#460: Why healthtech still hasn't had its big exits

0:03HealthTech, I think it's so incredibly fragmented, right? There's so many solutions to so many problems. Anyone can do the modelling, anyone can do the financing, but apparently not everyone can smell a deal. Not everyone can find that synergy between two companies. Is that the answer? Is that why we haven't seen these clear big exits that give everyone hope and ambition and all the rest of it?

0:30Si, welcome to Outtap Podcast. How are you doing, mate? I'm doing very well. Thank you very much. Thank you for having me. How are you? Very welcome. Very welcome. I'm good. I'm good. I was going to try and avoid like British thing and talking about the heat, but it has been so unbelievably hot that actually I checked the temperature this morning and it was going to be 23 degrees. And I thought I'm going to take this opportunity to put a long sleeve top on and a jumper on and sit at home, not just sweating and being disgusting so um yeah i'm doing i'm doing a lot better today and i've minimized my travel to london for that exact reason as well uh but yeah how are you man have you found it uh i don't know the heat has been uh really difficult as well i've kind of pre-cooled the rooms uh with the ice but in the in the past few days honestly i've been in the hospital um um in a and e and so many people are coming with like dizziness um feeling oh fatigue and things and we go well yeah look outside the problem is these are people who are let's say already prone to infection and they come in the infection plus the dehydration is just making everything worse we normally have these criteria to admit patients or to recommend admission um and i mean that criteria is kind of we now have to take into account the heat and the weather and whether or not they are you know drinking enough water at home um to you know to be discharged safely wow so no that's it's been a real kind of uh we we felt it um kind of in in a in a number of ways i saw this absolutely hilarious meme that said that in this 37 degrees celsius heat there are radiators in nhs hospitals that are still on and those are the same radiators that break in the winter and i i was literally like there is nothing more relatable than like leaning on the hottest day of the year just leaning against the radiator that you expect to be completely cold and the cold metal to give you some relief and for that really needed to be completely on maximum like oh god why is why is the nhs like this this is this sucks this is really difficult oh you know i was in uh so we were in resus yesterday um which i mean you see yesterday or the day before was i mean yesterday was busy as well but the day before was like manic busy we had so we normally have um was it seven bays uh for patients there which is already quite big for a resource unit within A &E.

3:12But then we had, I think, LAS kept bringing us more and more patients. So by the end of it, we had about, I think, 13 or 14 patients or something like that at the peak. We ended up obviously distrouting a lot of them and stepping down a lot of them and things. But there was a point where there were about 13 patients in our A &E. And I was just sitting back as I was taking three yards from one of the LAS crews. And I was sweating at this point. I was like visibly sweating. and i was like is what like am i sweating because of you know the stress of so many patients and they're all they're all unwell james they're all unwell two of them had to be intubated one of them had to be blue light from us three of them were like septic with like really bad really low blood blood pressures like unwell these are not just like standard patients um and along with that i'm sitting there sweating and going is it is it me or is it the radiator it turns out yeah the radiator under my feet is is on are you serious it's just this is this is not helping the situation this doesn't need to be so there you go memes memes in the wild memes literally being reality it's tricky man it's tough it's also tough it's tough actually having those shifts i can remember um this this all this feeling i remember it so vividly this feeling that i could not deliver the standard of care that i wanted to deliver because i was spread too thin and it's this i mean you tell me what it's like now but for you because i you know i'm i'm interested but for me for me it was just i just felt this weight and this pressure of there are there are people getting substandard my substandard care um because i just can't get across them enough and i i just man i i remember that sometimes i actually still genuinely have like actual nightmares that i'm trying to do do too much in a hospital then i wake up sweating it's yeah it's really tough it's really tough how are you finding it i think things are things are getting better to kind of uh kind of as a general trend what i'm there's there's more kind of support yes the nhs is understaffed yes there's you know we need more doctors we need more nurses we need more health care profession we need like more of everything basically to cope with the pressures but for example that example that i was giving you about the patient had to be blue lighted from entry from las bringing her in to us investigating her uh stabilizing her incubating her sending her out that total turnaround time was under three hours that is that is good for us that is well that's good for anybody um this is a time critical brain bleed that we turned around that we stabilized turned around and sent to whatever she needed management within three hours.

5:58So yes, there are stories of people getting substandard care, but there are also like, especially in A &E, the wards, I'm in A &E now, and I can tell you, like, especially in A &E, we really do kind of risk stratify and the most unwell patients, they get the care that they need. You know, if we pull doctors from other departments and get them into resus if things are busy it means that the wait times in let's say you know the the utc or other you know the the less emergent uh departments within sub departments within a and e yeah maybe the wait time increases from four to five hours or something like that and and the person who's had a chest pain for for six months uh with it kind of on and off chest pain which it now suddenly is a little bit worse than it was means that they have to wait an extra two hours or the back pain that's got the pain shooting down the leg and they're in a lot of pain and they do need to be in A &E but again they've had it for about five months it means that they have to wait an extra two hours but we get to save the life of the one who is going to die if we don't treat them within that hour these are kind critical things so yeah I mean we do apologize to the patients who are waiting in the air in the waiting rooms for like six hours but this is the reason why and i suppose if we had more doctors then yeah those wait those wait times would decrease but the patients who need that critical care are still getting it so in that way i'm i'm happy i'm kind of reassured um but there are definitely benefits to having more doctors um and yeah i mean what he describes actually one of the reasons that i chose anesthetics because i really liked anesthetics as a specialty because you had one patient at a time and actually your time was respected when you were dealing with that one patient and then actually things that happened outside of that were then i guess in inverted commas not your fault because you were dealing with the one patient you can only deal with one at a time so you always had a complexity issue rather than a volume issue which always made me far less stressed actually um which i which i did really enjoy other than you know compare that to like the med reg on call who's just trying to do a million things at once and being responsible and accountable for all of it it's um yeah that's a heck of a different skill and a lesson in um resilience certainly but um it's good to have you on man and and yeah you've got an amazing background as you you've just talked about you're still practicing clinical medicine you're also simultaneously doing investment banking which is no mean feat you've picked two things there that certainly demand all of your time so i don't know how you're doing that there must be like a clone sat behind the camera that you just sort of deploy the clone's probably doing some investment banking while you're doing all this so that's so that's that's quite interesting so i'm interested to hear how you're cloning yourself and doing that and i joke but i am very interested in how you manage manage your time and doing that stuff and we've also met a few times at events and various bits and bobs and and and stuff so i i know some of the answers but i don't know all of them so it's gonna be really nice to actually have a chat to you about it all but i guess the first the first thing that we obviously go through your story on this right but um yeah you tell me like what's what what is your sort of personal story your personal background and maybe are there other origins in your childhood about where this motivation comes from or anything to do with your med like med school or anything like tell me tell me the story yeah okay well so i grew up uh half half of my kind of childhood was in london and then the other half from the age of about eight to um kind of finishing high school the gcse so the indian equivalent was in india and then i came back to london for my a levels uh and then i moved to malta for med school so i've kind of lived in a few different places oh yes malta for med school yeah uh so i spent five years in the mediterranean it was a beautiful beautiful experience uh a very good also a very good college it's queen mary so it's it's bart uh so you get like really good um medical education but at the same time it's in malta so you get a really good kind of year-round sun yeah exactly they this is a stat they had sun for about 300 days out of the year it was it was beautiful we would study on the beach we would go to the beach and taking breaks from the water we would come and do some questions and passmen and do some revision and things but it was beautiful but yeah so med school in malta and then i moved back to london about about two years ago now so i started my foundation program in london where does business fit into this so that's the kind of that's the that's the medicine and in the doctor kind of trajectory.

10:44And I'd known that I'd wanted to be a doctor for, I mean, for a very long time. I think almost the age of like 12 or 13 or something like that was when I realized that I really, really liked, well, I liked biology as a subject in school. And within that, I really liked the human body. And I still remember there was this chapter on the nervous system where we were studying about the sense organs, the eyes, ears and things. And it was the eyes that actually really drew me into human kind of medicine where we used to go to these tuitions after class it's very common in India you'd go to school in during the day and then the entire evening was different tuitions and things so in my biology tuition I was picked to kind of explain to the class the different the different diseases and this was like myopia hyperopia you know all the different all the different vision problems.

11:37And I found that not only did I understand what was actually going on, and this is about age 13 or 14 or something, obviously at that level, I'm not sort of like med school level, but I understood what the textbook was trying to say and what we needed to know. But I was also able to explain it to my classmates in a way that they understood. And I found that obviously a lot of people can do the first part of that, but explaining to others in a way that they understand a complex topic is something that I've heard that not everyone can do. So when I found that I was able to do that, I really liked that about myself.

12:12And then I ended up going to a hospital to visit one of my mom's friends, was admitted at the time. And she was quite unwell at the time. She's doing well now, but she was quite unwell at the time. While we were walking out of the hospital after visiting her, I still remember my mother stopped. She's at the exit and she turned to me and said, Sigh, no one can alleviate pain like a doctor can. And I think that for me was a statement that it's a very simple statement. I don't think she realizes the value of kind of what it means to me, but that is it was a powerful statement to me. So at pretty much that age, I realized that I wanted to be a doctor and I kind of geared myself up for that.

12:48So I went to med school prep classes in India, Akash Institute of Coaching, if anyone kind of recognizes that. But that was again, that was that was crazy. I would go to school, was it eight? It was not eight to five, seven to three, I think, was my school timings in India. And then this coaching class would be on Friday, Saturday, Sunday. Friday would be 4 p.m. to 8 p.m. And then Saturday and Sunday would be the whole day, 8 a.m. to 4 p.m. So I basically, I was studying, and this was the A-levels kind of equivalent in India. Sure. I was studying pretty much every single day in a week so out of seven days I would be studying for seven days and the only free time that I had was weekday evenings and Sunday evening I would pretty much be studying the whole time apart from that so I guess that's where I kind of got the it became normalized to me to be working all the time or to be to be engaging myself all the time let's put it that way uh and then during med school it honestly became a little bit easier to be honest um the uh like uni lectures and stuff they were you know you'd go to them but there was a lot of socializing and stuff between lectures um the the anatomy classes it's it's obviously very practical isn't it med school so there would be a lot of uh interaction with other people and that was that was great from from going to start from coming from studying out of textbooks and and learning like thousand page textbooks to now learning with people actually made it a lot easier for me and I really really enjoyed that but then I got this um like I started understanding business now kind of taking a step back from med school pretty much when I moved to London so for sixth form I realized that I somehow I started almost in a way unconsciously analyzing how things work behind the scenes.

14:45So like a lot of the problems that my friends had, and I started by noticing the problems rather than the system. So I started noticing a lot of the problems that my friends had when they'd say, oh, you know, I, we have this, we have this exam or we have this test in school on the Monday, but I've been working all weekend because like I work at this pub and I like, I'm a bartender there or I'm a waiter here, I'm doing something there and I don't have time off and they didn't give me time off to study for this. And I realized that, you know, these are problems that my friends are having. So, you know, how can we solve them?

15:14And I started thinking about things from that point of view. And at the time during sex form, I put together a platform. It's like a gig economy platform to connect students who wanted zero hour contracts with employers, you know, working class people, working adults who don't mind paying, you know, 10, 20 pounds to get like the small odd jobs done, like cleaning the car, doing the dishes, laundry, things like that. You don't want to hire a full-time housekeeper because obviously you can't, but you can get someone to help out with those kind of tasks. And that was kind of one of my first ideas to kind of connect those two groups.

15:52And that was my first startup idea. And moving on from there, I think second year, first or second year of med school, I realized that again, a lot of my friends, and this is now creeping into COVID. A lot of my friends wanted to exercise but they didn't have that kind of innate motivation to exercise uh like yeah we'd go for runs and things but it wasn't there wasn't there wasn't anything consistent in that and i realized that this is a big problem for just generally everyone um so then i started thinking about how do we kind of solve that and i realized two of the two of the strongest psychological factors here are uh so the gamification system where you kind of build points and you compete with not just yourself, but also with others.

16:32But the second thing is money. And money is a very, very strong way to make it. So, you know, the more you exercise, the more money you'll get in coupons and discounts and things like that. So I built a platform to connect all of that. And that one I actually took up to the, I piloted that on a very simple MVP. And I got it out to about 50 people. And all of them said, we genuinely, we exercised and were motivated to exercise more because of this. And it was now second year of med school. And to take it to the next level, I needed to raise about£100 ,000, which, you know, it's not a lot of money for an investment, for a startup investment.

17:06But I didn't think that as a second year medical student, it was the best use of my time to kind of give my life away to startup or to VC because I'm not going to drop out of med school. I've worked so many years for this. I thought, you know, let me focus, let me get some domain expertise. And along through this as well was my family saying, look, Like, you know, you've had good ideas. You will get other good ideas as well. And to me at the time, I was like, oh, this is such a good idea. I have to do this. I will pour my life into this. Everything outside of all my time outside of med school, I will focus on doing this.

17:38And my dad was just like, you will have other ideas. This is a very, this is a very, what do you call it? It's a very general idea in that you've obviously found a problem, but you're not the only one that could have found this problem. He actually told me something at the time, which was quite interesting. He said, why don't you go through med school? Just trust me on this. Go through med school, find your niche within, you know, within something, whatever domain you're in, find your niche. And you will then have access to problems that not many other people have, which means when you then come up with a solution for that one.

18:12First of all, from a business point of view, it's harder to replicate because no one else knows that that's a problem. Secondly, you have the right contacts and connections to then facilitate that solution. so it's a lot easier than to build uh you know build a business it's not the focus there isn't building a business it's building a solution which you then have to have a commercial mindset to build into a business it's it's like you know you don't make money from an idea you make money from a business but you need to find a way to commercialize that and that kind of change in mindset is what you need to have and i think that change in mindset i started developing things from like from from sixth form when i tried to you know for those startup ideas try to find a way to commercialize them what's my revenue model what's my business model what am i going to do for let's say marketing for outreach for uh you know for tech for the back end the uh the i don't know the accounting the legal um the the software that i'm going to host all of this on how do i kind of build all of that how do i put together all the algorithms that are going to take this to the next level and things like that that's how i started to think about you know how do you commercialize an idea so first of all how do you get an idea and then how do you commercialize that idea um so my that was all kind of stuff that i was doing on my own uh just for myself learning for myself and things but then during again during med school and this is now after that startup idea that i had i said look i've got about like what three years of early startup experience where admittedly I haven't done too much in a startup but I haven't done nothing so how do I kind of use this experience in helping other people and I I kind of accidentally got into strategy consultancy where someone that I knew I don't yeah that's a heck of a phrase dude someone that I knew in the Indian embassy in Malta had introduced me to someone for this for that idea that I was talking about, the fitness idea.

20:12And this is the phase where I was kind of now winding down operations, but I had asked for that meeting a while before. So about a month or two or three months later, I think, is when I finally got that meeting. I was pretty much winding down, but I didn't want to waste that meeting. And I knew that this guy was trying to expand his business from India into Malta. So about five minutes before the meeting, I kind of switched and I went, And, you know, instead of me asking him if he can help build my product, if he can build the website and the software and the app and stuff for this, what if I offer to help him with his expansion to Malta?

20:47Very sensible. Yeah. In that conversation, I was trying to understand his business plan. And I realized that, hang on, I actually know things about Malta. I know I've only spent three years here at this point. but i know things about malta that can be very relevant to this person i i'm legs on the ground i am in the healthcare system here i know a lot of the doctors here i've been to a lot of gps and i know how they operate the healthcare system is very similar to the nhs so that in itself is is kind of useful there's a lot of background that i can give here just by physically being here so i i kind of this is my first mandate in a way uh to kind of condense all of my observations, my just general observations, and put them into an actionable report, which I then sent over to him.

21:39And I said, hey, I know that you have a plan. But, you know, in my opinion, I'm not recommending strategy here. This is my opinion. This is what I found. Based on this, this is what I would do. But you know, I'm not telling you to do. I'm just this is what I would do. And you know, have a read, see what you see what you think. and then they ended up actually changing their strategy to kind of reflect what i um what i suggested and that's when i realized that my general observations about the healthcare system about the country and this is you know like what kind of food do they the diet the population the demographic what what's the age group what um you know what what's the general you know the median salary what's the kind of occupation the general occupation that they do uh is it a tourism business Is it a finance business, you know, economy?

22:24Is it a tourism economy? What drives our economy? What drives the people? How, you know, how busy are they? How laid back are they? It's all of this kind of stuff, along with kind of inside healthcare, healthcare insights, really, kind of put all of that into a report and send it over. That's when I realized that, hang on, this is actually relevant. and I can help people with this kind of stuff. So I stayed then in strategy consultancy. Well, I stayed in kind of growth expansion consultancy with a focus on international expansion. And my kind of specialty was that India-UK-EU corridor because India is obviously a country that I grew up in and I had a lot of friends and contacts there.

23:11I've also done medical camps around the world. I spent time in Kazakhstan, in Nepal, in India. so you get to understand their healthcare systems as well and see how things work in in those countries um so basically bringing together all of this experience and and then helping companies and understanding how healthcare systems run and i did that for a couple of years before i then moved laterally into investment banking about a year ago where now i'd been working as a doctor for uh for just over a year so i again i don't have i'm not a consultant in healthcare um i don't have like niche experience, but I know how to navigate healthcare systems.

23:49I know how to have conversations with the specialists. I know how to have those conversations and have those conversations quickly is the other key kind of element to this. So I then realized that in order to evaluate whether an opportunity, whether a transaction, whether a startup is a good idea or not, it might take somebody else, let's say, hours to find the right consultant. There are, by the there are companies who specialize in finding medical consultants with relevant experience. And I've been approached by a lot of these people. And I've said, that's not what I'm, I can't, I can't give you that kind of, because I'm not a consultant.

24:22But I realized that there are, this is a very, you know, sought after area where people need that kind of specialist input on whether or not an idea will be good, whether or not an idea will take off, whether or not there is an actual problem and what the current solutions are. And so I found that I could do that very easily because I'm already in that system. I could understand, you know, I know how diseases are being treated at the moment because I am treating those diseases. So I know that, for example, right heart failure doesn't have a treatment at the moment. Left-sided heart failure does.

24:56But right heart failure is just, you know, treat whatever's causing the right heart failure, symptomatic treatment, but you can't actually treat the heart failure in itself. So, you know, if there's now a product that, and there is a product that is kind of being developed in that area, I know that that will be a useful product. In surgery, I know that, let's say, there are problems with medical devices, there are problems, and there's a lot of problems. There's space to improve in, let's say, medical devices, in set of turnaround time, in operations, in patient management, in waitlist management, and things like that.

25:35there is space for technology in that and if they can do that well as well as they always claim to do then there is a real you know there is an appetite from the healthcare system to adopt things like that and especially now with the NHS's kind of digital plan we'll need to see what the new kind of digital plan will be or whether the existing one will remain but you know the the NHS's plan to digitize and to use technology in the clinical settings you need to have someone with legs on the ground to be able to do that. So I kind of use that experience and all the corporate finance kind of experience that I've learned about and that I've built over the years to now do investment banking.

26:17So yeah, we do as a firm, we're actually, I think, I don't know if I've given you this update yet, but we've gone from a team of about 10 people now to a much, much larger team. We're in the final stages of discussing a joint venture with a global firm. um so previously we were you know our offering was pure corporate finance we do yeah mna buy side and sell side and capital raising but that was pretty much all we'd do um we were sector agnostic we would do kind of clean tech we would do clean tech we'd do health tech ed tech um and obviously healthcare and life sciences with me being there um but we've now got a team of about 500 people with a global footprint of about 37 000 uh and we can we can do the whole we are our offering is now so much, it can be so much wider.

27:04We can do accountancy, management consultancy, tech consultancy, corporate finance. Within corporate finance, we can do kind of the standard investment banking. So your buy side and sell side M &A, we can do capital raising, we can do corporate restructuring. And we can do all of these in over 100 countries. We have offices around the world. Amazing. So that really takes our capabilities to the next level. and interestingly i still want to do the variety of transactions i still want to do the kind of the spectrum of deal sizes kind of ranging from the five ten million dollar uh deal sizes all the way up to like we can do a billion dollar transaction as well now um we've got we've got the team that can handle the complexity involved in you know a mid-market transaction in a in a kind of a five million one billion dollar transaction amazing i'm hanging on by a thread in terms of some of the terms that you are using there i'm sort of just about i'm just about clinging on um but i will get you to uh explain just the 101 on what on earth is investment banking because yeah what's the difference between that and just anything else anyway we'll come on to that but awesome story man and like you're a busy guy like the the you you've done a lot and i hadn't quite appreciated actually that you had the sort of entrepreneurial flair right from early on super common on this podcast which uh won't surprise you obviously for people to talk about like entrepreneurial ventures when they were students or kids or that kind of thing and yeah i hadn't quite appreciated you had you had some of those now the one that you mentioned was the exercise one um it's funny this keeps coming up sweat coin obviously the is the is the obvious one that um had the exact business model you're well very close to the to the exact business model you're describing um in the same ballpark anyway um but the other one i've seen recently i don't know if you've seen it the one that's uh they're talking about basically you bet on whether you're going to do a certain exercise thing so you will pledge like i'm gonna like 10 quid i'm gonna do 10 000 steps today and you whack that into the app if you do it and obviously it's geo tagged and all the rest of it so it can actually see that you haven't just put your phone on some sort of like undulating automated motor on your desk um but if you do it you get a share of the money from the people who bet and didn't do it oh so it's all completely transparent but essentially you're you're then getting a share from all the people who said yeah 10 quid i'll do 10 000 steps today but then didn't do it yeah so it's very interesting no it's super it's super interesting anyway i've seen that banded around i don't know whether it's a joke actually or whether someone's just gone maybe this is a good idea anyway i've seen that as an interesting business model but that is an excellent business model i think it i mean it it leverages the betting mindset which means that you're kind of bringing all your energy and the whole addiction pathway into it uh along with the along with the money element um it's that's a great idea if someone has great if it's clean great if it's clean and transparent but then there's extenuating circumstances there's all my battery ran out but i did it but it just didn't track it there's you know what people are like you know people are like it gets messy um but yeah that that that was quite funny anyway a couple of things i wanted to pull out in your story i think are really interesting the first one is the the decision to do medical school without a life spit it being a life sentence i'm interested in this because i think this is becoming a bit of a trend you know you've got in the back of your nobody in the back of their mind 30 40 years ago thought i'm going to go to medical school and potentially do something different it's becoming something now i think for people to decide to do medical school as just step one and actually maybe that does turn into foundation training maybe that does turn into core training maybe that does turn into registrar training but maybe it doesn't And actually, maybe my path deviates after foundation, and those are my options.

31:25And maybe it deviates after core training, and those are my options. But it's interesting to me that you've got the entrepreneurial flair, you're doing loads of stuff, you're generating business experience, and actually you go into it going, well actually I've got the skill of finding a problem to solve or I've got the skill and the ability to decide what a solution might be and I've got the networks and the understanding and the blah blah blah actually I need to go into an area which has loads of problems to solve and maybe I can come up with a solution there that becomes a better problem to solve and actually if you do that in healthcare it comes along with purpose and it comes along with drive and motivation And it comes along with doing good for people and the world and all the rest of it, which is inherently motivating.

32:12And actually, that's a super interesting frame, I think. Do you think other people are now doing that as well? Yes, I think it's becoming a lot more common. The people definitely want to. OK, how do I say there's there's a lot more. encouragement even at the med school level to build on your ideas and to build on your entrepreneurial ideas your startup ideas interesting you know you find find a you know find a gap in the market and then build a solution to that i think my kind of personal take on not my personal thing my personal story on how i did this was again similarly i found i found a gap or I found something that can be improved on and I built a solution to it.

33:05But I didn't want to leave medical school in order to kind of go through with that. I didn't want to lose out on that kind of training because for me, yes, I do want to be a doctor. And I still do want to be a doctor. I actually had the opportunity to leave straight out of med school. One of the large boutique investment banks offered me an associate position, actually, not even an analyst. an associate position wow um uh to join their health care like specifically their health care team and they are top 10 in the world in investment in terms of things um and similarly a consultancy firm as well again a very well-known consultancy firm um we were talking about kind of what what i could be doing in their health care team this is more pharmaceuticals but um we were talking about what i could be doing in that team for me and what i think a lot of people forget is you need a certain amount of credibility and experience to be able to move out of something and into something else it's um you know the kind of expertise that you can bring in when you're an f1 or an f2 is very different from when you're a medical student versus when you're a consultant right that experience i mean months matter years matter so when someone comes in from medical school and they say i had this idea i'm going to drop out i mean the number of people that have dropped out of let's say a stanford or a harvard to build an idea yeah the ones that do and they go on to become success stories they make the news but how many people do that without it becoming um that kind of thing there was a joke that i was uh watching on tiktok i think yesterday where there was the investor panel that said, we don't invest in ed tech.

34:49This is a hard no for us. And the guys go, the startup guys go, we dropped out of Stanford to build this. And I go, oh, really? Yeah, we leverage AI to do this. Whoa, oh, really? Which is quite interesting, by the way, because I've literally just seen this morning that the founders of Cursor, who are also dropouts, I think of MIT or something similar. They've all just become billionaires. But of course, the fact that they dropped out of university is part of the headline. It's part of the, it's so glamorized of these dropouts. So it becomes this almost like either rags to riches story or almost like a confidence story or I gambled it all and it paid off story.

35:38And it's poor. It's quite dangerous because you're right. i've never actually thought about that like i wonder what the numbers actually are how many people dropped out and then failed and then didn't didn't reach their potential as a result it's interesting my my take on education and my take on university and i know it's becoming a lot more common to not hot topic as well at the moment this yeah the education is a small part of it it's actually not the biggest part of it and especially anyone doing like an mba or a master's will tell you that the mba you can learn the you'll actually learn the business and what you need to know better outside of the b school that outside the business school than in the business school that the experience the real world experience that let's say me personally the real world experience that i'm getting uh is probably more valuable than an mba and a lot of post mba people have told me that a lot of senior investment bankers and senior finance people have told me that si it's not actually worth you doing an mba for the education what you'll get there is two things.

36:38Both are very, very important. One is the network that you'll get, which is undoubtedly one of the most important things and probably one of the most talked about things. So the university or the school that you go to matters for that reason. The second thing, and I think people don't talk about this one enough, is the structure and the framework. Now, I'll elaborate on that one. So for me, when I approach a transaction or when I approach a business. I have my way of doing it, right? I have my way built over a number of years of experience. I have my framework and a structure. I don't know if it's the best framework or the best structure.

37:16It's this kind of stuff that I've put together with time. And, you know, it may take me, I may say that it takes me less time. And it does take me less time to diligence a company than someone else might be able to. But I don't know if I'm still being as fast as I can. and I don't know if the way that I kind of approach a topic from a theoretical point of view is covering all the bases and so what happens when you go to a b-school when you spend two years learning and learning and learning a topic and you get people you get really respected professors and lecturers talking to you is you start to get their experience and you start to get all of that framework and you put together a framework the reason why do people why why do people jump at let's say a Goldman Sachs or a McKinsey or a Bain or a Morgan Stanley, they have a repeatable process.

38:03They have a framework that they teach their employees. It's the same thing with Harvard or Stanford GSB or with Booth or something like that. Or in India, the IITs, the IIMs, the IITs in India, pretty much every major Indian educated CEO or startup founder that you know has probably come out of one of, let's say, one of five universities in India. They are cherry-picked. And the reason why is because they spend time learning a process. And that's what people like so much about it. It's not the knowledge. It's the framework and the structure. You can fill it with whatever knowledge you want. There are, you know, even at Goldman Sachs, there will be over-performance, there will be under-performance.

38:45The structure is the same. It's the knowledge that really changes things. But when you approach something new and you don't know how to approach that, you will fall back on your framework and your structure. It's like, even remember when we would assess clinical, when we would assess patients, unwell patients, you know, if you fall back onto your A to E, right? Your A to E approach. You have no idea what's going on. You approach something completely unknown, but you have a framework. That is the most important thing. And the places that you can get a really good framework like that is, you know, places like this.

39:17And that's why they're so well sought out. And that's why they're so sought after. I love that, man. it's um god you've done so much it's it's it's yeah it's it's sort of overwhelming just hearing just how much you've managed to cram into such a such a short short career so far it's crazy the um just one thing before we move on to um in fact there's two more things before before we move on to talk about investment banking and health tech and what that world is just the first one i want to call out is um you you talked about you mentioned very kind of quickly that you actually optimized for like how to get an idea you said you said obviously there's there's there's the idea isn't what gets you wealthy or or successful or whatever it's actually executing on the idea yes we absolutely know that but also you've got you had a process where you had a hypothesis of actually how to get an idea and you trusted yourself that you could put yourself in an environment in order to get more ideas you said that you had a conversation with your dad who's in business who said like i trust you i trust that you'll get the idea if you go to this environment I think that's really interesting and I think that's interesting because I'm fascinated by how we get ideas and I always struggle when I need to get an idea on a deadline for example and in a creative industry like I'm in that can actually be really tricky and so we actually have to have processes around how we generate ideas we have to talk about things and and do things like there's we talk about the clown and the editor and we actually have to have meetings where we're clowning and we have to where where there is no structure and there is no shooting anything down there's no going backwards you only expand on things and you get this output of loads of mess and then we do have an editor meeting where we bring that all down and i can and we can do that and we can and we can and that's a way of figuring out how you do ideas on a deadline and actually get to outputs on a deadline um but i really like the fact that uh in fact it's just quite nice that you know your family like will trust you they'll go i believe in you i trust that you'll get an idea if you throw yourself into this environment and i think as well that we can we can put ourselves under a lot of pressure um as entrepreneurial people that want to have an impact we can put ourselves under a lot of pressure to come up with the idea i hear a lot even with in my friends like oh i'd i'd be an entrepreneur i just don't have the idea i think all you actually need to do is find a problem to solve because that's what you talked about if i throw myself into environment which has loads of problems i'll find so many problems to solve and actually the idea just becomes well how am i going to solve this problem it becomes like first principle thinking and then i think then the entrepreneurial stuff is bolted on which is then like the delusional thoughts that you could actually fix this and like the naivety of not really knowing the depth of the problem but it's that initial optimism and belief that you can fix it which starts you on the path and then it's just this belligerence and it be impossible to kill and all the rest of it and eventually you'll you'll be in so deep that there's so much sunk cost that you end up having to solve that problem long term and then you have this thing called a business in my experience that's broadly how it tends to work out i just wanted to pull it out though because I just think a lot of people listening will be under pressure to come up with the idea, pressure they're probably putting on themselves to come up with the idea.

43:05Really, the work that you can do that's proportional and actually will make you feel better is trying to find environments in which there are loads of problems that you are likely to want to solve. That you can work on. And so you don't need to be sat in a quiet room just thinking of ideas. You can actually find problems to solve. I don't know if you'd agree with that, man, but that's just kind of my reflection on what you said. No, no, I totally agree. I think the right way of going about building a business is not to say, I want to build a business. What should I pick? It is, oh, let me have a frank conversation with, let's say, 10 people who know what they're doing, who are experts in their field, and ask them what their pain points are.

43:45the challenge is you're not going to get into the room with those kind of experts unless you have something to offer to them it's sure there are people who will talk to you uh but you know these are conversations that need to happen multiple times and to have that repeat conversation with anybody you need to show that you're credible so you need to have something that you're offering to them as well which is why typically you need to have a bit of experience uh you need to have a bit of experience before you uh before you're able to speak to somebody like that but i think that's where you know the hot topic again ai i think that's where i can help where you know i'm sure you can punch into ai saying hey what are the top 10 most painful uh bottlenecks in this niche uh and then you you take that list of 10 you read up on them try familiarizing yourself read you know read the news read uh books read about how you know adjunct businesses work or related ideas and things?

44:42What are the other solutions? Then you go and talk to these people and you say, hey, look, and then don't talk to them about 10 things. Pick out of those 10, pick one of them and kind of go down somewhat of a rabbit hole. And then go to these 10 people and you say, hey, I wanted to talk to you about this. This is what I found. These are the solutions that I've been seeing. Is this a real problem? Is this something that is actually, how big of a problem is it? What's the current kind of infrastructure around it? And how much of a change needs to happen before things get a lot better? How much incremental work do you need to do to yield a much more significant change?

45:24For example, there was a company that I'd seen recently that does, what do they do? They do standardization of discharge summaries, which sounds great, where they use AI to standardize discharge summaries. But what I realized is that, and their offering was, a lot of the laymen don't understand the medical jargon, which is what, as doctors, we tend to use when writing a discharge summary. But we're actually now told, and we all know that it's the F1s and F2s who predominantly write the discharge summaries. We're now told actively to write it in plain terms so that the patients understand. so over the next say one or two years when that change really becomes more and more impactful this business will actually go out of i say not go out of fashion it's not going to be as big of a problem to solve so i had actually i thought that the way that they need to kind of position their business is actually not to standardize uh what the doctor's right it's actually standardize it for the patient because yeah you can be admitted in different hospitals around and even if they're kind of you know saying it however they want to as a patient i have a way of understanding things and it can be a tool that standardizes the distrust summary but on the patient side not on the doctor side that's kind of that slight pivot that i kind of uh that i was thinking would be would be helpful but yeah spending time in these scenarios and and spending time in these environments and speaking to the experts in in these problems who encounter these problems is the right is in my opinion the right way to go about building a business is to find a solution to an actual problem don't invent a problem just because you have an idea that you think will be good see if it's an actual problem and the only way to do that is to speak to the people who supposedly have that problem so yeah i totally agree with you if that problem is still interesting for you to solve by the way you should look at a company called ditto they're based out of uh based out of the netherlands d-i-t-t-o yeah uh who you know yeah actually do you know what uh i remember when i was more fresh out of medicine when i was running accelerators uh people from other accelerators actually used to contact me and just ask me the sorts of stuff you were just saying you know you said pick you know find 10 people and find out what you know their impressions of certain problems where I actually did have that a few times where people would reach out be useless for it now it's been out for too long but I think yeah it's it's it's really interesting and yeah definitely gave my time for that because you know very well respected accelerators and people that have been selected to go on them are then looking for to refine an idea or to or to plot a path as to what the most impactful idea is that you know a problem to solve is I think yeah it's a great use of time it's a great practical exercise as well and um yeah you always want to be you always want to be working at it and so I think trying to find the problem trying to find the best problem interviewing people to find out what their take is I think is a a very good step definitely final thing I just want to say before we move on is um when you were talking about AI you know you can look up this you can look up that one thing actually when you were talking about Malta is I was thinking you know this person when you did just for ashtray consulting uh which is you know the the term for that person asked you the first time and you just gave them some information which you did by the way very humbly and and gave them a report and all that sort of stuff but you did like you you just said look these are my these are my thoughts i don't know whether they're useful but like it's just what i think and blah blah but you do have so much lived experience there of living there and all the rest of it that it's interesting in the in the modern world where we are with ai that person could have gone to ai and gone okay well where does my business fit in and they could see what that returns they could they could shrink the task and they could go okay well tell me about Maltese diets tell me about median salary tell me about all these things and they could have got that information that way but again it's interesting to me that you'll you'll know this as well that and I've spoken to you know investment bankers tend to definitely believe this that business is very human and very personal to people and actually that's how you build trust i think that person if they're going to make a decision on their business is still going to go to a person that understands that if anything to validate what they have found out or they're just going to go well this person's going to use ai but they're going to apply that level of lived experience and then i can actually trust the result because that's the other thing that i think about ai at the moment is that even when i'm doing stuff internally there's only so much trust that i can impart with the with the outputs and actually i would feel better if there was a human over it that knew the area and so i do you know you know we did the event with neko health the other the other week like i remember i did um i was just putting a few bits through there and blah blah about the event and the marketing of into the just to do a few bits obviously i knew the subject matter really well i'd written a few long form pieces on prevention and all that sort of stuff so i knew i knew the space so well that i felt very able to do that it mixed up danielek his background i the founder of spotify it just mixed up casually danielek's background with yaumar's background the ceo just casually just like conflated the two of them and you know when you're like when you when you like question it and you're like i think you've just mixed up the two co-founders and you were giving me information that would have like completely ruined the event and it was like yeah oh yes you're right to question me on that i did conflate the two here are their separate but i'm like oh come on man come on now like i can't like i'm like what can i possibly now trust of this going down the road do i just have to assume that opus 4.8 is as weeded out those errors for four points from 4.7 and like i i now really struggle to trust it with something similar as as you know i think you're completely reasonable if you had a phone call with four panelists and you and you put the transcript through ai and you're like can you just write me the four introductions that i can just do on stage i think that's a completely reasonable thing to ask ai to do that saves a load of time i now can't trust it to do that like i literally just i struggle because i've lost that trust and so i do think humans are going to remain um 100 for stuff like this um yeah at least in the short to medium term because i would much rather put my trust in a person that had the lived experience and that frankly i can blame if it does go wrong but um exactly that's that's that's the other big thing is who's responsible who actually takes the uh i mean i don't know diligence is diligence is something you mentioned you know i mean this is one of the things i'm talking about hey you diligence their market right and this is something that investors like yourself will have to will have to do all of the time you have to do your due diligence and i think it really is an interesting question you know you wonder how many pitch decks have been through ai all of them probably at this point beyond a certain date and you wonder how much people's markets have been questioned and yeah i don't know diligence and ai is probably something that you you think about or do or don't use it for or no no i do so i definitely use ai uh in kind of various elements of uh of my business uh i'm my clinical practice to be honest but it's it's like you said right um ai can recommend whatever it does to me but at the end of the day it's it's me that's responsible for that so i i can read what it says but you know it's only giving me ideas i'm not actually yeah this is basing a plan off of it it's it's like you know there's kind of there's two use cases here one is someone came in with fast af and we had to cardiovert them it was a very interesting experience but their family someone in their family has recently been diagnosed with aylodanloss syndrome and so they were wondering um they were wondering you know is there a link i go i to not that i can think of but then i asked uh i asked ai whichever one a very pointed question i said show me the literature that kind of links atrial fibrillation and aylodandloss syndrome so it's a very pointed question it just it cuts out the time that i would otherwise spend in doing that because i know how to do the search it's on public and you go at atrial fibrillation and aylodandloss syndrome and you look at those articles i can do that a lot faster than the second thing is is an open-ended question where that's the one where you're kind of you're getting ai to think for you and stimulate your own thoughts and that's the one where you have to be a lot more careful because you're trusting its sources um so a lot of the times whether it's in in medicine or business i i may use it for kind of ideas and to kind of give me another uh give me another option but at the end of the day it's still me doing the plan and i'm still putting together some something based on on my experience yeah and if i don't have the experience i have seniors in that i can go and ask and i say hey look listen this is my idea yeah i use the kind of thing but i i'm not really uh rolling down that route what do you think of this and and they go yeah you know here you go this is this is what i think it's really interesting because because in that in that aila danlos example you're still the critical thinking layer you've done information retrieval you've asked it to find papers and you might not found all the papers but whatever papers it finds you're still going to go all right let me have a look at the methodology what was the sample size okay what did they actually find let me see the results what was the variance what was the this like you you're still the critical thinking layer on the things that it has or if it just pulls a meta-analysis you're like oh this is a meta-analysis and you're able to apply your own critical thinking to go well i can probably trust this a bit more than a single etc etc so i think yeah that's that is very interesting because i'm sure there'll be people that go oh you use they are in clinical practice it's all about the how it's all about the how and then what did you do with the information and exactly exactly and that is nuanced and i i think we're in that part now where we're happy to have those discussions about the nuance it's not a broad ai yes or no anymore is it it's it's it's far more nuanced than that and people are building it in it's getting regulated within platforms now and um yeah it's it's a super interesting time man super interesting time but uh not here to talk to you about specifically ai i am here to i guess learn a bit more about investment banking from you um and so i had a couple of investment banks on here um that have moved from health care or or medicine into it previously um but what what is it and how do you work with health tech companies huh okay um investment banking is is It's a very broad term.