#6 How to Get Into Healthtech: Dr Dave Triska - GP Partner, Digital Care Expert, Clinical Consultant

0:00Dr Keith Grimes:Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology and I'm your host James Summeru. Hey everyone, you're listening to one of our special episodes, a mini-series hosted by Dr Keith Grimes called How to Get into Health Tech, where, you guessed it, Keith speaks to an incredible mix of guests who have each taken a different path into the space so you can learn how they did it and what they do now. This is all part of our mission to make careers in health tech far more accessible, so whatever your background, I hope you enjoy it. We'll be back with our usual episode soon, and here is another superb conversation in that series.

0:43Dr Dave Triska:Hello everyone and welcome back to How to Get into Health Tech. My name is Dr Keith Grimes, I'm a digital health doctor and a pure geek, and I am loving working in this space. and by loving working in this space, there's a lot of other people that love to work in this space and there's a lot of other people that want to know how to get into this space because it isn't terribly clear to do so. So I've said in the other shows, I've talked about this a lot and so you don't need to hear about my story quite so much but you might want to hear about other people's stories because to get into health tech in the absence of very clear career paths, you have to navigate your own way and there's lots of different ways in.

1:20So I thought I'd catch up with some friends

1:23Dr Dave Triska:who've made it into it and hear a little bit more about their stories and share them with you too. And so today I've got my virtual golfing buddy, Dr. Dave Triska, and we're going to ask him today about how to get into health tech. So Dave, why don't you introduce yourself to the audience?

1:39Dr Keith Grimes:Oh, hi, Keith. Well, thanks for having me. So I'm Dave Triska. I'm a GP partner in Surrey at Whitley and Milford Surgery. I also do consultancy work in health tech and latterly have been working for Tortoise AI Limited and Acurex. I'm known for a few other things but I'm sure we'll come on to those as we do the interview.

1:59Dr Dave Triska:Yeah yeah good two of the big names there in digital health are in the UK as well and combining that with clinical practice is quite the the balance and the juggle so there'll be folk out there who kind of aspire to something like that and so we are here for you to talk about that. So we're going to go back time machine zip back to time you being a kid as comfy as you want to be on this one but Dave what did you want to be when you grew up?

2:25Dr Keith Grimes:Not a doctor so everything has been a happy accident so actually as a kid I wanted to be a soldier which I got to be but I did it in a slightly different way so I didn't think I was going to be a doctor and a soldier so I did that. I never thought actually I was going to be a physician, I never thought I was going to work in the tech space, that was something I enjoyed as a kid. I'm sure you like me remember building your own 386 PCs playing Doom network policies and I guess that was probably the genesis of a lot of interest in how do we use technology to make things better because that was at the time when computing was just starting to advance and we were starting to do remarkable things now we live in an age where you know it does some absolutely wondrous things so I think for those enthusiasts like me like you who've been able to get into the market it's been sort of combining hobby and a job yeah I mean

3:16Dr Dave Triska:that's the dream isn't it you end up working in a job that you would otherwise do in your spare time anyway and finding a way to get it paid for it's interesting what you said about building 386s and so on i mean for those of us are a bit further along the journey than others you know 80s and 90s was a time of you know what will seem like very basic technology but it involved an awful lot of hard yards and getting it to actually do anything and i think as a result you naturally had to learn about how to get your hands dirty how to build things because things frequently

3:42Dr Keith Grimes:didn't work out the box did they no at all no so you know uh almost nothing works out the box so I think uh the lesson it taught me which I think has bled out into the rest of my career and life is fiddle with things try and break them see how they work try and make them better um and interestingly that's a lot of really what's spun out into my work as a doctor work in the health tech field uh I guess not being able sorry not being afraid to try things that are maybe other

4:10Dr Dave Triska:people aren't yet yeah yeah I know what you mean it's like yeah that that lack of fear of just giving it a go and pulling things apart and putting them back together was um you know par for the course back in those days and uh yeah i suppose people are still doing it now but a lot of the technology we get our hands on it's interesting the hardware technology we get really is very very good you know you don't have to build your own pcs unless you're totally up for that but i suppose what you get access to now is much more in the way of like very very powerful

4:38Dr Keith Grimes:easy to use tools to build stuff yeah for sure it's moved away from hardware fiddling which is something I barely do anymore to software and implementation of software how do systems how does it all work together because you know like any tool they're all great at doing a thing can you make it work in practice is it actually functional for someone is it something you need to have you know is it going to be like the bathroom buddy from gremlins that sounds nice but but doesn't actually work or is it going to be something that everyone needs to have in their hand you know in the workplace or patients really so i think that trial and error looking at pushing the envelope has definitely changed in terms of now it it is all about those those software-based things but i think the ethos is much the same and it's sort of interesting about who's willing now to try to always using these things in different ways than we have done because we've got a set of tools now they look great in principle how do we use them in practice that's that's a lot of the day job now.

5:38Dr Dave Triska:Yeah, yeah. The reality of it too. And I suppose the other thing is that everything can be done at scale. You know, back in the day, if you misconfigured your computer, you just maybe get a little puff of smoke or your sound card wouldn't work when you were playing Doom. But of course now when you can vibe code up an app and dump it on the app store, if you're not careful, you could cause a puff of smoke slightly larger elsewhere. But yeah, well, we'll come on to that, I suppose but so we're going back so so the childhood you're like a kind of gadgety tinkerer and stuff like that um but yeah I'm interested of course yeah you spent your time as a as a soldier so maybe sort of talk about how that will happen you know so you're at school you're doing these

6:16Dr Keith Grimes:things and then how did you make that transition out of the blue really um so it's something I'd wanted to do I think uh in a recurring theme it was about testing limits and testing boundaries and I guess the thought process was what's one of the most difficult things I could do with my life at the moment oh yeah that seems quite difficult so I'm going to have a go at that and see if I can do it and I didn't know whether that would be achievable like could I could I physically do it would I have the aptitude to do it I remember writing a letter off to a recruitment agency and sending it into a PO box that we had to find from the early days of the internet you know when i don't even google was like a thing then um or was at least go for and the like yeah like i probably was asking jeeves or something sent it off and then i was committed uh and you know so it was turn up to the um assessment centers have your interviews sign on the dotted line and then you were in so it was wow it was jumping off a big cliff and not being sure whether landing was going to take you but actually just that that that moment of doing that I think shaped the rest of my life because the things that I learned later and about what you can achieve what you can do teamwork systems and pressure that's all had impacts on my career and actually my career in

7:38Dr Dave Triska:digital health so did you go straight from school into service or was there anything in between was it like you know go from the common room down to the science yeah not quite no so I did go off and

7:49Dr Keith Grimes:do medical school so I kind of hit my all right okay yeah so I had my a levels and was thinking okay uh I was down to do biomedical sciences somewhere I thought I don't know if I want to do this and was driving to school with my best friend at the time in the car with me and I was going oh I don't really know about this and I think it was like the day we had to hunt in our UCAS forms and things they said I'm doing medicine have you thought about doing that oh that sounds good so I went to the library at school picked out the four glossiest brochures that I could find rewrote the UCAS form handed it in and then was then was applying to clinical medicine

8:23Dr Dave Triska:wow gosh that's quite a sort of late pivot some of the other people that I've spoken to in this situation were kind of like clinical lifers you know like they knew from a very early age that they wanted to do that and of course my story is that I always just wanted to write computer games and play with gadgets and uh and did very well and so it kind of came a little bit late about my decision but but where did you end up going on to so it's king's college in london um again

8:45Dr Keith Grimes:i i just thought okay where's where's something adventurous somewhere adventurous that i can go so i grew up in manchester so it was the other end of the country i thought okay sink or swim you'll be all right or you won't on your own uh and i was okay which was good enjoyed it enjoyed clinical medicine um much more than i thought i was going to not saying it was a bad thing to do it's a good career obviously but it was kind of not top of my things that i wanted to do with my life although I am deeply grateful that I did went through did my BSc in anatomy finished the the six-year courses it was then with that included and by then I'd signed up to the regular army so my first jobs after that were in military hospital units and then my very first job after foundation was in hellland so wow that's a i suppose a less common career path it's not not unusual particularly but it's not the not the day-to-day for most people no i'm sure it's not

9:44Dr Dave Triska:i mean i'm sure you know those people going through medical school or that now and are looking with a sort of sense of trepidation at going into the wards i mean this is a kind of next level isn't it and you were across there so you'd finished so but i don't know the exact route So if you finish your medical school and then you do your foundation and then go off in that position or do you do your foundation in the military? How does that go?

10:05Dr Keith Grimes:Yeah. So I was turning up to work in uniform. So foundation years one, two. I was in North Allerton, so Catterick Garrison region, North Yorkshire. Lovely area. Enjoyed it. Enjoyed doing the clinical medicine. Enjoyed doing, had a couple of ITU rotations because we, for the military candidates, you have slightly different set of rotations, particularly at that time. this was the height of iraq and afghanistan they were teeing you up for deployment so you know like for example a dermatology post might not have been as useful to them as critical care did those two two years finished then you go off to sandhurst to do your formal commissioning course so we were there the first run through of what was an extended time it used to be called the vicars and tarts course because we have all the professionally qualified officers on it so doctors, nurses, clergy, lawyers, similar.

10:56Dr Keith Grimes:It used to be only four weeks. We were the first ones that extended it somewhat to 12 weeks which clearly would make sense. Can you imagine going off to a war zone with only four weeks of military training? I did that and then literally straight after finishing that course my first assignment was backfilling to an ongoing tour of Afghanistan at the time. We flew straight out.

11:18Dr Dave Triska:crikey well what can you tell us about that i mean that's going to be very unusual for people to hear out there but so you you've done all of that you're out of sandhurst and then i'm sure that was tough in its own way but possibly not quite the same as being deployed like you were

11:30Dr Keith Grimes:it taught me a lot about what tolerances people have got as in personal tolerances and also you know just um how far you can go in adversity so it was i can i can still remember the very first job so you know you so the tour was midway through uh we we were sort of backfilling for people who were on leave or gone home or various things uh and a group of us went out landed in camp bastion and then four days later i was flown out to the ford operating base that i was taking over for a month from someone and i was on my own for the next sort of five months i don't you know not not literally on my own people around me but there was no supervising doctor there was no one in the room with me so that was that was at the stage where i would have been doing st1 so um again interesting for sort of ongoing career because you i guess my risk tolerance got very

12:19Dr Dave Triska:very high at that point yeah yeah i'm thinking about this i have a wee note you know my remarkable here and i'm jotting these things down there's something about putting yourself in a position and you know a novel situation risk tolerance uncertainty pushing yourself all coming through here and that tolerance for risk is really and managing it appropriately of course not just being gung-ho is is at the heart i think of a lot of innovation yeah absolutely and also thinking

12:43Dr Keith Grimes:about um what do i do with with as you say a novel situation or novel problem that's presenting itself so go i guess the thought process is okay what's the end goal what do we need to achieve where are we now what have we done before okay what's the shortest path you know as it was then from now to we've achieved it and i know that sounds really obvious but you know in nhs thinking particularly i'm not sure that's always the case is i'm not sure people define where they need to be very well i think they define where they are kind of okay and they present problems but they don't always necessarily know what the end state is and it's really straightforward for me all of this stuff everything that i do at work whether it's in the tech bit whether it's the nhs is does this make care better for patients which whichever measure of that that is and actually when you start to extrapolate backwards from that as being the end goal life gets a lot easier and so things that seem like they're you know off the wall or they might be risky to try when you start to look at it in those terms they look a lot more tolerable yeah you do really need to know where it goes and

13:48Dr Dave Triska:that's that's fascinating there's kind of two things there's a sort of personal aspect as in in my life where do I want to go what's the destination and that that's a common thing and that could be quite tricky but then actually just you know when you're talking about the world of product. You know, that question that comes up in the groups, you know, people are talking about great tech and you're like, yeah, but what problem does this solve? Like, why are we doing this? You know, it comes back time and time again. And then the other bit that you pulled out there, which I think resonates with me is like, what is the shortest route?

14:19Dr Dave Triska:Now that doesn't mean you have to take shortcuts, but it's more about, you know, what's the next thing that you have to do that will take me most rapidly towards that a small step as opposed to planning endlessly on a route

14:32Dr Keith Grimes:and not knowing where you're getting to yeah i think we see this in either um systems development or product development so people um they don't look at the shortest route so actually you know perhaps there's a big scary step like i don't know we need to procure a new epr or something um so people don't do that and they go they go all these illiterative steps where things are added onto the system or there's a slight tweak and actually when you look at it overall it makes an enormous amount of workload an enormous amount of waste slows down progress when actually inevitably you are going to end up at the same point whatever so why don't we look at how do we successfully navigate from here to where maybe seems a bit scary but actually it's the place we're going to end up anyway and we can save all of these man hours save all of this heartache all of this procurement that doesn't need to happen and do we do that very well not so much i don't think um i think lots of people are learning and i think particularly is that the pace of the tech sector is really definitely caught up with the nhs now um you know what was an nhs innovation some years ago was maybe like five or ten year cycles of things that might have happened now we're talking about weekly tools that are arriving daily tools that are arriving and all of a sudden people have got to have this skill set i mean it's interesting because i know you've talked previously that should this be a subspecialty in medicine possibly so because actually if you don't have these skills i can see how many times this goes wrong over the last couple of years for people and it's it's a real area of development i definitely believe in that it's a very active

16:02Dr Dave Triska:part of the work that i do maybe slightly less in sight at the moment but you know digital health as a distinct specialism, long time overdue. And yeah, but we need to know what's the route into it. And some of the other podcasts, sometimes I've wondered actually, well, do we need something formal in the sense that there's some very interesting routes into this space? But at the heart of it, I think there are some core competencies. So what do you think those core competencies or skills would be? You've talked about a sort of change happening within the NHS, a recognition that things happen. Those people that are doing it right or doing it well, you know, what are the sort of core skills or experience that they have?

16:43Dr Dave Triska:Maybe not having to go to Helmand, of course, but, you know, what are they, do you think?

16:49Dr Keith Grimes:So as much as I don't want to lead off with something that might put people off, but I think an appreciation of data security and how all these systems fit together is really important because actually, you know, you can understand the tools, you can understand what they do, even actually how they're structured. But where people often come a cropper is like, how do we implement them safely properly so as a career skill now i mean for me this is something that came later down the line so i was a hobby tinkerer which we can get into but actually as a baseline you have to know like any clinical intervention because let's you know know to your bones about it these are clinical interventions so i guess the equivalent would be like picking up some drugs that you're not that familiar with and just having a go to see what happens and getting your feels that way, which is not really safe in the health sector.

17:37Dr Keith Grimes:So actually we need to know not only what do they do, how do they work, but how do we use them safely day to day? So I think that's going to be one of the major challenges because for me, it's the bit that I think is done least well across the system and even at quite high levels. People don't necessarily appreciate some of the jeopardies that this can put you under.

17:56Dr Dave Triska:Yeah, no, you're absolutely right. I mean, I've built my business, Curistica specifically about that combination as well. So I'm definitely going to agree. Yeah, I think you're right. It's very easy to not know about it, but not knowing about it is certainly no excuse for putting your foot in it. Yeah, things like clinical safety, of course, regulatory compliance, data protection, cybersecurity, usability, interoperability, all those lovely components that we get and things like DTAC would be part of it. And, you know, I'd love to see components of this taught at an undergraduate level and made more widely available because everyone needs to have at least a basic understanding of this, if only if they're to use these tools safely.

18:37Dr Dave Triska:But yeah, when it comes to actually getting things done, you know, you need some specialist knowledge fed, I think, by the clinical side.

18:45Dr Keith Grimes:You do. I mean, again, it's always about what is the problem that you're solving so the the bit that's really valuable is if you are a clinician who's got hands-on day-to-day activities with these tools because you know how many times have we seen things in healthcare where stuff's procured or it's trialed and the people who are doing that are not the end users day-to-day and then actually when you roll it out it's a complete disaster so you do need to have that understanding of okay what does this do for me how is it going to work um it that's the bit where you get the tools that you want i think i think the bit where you can finally implement the tools that you want is the bit about okay what's the bits that we need to do safely so you know not accidentally sharing all of your patient clinical contact details with another provider when you don't need to for example or some such thing but actually you know getting into it i think is really about that hands-on day-to-day understanding and acknowledgement of what these things do for us if we're just a silent user you've got no voice in any of this and you're certainly not gaining much experience if you're an active user who's questioning why things are the way that they are that's some of the ways that we as clinicians can provide value to the sector yeah i suppose we're

20:01Dr Dave Triska:back to disassembling our 386s and like trying to understand why it's doing it and getting it back up and running again. So you're doing your military work. And within that, I suppose, I've got a question that's interesting to me about the use of the technology in the military and healthcare as well. Certainly, I don't know as much about it. But what I have seen is proponents of remote care and a lot of advanced technologies as well. Was that your finding too?

20:30Dr Keith Grimes:at the time i left that was much less of an issue um i mean it was on the table so i left in 2016 so we were operating remotely at those times so there was so essentially things were going back and forth to the uk because we're deployed overseas so obviously you don't have every single healthcare professional uh deployed so things would have to go back and forth you know via digital routes often um there were some interesting moments there which was again looking at these systems and going okay if we can do that why can't we do so one challenge we we fixed for example was um there weren't actually live transmissions of patient records back and forth to the uk so things would literally go back on a cd that was burnt every couple of months back to the uk to be uploaded to the uk health system but actually a lot of the other computers were talking to each other so um myself and a colleague looked when we were away last time and went well if they can talk can this bit not talk and actually then problem was solved and again it was just looking at how does that all fit together why is that working the way it is um but at that moment and that was that was almost at the time where we first became acquainted because that was not very long afterwards we met there was very little in the way of digital online consulting that was happening probably anywhere in the world I think yeah I mean it was happening sporadically

21:47Dr Dave Triska:as well and I tried so so just in terms of grounding mine I you know I was working very full time as a GP in a walk-in center, an urgent care center in Eastbourne. And I was using technology intermittently as well, much as you were maybe like seeing the problems in front of us, being a very keen technology user in the background and sort of beginning to deploy it myself and seeing what worked and what didn't work. And I clearly remember doing consultations with patients over Skype, just like my patients and agreeing to do this. And one point I had a consultation with a patient when he was on a plane flying to America and then afterwards found out that was maybe not the best thing to do but um but sort of tinkering away at that but there were some people doing this and you came back so you've got that you've got some experience that sort of remote care and you know that problem needs to be solved and you've come back to the UK and we'll come back up when we met we met in 2018 um but 2016 you come back and at that point you're back in general practice you at that point you're like because I'm trying to think how did you get

22:46Dr Keith Grimes:into general practice when you're doing your gp training you can't do it all in a military setting because clearly there is quite a significant demographic restriction so having no elderly care whatsoever is not great for learning how to be a gp so i did a placement at the practice i'm now a partner at so as i was finishing my gp training and they said if ever you want to leave the military and come back and be a partner let us know and there was a moment when that happened and so I finished my final deployment uh stepped off the coach in Woolwich um and I was in the NHS two weeks later and then starting to work as a GP partner so from a very a very different environment in terms of actually I had a lot more tech available to me on my last deployment um arriving back into a very traditional Surrey general practice so at that time we didn't even have phone consultations let alone anything online so there was this enormous shift from um a very structured um professional working environment to then something which was completely different both in terms of how would you allocate needs to bear in mind i mean it's interesting coming on to later what i what i ended up doing with all those years uh from a place where i was triaging regularly because we had all sorts of stuff happening so triage in the most literal sense and then coming back to watching this sort of unfiltered masses of people trying to get appropriate care and that was the germ of what eventually led me to thinking is there other ways of doing this because I'd just been in an environment where something happened even in the worst of times it seemed more structured than the offer from the NHS at the time.

24:25Dr Dave Triska:Crikey yeah I know it's that interesting as well because I think that that was the other experience I have a lot of people have is that technology works outside medicine. You know, I use it for X, Y, or Z, and then I come into medicine or I come into my practice and I step backwards, you know, that the technology is not as good. Things have improved slightly in there. But one of the things that I knew that you were working on, I'm trying to sort of get the timing of this right, because between sort of 2016 and 2018, I went to Babylon in the middle of 2018, and I was involved in a lot of deployment of technology with things like Google Glass and virtual reality and the practice I was working at.

25:01Dr Dave Triska:but I was also aware of that kind of triage side of things was it ask my GP there was um there was a I remember being aware of this this is when Twitter was a place that you would actually quite like to be and and you sort of saw this rising you know um a really interesting approach I mean it seems really obvious now put forward about being much more analytical about the nature of demand and so on was that around about then or was that later yeah it was I guess probably 2017