#459: What if we monitored everyone that leaves hospital care?

0:02The minute you leave, there is no monitoring whatsoever. But in the UK, which is our largest market by far, 5 % of patients consume more than 50 % of acute costs. This is not a technology issue. The tech is not the problem, right? The tech is here.

0:24Hey, everybody.

0:25Dr James Somauroo:This week, Delighted to be joined by Martin Ratz, co-founder of Dockler. How are you doing, Martin? I'm very well. A little bit exhausted, frankly, because it's full on. It is. It is. I think working in health care is full on. Working in health tech is full on. Having a business that you co-found is full on. And growth is full on. So you are probably playing in all of those camps currently. so i'm not surprised i'm not surprised you look great on it though i thought you'd be a lot more tired you're too kind add to that that you're also i mean i'm a father of three boys and a husband so you have you know try to have a private life as well but we i shouldn't complain it's it's good it's good but but yeah this particularly this bit you know before the summer it's always extra full-on absolutely how old are your boys they're a little bit older they're 16 20 and 21 okay nice yeah i'm uh i grapple with one boy currently an 18 month old so very 18 months yes so different different side of the scale i guess age-wise but um yeah yeah he keeps us keeps us busy at home but he fills the house with joy and love so it can't you you cannot complain and three of them is three three times the joy three times the love three times the work three times the wrestling it's yeah i imagine i imagine that's been tricky but you do you get some economies of scale though it's a little bit when you do you know when they get older and particularly when you have more of them yes yes wrestling each other rather than you i imagine which is kind of nice they're nice excellent so martin listen obviously docler you've been around a little while now you've been doing a lot of interesting things um and it'd be very cool to hear the story of where where it all started um your background your run up to this i mean where does it all begin for you sure so i've i've been an entrepreneur for the last 20 plus years and um when i was 44 years old i very very unexpectedly suffered a heart attack literally out of nowhere as you can tell for those looking at this i'm relatively slim i don't have any my vital signs are good i don't have any there's no reason for me or there was no reason for me to to suffer a heart attack other than a hereditary one both my parents suffered relative at relatively early age wow so you know out of the blue literally i i i was you know from being or viewing myself as being completely healthy to not being healthy and one of the insights when i was in in hospital i was hospitalized in Stockholm in Sweden, I'm Swedish, was that when you're in a hospital setting, you're constantly monitored, right?

3:23But the minute you leave, there is no monitoring whatsoever. It was just striking to me that, you know, we have all this new technology, you put it in cars and elevators and everywhere, but we don't use it on ourselves. Particularly, we don't use it in healthcare. And to me, that was just wrong. And when you see something that is wrong, you almost have an obligation to fix it if you if you can right so that's how we began amazing were you

3:52Dr James Somauroo:a born entrepreneur were you the type of person that was like doing businesses since childhood and all these different things or were you more of a do things at university get interested and then do different things like what's your sort of lifetime as an entrepreneur well i've never gonna ask that before um i mean to some extent yes i probably had an entrepreneurial vein early on selling selling things as as a kid um but but this grew on to me when i after having worked in the private sector for for a couple of years and so my first uh this is my fifth company my first company was recruitment and training of doctors across Europe.

4:41Since then, I've been fortunate enough to start a few other ones. Four of them have been successful. One has been a failure. But DocLiz, the first one where we've used external VC capital.

4:59Dr James Somauroo:Interesting. So you were a bootstrapper? I was. and it's you know when we when we had our seed round i remember we were so proud you know we showed that we were profitable year one and i thought that was a good thing and you know these vcs said well that's not really yeah sell that down that's not the most exactly you know that's not the most important thing right very interesting so what were the four other business oh the yeah the four other businesses then so the first one was recruitment and training of doctors across this was exactly when the eu was was um expanded so the accession states were admitted and there was mutual recognition of professional organizations across the country so you could work anywhere as european at the time when the uk was still i was gonna say good old days yeah so anyway we recruited doctors from all of europe we brought them to a campus outside warsaw where we taught them medically flew in Swedish, Norwegian, Danish, English, French, German, and then they moved on a permanent basis.

6:01And the NHS was actually one of our largest customers. So we recruited over 350 dentists, well, I think 150 plus GPs and a variety of other healthcare professionals. So that was the first business and that was actually my first interaction with the with the nhs did you sell that business

6:25Dr James Somauroo:or did you did you wind it up did you move on did you that's still yes that's still going and the second business it was a actually on the back of that there was no mckinsey strategy behind this it was just circumstance right um was a staffing business for the transport and logistics industry and we got into that because there was some there was a tension natural progression from recruiting doctors from the sounds of things yeah exactly one of a one of the partners we had in the uk they worked for the one of the departments in of transport i believe in the uk and it was a huge shortage of gas engineers lorry drivers and so on and they thought well if can you can you source them from internationally and clearly recruiting doctors was was a was a stamp of confidence in a sense so very like based on that clearly it was the curriculum was different and so on but but based on that we then recruited these various different uh professionals and then they worked more on a temporary basis across europe primarily again in the uk and that business we sold to our largest customer at the time perfect and then the third business was a chain of dental clinics i got into these dental clinics again because we recruited among the healthcare professionals we had dentists was quite a quite a large portion we had these we recruited to primarily to the public sector but also to a few private private organizations and so we recruited dentists to entrepreneurs in Denmark.

8:10And it turned out that one of these entrepreneurs was not fair to the dentist that we had recruited. They treated them very, very unfairly. And to make a long story short, we decided to take over a clinic and engage the dentist that we had recruited. And within two years, we became the largest, well, one of the largest clinics in in denmark and then we grew and subsequently sold that business to a private company wow and then the the fourth business which was a failure was a telly about time you failed on

8:49Dr James Somauroo:one of them otherwise i mean these statistics would have been ludicrous otherwise yeah but it was uh the fourth business was a teller radiology business so we would we would use again from the from the doctors that we had recruited we had radiologists and they would stay in their home country and and evaluate radiology images the so as an idea of course you know this was earlier this was 10 50 15 years ago right at the time it was you know it wasn't the ai scribe buzz but it was definitely yeah very very busy to do right yeah uh the the challenge we had at the time was latency. Like it was literally a, you know, when you looked at mammography images, for example, there was a lot of latency and we couldn't get that to work for these doctors where they were working from wherever they were.

9:41So that was one challenge. And the second challenge was the local operators, particularly electronic healthcare record providers, they did a masterful job blocking new entries so we had even though we had a it's one of the few very few contracts with a pub with a public sector that we've decided to decline an extension to because we just we couldn't make it work right they were really they were they did everything they could to block any new entrance right yeah and then the the fifth one is is docklet which again is the first one that that we have with um with where we're backed by wonderful and i really

10:27Dr James Somauroo:mean that wonderful investors amazing story um why do you think that your business is four out of five being successful depending on how you define successful certainly you know three out of four successful exits so far, fifth pending, fourth pending. Why do you think they've been successful? I think you've clearly had like a central thesis or at least a central skill set from like since the first business. And it seems to me like you've just applied first principles of supply and demand essentially to then carry that through into the separate businesses. But being an entrepreneur is not just about the idea obviously those ideas might be good the supply and demand delta might exist but as an entrepreneur there are so many other things skills required in order to run a successful business you also need a lot of luck and all the rest of it which I'm sure goes in your way but it always is skill hard work and luck that's what I've learned doing 500 of these podcasts it's definitely a mixture of those things but I'm interested in in in what you think your skills were that that contributed to that success like why why you as an entrepreneur did did those work was it that you were good at finding co-founders was it that you had a model that worked that you carry forward like what what do you think it was first of all one of the three things you said luck i think that's like by far and i mean by far the biggest denominator here i've been thinking about this a lot recently you know you know i i'm almost allergic to entrepreneurs you know beating their own drum saying oh i saw this opportunity oh i did this oh i was survivor bias yeah and it's it's just i don't think it's true i think that a lot of this is circumstances and luck dockler would never ever ever have been able to grow the way we grew without covid we would never have been able to grow had not the british government decided to earmarked 450 million pounds to scale virtual care uh but but aside from luck and i really mean that as the like circumstances as as a fundamental uh part i think you you know you need to there needs to be a good the fundamentals of the business idea i need to be very very powerful like and yeah i i asked myself the question what's the what's the destination of this train right if things go really really well what what what could it be and then being i guess opportunistic right when you see enough you see that there is a gap um i can give you another example right when again linked to my to my heart attack um being that i i I suffered at a relatively early age.

13:23I was scrambling for data. You know, how do I, how do I learn more about this? Who are other, what's, what's my cohort like, right? So I went in Sweden, you have like the Amazon of Sweden for books. I pressed in heart attack in that database and I got zero hits, zero. And then I put in cancer and it was 25 ,000 hits. and again you know it it's a disease that affects you know so many people why isn't there a book so together we're three brothers and my together with one of one of my brothers who's like you trained as an anesthetist uh we wrote a book and and that book uh you know contributes to filling the gap of of of lack of literature at least in sweden in this in this space so i think it's very much about finding you know where is there a gap what is the potential and how do i how do i mobilize the right team to make this happen and in my case and you know in case of dokla dog is one of these people right he knew my co-founder right he knew tech really well i didn't yeah so so partnering together was was a was a strong move and we we very early on decided to divide our roles in a sense that my would be to you know more external to bring in customers and his would be to deliver a disservice in a sense yeah and then finally i'd also say you know the the people that we've

15:06Dr James Somauroo:managed to attract really make the difference and i know you know it's such a cliche to say but but without that you literally have nothing yeah so talk to me about the having a heart attack and then sort of the subsequent period afterwards what what stage were you at at that point because it sounds like you've you've had that heart attack and then decided to divert your attention to health care which has then got you thinking which is how doctors then come about can you plot that for me in detail so what what was that period like and how did the idea for doctor come along and how did you go from zero to one essentially in that period I mean, the period immediately following the heart attack was one of shock.

15:54It was really, you know, you feel very fragile.

15:59Dr James Somauroo:Yeah. It's, and a lot of, again, scrambling for facts. How do I make the best of the situation that I'm currently in? And I was blessed with having, you know, a wonderful family, wonderful friends, colleagues around me were very, very supportive. But this idea of not being, you know, not using the latest technology to monitor myself and other patients was really, it was really the driver behind DOCLA. And I, very early on, I had a wonderful relationship with a few of the senior folks at the NHS. And I obviously told them about what had happened. And we discussed these ideas of how to use technology.

16:50And within a couple of months, I got a call from one person, Professor Ali Rashid, who said, you know, there's a research study that will look at how do we look at patients who have a heart disability and prevent them from unplanned events in hospital. And this research study, I think they invited, I believe, four different providers. It was Babylon, Philips, a local company, and us. And then we pitched this research program. How do we do this using new technology? And much of a surprise, we were one of the four winners here. and we started this we went through ethics committee we were about to recruit our first patient in February 2020 when of course COVID hit and all non-essential research was put on a hold including ours and we quickly realized that the hospital that was hosting the study Northampton General Hospital in the UK we got along really well with them there were wonderful clinicians there.

18:06And we saw that, well, we have this disease that we know nothing about. We have clinicians who need to shield. And we have this research project where the whole point of it is to monitor patients outside hospital setting. So we quickly evited. And within 16 days, we were operating a virtual ward for COVID patients. And I remember in the beginning, we given that we didn't know anything about the disease we were measuring all these all these different vital signs whatever we could right and then as as we progressed over the coming months and so we we quickly cut and towards the end the only thing we were measuring was temperature and oxygen saturation that was really really it and since then we we literally exploded right we we we we now work with 60 of the intricate of the icv's integrated care boards in in the uk with a large presence in ireland in germany in austria uh and uh but it started off that yeah

19:16Dr James Somauroo:that's how we that's how we got started that's really interesting so can you then explain a virtual ward virtual ward as a term gets banded around a lot and i think i actually think it means a lot of different things to a lot of different people i don't i think some people um i mean i'm bearing in mind i've been all of these different people thinking about it in terms of what like where where is it like what is it so some people will kind of understand that but what do you measure and does that change is this step down care into the community is there a link between that into the hospital is that now something available versus not in different places i think the the concept of virtual ward i think i think probably does need cleaning up here so what's your definition of virtual ward like what and what is essentially now the dockler product and who do you sell that to?

20:15Right. So let me just clarify one thing. You asked about how we came about, right? Yeah. As part of that evolution, we started off as a research project, then we became a virtual ward provider. And today we are really a provider or an enabler of proactive care. So that we exist to keep patients out of hospital by intervening early. and we're really a lot of our focus in is on high intensive users those patients who use who tend to to to use health care uh the most right and and and i agree with you the term virtual you know virtual wards is is sloppy right it means different things to different people but essentially you look we look at it or where we come at it from is what is the required level of care for these patients.

21:08Virtual wards for us means more intensive care. So these patients will stay on our program, for example, for 10 days on average, right? Whereas long-term monitoring, these patients stay with us for, well, indefinitely. And we sit somewhere between primary care and acute secondary care. That's the space that we fill.

21:36Dr James Somauroo:Nice. When you're framing this to ICBs, what is that frame? What's the advantage to them? And yes, okay, this keeping people out of getting escalated into care and what does that save? And yeah, what does the world look like where this is everywhere? And I'm interested in all of that. Right. So on a macro level, and these stats vary from, we have 200 countries plus in the world, and they will vary somewhat from healthcare system to healthcare system. But in the UK, which is our largest market by far, 5 % of patients consume more than 50 % of acute costs. Of those, between 70 % and 90 % are patients with long-term conditions.

22:33right and if we if we fast forward you know to 24 20 40 we'll see a an increase of chronic diseases of nearly 40 37 right and just to put that into context that growth is nine times bigger than the working age right it's we'll see a dramatic increase in this right so we have on the one hand we have this demand push in a sense right and as we know health and you know healthcare is It's an unsaturated service, right? You can always consume more care, right? It's unsaturated. And then on the supply side, we need to bring down most healthcare systems, and particularly the one in the UK, scrambles for money, right?

23:16So we need to push down the cost of care. So when we go into systems, this is our starting position, right? And by the way, this is not controversial. Everyone agrees with this, right? Everyone agrees with, in general, the direction that there's a small part of the population that costs the most. So then the question becomes, what do you do about it? How do you fix it? And I think one of the things we learned through the growth of virtual wards was that we solve, it's not strictly a tech issue. And it's very easy to be confused by that. It is a combination of tech, operations. You need to send out devices, the logistics of it, the decontamination, all the operational unsexy work that comes along with it.

24:13And then there's the clinical aspect. You need clinicians ultimately to monitor patients. And the NHS and most healthcare systems, public healthcare systems, are strained on all three categories, right? They don't know how to implement tech effectively. They have a clinical or a shortage of clinical staff and they're not Amazon when it comes to delivering operations. So we've been listening very, very, very closely to our NHS colleagues and really trying to understand what do they struggle with specifically to enable, you know, previously it was virtual wars and today it is proactive care. How do we really make this work?

24:56How do we solve that for you? And then we start. We're extremely data-driven, of course. You go to a system and say, so give me a list. Show us who are those patients specifically that consume most healthcare. And you stratify that group. And you drill down on those 5%, and then it quickly becomes 3%, and then 1.5 % that are suitable for what we do. and we we take out say a population of 10 000 patients right uh and then we match this with a cohort that is uh almost like a control group so you find a a digital a digital twin in a in a geographically different area and then you know we we track we see how how does our cohort uh perform compared to the uh to the control group and what's a good example of give me an example patient there

25:54Dr James Somauroo:so is it someone with say heart failure that you send out digital scales and something that measures this that and the other and and and you're tracking them in the community and and that this has been sort of almost you know prescribed or they've been discharged to this virtual ward from and then steps down to it from yeah from on-site care is that right is that Well, it's a good question because it comes from, we often get that from clinicians, right? Yeah. So what's the clinical pathway, right? So when we started out, it was very much, as I mentioned, we started off with COVID patients. It was a lot of them were COPD patients.

26:36Then we moved into ARC patients and we added on disease. And I think we now have 40 plus different clinical pathways. But what we find is, and particularly with this group, these are multimorbid patients. They don't have one disease. It's a combination of several, right? And mostly it will be a combination of hard COPD and diabetes, I would say. That's your typical patient. And we've also seen that the most successful hubs we have across the country are those that are disease agnostic, if you wish. So they don't set up a separate hub for heart patients. It's genuinely a holistic approach to these patients.

27:22And then they are a mixture of, to use NHS terminology, they're a mixture of step-down patients and step-up patients. We make sure that we're not treating the worried well. if you right so these are the patients that we look after on our proactive care pathways they are they are sick they are they have um we have an algorithm for this to find out you know which patients are most likely to end up in hospital how do we and and a key marker for that is your your last admit where you admitted to hospital you know recently that's a very very

28:02Dr James Somauroo:strong along with others so this is really interesting to me because i've been doing a lot of work recently looking at the preventative health space i don't like the term longevity because of the associations with bio like biohacking and and pseudoscience and the rest of it but my my question was going to be where do you fit in in comparison to everything going on here with wearables and the public and all the rest of it the the answer you've explained is that your patients are sick like the patient the patients that have this are sick they should not have the stuff that everyone gets in the community google's latest fitbit thing or you know an aura ring or whatever but i think it's really interesting as to the the the almost juxtaposition of you against them in the it's funny that so much of marketing to the public now is that everything should be measured we can prevent things we can pick things up and the signal versus noise like there's not a great deal of contrast there there is in someone that's sick you know a heart failure patient that's putting on weight rapidly okay that's a that's a pretty strong signal against the noise of weight fluctuating up and down and body fat percentage because you've done the thing and and it trying to find a correlation there that you can attach to being relevant as a just a relatively healthy member of the public it's it's quite interesting that that actually your your positioning your positioning with them is very very very clear that actually the patients that those companies do not want to be associated with because of all the potential risk to them it's quite interesting that they're almost the best partner for you in some ways because it's like any by the way if you find anything here we are and there's a pathway for them to get to us if you just go to these places so it's it's interesting to me because a lot of the work that i've been doing a lot a lot the kind of i mean it's my own work it's my own interest about figuring out where this pathway is for everyone because ultimately i'm a health care person and yeah okay preventative health for the public is is something that i'm interested in particularly when people have heart attacks at the age of 44 that have undiagnosed familial hypercholesterolemia or whatever it is like that that's that that is a very interesting space and the nechos of the world are figuring that out for the public but it is interesting to me about who that leaves behind and i think that's where this path is becoming a lot more trodden isn't it in wearables and us being comfortable with wearable data especially with us being comfortable with wearable data being clinical grade and i think in the time that docler has existed the hardware seems to have improved massively the software seems to have improved massively and you've kind of grown up in this era where it's it's becoming so good but you're already kind of embedded into the clinical system and i think actually with the people that listen to this podcast relatively regularly will know that with with conversations with neco and all the rest of it it's been an area of like hold on a minute who does this leave behind i think actually that with people like yourself that are willing to pick up that mantle which by the way is often a poison chalice because if if if those if those b2c companies try to deal with this stuff clinically which there are signals that they are with you know mayo clinic taking a position in i think it was aura in their latest round and all these things that healthcare but but public community line is definitely blurring it's nice to know that there is actually clear contrast with you guys in the healthcare bit and and there's there's cause for them to stay where they are over there rather than deal with this bit because there are experts in it but i'm interested in your take i'm interested in how you feel about that space as a whole and where you fit and are there any potential lines drawn between what you're doing and and the wearable companies in the public and yeah i'm interested where it all goes and what your thoughts are no it's really interesting so a couple of points uh i mean on hardware that that's a victory you know we made an early decision that we will never ever provide our own hardware yeah sensible yeah you don't need to start a new company within this company like that's no no no no No, and I think a case in point there was, you know, when we did this initial research project, we qualified a set of devices that we would use.

32:44And by the time we had gone through ethics, you know, one of them was already off screen and there was a better one on the market, right? So it just shows that this goes so quickly. And this was six years ago, right? So I couldn't agree more. Like the development of these devices will only improve and costs will go down for sure. For sure. So we'll get much better at that. um that said it's still it it very much depends on who the user is right because again the patients that we look after they are really sick right so you can't these need to be medical class devices we can't use fitness devices for this right even when you i mean you will know this right even when you're in the icu even if you have you know you're checking oxygen saturation in like in the vein then still you will see fluctuation, right?

33:37100%. I think it's very important to distinguish that. And we're regulated as a hospital in the UK. We're CQC accredited. That follows, you know, a lot of responsibility follows with that. And we take it very, very seriously, right? So anything we do needs to be medical class, medical grade. And another point is, how do we cooperate with B2C providers? A fundamental difference is that the decision to engage with us rests with the NHS. It's a clinical decision, right? They decide which patients we should enroll. It's not driven by the public. It's not like I feel unwell and then I initiate a contact with the care.

34:32It's the other way around. I think there are primary care providers like the space that Babylon very much pioneered. That was, again, driven by patients, by the public. They decided, well, now I do need care. And there's a risk, of course, of overconsumption of care and that you're draining resources. right um particularly you know among certain certain patient populations right whereas we're the we're the opposite of that we we take out patients from from from hospitals we reduce corridor care that's what we that's what we exist to do and i think the you know will the two these two segments you know come closer to each other yes but i still think that they're two very very

35:21Dr James Somauroo:different uh cohorts very different you know yeah what do you what do you think about that them coming together and and there being this continuum it seems that with these big providers in the u.s taking positions in wearable companies the there's there's going to be this thing that bypasses the nhs even in the uk there's going to be cleveland clinic patients or mayo patients or johns hopkins patients are going to have these wearables that are going to be maybe medical grade and they're going to have those in the community because they do have a chronic disease but they're okay now but then if they do escalate they're going to be pushed into private care earlier and it seems i don't my like my thing about this is are you creating a level of stress for these people have been being constantly monitored but if they have a chronic disease maybe it's okay and i guess my question broadly is is this a direction of travel do you think for for public sector like countries like ours that have that have an nhs or something similar that that it is it is a case of putting certain wearable uh medical grade wearables on on on chronic disease patients in the public that want them so that they can be escalated quicker because i imagine you know if the nhs is making a decision to discharge them from your care into the community it's interesting how you described it initially that um you know you're discharging to public and then there's a drop-off and then that's the bit that we come in there's another level of drop-off obviously when they discharge from your care that then they're back into the community again and is there a space for some some kind of step-down care even there i'm just interested in how you see the structure there ultimately this is a political question right we have in most countries in Europe, we have a publicly financed healthcare system, right?

37:15So some of these signs are a consequence of the public not delivering the services that the public expects and that there are technological opportunities that these public sector providers are not great at exploiting, right? But I think the, you know, from a Just coming back to the patients that we look after, this group, again, they need holistic help. It's not like, oh, you're with us for two weeks and I am going to look after this particular thing. If you take the proactive care work that we do currently, when patients are onboarded to us, we do three main things. One, we track their vital signs 24-7.

38:06So we follow them over time. Number two, we review their meds. So we have prescribing rights and we can change their medications if they're not correct. And then thirdly, we do a type of health coaching. And that can be ranged from a wide variety of things. Like, for example, if there's a patient who's lost their partner recently and they're not used to preparing meals, right? And we unfortunately had examples of this. The only thing that person eats is sausages. That is not a good diet to eat sausages three times a day, right? So, and it's very difficult for a healthcare system to pick up on these, not only on the vital signs, but to have this holistic view, right?

38:58And I think to look after these patients who are seriously unwell, one needs to have this holistic approach. So you need, like a chaperone, to guide them through the healthcare system and to look after them holistically. And there are examples of companies in other parts of the world that do this well. There's a company in the U.S. called Citiblock. They look after very, very sick patients or very, very costly patients. And it's like a conseiller service. They are the first point of contact. And I think we want to emulate that to some extent for this cohort. We are the number one point of contact for these patients.

39:41It's our obligation to help them. And then, of course, there's a clinical escalation protocol that we follow. If they need to go into secondary care, they go into secondary care, of course.

39:51Dr James Somauroo:right is it hard drawing that line i think i mean i the itu doctor in me says it's not difficult to draw that line at all because you would just put hard lines around it but i think there's always going to be a fuzzy gray area because you're in you i think the the tricky thing and the skill of this and where a lot of the value of this is the sensitivity and the specificity of what what you do it's the specificity bit that's very important because it's the specificity that keeps people out of secondary care and in the community with confidence and i think unfortunately that's also where the negative headlines live that someone was kept in the community too long and this bad thing happened and so you're always having to play on the side of keeping the serious events to zero but at the same time keeping as many people out of hospital as possible i imagine that's i mean as i say is is that a hard line to draw and across so many disease processes and areas and complex patients it must be tricky yeah of course it is right and then you have uh you know we'll get you you fine-tune this right yeah we get better at it as we progress but i think uh very often this when this argument comes up it's it's it's put as as if there's as if there's clear option so the yeah well this is like yeah well it isn't right the alternative is nothing the alternative is nothing right and it's really important to stress that though you're not comparing oh you know do i do i get uh first grade care in the hospital or am i left alone in the community no no you're in the corridor yeah yeah you're in the corridor we have no you have no monitor you have no one looking after you that's the alternative and then is it better to have an imperfect system you know looking after you yes yeah i must say that something's better than nothing argument comes up a lot i i've i've had this i i i took an uh what i now know is an incorrect position on uh mental health chatbots like ai mental health chatbots in that i i thought what a hard line should have been that we don't put AI alone at the point of human suffering.