening um but we went on site to one of the trusts she'd been working with and the um one of the uh transformation team on the trust side ran up to her and just gave her a huge hug when she saw her and i was just like that's amazing this is someone who's just interacted in for like for months on teams and clearly have bonded and just such a great relationship so nice and that that's kind of testament where people are really working kind of hand in hand kind of walk in the same direction And I think that's the thing is, I don't think there's much space in this ecosystem for people who don't have a genuinely good agenda.

1:11:50You talked about the kind of grubbiness of the kind of VC funding cycles and stuff like that. I really don't, I haven't seen that. I think there's a lot of people here incredibly mission led who are trying very hard to do good. and I think once you kind of get past that cynicism and that skepticism and that reticence to engage and actually do stuff together it can be absolutely game-changing um but it it kind of takes time to build that trust and and that relationship and usually then it's time for contract renewal and then it's absolutely well that's a lovely message to finish on and just a quick word about about Dr.

1:12:24Doctor I mean Tom Tom absolutely legend of the health experts I mean he literally was one of the you know that job that I mentioned I just saw in the whatsapp group and ended up applying to and getting that was to be a navigator at the digital health london accelerator and as part of our induction tom gave a talk to us four navigators of like this is what health tech startup is like i am one this is this is what that means and yeah i think they were you know bootstrapped at that point as well and and yeah he's been in the space longer than I have even so um yeah always always a pleasure whenever I see Tom and speak to him so and Dr.

1:13:02Doctor obviously an amazing company doing incredible things literally the OG of the space so um yeah fair play to you it was always one of my backup plans in my mind actually to if ever anything went wrong to just beg Tom Witcher for a job that was always in the back of my mind if like there's a guy I could work for definitely and you're not having working for him I mean, I, yeah, you talked about good fortune in terms of kind of your transition. I've been incredibly fortunate to kind of to work with our team. Yeah. They are, you know, without exception, a really dedicated, dynamic, motivated.

1:13:39And, you know, it's that mission, which I think aligns with my own personal values, which counts for so much. Well, I was actually going to say making an actual difference as well. and actually going in at the point of, yeah, not quantum computing, let's solve a problem. Like that's what I've always respected about the doctor-doctor way of doing things. Yeah. So, yeah, I feel very fortunate. So, yeah, if they're listening, thanks, guys. I'm sure a couple of them are. Yeah, Laurie, absolute pleasure. Thanks for coming on, man. If people want to get in touch with you for any reason, they've been inspired by what you've said and want to ask you a question, what's the best way for them to reach you uh probably like most people linkedin um i think there's only one lawyer kid on there um so that's probably the best way um i try and uh i try and kind of respond to um uh dms um uh like everyone quite busy so i'm sorry if i'm slow and um i always like it when people uh connect but i always like it when people actually um explain where the connection request came from it makes it so much more personal um even if it's just you know linkedin suggested i made friends with you that's fine um but they can say they listen to this right they can say 100 yeah yeah they can tag you but no it's been it's been an absolute pleasure it's a real honor like you know i've listened to a ton of these um and it's um it's really great and um yeah i mean for you and your team carrying what you're doing because it's great thanks buddy thanks buddy we'll uh we'll speak to you soon all right real thank you hey everyone thanks for listening and making it all the way to the end of this episode remember to subscribe rate us and leave a review.

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