[Music] I want to help these doctors because they have so much passion for patients and patients don't see it I met know tens and thousands of doctors all different Spears what are some of the things that doctors get wrong when it comes to running their business there are a lot of doctors who were very smart and who knew their subject matter very well but when it came to the non biology part the non-science part which kind of went into the management and went into this thing that's where you know they would find it very challenging unfortunately for doctors it's their time which is the most valuable precious commodity correct when it comes to healthcare trust is more important right and so that's why you know two factors one build products and services that encapsulate this trust be factor in the time it will take it will take decades yeah but then the good news is that those are also modes and that's how even brands in healthcare work uh a det all is a 150y old brand through data we can for the first time show much better health outcomes we built India's first and even sometimes I think it's also the world's first uh online software for doctors right we were online 2008 so we built SAS in 2008 wow and then in 2012 we built the first uh doctor Discovery platform right a few years later we built the first mobile app what this Innovation can do for health SC is phenomenal this is a very special doctors's day episode of the create 12 podcast in this episode I'm hosting Shashank Andy who's co-founder and CEO of practo and the CI chair for digital Health in India we talk about what it takes to run a successful Medical practice how doctors are adopting to technology and specifically to data science and artificial intelligence we also cover shash shang's own unique Journey that of starting prao as a young college student and taking it to becoming India's only profitable healtech startup I'm sure you'll enjoy this one I'm sandip Jani the host of the create weth podcast and co-founder of deserve shashan you were telling me earlier today that you've interacted with 12,000 doctors in the Journey of setting up and building practor now one of the most interesting things is a lot of doctors are also entrepreneurs in many ways they've set up their own business hired a team running uh a system what are some of the things that the best doctors have done really well so you know it's so happened that I met these many number of doctors um but just to give you a little bit of um back story on how it all started um I was in my third year of engineering and I was trying to figure out you know which space do I build a product this back in 2007 and I met a bunch of people and I met this one you know I met lawyers I met people from very diverse background and then I met this one doctor in Bangalore I remember you know vividly because it was afternoon time you know he's uh in between patients and I go meet him telling him that hey I have this product I want to talk to you about and I could see the you know even in that afternoon he was sitting all alone by himself in this Clinic of his but the you know the passion he had for this patients um really inspired me um you know he was planning for what to do for the next patient he was excited about what he had done for his previous patient and he was so worried about this patient that happened a few days before that and he was explaining all of these things to me and it was a lunchtime yeah um so I got a really one or two hours with him and I could see the passion that he had for patients and a similar thing happened to me just a few days later with another doctor you know this is this was in shivaji nagar the first doctor in a part of bangal called and in the shaji nagar doctor right it's a slightly more crowded space he has a slightly more tinier setup but just the sheer passion for his patients and how meticulously he was trying to improve their health was really you know kind of inspired me I said I want to help these guys right and I want to help these doctors because they have so much passion for patients and patients don't see it because you go meet them you know you have this kind of a slightly more transactional relationship you you have a 15minute conversation or let's say you have because you were worried about your own health at that time you anxious about your own health right so it's all about you but what you don't see behind the scenes is the passion that sheer passion the doctors have for patients and I I saw that upfront and I I got really inspired by them and I said okay what do I build that will enhance their you know productivity and that's how the software G and that's how I ended up you know going on to meet 12,000 of them or more actually I know that's just the back of the hand calculation but in the last 16 years um I met know 10 and thousands of doctors all different Spears I met beginners I met doctors who have done 40 years plus I've done you know I've met you know Physicians I met surgeons I met doctors in India outside India across and couple of things that come through is that the there are you know there are do all doctors one thing that's common is that they have sheer insane levels of passion for their patients and genuinely that is one of the reasons why they pick medicine I guess and that's why they are kind of self- Select themselves into that cohort and it's a sheer pleasure to you know you know be with them because you know they the genuine care that they have for patient uh is something very motivating and inspiring and even it doesn't matter which level you are it doesn't matter if you're owner of a you know five story 500 bed hospital or whether you're a a single doctor getting into practice so that that was something that's common but something that was I felt um what differentiated doctors between two was I think there were there were a lot of doctors who were very smart and who knew their subject matter very well but when it came to the non biology part the non-science part which kind of went into the management and went into this thing that's where you know they would find it very challenging because it it you know it's similar to how I'm I'm more math and computer science and I find biology more challenging so it a reverse so and the good guys I found you know kind of teamed up they found ways to team up with others who had those strengths okay um the second thing that I saw was that there was you know the doctors who succeeded a lot I I I saw a sense of ability to you know doctors you know genuinely with with patients I would not call it a a God complex but they God to patients right so they are at all time you know uh having a very different kind of a mindset when dealing with patients now how do you marry that with a beginner's mindset is a challenge that a lot of doctors you know don't very easily um move into um so you know as businessman and as uh as any professional any any sphere having a beginner's mindset is very important doesn't matter whether you a beginner whether you're a you know you're 5 years in 10 years there's always more to learn yes right that curiosity is required and exactly willingness to learn and you need to have that humbleness to know that you don't know enough yeah now how do you marry that to a doctor is a very interesting interesting thing right because as a doctor at the receiving end of being thanked each day for saving so many lives or for contributing to so many people's betterment sure now how do you marry that to a beginner's mindset it's a challenging one uh you need to have you need to be at both you need to be have that confidence to treat patients at the same time have The Beginner's mindset to be ready to learn even from somebody younger even from somebody outside your field even from somebody else so that is the challenge I've seen a lot of doctors face and the ones that have really always skipped a beginner's mindset right from College to starting their practice to you know going on and having that humbleness to learn balancing out their is is what I've seen play out well for them I think you described it really well Shashank I think it seems like on one hand you've got to be really confident uh about dealing with a patient but at the same time when it comes to the economics of your business you need to be willing to learn a lot of new things or probably even on the technology side uh be willing to sort of adapt uh and grow over a period you've looked at a lot of uh doctors up close looked at their economics of their business uh very closely what are some of the things that doctors get wrong when it comes to running their business H now um I think first of all you'll be surprised uh when we started working in this field I was very surprised that doctors maintain very little um have very little knowledge of the economics uh they in fact maintain any little data uh that's the first unfortunate part right it is you know I think I think there's also a challenge in time uh there's a challenge in uh Learning Management um so because of that you know they have to end up doing everything and they don't have enough time allocated to understanding their business like in a business when you grow the time you spend doing the the dayto activities reduces because you are able to get other people and then you get more time to analyze data and see what you're getting right and what you're getting wrong unfortunately for doctors it's their time which is the most valuable precious commodity correct and so they really not able to step back if you look at the best surgeons today they even today would be you know spending those many number of hours in OT because that's what's required of them so I don't know if there's a solution to it but uh maybe there are tools or products that they can use to do this or they can hire better people uh is how do you get data that data or orientation is something that I don't think doctors are really equipped with and without understanding data you can't understand patterns you can't understand insights about your business sure and the lack of data itself leads to lack of insights right and lack of very basic insights watch my profit margin what is my you know you know they have a sense of how it's doing because they have a overall number but the breakup of that what is giving me Roi what is not giving me Roi now Roi is return of investment how how do they break all this up and understand this and then focus on things that is helping them for things that are not helping them they go by intuition a lot right that because that's how they treat patients they treat them based on their experience now running a business you know you need to marry that intuition with data sure and that lack of data I feel is one of their weakest points right so they don't get deep into their data understand which procedures have what kind of margins um they go by gross numbers they don't go into the details and understand okay even though I'm earning so much from this procedure if I take out all the costs what am I actually left with and how much time am I spending on that procedure and is it really my skill set or not which are the treatments for which I'm really good at just because take an example just because I'm an orthopedic doctor am I good at all things Orthopedic or am I good at a few things Orthopedic should I specialize those are the things that you know uh get missed out um and so because of this lack of data um that imped and that impedes their growth in my opinion that's one thing that I would think that you know um is thing that I think that gets missed out um apart from this the uh the second thing I I you know is that there is a sense among doctors that um it's only the seniors that they learn from but growth and learning is everywhere right it's in every books it's in books it's in their field and other fields I feel like they them them stepping out of their core comfort zone of biology is not really there they love to go deeper and deeper in their field they do CME programs but in adjacent adjacent areas they don't and the ones who do kind ofit and by adjacent do you mean in the in the medical domain or in the commercial side of things I would say that you know uh you know commercial you know technology um it could be um uh I mean commercial we mean you know business it could be Market it could be um you know it could be how to understand consumers it could be empathy it could be there are so many different aspects that you need as a doctor the biology part is an important one it's the core competence but that's not just enough like I mean if you know you you are um probably phenomenal at finance and that's why you have picked up the fintech space but then to run a business you need to know so many other domains you need to be you know maybe not phenomenal at but at least good at and so those are the areas where I feel that they they miss out on and um I've not seen enough doctors taking the initiative um to learn and uh equip themselves with that I'll give you a small data point we did an analysis of patients who did not recover right because we have so many patients who come to us so um we able to send them a a request after a few months of treatment and say Hey you met this doctor so many months back let's look at but did you recover did you not recover right and if you did not recover what are the reasons mhm and if you recovered you know how how are you doing now and also did you end up going to some other doctor because you know for some other reason you didn't recover neither the third bucket the data was quite surprising the data was surprising to the tunes that you know there were a lot of patients because they couldn't understand the doctor just because of that reason they start to somebody else the treatment was right perfectly fine but then there was some level of connect that did not have the doctor the trust that did not build to the doctor the doctor spoke to fast the doctor gave me two short time period he didn't answer all my questions he spoke a little rudely he didn't I don't know you know those those human signs right of saying how do you communicate a right thing in the right way that was not there so I went and met another doctor that's you know almost another you know like a good percentage of consumers and the other consumers who did not recover did not follow the instructions right the treatment was right but they just didn't follow the instructions right and all this data put together publishing paper very soon we found that almost 8 to 10% of the patients didn't even you know put were in the bucket of not recovered right and so when we go deeper into this bucket we realize that it's very little of actual treatment but it's a lot of the non-treatment part yeah which in communication in conversation gets missed out because of which they don't recover or you know they go somewhere else um so out of the you know 8 8 to 10% that did not recover there was just about 2 to 3% where the treatment could have have been you know maybe a little different maybe and that also and the remaining 7 to 8% 70 to 80% were more non biology oriented things that could have been explained better to the patient or dealt with the patient better and even in the treatment portion it wasn't the knowledge being a problem it was more about do not take enough medical history if the if the doctor had taken enough questions or the treatment could have been slightly more customized or personalized which should have been more effective so yeah so those are the things that you know uh where you know you you you know the doctors could clearly add on to now again you know this nitpicking right because I know I want to definitely put the disclaimer that you know they do probably the biggest uh service and profession now I'm just trying to put out data that will help you know take that 9 92% to 900% which is what they want to do correct and that's what I wanted to partner with them for yeah no absolutely and I think you know you said it very interestingly that it's the human side of things because you're so passionate about your craft uh the the job that you do that sometimes these ancillary things which actually are the last mile of closure right so the experience that the customer gets or the patient gets when they walk into the uh Clinic I think is is one of the most important things right I've seen this up close that you'll go to a clinic where you feel that overall Everything feels good right there are so many times when the doctor or their assistant calls and checks in on uh you one day two day 3 days later and then you by default will go back to that doctor because you feel cared for right and the treatment might be exactly the same between somebody who does that and somebody who doesn't but the economic outcomes might be so much better for the guy who does it yeah absolutely absolutely should see how difficult this job is right imagine you to be at the front line yeah all the time yeah right and I can't even imagine and even if um you know even if they have a bad you know let's say there's some bad news or there's some bad outcomes so many go into and I'm I'm not one I can tell you for one that I'm you know it's I'm only speaking of data I'm sure the experience would be very sitting here uh in a recording studio is very easy for us to say this but when they are actually living it on a day-to-day hour to hour Patient to Patient situation it's uh very difficult how do you think doctors can solve this challenge are there is there through tooling is that through getting a commercial person into the into their organization how have some of the guys who have done it well addressed it yeah see I mean any problem has three components system process people right and so this also requires that it requires all three you need I would say people is the last I think you need a system A system that collects data uh that system could be any system that collects data so you should trust in data that data should lead to processes that you fix in your uh it could be Clinic hospital it could be in your practice and then you have people who oversee those processes if required right so it it flows in this way so you know I think being Guided by data um is being the most important and the collection of data is the most important um and and I've seen that you know what I just mentioned to you is all data that we collected from thousands and thousands of patients uh we were the first ones 10 years back uh who started taking you know feedback about patients stories from patients after their treatment and started sharing that with with the doctors the first few years were very hard because you're the first ones to do it right and so there you know there was like this push back saying why are you showing me all this right because 95% of them were positive but five% showed what they could improve sure and the Improvement was usually around could have the like you called out right the environment could have been better it was too noisy it was you know you know these small small things could have been better uh and there were other things also but getting the data to the doctor it was it was it is we have done analysis we have seen year on year how this feedback has completely changed how things that people used to complain about 10 years back are no longer even relevant today like just to give an example there were a couple of doctors who because of their stress levels and because of so many things they manage sometimes would be rude to patients and they were not knowing that they were actually rude uh but they coming across that way because patients never go back to the to the doctor and tell them that right um but through this feedback uh they would you know share that it could because it could be anonymous it could be and they found a mechanism to pass that feedback back and maybe the team that the doctor had was not again uh strong enough to pass on the feedback earlier but we were just showing them a dashboard where it would on real time they would see the feedback and before publishing we would show it to them that hey this is the feedback would you have any comments and if they had anything we would publish with it yeah and so this kind of data really helps the doctors understand where are they you know where could there be area of improvement because everybody wants to improve and that's how they grow and so you know you already doing well you know every doctor is doing well but how can you focus on the things that you personally need to change and you can understand that better so it starts with data and then that data through a system will allow you to understand which processes to improve which areas to improve and then you can have people to solve that this seems like an expensive Affair like you know because building these systems first of all data collection uh the analytics and then the people around it to be able to deliver the improved experience or outcome seems like you'll have to put as a doctor more money into it which potentially means that in the initial part of making the shift you are actually sort of making much lesser than you would earlier and only over time it sort of results into better outcomes I don't think so uh at least when we look at our data about why do doctors adopt technology or do Nott technology cost is not a factor okay it's usually U mindset which is under do I do I have the need do I do I understand the benefits and two is time right uh that do I have the time to involve myself to take myself out of so it's it's you know and and being in India you know India is the capital for technology is you know technology is the you know and just to give some some more numbers the amount of money spent by uh by in the US on technology is usually around 5 to 10% of the revenue is spent on technology in in which in inth healthare around 5% you know some go up to 10.5 in India if you take the pnl of all public listed companies and look at how much are they spending on technology you'll be shocked it's less than 1% okay and if you go to other and it's and that's the it's not just in the large public ones but across this thing less than 1% of the revenue goes into it and uh or you know picking up tools any tool right and I think that's where there's a there's an opportunity um of course um you know I might sound biased because I come from that domain of it uh but I think that it can give a multifold return if if understood well how to use and if implemented well how to use it can give a multifold return uh and that's where I I think that there's a mindset that you need data yeah now that data could be from any system but you know being data oriented is something that any business will will will see itself as a strength of theirs and that's one area where where Healthcare is you know they they measure a lot of uh uh data around Health outcome I mean clinical outcomes like when a hospital measure how many times has the patient come back what's the length of stay but treatment outcomes that is what happened after after 6 months what happened after 12 months that longitudinal data and more analysis on that that is still starting off now it's beginning to start and when I was you know reading about uh the htech ecosystem it seems like over the next few years it'll be a $50 billion Market there are at the face of it there's enough to prove that uh this is a very very large opportunity and yet uh it's not progressed at the pace at which it probably should have what caused this delay uh Shang because this 1% versus 6 to 7% in terms of spends is it a function of our mindset or is it that the fundamental Tools around this were not built like the data systems were not there aush man bat has only just started happening what were the some of the issues see I I I think this was I would say expected uh some of it is unexpected some of expected I'm taking the whole healthtech ecosystem primarily because you look at Healthcare if Healthcare is the last toop technology okay okay and that is worldwide even though us is where it is it's because it's taken time and it's you know we are probably you know a few decades behind but you know we'll catch up but worldwide health is the the last prodop technology and the reason for it is because Healthcare runs on a single thing that's most important that's trust trust is the most important thing in healthcare efficiency is not right you know that's why people love to wait for 3 hours for a good doctor then get the next one minute available doctor right uh people love don't mind spending a little bit more on Healthcare versus finding a a discount coupon for a doctor right so Healthcare Works differently uh because it works on trust and trust is something that you can't replicate through technology you know overnight it takes time so trust as a fundamental concept takes time to build time to build and decades to build so doctors do that you know by Word of Mouth they treat patient the patient spreads good word and Etc so so then tools and technology and htech has to factored in two things a how do I build products and services that can understand this concept of trust and amplify it incorporate and amplify it and second factor in the time it will take to capture this trust and then amplify it right that's why the the best hospital usually is the oldest Hospital right or the one that has tenard the newest shiny building next door is not the one that you will step into versus you'll do the complete reverse in other Industries where you'll say hey there's this really great place for entertainment or very good new restaurant that's opened up but when it comes to healthcare trust is more important right and so that's why you know two factors one build products and services that encapsulate this trust B factor in the time it'll take it will take decades yeah but then the good news is that those are also Moes yes which means that you know as they say a doctor as the ages only earning capacity only increases increases right and that's how even brands in healthcare work uh a det all is a 150y old brand like all the brands around us which on Healthcare are are decades old right are like people don't even realize it are decades old like even even MRI you think about MRI which year do you think MRI was in was first came into being 1940s I don't know maybe yeah I mean it's that old right I mean it's actually 1980s but it's still 40 years the latest technology we use today in Diagnostics which is imaging technology which is CT and are like 40 years old yeah right but your UPI is how old how old is even credit cards it's so finance and other adopt technology faster uh there are other industries that adopt later last is Healthcare yeah but it's also more sticky right and that's that's and so there are a lot of good things about it that Recession Proof it is you know Evergreen all of those things but it's also last technology so I think htech has a role to play I I personally believe and um you're putting a paper out on this also that htech uh adopts a branch of science which is data science computer science which I think will enhance Health outcomes for the entire world um and this is the century in which it will happen uh there's no doubt about it it's it's just going to take time so if you're going to apply the same timelines of other Industries on health you know that's being unreasonable I I guess so much of what you say is very familiar when it comes to wealth management also right there's so much of that interpersonal understanding and the reluctance therefore to adopt to technology where you know a human being can do it well same I mean we were surprised when we did our analysis you know finally funnily enough wealth advisers were similar to doctors because it's all about trust right and because there's a lot to lose yeah right there is um you know the the phrase we we constantly heard in our consumer research was risk right right because this is something that you know is life so it's funny that you know we have a similar problem no and you know to that end uh the businesses therefore and we were speaking briefly before we started have generally longer gestation uh in this uh in this space uh and yet you know when you talk about the lack of adoption of Technology there seems to be this whole thought process around using data science better uh you know when I was talking to a a htech entrepreneur in the US and he was telling me about so many of these creative ways data is being used where reports are being scanned doctors are getting inputs ahead of time before the patient even sometimes walks in uh what is happening on on that side and the next next uh phase of that is probably artificial intelligence how is that likely to impact the doctor business or the the the profession of medicine yeah if you you know if you ask me 16 years back when I was in my third year of College of Engineering and that I'll be doing what I'm doing uh 16 years later I'd be like the odds are very less and that that won't happen but if you told me that I would enjoy it more now than before I would be like you know that's just you know yeah um uh a fairy tale right and I unfortunately or you know maybe fortunately for me it's true I've never been more excited about the role technology and data can play in healthcare than ever before and thanks to you know whoever wrote that paper in Google on attention is all you need and whoever I mean and and whoever I mean whoever at Nvidia who built those h100s and whoever in uh you know open AI uh who figured out how all this can put together to create llms oh man they've changed the world right and uh it was beginning to get a little stale I'll be honest I know we started off in 2008 when uh we built India's first and even sometimes I think it's also the world's first uh online software for doctors right we were online in 2008 so we built SAS in 2008 wow and then in 2012 we built the first uh doctor Discovery platform right um and then in 200 uh I think few few years later we built the first mobile app right and so after mobile there was really nothing major tectonically happened right there was internet where SAS came in then there was internet penetration through mobile and then there were mobile apps through play stores like app Apple Stores but after that you know and then two and then the last two years and especially last year it's it's unbelievable and I'm pace of change is incredibly high now yeah but I'm I'm just being very specific about this Innovation right and what this Innovation can do for healthcare is phenomenal and and and I honestly I used to hear podcasts about this I used to you know read headlines about this like one more you know some kind of frenzy and you know media frenzy Etc but now I'm using on a daily basis I'm not talking about using chat gbt on for my personal or professional use I'm talking about using that data science or rather those those models in our product and services and I am truly Blown Away give give me an instance of like some of the surprising stuff I'm trying to not reveal too much because uh I need to I know keep uh keep some you know as you can see you know I think I'll give you an example uh we did this um a human brain can only consume so many papers let's take a doctor and doctor has done um has studied X number of books and has uh passed you know neat today's neat exam and then goes on to do uh neat PG then you know meets bunch of patients gets those knowledge and then throughout his years of experience each year learn reads up on CME programs attends CME programs reads up on journals does all of this and he accum accumulates knowledge right now that same knowledge can be accumulated within 3 months yeah all right of course you know what I'm talking about doesn't encapsulate the surgical part yet but just the phys physician portion which is what I spoke about like understanding it's uh it's there now the technology to understand data and convert into intelligence is is here it's not in the future so it's not you know while this word of artificial intelligence is you intelligence is you know different IQ levels but the basic knowledge is there now yeah and it's getting better at an incredible pace and just the number of journals released each year is um at least a thousand times more than the amount of journals a person can read and understand so by default the knowledge that a doctor needs to have is being outpaced by the supply of knowledge by a racio 1 is to, because you can't read everything yeah so you're already so this is creating a way to funnel it and like analyze it synthesiz and all of it right so what I mean I feel the closest I can get to and I'm this is just something I'm just thinking of right now is that what Quant did in trading for example yes um and it's going to get smarter now I'm sure is something that's going to enter into Healthcare now where through data we can for the first time show much better health outcomes um and I've told you offline about some of the results we have seen in our lab of this products that we building and and its efficacy uh it's truly outstanding it's uh it's it's something that I've never seen and I we are now putting some papers together uh which which hopefully we get peer reviewed and we'll publish them on how factually we are able to correlate data science and its impact on health outcomes it is you know so because one good thing about Healthcare is that nobody wants to take any risk right right from the patient or even doctors so they don't want to use anything that is not peer reviewed and doesn't have so every product that they you know prescribe or test they prescribe has been peer reviewed and then they have the confidence that I can now trust this review right they believe deeply in science so we want to use the same methodology to share with them how data science can really impact Health outcomes clinical outcomes how clinical outcomes can be better off with computer science and data science and when that empirical data which we already have and we are now in the process of publishing uh it will then become crystal clear on this being true science leading to clinical outcomes not just convenience and you know um superficial impact on consumers but actual Health outcome impact on on consumers and I think it's only going to get better so 16 years in into the into the space and um I'm extremely excited about next four to 5 years what we can build it's some absolutely kickass products are going to get built some very uh fundamental changes are going to happen in the way people are going to receive Healthcare uh there is absolutely no way that the person I see that in after a few years will a not be able to get the best Healthcare advice in any language they want anywhere in the world at a tip of their fingertip and I'll be surprised if uh the clinical outcomes don't you know significantly improve by providing co-pilots to doctors and by providing access to AI doctors to patients I don't see how that's not going to happen in the next five years so I'm I'm in probably one of the best seats um so I'm very grateful that it's happened now and I'm here it's exciting and the kind of impact that you can you are creating is I think fantastic uh Shang you know it's great for I guess a patient to have all of this available and therefore they will heal faster probably have more certainty of uh healing Etc but now when you look at it from a doctor's perspective somebody let's say who has 15 20 years of ahead of them in their career we are saying that they need to be good doctors they also o need to be good at understanding commercials they need to be good at Pro interacting with patients and now we are saying they also need to be good at adopting to technology in a way that uh they can deliver better outcomes now it seems like very intimidating for somebody who's been around for a while to figure out how to consume all of this change that is happening so what's your advice to doctors on how to adopt uh some of these uh new Technologies I mean you know if you look at the people actually who become doctors they some of the smartest people in the in the country right you look at the ratio of seats to uh the scores and you you're talking to some of the smartest people in in the in the country so I don't think there's any uh you know I'm sure they'll pick up this and more as long as they believe that it is going to be important I'm I'm pretty sure that you know they'll pick this and more um I know most of the best hospitals are by doctors um they are so they have you know they are they phenomenal at picking up uh you know all the different uh components and and running with it uh and you know like any person like you know take an example of me for example I just knew computer science when I graduated then I had to adopt sales skills when I started a business started started a startup then it would adopt you know commercial sense when I started getting investors then it would adopt you know uh uh H skills when I started um adding team members I needed to adopt Finance skills when I started you know uh I need so I need to have good knowledge everything to grow and I think that's the innate Evolution uh of humans that we are able to build tools and services for each other that make it easier for each other to grow and each generation of generation we we pass on that knowledge and we build tools for the Next Generation to make it easier uh and that's what you know so I don't see it as a challenge I just see that the people who adopt first and faster you know get ahead and the ones who are later then you know will also go forward but you know it'll be at a slower pace and they might feel a sense of being left behind but I think it's just about you know investing that time and curiosity to learn um and this is what the world needs and so you know the people who do it will move forward and those who won't will step back I don't think it's in intimidating I don't think it's more complex than biology at least for me I was I wasn't one of the best bi students uh so I think they will quite easily move forward and the best thing about Healthcare is there's no limit there is no limit set that people have to live to 80 or 90 or 100 or 110 so this job is the best job because it has an infinite Horizon yeah right and today they're talking about the first person who live up to 150 years has been born so the best you're in the best business that you can be in because there's no limit right you can there's no and unlike wealth where you can say okay you know what coffe I never heard of somebody who says you know what 60 coffee right I think if they were in good health everybody wants to live and experience this world and uh if Elon Musk is uh successful more worlds uh in this lifetime so uh we're in the best business and tools can only help us get better at what cons patients want and patients want to live healthy lives for a very long time so I'm sure people will pick up the skills required to deliver that no uh you know when you were saying this better Healthcare is actually putting more pressure on wealth management because folks will live longer the money will have to last longer and therefore the portfolio needs to do better than before of course I'm sure you'll figure that out that's that sounds easier than making people live longer I'm sure I'm sure that's for sure your own personal Journey has been fascinating you talked about how you learn different things at different points of time but sometimes we forget that you were a Founder right out of college uh and in a area which is defined by trust uh and I can't even imagine how doctors would engage with a Founder right out of college who is trying to tell them how they can do their job better because of tooling and so on how was that initial experience of uh setting up yeah I mean I know uh I had to pretend a lot so I I remember you know I was in college when I started um I was in my final year and I used to take my uh father's shirts which are outsized shirts um I was trying to grow facial hair um I was trying to look older um and then I would borrow my friend's laptop because I didn't have a laptop um and then I would borrow um you know all of this and the only thing I had was a a two- wheeler um which my parents had you know gratefully given to me so I had that one thing and then I would take that and go off and I would print a card which would say I'm the sales executive right I know pretend I'm working for this you know big company which is very reliable CEO and founder that wouldn't that wouldn't work they like see you us this then company to right so I would have a card I would have two cards right I would have one card which is CEO and founder one card which is sales executive and sales executive I would speak I speak very highly of my management like management but I never say anything wrong like I know say that to somebody else and if they figured it out then I would of course tell them they really asked three four levels uh they would that would definitely tell them and then if the next meeting was investor meeting I would give the CEO founder card if the next meeting was uh the thing I give the sales EX card but for me most importantly was in college I was not really looking to start a company per se I was trying to solve problems I was try to solve like for some reason I just wanted to use my computer science skills to solve a problem and I was just to find who would you know um engage with me and doctors did and they had problems they had problems in uh in keeping track of their patients they had problems in you know like you called called out in sending reminders to the patients about their appointments patients were missing their appointments they had problems with telling keeping track of their patients health records They had challenge in understanding their own time and where they will be what they will be so I saw an opportunity there and I saw an opportunity in how patients lives can be improved if the doctor were to adopt this the patient's life would improve I mean I would want my doctor to use the tools that I'm using so that he would treat me better um so I saw lot of inergy there and you know it just kept going on from there solving one problem to the next to the next to the next and it was kind of a rabbit hole that I got into um I would say that you know uh when I was in college it was much more easier because um I had know you know there was really no I knew that you know when if did not work out I always you know get a job that that that's not in a challenge um but there was no dependencies so you know even if the startup was generating a few lak rupees you know it's great you know so we we had very little uh to lose I remember also going to business plan competition that was my fundraise right I would go to business plan competition submit my actual business as a business plan and then you know go tell them that and then I would I would get the third price I be like the first two are not even you know business I'm running this running a business and you would be surprised how much of my initial Capital came from business business plan competitions wow I I only time I went to MBA colleges was to present business plan competitions because they used to have the business plan competition and so the weirdest moment used to be when uh they would you know I would submit my business plan and I would get shortlisted in the top five and then they would come and pick us up right uh the students would come and they would be like you are the one and yes I'm the one and because I would be younger than them I be younger than the people you know um conducting the event and they would have to call me sir which was also very weird right and um and then I would win the business plan competition some of them not all of them I I think I think I am B1 I did not win um you hold that against us I should I should go and check up on my records I won a couple I think in Delhi I won one or two so anyways so we won those competitions and that cap that became capital for us because they would you know give you 50,000 Rupees for you know a business plan competition so and and which point did you realize that this is now a serious thing that's happening because you said there was a plan B in the sense if it doesn't work out you'll go and get a job but at some point you felt okay now this looks like a real company happening what were the some of the metrics or some of the indicators that felt like now practor can be a large business I don't think that and I think at the starting it was not about it be a large business and I was 21 uh we were in 2008 after the Meltdown Financial Global meltdown Leeman Brothers had gone of out people were giving pin slips everywhere and I had not sat for my college placements um so I decided very heroically that I'll I'll not sit for it I don't want to have a plan B Because if you have a plan B there's no plan A sure uh then after 6 months of all companies coming and going and all my friends being placed and everybody in my badge being placed and going off to go and other places to party I was sitting in sitting in Bangalore trying to sell this product to doctors um and then after 6 months I thought you know what's the harm so I I went to college uh I took the first overnight bus to college I landed up which the first company that came in I sat for it luckily I got through evening bus I took I came back so I had that option um after 6 months of placement so luckily that company came um but what what uh what gave me conference was after the first year just as I was to join that company I was sitting and I was thinking that hey I really enjoy this right there's a lot of hard work uh you know and I used to go I used to see my you know my seniors and we used to go meet them and everybody would come to this uh Picos uh in mg Road right and they would always complain about their jobs right they would say this what I'm doing itself sounds not too bad yes you know I you know doesn't earn money but uh I don't have too much I'm just coming out of college right so I don't have you know too many Ambitions only thing I had to do was switch off Facebook uh switch off all these uh places which would show how others are doing and just focus on what I'm doing and I I just genuinely enjoyed what we were doing like I was learning new things while coding I was learning new things while selling and and doctors really and the one thing I remember couple of doctors when I sold them the product in my final year told me and remember the two doctors um who told me that um and this one one dentist um he told me that sh you're too smart for this I've seen many come before you and they've all you know like gone away they taken my money and ran away I'm sure you're one of them you'll be like that because and yet he gave you money yet he gave me the money right and that's the large heartedness of doctors um not just one three of them they said I have bought five softwares before you they've all come and gone away they have all sold me this pitch and gone away you are smart you'll go to the US it's 2008 you know you'll clearly go to the US um you're studying from a good Institute so you'll definitely do your Masters or whatever yeah you're going to go away then actually some of them and I still pay you some of them said you should go away right don't do this some of them even called me to the side Dr J jish C I remember he called me to the side and he said that see you I have paid you for a year you've done this for a year now don't do this you too good a good a person right go because this is not a good business right and so that was also in the back of my mind right and I was like hey you know they've trusted me right and by that time we had 100 doctors right who are using our software and I was having fun learning so I was like what's the worst thing that can happen let me let me keep uh keep pushing and there were hard times there were really hard times like this is before any funding right and this is when 2009 startups not even a word right it was um you know money would be given to a large established people and we were 21 year 22 year olds so I had no hope but I was just enjoying myself and I was doing it just from that standpoint never really thinking it'll become big or whether it'll become I just genuinely enjoyed meeting doctors solving their problems building a good product getting good feedback solving the patient problem I felt there was meaning in that um and uh naturally what happens happens right uh and so there was no there's no hope that and I also used to meet investors which would be even more demotivating because they were like what is Tam I say what is Tam I like you're not even going to MBA I'm like no I'm not an MBA so they're like you should know your Tam yeah I know literally you know you have seen Silicon Valley or you seen these sitcoms it literally you know used to be like that where I be like buzzer you know these Buzz wordss be thrown at me and I would feel very awkward so we we got about a thousand customers or something like that without a single investor um and um so we would have continued and you know you know curiosity was what driving us it wasn't any large outcome or let's build a large company it was just curiosity the the other fascinating thing is that given how much Capital it takes to build trust uh for you to now turn probably India's first profitable htech company right and certainly in the VC funded ecosystem what are some of the learnings from that particular Journey that what is it that worked U at a certain point of time was the kex sort of played out and therefore the profitability came or some optimization on marketing Etc yeah there are two ways to see this yes we are one of the first few to turn profitable um in the he Tech space and uh you know we want to do to show that healtech can be profitable it can it can grow and be uh you know profitable you know all the way down to the eida level and cash level um but I don't think um you know I think I could have done a much better job uh for sure uh I think I ended up raising much more than I needed um but all this comes in hindsight sure I made a bunch of mistakes and I think my Capital efficiency you know before 2018 mhm was like I wasted 80% and after 2018 because I wasted 80% I you know I've been like 100% right after 2018 um or maybe 95% plus right the efficiency of use of capital uh wastage has been you know maybe 5 5% or so but that you know still hurts me uh that I could have done a better job uh between the 2016 18 18 period and that those learnings are what I take forward right I I have um failed in so many ways that you know I I find that failure is a learning you've done once it's a failure if you do to 20 twice right so luckily I feel I'm not repeated a failure or a learning twice um but yeah I've had those learnings and so those learnings have been helpful so I feel even those companies today which are going through a similar phase where they might have raised lot of capital and they have um they little ahead uh you know on the valuation um I think there's hope right I think um I have been there I have had that in 2017 and 18 where there was just too much Capital that I had raised valuations were high but then if you put your head down and focus on what is truly uh worthwh you can turn the company profitable I mean you know you need to have the right products and services for which um so the learning for me was that you know um perseverance is a very big component of it um don't get distracted um even during 20091 I would not get distracted by Facebook or any of these tool same thing in 201819 cut out all the noise from outside there'll be a lot of noise people will push you up and then they'll pull you down and they'll push you up again covers and all of that so those are all need to be you know distant from um and yeah and and then uh um I think Health Tech is one of my you know like I feel that you know where where else you get a sector where you can make an impact on your family members and earn money from it right I mean very few sectors are all for that yeah you you're literally increasing the lifespan of your family members like who doesn't want their parents to live longer your grandparents to live longer your children to live longer longer your spare friend to live longer and you're doing that on a day-to-day basis and you are also creating uh you know value for all the uh shareholders so it's an absolutely brilliant space um I think it just takes more time so if you if you thought that a startup takes 5 10 years this one takes 15 20 25 years but the good news is that um the extra 10 years you need to put in because it gives you some extra it gives you a lot of meaning and value yeah and creates modes like you earlier said yeah uh you know it's been a fantastic journey I was reading your new uh letter uh and it's it's very well written I must say it's covered like how medicine has evolved over a period of time you have over two lakh doctors crores of patients God knows how many consultations uh shash it's been fantastic seeing the journey from the outside and I remember meeting many years ago and being fascinated by what you building and continue to be uh thank you so much for doing this thank you so much for having me over