An open letter to health entrepreneurs

Jae Won Joh is a newly minted M.D. training in emergency medicine.  We tracked him down on Quora.

Dear health entrepreneurs,

Throughout my journey in medicine, I’ve been asked countless times why healthcare moves so slowly. Many of the same technological challenges have existed for years, if not decades, and despite numerous attempts to invade/disrupt/revolutionize the healthcare space, these efforts have altogether been more amusing than fruitful. Despite having so much bait around, most clinicians just don’t bite.

Regulation and funding issues aside, this apparent apathy when it comes to novel health products is at least in part due to two fundamental differences between how you and I think. If we’re going to work together, it’s about time we acknowledge that these differences exist, establish why, and figure out how to deal with them.

First, my threshold for allowing error is insanely high. My job doesn’t give me the luxury of beta testing or iterating. When your work is faulty, your site might go down, customers might get angry, you might lose money. When my work is faulty, people die. Call me OCD, call me conservative, call me whatever you want, but if you want me to use something new, it needs to have an error rate at least equal to, if not significantly better than, the status quo, preferably with data to back up that assertion.

Solution: Lengthen your product timescale, and make sure everything has a level of polish that puts doubts to rest, particularly with clinician-targeted apps. The “move fast and break things” motto that worked for Facebook does not apply to healthcare. “Be deliberate and test everything” is probably more appropriate. When you give demos, take the time to explain and prove that you went the extra mile. For example, if it’s a secure messaging app to eradicate pagers, explain basic cryptography and show both the completely incomprehensible garble that results from your encryption as well as the flawless retrieval at the other end. Reassure us that your servers are HIPAA-compatible with backups ready at an instant’s notice. Make sure the safeguards to prevent data leak in the event of a lost phone/laptop are front and center in your presentation.

Second, if you’re going about product development by thinking “this could be cool”, instead of “This fulfills a pressing clinical need better than anything else out there”, you’re doing it wrong. Just because a piece of hardware/software can be made does not make it clinically useful or interesting. It’s admittedly quite nifty that for under two benjamins we can now create a device that measures my heart rate, temperature, and oxygen saturation in 10 seconds by putting it to my forehead. Clinically, I couldn’t care less, and I don’t think the vast majority of patients should either. Anyone can get their heart rate in 15 seconds for free by putting two fingers on their wrist/neck while looking at a clock and doing some basic math. They can get their temperature at the same time with a $10 thermometer from Walgreen’s. If they don’t have a lung condition and they feel ok, their oxygen saturation is almost guaranteed to be 98-100%. Even being in the low 90s generally feels incredibly uncomfortable, and healthy adults don’t go that low without serious problems, so if someone feels this way, it would be wiser to just call 911 instead of wasting time seeing what a device says, particularly since an O2 monitor can be fooled by emergent conditions such as carbon monoxide poisoning.

Solution: Make your product so clinically compelling that physicians want to use it and maybe even “prescribe” it. While pricey, the Withings Scale, Runkeeper app, and Sanofi’s iBGStar device are fantastic examples of this. For a less expensive example, watch this TED talk on a simple diagnostic test for anemia. If your product clearly provides meaningful health benefits in realistic scenarios, I will want to use it without much convincing, and chances are I’ll be more than happy to become an evangelist.

I hope this has helped clarify why I view just about every new health startup with a cautious eye. I’m not against change at all; in fact, I have tremendous respect for your abilities. It’s just that, if you come barging into my domain without adequately considering patient safety and product quality, I will lose all respect for you. I get it; we both belong to peculiar, and somewhat arrogant, fields, and we both want what’s best according to our worldviews. But let’s try to meet eye-to-eye, or else we’ll get nowhere.



Jae is a newly minted M.D. training in emergency medicine. He enjoys bacon, sleep, and shiny things, and also expands to four times his normal size when placed in water.  Catch up with him on Quora and on Twitter.

 This post is above is strictly Jae’s opinion and does not reflect the position of any other entity.

Photo by Paul Simpson.