Insights from a physician, entrepreneur and investor.

Shrawan is a physician, entrepreneur and angel investor. He is the managing director at Strategy Health and founding team member at PharmStars. I have known Shrawan for a few months now and find him to be deeply reflective, intelligent, curious and open minded.

We talk about:

1. His childhood

2. Decision making

3. The existence of a soul

4. What he looks for in founders

5. Clinical trials

6. And more!

I am thankful for his friendship and grateful for his transparency and honesty in sharing his experiences and knowledge.

Transcript:

Rishad Usmani: [00:00:00] Thanks so much for coming on today, Charvin. I'm really excited for this conversation. I think to start, let's talk about your childhood. There are things we learn from our childhood and are there are things we have to unlearn as we grow up. Talk to me about your childhood and how has it contributed to who you are today?

Rishad Usmani: What are things you had to unlearn from it, and what are things that helped you? ? 

Shrawan Patel: I'm not sure we have enough time to talk about my childhood, but, uh, , we can give it a go. I'll try. I can try and be brief. My childhood, so I'm, if the accent doesn't give it away or hasn't given it away, I'm English by background, so I was born and bred in the uk, grew up in a, in a city called Birmingham, and I'm kind of the oldest of three, which I think probably plays a little bit into me and, and how I am.

Shrawan Patel: How would I describe [00:01:00] my childhood? My childhood was definitely full of ups and downs from a young age, I think most of my family would describe me as quite a difficult child, and it was pretty often that my grandparents would be more than happy to take my brother and sister for the weekend, but would say, you know, Sharon can stay at home with, with you guys.

Shrawan Patel: To my parents, that was fairly, fairly common. Um, you know, whether or not it was, I had some element of attention deficit issues or as I later found out when I was about 13, 14, that I was dyslexic. Um, and so I think, you know, probably a combination of those two things factored in, but I definitely was a bit of a trouble child and.

Shrawan Patel: you know, academically that kind of factored in. So if I read back through my school reports, it's very often that my teachers would say, you know, very abled [00:02:00] child, but just not trying hard enough or not applying himself or, um, all things along those lines. Um, and I think the real thing that changed was when I was about 13, the school that I had subs subsequently started at, had a teacher that was specialized in special needs and thought, oh, maybe actually there's something there.

Shrawan Patel: And so I went and got tested and, you know, I have mild to moderate dyslexia and quite specifically around languages. Um, and in retrospect, I think I can see that the dyslexia has definitely changed the way or has had an impact in the way in which I function and the way in which I see things, the way in which I learn things.

Shrawan Patel: You know, my nightmare as a child, even now to be honest, is being asked to spell something because I spell phonetically. It's like, cat to me is not c a t, it's, that's how I spell, spell in my head. And I [00:03:00] kinda have to go through the spelling and then imagine the word and then read it out, c a t for me to be able to spell something as people expect.

Shrawan Patel: Um, so that's always a bit of a nightmare for me. And being asked to stand up and write on a Flipboard is, is another nightmare. Um, but in, in a way that's a deficit, but has also changed me massively. Imagine being in an exam, writing an essay for an hour, and your writing. You want to write a sentence? I dunno.

Shrawan Patel: Let's think of a word. Discussion, right? The discussion that was happening within the class, nine times outta 10, I'll have no problems writing, spelling the word discussion one time outta 10. Just in exam conditions I might freeze. I, I'll forget how to write the word. And so I suddenly need to mid-sentence.

Shrawan Patel: The class was having a conversation about where, as opposed to having a discussion. And so I think [00:04:00] after years and years of having to very quickly change sentences on the fly has meant that the way in which I think and the way in which I speak has changed, that I'll, you know, naturally think of slight variations on the same theme to match what I'm wanting to say or to match what other people are saying.

Shrawan Patel: Um, and so I think that's definitely been a big thing, things that I've learned. Has definitely been that right? I now know how I learn what I need to do, that if I have someone there to keep me accountable or I have something to keep me accountable, that's a big driver for me. I will book random things or I will set myself a task where someone else is involved.

Shrawan Patel: And for me, that's a really big way of learning. When I started at university, long story short, a lot of my best friends are non-med and [00:05:00] they did electrical engineering or they did chemistry and, and a whole bunch of my friends were studying IT related courses, kind of data science or, or computer science.

Shrawan Patel: And they had persuaded me or had said, oh, you should start to learn to code. It's going to be forever valuable. And so I started off by learning H T M L C S S and JavaScript. and I did the courses, I think like lots of people. But the thing that I did to drive myself was I have all these, I ha I have leather shoes because I was a medical student and I was going to the hospitals and I needed smart shoes.

Shrawan Patel: And I think as I'd started to buy leather shoes, I realized that you should take care of them. That you should get them sold and resold. You should have, um, kind of rubber souls put on them if you want to keep them protected for a long p long period of time. And so I had a cobbler down the road that I used to go to to get my shoes sold.

Shrawan Patel: He [00:06:00] had no website, no online presence whatsoever. So for me, that was my driver. I went into the shop and I said, Hey Matt, you don't have a website? I'm starting to learn how to code. I have a proposition. Would you be willing to let me build you a website? Set up the seo, set you up on Google and. in exchange, if you see an increase in foot traffic, will you do my, my shoes for free

Shrawan Patel: That was my, that was my bargain, right? And I did it right. I went away and I had my little project, and I had Matt, who is now relying on me. That was my impetus to actually do what I had set out to do. And over the course of a month or two, I kind of learned how to tie everything together. And so how to build the front end and the static pages in HTML and c s s and then build dynamic content with JavaScript.

Shrawan Patel: And then how to, I was originally hosting it on GitHub for [00:07:00] free because, like, it was, this was a, a, a cashless exchange. I didn't want to pay for hosting, and so I'd uploaded it to GitHub and set a CNAME page and, and kind of the website was up for free. And then we migrated it over to a, a normal, um, server domain and, and had the.

Shrawan Patel: The dynamic JavaScript elements, uh, added in. So like, I know that that's what I need to push myself. And so I think that's what I've learned over my childhood is I think people often don't know themselves, that they don't necessarily know how to get the best out of themselves. That there's always this thing of as long as you're good enough, then no one pushes you to be better, right?

Shrawan Patel: If you do well enough at exams, but you're very intelligent, how do you know that the way in which you've learned for the exams is optimal for you? All you know is that it was optimum. To be good enough to get that a or to get that a star or a plus in the exam [00:08:00] doesn't necessarily mean that you writing it out a hundred times was the best way of learning it, right?

Shrawan Patel: Maybe you needed to dictate it into an iPhone and a memo and listen it to it, listen to it in the car a hundred times, and actually that would be a much better way of you remembering it. . Um, and so I think the dyslexia has definitely fed into that, that as soon as we found out that I was dyslexic and I had these very specific areas where I had issues with, suddenly there's this whole structure around coping with those and potentially making them work in your favor, right?

Shrawan Patel: Taking those things that are difficulties and turning them into positives. And so I think that's then begun to pervasively spread into the rest of my life and, and how I see things, things that I would unlearn.

Shrawan Patel: it's a good question being, the one thing that comes to mind and it's [00:09:00] topical because of a recent conversation I've had is knowing your self worth. That when I was going through school parti. Pre dyslexia diagnosis. I was constantly being told I wasn't trying hard enough and I wasn't putting in effort.

Shrawan Patel: And on the sports side of things, I ended up leaving school being for US listeners, varsity sports level in a number of sports. But it was almost by happy accident. Right? The coaches didn't even realize that I was playing varsity other sports. I was just kind of the, we need a 13th person or SP's, SP's the 13th person on the list, so he'll go in.

Shrawan Patel: Um, and so I was never like I individually identified by any sports coaches having some degree of very high level of athletic ability. I was kind of just good enough. Um, and so I spent all of my school life and I think even into med school thinking like that. And [00:10:00] it wasn't until really leaving med school, starting to practice the.

Shrawan Patel: I think suddenly things changed that people would say, oh, you are actually quite good at doing this. Or we, you went above and beyond. Suddenly the, the language changes and it changes your confidence and you suddenly realize, oh actually I can do something and I can do something. Well, and you know what?

Shrawan Patel: I've always been able to do these things. I just never have had someone tell me that I can. And that's definitely changed. Like now I know what my self worth is and I know what I can do, what I can't do, and for the things that I can do, I ask for the appropriate value for my time and energy and expertise.

Shrawan Patel: There you go. It's my long answer to that first question, . I 

Rishad Usmani: think knowing your self worth is something we could all come to sooner in life, and too many of us come to that [00:11:00] evaluation in our thirties or beyond. Yeah. Feel free to answer this question with as much or as little specificity as you'd like. Do you think life happens to you or do you think you make life happen?

Shrawan Patel: All right, so I'll, I'll start. My favorite word is, it depends. Um, that is kind of the running joke amongst my friends is if you're ever gonna ask me a question, my first response will be, it depends. And you know, I think this is a prime example. It depends. I think life does happen and there are definitely elements of right place, right time, and feeding into that right skills, you know, is kind of part and parcel of that.

Shrawan Patel: If I think about me, I was in London, I had had businesses before being at med school, but I was in London starting med school, 2000 [00:12:00] and kind of mid two thousands and. I was beginning to learn HTML c s s JavaScript. At that point, I had also started to learn Python, and I think being in London in 2006 seven, having been involved with businesses and knowing some degree of kind of technology meant that I had the right skills.

Shrawan Patel: I was in the right place, and I was there at the right time to begin working with early stage health tech companies, and it was still called eHealth M Health at that time. It wasn't until Health 2.0 came, I think around 2011 or 12 in London, that kind of digital health as a term started to be used. But you know, that meant that I got to know some of now the kind of the OGs of the British Health Tech scene right at the very beginning had I been in, you know, Nottingham or Liverpool or somewhere [00:13:00] else in the country.

Shrawan Patel: there's plenty of technology and plenty of really great ideas being developed, particularly now all over the uk. But at the time, London was really the epicenter of all of it. And so had I been anywhere else, I probably wouldn't have had the exposure or the opportunities that I had. So that's an element of, I made some of that because I had learned to code and I had made a deliberate decision to go to London for other reasons.

Shrawan Patel: I didn't know I was gonna go into health tech at the time, but wait, I made those decisions. But then there was also an element of life happened alongside, right? I, we don't live in little bubbles. We live in this wider landscape. And so it happened that health technology as an industry was beginning to flourish.

Shrawan Patel: It was particularly beginning to flourish in London. Those people in London building these technologies and building these [00:14:00] companies needed the help of someone that understood tech and business, but maybe more importantly was also quite good on the clinical side and could bring that perspective in.

Shrawan Patel: Like, those aren't me building or me making those things happen that happened on the side. But you know, it's kind of a, a clashing of two worlds. So I, I think it's a bit of both and I'm pretty sure I can go through everything that's happened to me and I'm sure we all can and say there are elements of this that happened and could happen because I had done the work, right?

Shrawan Patel: I had learned a skill or I, I'd developed certain knowledge or I had made the move to, to move. I had made the decision to move to a city because of increased exposure to a a particular industry. Those things are on you, you've done those and you should be, you should pat yourself on the back. But then there are other things around.

Shrawan Patel: like random conversations in a bar that happened and you suddenly start chatting and [00:15:00] you realize, oh, there's a connection here. And you have a lifelong friend who then connects you to someone that's not really looking for an open posi, not really looking for a position of to fill a position, but after meeting you says, you know what?

Shrawan Patel: This is the person we need. Life makes those things happen. Can't plan for them. They happen whether you want them to happen or not. I 

Rishad Usmani: agree. There's nuance and complexity in most questions and answers. and Japan is usually a good place to start. . You said you were a difficult child, but you were also the oldest of three and you went to medical school,

Rishad Usmani: Some people would say those things are not aligned. Talk to me about being the oldest and let's go deeper in being difficult. and how did that play out to your journey to med school? I would classify myself as difficult, and I would think [00:16:00] most people should be difficult, as partly it means they're standing up for what they believe in for themselves and being normal is being conformist, which is arguably, uh, damaging as an entrepreneur.

Shrawan Patel: It's How did it, how did it feed him? That's a good question. I'm not sure I've ever thought about it like that.

Shrawan Patel: So I think being,

Shrawan Patel: I don't think any of this happened consciously or deliberately, but I think being a difficult child meant that my parents in particular were constantly looking for ways. to keep me occupied, , and part of that was sports and activities. [00:17:00] And so I, you know, wasn't a bad figure skater and I played, played ice hockey.

Shrawan Patel: Can you, if you can believe it. I played badminton at a high level. I swam, right? I like did all of these things. I think because my parents kind of just like, they actually just wanted to tie me out so that I would go to sleep at a reasonable hour. But, you know, those things actually ended up being really pivotal and, and quite important to making me into the person that I am now.

Shrawan Patel: Right. I still run every day. I'm still playing sports at a high level and you know, There are skills that you pick up in all of these things that you then pull into other parts of your life. Everything is related in some way or form. It's, that's my philosophy. You can be a, a medic and be a doctor, but there are skills that translate to other things.

Shrawan Patel: Medicine doesn't happen in, its, again, own [00:18:00] little silo that you can take one concept and apply it to lots of other places. And so I think the things that I'd learned as a child then helped me work in teams, helped me to understand the importance of training, for example, right? I remember playing badminton and we would have these sessions.

Shrawan Patel: There's this thing called shadowing in badminton, which is where you're pretty much just practicing footwork. So there's, you have your record in your hand, you're on the court, start in the middle, and then you're doing footwork over and over and over again. . And the reason why you do that is so that when you are in, in a match and you're fighting for a point, if the shuttle goes into one corner, you don't have to think about your footwork.

Shrawan Patel: It just happens because you've spent the last five years of your life, two, three times a week spending an hour just shadowing your footwork. And so you kind of take that and you apply it to somewhere else and you say, okay, well how do I get good [00:19:00] at this particular thing? Is that something that would benefit from a shadowing style of doing something, uh, doing it right?

Shrawan Patel: Do I need to practice it over and over and over again to then make sure that it becomes muscle memory or kind of knowledge, brain memory? Um, you know, think about how we learn for medicine. It's all pattern recognition. The more patterns you see, the better you get. Now, do you need to understand those patterns?

Shrawan Patel: See those patterns? Before you can then pick them up. Do you just need to see as many as you can? Do you need to be more conscious about it? Like there are different layers and complexity to the onion. Um, and I think the, that kind of being a, being a more difficult child definitely meant my parents did things that then impacted my life further down the line.

Shrawan Patel: Um, how did it lead me to med school? That I'm not really sure. I think actually the big shift [00:20:00] was at 13 suddenly being told, oh, you know, it isn't that you aren't trying, it's that actually there are things you can do. You, there is an issue or there are, you know, what's the word? There are certain areas, certain things that you are always going to find difficult.

Shrawan Patel: There happen to be ways in which you can get around that, that changed. Going back to your question, do you make your life or does life? Present you with opportunities, right? That was one of those things. I happened to go to a school where there was a teacher that specialized in or was doing more and more specialization in educational needs and highlighted me as someone that may benefit from being tested, right?

Shrawan Patel: Different school, different time that may not have happened, and my path, my journey might have been very different, but as soon as that was [00:21:00] recognized, suddenly my performance started to get a bit better. And so academically, I was then performing at the right kind of level. And I, I'm definitely the kind of person that tests well, put me in an exam.

Shrawan Patel: As long as I've, you know, done enough work, I'll do pretty well. And so during the year, I'd often be told off my teachers and say, oh, you're not trying hard enough, da da da da da. Thankfully the British system relies heavily on exams. It's a big component of your final grade. Because I'm a good test taker, it meant that academically I stayed kind of at the right level to then apply for med school and, and subsequently get it.

Shrawan Patel: I'm not sure I completely answered your question, but Yeah, it gives you a little bit of a flavor. . No, 

Rishad Usmani: you did. We can talk about standardized testing and education. Let's keep that for later cuz I have too much to say about that and most of it is negative . Okay, [00:22:00] let's, I'll ask you, uh, a shorter question.

Rishad Usmani: Why medical 

Shrawan Patel: school?

Shrawan Patel: It's a good question and I don't think I've ever really figured out the exact answer. I remember. So when I was at med school, later down the line further, Further through med school, I began doing, or being part of the interviews for med school. And one of the questions that's very typical in the UK is why do you want to be a doctor?

Shrawan Patel: And one of the things that question always graded me because, you know, by that point I realized I had no idea that I wanted to be a doctor, specifically the operative word being doctor. Because a doctor being a doctor is a profession. And I don't think at 15, [00:23:00] 16, which is really when you start making that decision in the UK I had any idea of what the profession of being a doctor was like.

Shrawan Patel: What I did know is that I wanted to go to med school. And so I kind of pushed in the interview committees to change our question, our stock question from why do you want to be a doctor to, why do you want to go to med school? And it suddenly opened up people's ability to answer the question. I think more truthfully, because if you get asked why do you want to be a doctor and you don't know the answer, you automatically start confabulating.

Shrawan Patel: You start making something up, or you start reciting the answer that you think the person needs to hit. Whereas if you get asked, why do you want to go to med school? You can be truthful about it and you can say, well, I want to go to med school. So for me, I had, in terms of my A levels, so my final exams or my final subjects, I was doing maths, [00:24:00] chemistry, biology, and fine loved biology, enjoyed chemistry, loved fine art, and.

Shrawan Patel: Enjoyed maths. I think I have a love hate relationship with maths. I enjoy maths now. I think I didn't really enjoy maths quite so much back then, but on the biology and chemistry side, I really enjoyed biology. I really enjoyed human biology. I knew though that I didn't want to study biology as a pure subject because in the UK it's not a liberal arts system.

Shrawan Patel: You go in, you pick your subject and you started at 18, so you're doing biochemistry or straight biology or biomedical sciences, right? You're doing a a specific degree in a subject. And so I knew then that I didn't want to do a pure biology degree or a, or a subset of biology. I knew I didn't want to do chemistry as a pure degree, but I enjoyed both subjects.

Shrawan Patel: I enjoyed art and I [00:25:00] enjoyed humanities and I enjoy being with people, part of teams having a job that. Kind of active or doing a degree that was active and you were on your feet and doing stuff and, and interacting with people. And as soon as you start to lay these things out on a piece of paper, almost like a checklist of what am I looking for in a degree, you whittle the choices down pretty quickly to vet re science at, I think takes a lot of those boxes.

Shrawan Patel: Dentistry, medicine, nursing, school, physician's, assistants, you know, as we now know them, that wasn't a degree back then, but is now. Right? So you start to end up with these mostly health related degrees, professions, and you know, I will be very honest, my grades were good. And so there's definitely an element of, out of all of those things, what's the best that I can [00:26:00] choose.

Shrawan Patel: And it kind of ends up being veterinary science, dentistry, medicine. Didn't wanna work with animals, didn't want to work with just teeth. And so I'm like naturally left with a final option. Medicine. In retrospect, that's probably the subconscious thinking that was going on, the truthful thinking that was going on.

Shrawan Patel: Why I went to med school. I'm not sure. I knew at that time that I wanted to be a doctor. As it happened, I loved practicing. Still miss it. To this day, I'll be moving back to the UK soon, and when I do, there is a high chance that I'll reinstate my license and practice at least a little bit because I loved it, really, really enjoyed it.

Shrawan Patel: But did I know that at 15, when I first made the decision or began the path to med school and at 18 when I started, no, not in the slightest. , 

Rishad Usmani: what advice would you give your 15 year old self if you [00:27:00] could go back in time?

Shrawan Patel: Uh, what advice would I give? It's tough. I think if I, if I were, the one thing I would have wanted is to have found a mentor in some ways, or a, a more senior figure that could have given me some good advice when it came to making some of these big life decisions. Now, I say that, I say that that's something I would've liked.

Shrawan Patel: I don't think that's advice I would give myself as a 15 year old, because knowing the environment and the people I was surrounded with, I don't think there is anyone in there in my network that could have been that person, but my parents. Gotten green cards, and my parents moved to the States pretty much as I started med school, but that process began a little earlier, and so I knew that they were [00:28:00] going, and so I had applied to US schools, US colleges.

Shrawan Patel: I had a bunch of very good offers and the advice given to me was I had these offers at Imperial and a few other universities in the UK for straight medicine. So the advice was you should choose one of the UK universities because you'll go straight into med school and you'll come out with a medical degree, and then you still have a green card.

Shrawan Patel: You can go to the States. The reasoning for that was if I go to the States, you know, I had a offer at Berkeley, nyu, Yale. Even if I'd gone to tho any of those three, I'd still only be doing a bachelor's and then I'd have to apply for med school afterwards, and there was no guarantee I'd get it. , like, now I know that actually that's probably not the best advice to have given , but there was no one I had access to at the time that would've told me any [00:29:00] differently.

Shrawan Patel: So I think now I know that, you know, within my network and for my kids, I'll always be looking out for people that could help and provide some insight into some of these big life decisions. So it's not really advice because I, I could say it to my 15 year old self, but it wouldn't, wouldn't make a difference.

Shrawan Patel: Um, but I don't regret anything. I, I'm very happy where I am now. I think part of regret is making a decision that you, or making decisions that you regret, but realistically, in pretty much all the decisions I've made in my life, if I go back, Were given the same decision to make a hundred times over, I would've made the same decision a hundred times over.

Shrawan Patel: So if that's the case, why would I regret the decision? Because there's no scenario where I would've done anything differently. Um, and so I don't regret where I am now. Therefore, I [00:30:00] think I'd say to my 15 year old self, just, you know, keep enjoying life and everything will be fine. It's a long road, but everything will be fine.

Rishad Usmani: I'm happy to hear that. Shava, let's come back to the present as a question that came to me as you were talking. If you could pick a career knowing you would be successful. So if you're an artist, you're rebrand. If you're, uh, composer, you're a Mozart. If you play basketball, you're LeBron James. You know you're going to be the top of the game.

Rishad Usmani: What career would you pick?

Shrawan Patel: Oh, we're getting into fantasy now. What would I want to do? 

Rishad Usmani: So I would be an artist. I would be an abstract painter. Similar to Montera or Van Gogh and I would paint all day and lose track of time and humanity and being a person altogether.[00:31:00] 

Shrawan Patel: Okay. So I think I would love to do that. I'm going to be, this is going to be the most, you can start with underwhelming answer, I think, or think you're getting a laugh at this answer. You know what? I actually don't think I would do anything differently. There are lots of things I would want to do and I would love to do, but I think for short periods of time, if I were LeBron James, I was playing the highest level of basketball, one of the greatest in the world.

Shrawan Patel: I'm not sure that I personally would. The pressure that LeBron James feels every game that he plays. And it's not just the pressure that he feels during the game, it's that when he goes to dinner with his wife, the paparazzi outside, let's 

Rishad Usmani: say, uh, let's say Lee Chong, we or Linda let, let's say a badminton superstar.[00:32:00] 

Shrawan Patel: But see, even fe, like even badminton, I love playing and I love playing now, and even hockey I, that field hockey is my primary sport nowadays. I love playing it, but it tickles, it ticks a couple of boxes and it tickles a couple of things for me. But, you know, actually the, the way that I've set my life up now is that I run a business or technically part of two businesses, they.

Shrawan Patel: One of the, you know, without tooting horns, farm Stars for example, is, is the premier accelerator for companies trying to break into the pharma space. There is no one that can compete. We are the best of the best and at Strategy Health on the consulting side, we do software as a medical device. And there aren't that many companies that do do what we do or have done what we've done.

Shrawan Patel: Like we are maybe not in LeBron James, but you know, we are [00:33:00] a Lakers player level in the industries that we, we play in. But you know what? I get an evening when I can go play hockey and I have weekends when I can paint and draw and I can go for dinner without being bothered by anyone. But I still get respect in my professional life and I still feel.

Shrawan Patel: Value. I feel like I'm creating value. And you know, those are the things that are actually important to me now, is that I'm doing something that I want to do, that I have autonomy in what I do and how I do it. That what I'm doing brings value. Did I say that? Think I said that already. Um, and I get to do lots of things.

Shrawan Patel: I want to play sport. I want to paint and draw. I want the sculpt. I want to have [00:34:00] a good professional career. I want to have time with my kids, time with my wife. And those are the things that are important to me. It's what I want from, from a career. And, and you know what? I'm lucky. I ha I, I have that. So yeah, it'd be nice to be LeBron James for the day.

Shrawan Patel: It'd be nice to be Rembrandt for the day. But I think to feel and, and experience what it might be like, I'm not sure that I would want to do it full-time. , 

Rishad Usmani: I will refine my answer based on your answer and for similar reasons. I think, uh, more experience I gain. And that's a nicer way of saying the older I get, um, , the more I value balance, the more I value spending time with my family.

Rishad Usmani: And I think art is something I can see as losing myself in and there being nothing else in the world. And I think that is a damaging way to live even though you [00:35:00] might produce things that live on forever. Yeah. It's not fair to myself or my family. 

Shrawan Patel: I think it's going back to that knowing yourself bit, right?

Shrawan Patel: The, now we call it mindfulness. Now it has a name that's in the mainstream mindfulness. So we get told to do mindfulness because if you do mindfulness and you're focused on. One particular task and the action of doing that task, it takes everything away, right? It let's the rest of the world just drift off and all the worry and all the doubt and the anxiety, it gives you some respite, which means that when you suddenly get focused back on the rest of life, you've had some respite, you've had a chance to relax and breathe, and so you can just tackle it all with a fresh head, right?

Shrawan Patel: I have unknowingly been doing mindfulness for the whole of my life. [00:36:00] You know, I can't reach it, but there's a little R two D two metal sculpture up there that my sister bought me for Christmas, and it's these tiny little ity pieces of metal that you have to bend. And I have, you know, an old little pair of, well, these ophthalmology tongues, but, um, like little.

Shrawan Patel: Pair of, uh, tweezers and you have to use them to just bend the pieces of metal and thread them in. And you know what, that was my little evening hobby, and I was doing that at midnight. One in the morning. I was maybe midway through a document, and you know what I thought bad enough, just going to take my mind off it.

Shrawan Patel: And I had this little sculpture that I put together. And there are lots of things like that. I, I, something, one of my fun facts that's on the Web Farmer Styles website is that I sew and I, I can make clothes. And so I have lots of [00:37:00] these little projects in the, in the closets of shirts that I am altering or making or a pair of, almost finished, a pair of gloves.

Shrawan Patel: And those again, are things that I'll just do in the middle of the night. When can I have had enough? And it's mindfulness because, I'm having to really concentrate on a very specific task and I can't think about anything else. Um, and you can get that from your job, but you don't need to do that a hundred percent of the time, at least not for me.

Shrawan Patel: Being able to do it every couple of days is enough for me to stay sane and enjoy the other things in life that are happening. And so, you know, that's kind of, I guess, how I've built my life up. And I know me that I have these little projects that are all in various stages of, [00:38:00] of completion and over time, one by one by one, they get completed and I'll move on to the next thing.

Shrawan Patel: So it might be a drawing, it might be a painting, or it might be this little R two D two sculpture or, or a shirt that needs altering. Those are my mindfulness moments. I don't need that necessarily from a job. , but I do know that I need it every now and then. So that's how I built my life. 

Rishad Usmani: I agree. I I, I don't think we spoke about this.

Rishad Usmani: I did AK a while ago, which is a 10 days long meditation. Mm-hmm. , and I'll talk about in detail in a later video, but being able to sit in stillness by yourself in your own presence is incredibly important. When I meet people, I ask them certain questions to categorize them. , this is something I need to stop doing, but I want to categorize people and to a strong bias or proclivity to action or a strong [00:39:00] bias or proclivity towards planning.

Rishad Usmani: And I won't ask the questions. I ask them, cuz this, this is not a test , but which category do you think you fall in? And do you think that category is innate or learned? 

Shrawan Patel: Again, it depends.

Shrawan Patel: If I think about me making decisions, it'll be, it'll be a mixture of both. I'd say my initial reaction is towards AC action. Maybe it's not the right word. I think it's more about actually how you, how you approach something. I'm very focused on, or a lot of how I approach things is based on pattern recognition.

Shrawan Patel: My gut over the years has gotten better and better and better, and as I see more things, [00:40:00] experience more things, my gut feeling continues to get better. And so if I see something or need to make a decision, I will first just think, what is my gut reaction? and there are times where my gut reaction will be very strong for a particular type of decision, right?

Shrawan Patel: Either buy this or don't buy this, or this seems fishy. We need to take a step back and look at, look at it in more detail, or all of this seems to check out. Let's just go for it. So we don't miss the boat. Like I'll go to my gut and my gut will tell me strong strongly, one way or the other, or something in the middle.

Shrawan Patel: And if I don't have a strong gut feeling, then I'll go into planning and analytics mode. And I maybe do it a bit too much. Like I'm very, very pragmatic in, in how I see things is very analytical, but that [00:41:00] always follows or proceeds gut. Which will dictate whether or not I just do something or don't do something.

Shrawan Patel: And so there are lots of things where I've just made a split second decision, oh, you know what, let's, let's just do that now. I dunno why I can't, you know, I'm sure if I were to take a step back and list it, I could come up with a hundred reasons why I'm coming up with that decision. But my gut tells me that that's the right decision.

Shrawan Patel: So I go with it and I'm constantly trying to think back at decisions and experiences to just make my gut better, because that makes me make better decisions more quickly. Um, and so, again, I don't think I really answered your question . Um, but it would be gut feeling first, strong, yes or no, go of it. If it's somewhere in the middle, take a step back and think through it in more detail.

Shrawan Patel: I think that's [00:42:00] barely, I think that's nature. Sorry. I think that's nurture. I think I've learned that over time. Didn't my gut today is better than it was yesterday, which is better than it was a year ago. I don't think that's, I think there may be some nature to it, right? There's probably some proclivity that's a bit innate, but I think we can all get there.

Shrawan Patel: Think about med med. Think about medicine. You're a gp, you're a pcp. Someone comes in through the door. There's a, I remember one of my first Instagram posts was, uh, a, uh, a question, an E M Q question. Can't remember exact specifics, but it was something along the lines of say 23 year old Indian male comes in with a cough and then, you know, what's the diagnosis, uh, for you on the spot?

Shrawan Patel: Oh, like just in Indian male, 23 chronic cough. [00:43:00] 

Rishad Usmani: I'm tvb is like, I'm zooming it, trying to lead me towards that. But basically prevalence, I would 

Shrawan Patel: say, but it just like, it doesn't need to be okay. The extra information will give you more information. He, you've done an chest x-ray and you see these capacities in the, in the, in the apex of the lung.

Shrawan Patel: Um, that, okay, now you have your answer. But the thing is, is that as medics, if you've got 10 minutes to see a patient, from the moment they step through the door, you begin assessing them and you begin ranking potential differential diagnoses. If they're male, more likely to be certain things, if they're female, more likely to be certain things.

Shrawan Patel: If they're young, female, more likely to be other things. If they're. Young, white female, more likely to be other things, young, black female, more likely to be something else. Right? And you are not discounting anything, but you're taking all the possible differentials [00:44:00] and you are ranking them. And every question you ask is about getting a better top couple of ranking, like differentials.

Shrawan Patel: We are using our guts. Like we're not sitting there thinking, okay, this is a 23 year old white female or a black female. Okay, this is more likely. Okay. Let's ask about why she's, is it gut or 

Rishad Usmani: is it 

Shrawan Patel: pattern recognition? I think it's both, but they're not, are they not the same thing, but you are relying on your gut, your gut feeling is that unconscious, subconscious ability to pick something up.

Shrawan Patel: I don't think that most PCPs or gps are going through every single differential. What they're doing is they ask a couple of leading questions, open questions, and as soon as they get those answers, the differentials start popping in their head. Right? That popping of a differential in their head. Yeah. Is that gut feeling?

Shrawan Patel: You know what? I think endometriosis is more likely to be the [00:45:00] problem here. Let me ask a couple of questions to start seeing if that's true. Now it becomes a conscious decision, right? You're asking very specific questions to rule that diagnosis in and rule other red flag issues out. But when you like, do you not?

Shrawan Patel: I think a lot of doctors get that initial feeling, oh, actually I think I know what's going on here. That initial feeling is your gut feeling, and that's learned. We've seen it so many times. We've read it so many times. We've gone through four to six years of med school and we've had all these questions, and what they've been doing is just teaching our gut to be better and better and better.

Shrawan Patel: Right? Our gut is not just a random thing that just pulls things out of thin air. It's our gut is based on lived and learned 

Rishad Usmani: experience. What's the difference between gut feeling and 

Shrawan Patel: intuition? Same thing for me. I think gut feeling and intuition are, are synonyms of each other. Like your intuition is that this is the right [00:46:00] decision or not.

Shrawan Patel: Your gut feeling is that this is the right decision or not. This synonyms the same thing. 

Rishad Usmani: This gut feeling and intuition is what a lot of people feel distinguishes us from ai. If all it is is pattern for ignition, can AI be human?

Shrawan Patel: Can it act like a human at some point? I think most probably, yes. I'll, I'll ask 

Rishad Usmani: a more esoteric question. Do you think we have a soul or are we billions or trillions of synapses just firing randomly? 

Shrawan Patel: You, you'll get my pragmatic science answer. We are bags of flesh enzymes, proteins, water ions. We live our lives and I think some people don't [00:47:00] like to think about death and, and what happens afterwards, but in my mind and when we are dead, that's it.

Shrawan Patel: Right? There's, there's nothing, I don't think there's anything else that it seems incredib. What's a word? It seems almost impossible that life could have sparked in the way that it did. But when you start to realize that the actual time involved and how vast that is, suddenly you start to realize that we as humans just aren't built to understand certain things.

Shrawan Patel: If you ask someone, you know, there's that common thing you see on TikTok videos, Facebook videos of someone being told, okay, if you take a hun take $1 bills and you have someone that earns a hundred thousand, how far do those bills go? And it's, I don't know, let's say like [00:48:00] a mile, hypothetically. If you now take a millionaire and take those $1 bills, how far would it go?

Shrawan Patel: And people will say, well, if it's one mile, then. one mile's not a good answer because it, it expands out. But, you know, let's say 600 meters, maybe, you know, a hundred miles, but the actual answer is halfway around the world. And then you go to a billionaire and you say, okay, how many, how much would tho those bills go?

Shrawan Patel: And people say, oh, all the way around the world when actually it's to the moon and back. Right? I, it's just our ability to understand the size of things in relation to others is really, is not actually very good. Right? We're good at small scale things. We're good at assessing something that's one centimeter to something that's a meter.

Shrawan Patel: But things like perspective and like even just her ability to quantify stuff, when you start talking about millions, hundreds, millions, [00:49:00] billions, we have very poor understanding of kind of just how vast those numbers are. . So actually if it takes 3 billion years for, you know, things to be right or a basic enzymatic pathway to begin, or a, uh, you know, like a TP pathway for energy creation.

Shrawan Patel: Yeah, 3 billion years, like when you actually think about, or 4 billion years, or 8 billion years, whatever it is, when you think about how long that is, actually probably doesn't, it seems less in uh, less insane of an idea. Cause you also only need it to happen once and then things can begin to grow. And then also going from first pathway to sell takes another billion years.

Shrawan Patel: And when you, again, think about how long a period of time that is, you suddenly realize, well actually I can see that through trial and [00:50:00] error. If it's, if it's happening multiple times a minute or even a second. How many. Variations. Have you gone through over a billion years? I, one of them is gonna stick at some point.

Rishad Usmani: Yeah. I think, uh, our, I agree. We are terrible at quantifying larger numbers. I think a million seconds is 12 days and a billion seconds is almost 40 

Shrawan Patel: years. Yeah, it's exactly. And like, those kinds of things help us realize how bad we are at knowing the size and scale of things. There are some things we're good at, and as humans we're built to do, there are other things that we as humans aren't built to do or we, we are built and built in a way that makes us pretty poor doing them.

Shrawan Patel: So, in terms of a soul, I, I don't think that we, we have a soul in the traditional. . I think we as individuals [00:51:00] have an essence, which maybe you could call a soul, but I think that essence is really what kind of makes us as individuals. But that's how our synapses and our neurons have been arranged. That as a child, you have all these neurons, they're all firing in multiple ways and in all these loops.

Shrawan Patel: And as you grow, you shed a lot of those pathways and you tailor those pathways to make a functioning adult. And even as an adult, you have, you have plasticity in your brain to be able to adapt and change. And that's really the essence, right? It's that pattern of firing neurons in your brain and in your body.

Shrawan Patel: That is you. There is no one else, and there will never be someone else like you. Is that of souls and essence? Is it just. And, I dunno what you want to call it, but sol in the traditional sense, I personally am [00:52:00] I, I'm, I'm not a believer, or there 

Rishad Usmani: will be no one like you until we map out your synapses and replicate you.

Rishad Usmani: At which 

Shrawan Patel: point, I think even then it's difficult because nothing happens in isolation. So your synapses, you can map out your synapses, but within your synapses. Now I'm forgetting my neuro and my neuroscience, but you know, you have, you have your neurons, but how those neurons actually structured will make a difference to how an electrical current passes through them.

Shrawan Patel: So you can map them out and you can build it, but how those neurons react based on how much water you've drunk during the day, for example, or how much you've eaten. Whether you've gone for a run the day before, those make a difference to how your neurons act. [00:53:00] And unless you spend time mapping out the specifics of how your neurons act to different scenarios, you won't be able to necessarily recreate that person.

Shrawan Patel: And even if you do spend whole lifetime mapping out, okay, if someone's dehydrated, how do their neuron firing patterns change? If someone is, has starved for a day, how do their neuro patterns change? Even if you spend a lifetime mapping it all out and understanding it, they'll still be edge cases where you haven't mapped out that specific scenario, or there'll be, you know, gaps or holes that you haven't quite filled in building this knowledge base that you'll miss.

Shrawan Patel: So I think actually as individuals, You'll be the one and only of you.

Shrawan Patel: The 

Rishad Usmani: realization or the acceptance of the [00:54:00] randomness of it all can be either incredibly freeing or incredibly scary. Hmm. For me, it's freeing. It's freeing to know we're here for a minute amount of time, and our scale of our existence of our world is minuscule compared to the universe that it doesn't really matter.

Rishad Usmani: At the end of the day, nothing matters and you should live your life building the most value and creating the most joy you can. 

Shrawan Patel: Well, that also isn't, is based on your perspective and you say we're around for a minus minuscule amount of time. If, if the, if the earth could talk, then yes, it would say. . Each individual human is here for a minuscule amount of time because I've been around for the last however many billion years.

Shrawan Patel: But if you have a task to do and it's gonna take you an hour and you've [00:55:00] got a day to do it, that's a long amount of time. Right? Like it's actually your perspective on, on how long you have. If you're a 30 or a 40 year old, you might think that you are heading into middle age, you know, true middle age and life is short and you need to enjoy it.

Shrawan Patel: But actually the difference between a 40 and a 45 year old is five years. Right? That's the length of med school . Yeah. How much change happens between an 18 year old going into med school and a 23 year old coming out a lot and there's no reason that amount of change or more can't happen to a 40, 40 year old going from 40 to 45.

Shrawan Patel: It's a long amount of time. If you want it to be a long amount of time, it's a short amount of time, and it'll go in a flash. if you want it to be a short amount of time and go in a flash. So it's it's perspective. We live, you know, the length of time this is gonna, I don't, I'm not sure exactly how to phrase it, but it's almost, you know, the, [00:56:00] how you see the length of your life is how you want to see the length of your life.

Shrawan Patel: You either live a short period and you have very little time on earth, and then once it's done, it's done. Or you have 80 odd years to live and enjoy and experience things on a second minute by minute, day by day basis. And, and to be honest, we probably have differing views depending on how life is going, how stressed we are, whether , yeah, they're feeling a bit depressed with where we are in life and, but we, we actually do cycle through all these different feelings.

Shrawan Patel: So, you know, okay, fine. Some people might say yes, but. Then is your life inconsequential? And, and what are you living for? If there's nothing else afterwards, I think I'm living, I'm enjoying what I want to do now. That's it. Nothing more. 

Rishad Usmani: Yeah. Sharon, if you and your family had a one-way ticket to Mars, would you go?[00:57:00] 

Shrawan Patel: No. No. Not at all? Uh, no. It depends. Again, right now, no. If, well, it will, we'll do a couple of scenarios, right? Imagine that climate change continues to progress in a, in this negative direction that we're heading and the world becomes rather inhospitable in 40, 50 years time. Yeah, I'd potentially still be alive at that point, but Mars has been colonized.

Shrawan Patel: Things are well set up. , everything's nice and hunky dory. Would I take a one-way flight to Mars? Yeah, , of course I would. But right now where there is no framework or no setup on Mars where the whole of my life is on earth, and actually my life on earth is pretty good. [00:58:00] No, I, I, yeah, I wouldn't, I wouldn't go, not now.

Shrawan Patel: Sorry. Again, probably not the answer to the question you wanted , but again, it's, it depends. Different scenarios will warrant different responses. So if you're asking, would I go, if Elon Musk called now and said, you can have a one-way ticket to Mars, someone else can volunteer to do that. 

Rishad Usmani: If your previous startups came to you to ask for funding, which one would you give funding and which one would you say no to and why?

Shrawan Patel: Ooh. So I've, I've been involved and had a couple of startups in, in the def or that would be, meet the definition of what we see as startups, kind of venture capital, venture fundable businesses. A lot of my businesses, [00:59:00] however, have been what I now, now know, is called lifestyle businesses. They have positive cash flow pretty much from day one.

Shrawan Patel: They tick over nicely. They have some growth potential, but it's gonna be fairly linear growth. So I, I think it's a little difficult if you call them all startups in the sense of they're all early young businesses. I think the f again, going, you know, going back to my word, it depends. I would fund them in slightly different ways.

Shrawan Patel: I had a. I had a wholesale business. I was distributing a, a particular product. I was buying, buying it, wholesale and selling it. It was a great business, turned over. It was a really nice cash flow business. Would I give that, would I want equity in that company as a, would I invest money like a VC would in that [01:00:00] company?

Shrawan Patel: No. Sure as hell wouldn't. Would I give that company a revolving line of credit? Yeah, probably. Right? I'll make my 5%, 6% interest on whatever money's coming outta the revolver. I'll be happy with that, right? There's more than I'll get in any other investment account and I can look at the financials of that company and see that it's been going for the last year or two and it has really, really solid cash flow, right?

Shrawan Patel: So would I fund that company? Well, if offering a evolving line of credit is funding, which in some ways kind of it is, yeah, I would do that for that business. . I had started this tutoring company business with a couple of friends at university and you know, we got it to the point where actually it was beginning to, you know, slowly still very early days, right at the beginning of the curve.

Shrawan Patel: It was in this section here, but you could [01:01:00] see where it was going. And if you just see what other companies that started a little after us have done, you know, they had that typical hockey stick curve that venture capital firms are looking for that business a hundred percent. I would put money in because we were at the right time, we were at the cusp.

Shrawan Patel: The technology was good. Uh, we had early users. The MVP functioned and did everything that it needed to do, and we were unlike anything else on the market at the time. So I had a hundred percent give money to, are there any businesses I wouldn't give money to?

Shrawan Patel: So this one's gonna be a bit unfair, mostly because it wasn't started by me. So I feel people might think I am having a jab at someone else, but I'll, I'll explain why I wouldn't give money to it. So there was a, a company I was involved with called Med Hunts that was all about educating patients on [01:02:00] how to use and take their meds, how to kind of follow procedures, medical procedures properly.

Shrawan Patel: And it was great. And from a clinical perspective, I could absolutely see the value that it would bring. The clinical practice would make patients better. They would be well educated or there would be their education on their disease, their symptoms, their treatments would be better. And we do know there's a good solid evidence base to say that if patients are more educated on their diseases and their treatments, their outcomes are better.

Shrawan Patel: Great idea, right? Concept really would do good in the world. But what's the business model right? In, in the unfortunate world of healthcare that we live in, the way that money flows from one place to the other, it doesn't flow based on clinical outcomes or primarily doesn't flow [01:03:00] based on clinical outcomes.

Shrawan Patel: It flows based on the provision of services. And those services need to map to particular payment codes, right? They be, all these services are being codified and then you get certain payments based on which codes you, you can tick. That's true in the uk, that's true in the us. That's true in most, most western world countries, if not most countries, with, you know, well-structured healthcare systems, patient education.

Shrawan Patel: What payment code does that tick? It doesn't, unfortunately. Right. Maybe it's beginning to, in the US you're starting to get value-based care arrangements and, you know, you could theoretically say that you could tap into some of that funding. It's done difficult. Um, but that, you know, I think doesn't really meet muster for VC investment because the business model doesn't exist.

Shrawan Patel: There you, there you go. Those are be my two [01:04:00] answers or two parts of the answer. 

Rishad Usmani: I, I've talked about this before, but outlining a financial ROI for your buyers is arguably more important than outlining a clinical ROI when you're a healthcare startup. Mm-hmm. , what do you look for in founders and how much do you value previous founding Experie?

Shrawan Patel: If the last, what has it been? Probably hour. Hasn't teed up this answer. I'm not sure what else will. We spent a big chunk of this conversation talking about experiences, about having seen and done things that will inform you going forward. I don't think I could ever discount that prior founders do a better job of [01:05:00] starting companies than first time founders.

Shrawan Patel: So it's important, but it's also a bias. And so people like me, you, anyone else that invests in in startups should understand kind of the basis of the bias. To what degree are first time founders not as good as Pryor founders? Are there differences between industries? Are there different? If one comp, if one founder had an exit, had built a company in and a machine vision and sold that company and now wants to build a healthcare company in patient workflows or in, uh, , um, clinical workflow management, does that prior experience translate into this new business as well as if the founder had had a prior company in building a patient front door?[01:06:00] 

Shrawan Patel: Right? One probably relates to the other hell of a lot more than than the other. So I think being a part-time, uh, being a first-time founder does put you at a slight disadvantage purely because you're learning everything for the first time, but, , at least when I'm asking founders, I'll actually put them through some scenarios.

Shrawan Patel: I'll, I'll say, okay, well, you know, imagine that this were to happen. How would you approach them? And more often than not, the good first time founders, the ones that really perform as well, if not better than Pryor founders, are the ones that can pull on experiences from outside of building a company because they, they haven't before, but pull an experience from somewhere else and rel see the relationship.

Shrawan Patel: So if it's your, uh, first time founder, you've got your company, you had some seed funding, you're [01:07:00] now starting to get quite close to the end of your runway, but you haven't raised a follow on, kind of, how do you start to deal with that situation? Some founders will, some founders will flounder around in their answer, right?

Shrawan Patel: They'll. Give a bit of an answer, but not a particularly well thought through answer. But the good ones will say, well, you know what? I had this project that at, at the hospital where I was working and it was going on, it wasn't quite finished, but again, we were getting, we were running outta funding, so what we actually ended up doing was putting certain things on hold In the startup relationship in the startup world, that means sunsetting certain product features or slowing the roadmap down.

Shrawan Patel: They would say, um, we actually repurposed staff to other projects so that we could reduce the burn on that project. Well, they wouldn't say burn, but like reduce the, the expenditure on this project whilst [01:08:00] we went back to the drawing board to come up with a plan so that we could apply for an extension of the grant.

Shrawan Patel: You know what that tells me is that that founder is willing to slow down on product roadmap to. Highlight features that are actually important to potentially let go of staff to take a step back and say, here's what we have done, here's what we are doing. Here's how much money we need. Like put a plan of attack in place and then go approach fundraising in a really well organized manner.

Shrawan Patel: If they, if they pull from an experience like that in, they may not say all the right words, but I guess that as someone that's investing in companies, I also need to read between the lines sometimes. So again, I'm not sure that I've necessarily answered your question, but I think first time founders can be as good, if not better than prior founders.

Shrawan Patel: Prior. Founders do tend to have the [01:09:00] edge, but only in certain scenarios, and I think as an investor you need to find out. , whether or not certain scenarios exist, and therefore you can give weight to someone being a prior founder 

Rishad Usmani: early on in a startup. I would say a distribution strategy is more important than the product itself.

Rishad Usmani: Do you agree with that statement? I will add, uh, a good distribution strategy allows you to iterate faster on your product, which seems to be a consistent marker of a successful startup is a speed of iteration and refinement.

Shrawan Patel: So I think yes and no. Again, depends. Some companies, so there's one company that I know very well, they had a couple of options, so they were very early. They had started to [01:10:00] build an m mvp. They had an outline of it, and they had a few options in how to begin testing it. They had an academic medical center, they had a potential distributor that could have given them access to a few different, um, sites, and they had some early inclination that the sites would be of interest.

Shrawan Patel: So they could have worked with more than one kind of first customer pilot customer. You know, my advice to my advice to them was for them specifically, they should find a small private clinical group that's no more than 30 or 40 minutes drive from where they live. They should just draw a ring in Google, type in, you know, that specialty, the, the like, type in that specialty clinical specialty area.

Shrawan Patel: Find all the groups that are within 30, 40 miles away and ring. Find out who the clinicians are. Start ringing and see [01:11:00] if one of them will bite and be your first pilot customer. Then go there. and be on site every other day and be part and parcel of making that product work. And you'll learn more about what features work, what features don't work.

Shrawan Patel: They weren't clinicians. So you'll learn more about how clinical practice actually works, like how long people, some people will say, our people should fill this in before they go see their clinician, if they're in the waiting area. But particularly in US healthcare, when someone's seen by a nurse first, then by a pa, and then by the doctor, actually, they may not spend that much time in the waiting area.

Shrawan Patel: They'll spend five minutes and then they'll get called by the nurse, and then the nurse is taking their blood pressure. They might take some bloods, they might do some weight to height, then they'll go back to the waiting area. Three and four minutes later, the PA will call them and ask them an initial set of screening questions.

Shrawan Patel: Then the patient stays in the room and five minutes later the doctor comes and then finishes off the assessment. [01:12:00] So if you have a five minute questionnaire for patients to fill in, In the waiting area. When, when, when Do the patients actually spend five minutes in the waiting area or that whole concept should be Ben, because the clinical workflow for that practice or that type of practice just isn't amenable to your original idea.

Shrawan Patel: You'll only find that out if you're there on site. If you work with a big academic medical center that's in a different state, you're never gonna go, you're never gonna see all of this in action. You might get some feedback, but the clinicians that you'll be working with will be very busy, may have clinical studies that they're working on.

Shrawan Patel: They may have their own private practice outside of the hospital setting. They may have all these other things. If you go through the distributor and you work with three or four sites, I'm gonna be so spread thin that you aren't gonna get good, valuable feedback and iterate. And so they started, they, they did exactly what I had recommended [01:13:00] and that gave them enough.

Shrawan Patel: Of a final product, like their product got to the point where they could then do a Siri to do their seed rays, and they had a good, you know, healthy seven figure seed rays because their MVP was good and they had data from this clinician and their patients about how the product worked and how it would fit.

Shrawan Patel: They still had to come up with a good distribution plan. Don't get me wrong, I'm not saying that you should just sideline your distribution plan. They had one, they had a good one, but straight off the bat that wasn't the thing that was important. Well, they actually needed to do was make sure that their product met the, or actually solved the problem they were trying to solve.

Rishad Usmani: Cold calling and cold emailing is a superpower. . Every founder should force themselves to do it. 

Shrawan Patel: Oh, absolutely. [01:14:00] The, let's talk about clinical. You know, going back to that whole thing of first time founder versus Pryor founder, you asked that question. A good first time founder will sit there and say, you know what, when I was at college, I used to wait tables and I would have to talk to a hundred people that I'd never met every single day and ask them what they wanted.

Shrawan Patel: Tend to their needs, bring them what they need, deal with problems, right? And if you're a waiter in a restaurant, there are problems galore, right? My food isn't right, it's hot, my steaks undercooked and deal with that in a good way. I'm not sure how any of those skills are different from the skills I'd need to cold call people and find out what their problems are and how I might be able to help fix them.

Shrawan Patel: Like that to me is taking a skill that you've learned in one place, seeing how it relates to what you need to do as a founder and, and use it. . Okay. Um, I agree. [01:15:00] Cold calling, call, emailing. Is, is an art that you learn over time. , I think a 

Rishad Usmani: lot of people fear rejection. My response rate right now when I called email cold call people is I would say 10%.

Rishad Usmani: In the past it was likely 0.1%, but you have to do it. There's no alternative there. Yeah, exactly. Let's talk about clinical trials. This is, uh, this is the last question, Cheryl. Okay. The, from an outsider perspective, the clinical trials recruitment process seems very inefficient and overly reliant on health systems and hospitals, whereas primary care is likely an easier target to acquire patients.

Rishad Usmani: Do you agree with that statement? And if so, why is it so inefficient? And for context, from my conversations, it's about 25,000 to recruit one patient for a clinical trial. 

Shrawan Patel: Yeah. [01:16:00] So you could, there are multi-day conferences on this topic multiple times a year. And even then people haven't figured out kind of the root cause of the problem, root causes plural of the problem and how to really address them properly.

Shrawan Patel: So we can scratch the surface on this now, but it's, it's a whole big topic. And pharma is a mul, you know, multi-trillion dollar industry. Maybe it's a trillion dollar industry and they have money cuz it's such a big. and a lot of the product and how they work is based on trial recruitment. So it isn't for want of trying, want of money, want of priority.

Shrawan Patel: There are just issues with the realities of how clinical trials work and function. So I'll give you an [01:17:00] example that I'll try and tie into a larger thought. If you are a trial looking at colorectal cancer screening and you want to recruit patients that have polyps, most patients in the US have their cancer, have their colon colonoscopies done at at colonoscopy centers.

Shrawan Patel: Small, small to medium sized private groups. So you'd think that that would be a great place to recruit patients. The problem is that. , what do those centers, and what do those clinicians do? 90% of the time colonoscopies, that's their bread and butter. The more colonoscopies they can do, the more money they make.

Shrawan Patel: So if you are a trial and you want to recruit patients that have polyps, you go to these centers and let's say one of them says, okay, we will refer patients to the trial, but we find have, you know, [01:18:00] particular polyps patients. Then go to the trial site that's maybe an academic medical center and will go through the screening process, enroll in the study.

Shrawan Patel: That study may have a one year period where a treatment gets given or a procedure gets done, then they have a colonoscopy in 12 months time. Where does that colonoscopy need to be done? At the academic medical center, because it needs to be, the findings need to be done and recorded. In a very particular way to be able to assess one patient to the next patient and to the next patient because if those, that data goes to the f FDA for a, an approval of a medical device, the FDA will say, make all the patients and the reporting needs to be standardized.

Shrawan Patel: And you can only do that if they're all done within one or two or a handful of centers. So actually what you've ended up doing for the private group [01:19:00] is taking one of their patients and then having that patient do their following colonoscopy somewhere else. None of the private group, so what the private group has actually done is just lost someone.

Shrawan Patel: Right. They've given a patient away. And that's the last thing that private groups want to do is lose patients that they're treating. So that's an example of kind of one of the issues with kind of just how trial recruitment works. Thinking about PCPs and primary care, they're great recruitment OP pathways.

Shrawan Patel: One, there's an issue with identifying the right trials for the right patients. One P C P is seeing, let's say 15 patients in the morning, 10, 15 patients in the morning, 10, 15 patients in the afternoon. They don't have time or even the head space to think about [01:20:00] more than one trial. So then you are competing against each other.

Shrawan Patel: Like actually you might have five or six trials that want someone F to be recruited from a PCPs office. So now the PCP needs to sit there and think, do any of these patients meet the trial criteria or inclusion exclusion criteria? So, okay, the PCP doesn't have time. Maybe a nurse can do it, but then that's a.

Shrawan Patel: Time spend on trial recruitment, not on other patient clinical care tasks. So then the pharma company maybe has to pay for the nurse's time in finding those patients, but then is it worth spending money on that nurse's time? If one PCP practice can only recruit, let's say one patient a week, if you are trying to do a thousand person study and have recruitment done in, let's say five months, six months, it's in feas, it is not feasible [01:21:00] to have a hundred primary care practices where you are funding a nurse to do the inclusion, exclusion criteria and fill your trial funnel, your recruitment.

Rishad Usmani: I'm assuming there are AI startups scanning EMR data to do this already. 

Shrawan Patel: Yeah, so there are a whole bunch of startups. It's actually a really exciting time. There are a whole bunch of startups that are helping with trial recruitment because trial recruitment, as you said, is such a big problem and costs so much money.

Shrawan Patel: There are a plethora of ways in which you can help address the problem. There's one company that, um, I'm an advisor for called New Route. Their whole thing is around looking at social messaging, social content, and using that to start to understand patience, understand where they are, start to put trial information in front of those patients so that [01:22:00] if you have a trial that's recruiting out of an academic, academic medical center, the only patients that are recruited into the trial are patients that come for an appointment at the center.

Shrawan Patel: patients that go to that center are within a certain catchment area, but there are overlaps between centers, right? There's, it's almost like a Venn diagram. There are three hospitals where I live in Manhattan that are within 20 minutes drive. I've got Sinai, Cornell, and Northwell all about 30 minutes away from each other.

Shrawan Patel: So what happens if Northwell is recruiting for a trial that I could participate in, that I go to Columbia? I'll never know that trial exists, but I'm 30 minutes away. So what Nero is trying to do is to say, based on conversations and material that I'm posting, I most likely have this particular disease that I'm geographically located within 30 minutes of the trial site.

Shrawan Patel: So let me [01:23:00] put this information in front of you because then I can reach out to Northwell and maybe get enrolled in this study. That's one issue that's tackling the issue of patients being in between different sites and maybe not going to the one site that's recruiting. There's another study that's looking at, uh, there's another company that we, that I know that uses metadata, EHR metadata to help hospitals identify what patients they have and whether or not they have enough patients that could help with recruitment.

Shrawan Patel: Seems silly, but hospitals often don't. Their patient populations particularly well, you'd think they would because they have EH R systems, but data in the EHR systems may not be always up to date, but also getting that information out of an E H R can be really difficult. So trial sponsors will usually go to academic medical centers that have done trials in the [01:24:00] past because those hospitals have a good handle on what patients they have in their population and therefore can say, yes, we can help with recruitment, or no, we can't.

Shrawan Patel: If I went to a hospital in the middle of New Jersey that's never really been involved with trials and I said, I'm looking for 500 type two diabetics female between the age of 55 and 75, do you think you have 500 of them? The hospitals say, come back to us in a couple of months and we'll, So what this company does is allows that hospital to deliver a metadata extract.

Shrawan Patel: I e has zero patient identifiable information in that, so they can pull that within a day and send it to the startup. The startup can use quite advanced analytics to take that metadata and extrapolate the types of patients in the population, and then the startup can tell the sponsor, yes, this hospital can probably recruit the 500 patients, [01:25:00] or no, they have maybe two or 300 patients that meet the enrollment criteria max.

Shrawan Patel: Now suddenly sponsors can choose better sites because if the rural hospital has the patience, that's probably the only study they're recruiting. Therefore, all their time and energy is spent on recruiting patients for your study, as opposed to an AMC that might have a hundred studies going on at any one time.

Shrawan Patel: And therefore, recruitment may be split between different studies. Right. Studies are competing against each other. Yeah. As you can see, and I could just continue on and on and on, there are, there are an infinite number of issues with trial recruitment and even just how, how studies are designed. Some of that is for scientific purposes, some of that is for regulatory purposes, and some of that is for ethics and for compliance purposes, how trials need to be designed, impacts how you can [01:26:00] do recruitment.

Shrawan Patel: Um, you know, there's, there's a lot. Again, you could go on for days, you could talk for days on this topic. 

Rishad Usmani: I think we need to do a part two. , we didn't really talk. Enough I feel about investing or healthcare . So we should do a deeper dive into pharma and clinical trials. Yeah, sounds good. Yeah, this has been incredibly informative, Charan.

Rishad Usmani: Thanks for taking 

Shrawan Patel: the time to talk to me. It's been a pleasure. Thanks for asking.