Medical Student Entrepreneurship

With Motics, it really was born out of a personal frustration — my dad needed physio. Back in 2014 he had pains down his legs, went to the GP, and they said it was sciatica and he'd need physio. They did the classic thing: here's your sheet of paper, do your exercises, see your physio, see what they say.

It took him two or three months to get a physio appointment — those waiting lists are horrendous, we know that from the inside. And even after he saw the physio, they said the same thing as the GP: here are the exercises, keep doing them, take your painkillers. In classic dad fashion, he took that piece of paper home, put it on the fridge, and never looked at it again.

Seeing that, I realised he just wasn't doing his physio, and his pain never got any better because of it. He was in pain, taking painkillers to help but not actually addressing the problem — partly because the state of physiotherapy isn't quite there. Adherence is such a big problem: people aren't doing the exercises despite their physios telling them to. So what we try to do is tackle that root cause of adherence to physiotherapy.

It's really bad. The standard adherence rate to any medicine is typically 50%. For physiotherapy, it's 30%. And there are so many reasons when you dig into it — psychological factors, like higher rates of depression and anxiety among patients who need physiotherapy; sociological factors, like certain groups being more likely to do their physio than others; the whole physiotherapist–patient relationship; observation behaviour. It gets really complicated in the psychology of it.

So what we do is break down a lot of those layers and get to know the patient at a deeper level: we want to understand what's going on and how we can help you do your exercises. Is there anything we need to change to enable that to happen?

A couple of ways. The big one is through a wearable. You put on a device and it gamifies the whole experience. Rather than the standard "move your arm up, down, left, right, ten times in a row for weeks on end", you simply put on the device, play your games for 20 or 30 minutes a day, and after a couple of weeks start seeing improvements.

What we're doing on the back end is that we've got sensors embedded inside that sleeve, so we can see exactly how well your muscles are working — and we can also stimulate muscle function. In real time we know exactly how well each muscle in the arm, the leg, the back, whatever we're looking at, is working, and we optimise your therapy on the fly. We combine that with advanced software behind the scenes — a bit of machine learning to track your recovery over time — and some simple psychology. We think about when we send notifications, trying to almost pretend we're human. It comes back to observation behaviour: if your physio is watching you, or tracking your activity, you keep going. Even though it's actually a bot, it's quite easy to convince a patient that someone's watching, and that they should keep up with their physiotherapy.

Exactly. There are a couple of big companies that have tried it, but a lot of them are still struggling with the same problem: how do you really get people to do their exercises? You can get them to download an app — that's not the issue. It's the adherence. How often will they come back to it and keep using the platform?

Well, the question is: do they want to do it? On a deeper level, people do want to feel better about themselves. All we try to do is find out what's stopping them, because there are a lot of barriers we put in front of ourselves — "I can't do this because it hurts", or "I haven't got the time of day." Our first layer is just breaking those assumptions down to their base level. It's almost a bit of CBT, in some mild form — saying, what's actually going on, let's get to know you.

A lot of the solutions out there are so generic: do this many a day, and that's it. They don't treat the patient as an individual, which is the whole point, because that's where you get the better adherence. And we're already starting to see much better adherence rates with our platform.

It's not an easy process. I'd say the two things you need are an idea and a good team. The moment of inspiration — and I love this story, and it's true — was when I went home from university one weekend, opened the door, and saw my dad playing the Nintendo Wii. He'd set up my old Wii from when I used to play it, and he was playing Wii Bowling and loving it. I've actually got a video of it. He was lunging around, having a great time — and he found the gamification made it far more enjoyable to do his physiotherapy, in inverted commas.

So we thought: how can we turn this gamification, which clearly works, into something beneficial — not just for patients but for physios and doctors, so they can see the recovery and get patients to complete their physiotherapy so they don't come back with the same problem again and again? One in three GP appointments is musculoskeletal, and it's often the same problem because people aren't fully recovering the first time. So we're trying to nip that in the bud right at the start.

There's no right answer, and every team has a great story behind it. For us, we met through an incubator programme in London called Kickstart London — for ambitious students who want to get involved in the startup scene. You apply as an individual, form your team, then form your startup. So I applied with this idea of solving the physiotherapy problem, and I met three fantastic co-founders. One later wanted to leave, but there are still three of us going.

We've all got that diverse skill set we bring to the table. It's not three medical students — and that matters. One of the problems when I had a different team early on was that because we were all so similar, there was no diversity in skill set, and you can't push further than the skills you have in the team. You can solve all the medical problems, but you can't solve the engineering ones. So now you've got me from a medical background, Salinna as our engineer, and Peter as our CMO with expertise in marketing. That trio of skill sets pushes us forward without having to do any hiring in the first instance.

The perfect one is a hardware solution. As background, I did a bioengineering bachelor's in my integrated year for medicine, so I know enough engineering to have a good conversation with an engineer. But I tried to design some of the hardware myself — not a great time. I couldn't figure out half the problems. Salinna came in and basically designed the entire platform in three days.

That's the beauty of it: the co-founders have such diverse skills, and you bring them together and push each other forward. You're covering each other's — I don't want to say weaknesses — let's say the areas people are stronger in than others. If I'm stronger in medicine than Salinna, I cover that; if Peter's better in marketing, he covers that. So as a team we address the areas we need to, to push ourselves forward.

Oh, that's a tough question — and your audience is all medics, so I feel like I'm going to make some people very angry here.

I think medicine is very good at two key domains. One is scientific knowledge: we're very good at memorising lots of facts, learning how the body works, and in many cases thinking from first principles about how things work. The second is the human-centred aspect, which in health technology you absolutely have to think about — how does the person at the end interact with what I'm making, and how does it help them at a deeper level? You have to show empathy, which medics are fantastic at, because that's most of the reason we got into medicine in the first place. Those are our strengths, for sure.

In terms of areas for development, lateral thinking is one. Particularly in my bioengineering year, a lot of the engineers I worked with could think so laterally — take one concept and think, what if we tried it this way, and that way, and another way? That's where the really funky, really cool new ideas come out.

It's tricky, actually — we're actively doing that right now with our marketing campaign, so we're very familiar with A/B testing.

It's good to see the scientific method being applied more and more in business. That was one of the biggest shocks for me coming into entrepreneurship: how often assumptions are made but not validated through any scientific hypothesis. It's just, let's try this and see how it goes, without any data. That's very different to medicine, where we don't make decisions without data, because there's data everywhere. Getting into the fray of "how do we make a decision without any data, what's our first step?" — that's where marketing comes in, because ultimately they say, let's try all of them and see what sticks. That was probably one of the biggest things I learned early on: just try everything, then go with what works.

CodeMD is the platform. I had the idea in about third year of medicine — 2017 — because I was trying to teach myself to code. I was passionate about learning new skills in every area, so I taught myself, starting with machine learning, because I thought that's a hot topic, let's go for it. And I found it so difficult. There were no resources out there for people interested in coding or innovating specifically for healthcare — how, as a healthcare professional, you can apply your knowledge and use coding to speed something up or discover something in an area.

So what we're trying to do at CodeMD is be quite niche: focus on the group of healthcare professionals who want to learn to code for healthcare specifically, to push forward our ability to care for patients — through code, and through simple innovations like streamlining pathways through A&E, or automatic triage. Things you can solve with a few lines of code that can have a great impact on patient care. Essentially, we give skills to the people who see the problem day in, day out, and let them create solutions. That's the tagline for CodeMD, really.

It depends on the individual. For me, I've always been interested in trying new things and experimenting — I've got an idea that some intervention might have an effect on a group of people, and most of the time it's an app or a website. If I didn't know how to code, the alternative is I pay someone to do it, or find a friend willing and gullible enough to do it for free. And at the end of the day they still won't produce exactly what you're looking for — it's their interpretation of what you want, not the same thing.

If you've got the skills to make what's in your head and test it yourself, you can validate your hypotheses far quicker, go through all your ideas and see which ones actually work, without shelling out thousands for a software developer or going through all your friends.

I agree, yeah. This is one thing we realised on the journey: medics aren't going to be software engineers by trade — that's a fact of life, at least in our current state. But the point is to foster the sense of innovation in healthcare. The NHS is limited by funds and being pushed to its limits, and we're relying on technology to help that system. If we can optimise a triage system — a huge problem in the NHS — with a simple bit of code that analyses your symptoms as you come in the door and saves, say, an hour for every patient, small things add up.

So we're really trying to foster that sense of innovation, and also let medics talk to software engineers and hardware engineers — give them the skills to have at least a basic conversation and realise what is and isn't realistically possible through code. Once we get that sorted, it'll be interesting to see the results.

There are a couple of good books I'd recommend. The first is Trillion Dollar Coach, about Bill Campbell — written by Eric Schmidt, who was CEO of Google. The other is The Hard Thing About Hard Things by Ben Horowitz. Both fantastic, and I read both as I was starting Motics — they shaped it into what it is today.

They made me think about two things. Trillion Dollar Coach made me think about the value of the team, and how to get the most out of high-performance teams. And The Hard Thing About Hard Things teaches you the basics of startups, which you need when you're starting out. As a first-time founder, there's a lot you don't realise when you start — you realise a lot through the journey, but by then it's too late for some of the big problems. Reading those books to get a feel for the land really helped me get ahead and be clued up before I jumped in.

Every day is a new challenge. One day it's a software engineering bug — a critical one where our entire system is down, which has happened. The next day it's a team issue you've got to resolve. Whatever the issue, the biggest lesson I've learned is the value of communication in the team. The stat is that 90% of startups fail, and I'm assuming the majority of the time it's poor communication between founders — a big, big reason startups fail.

So my biggest learning has been: how do you talk to your team, how do you make sure the team works well? It comes back to Trillion Dollar Coach, because it's all about Bill Campbell being essentially the coach of Apple and Google — two of the biggest companies in the world — and he said the same thing: communication is how you turn a high-performance team into an amazing company.

I wish I knew. This isn't a typical journey. I'm at the end of medical school with exams in a few weeks, and it's essentially a decision point: do I go into medicine full time, be a doctor and go through training, or do I do Motics full time, or half and half, or anything in between?

I always look at my internal mission and what I want to be doing, which is to improve human health in whatever way possible, to the maximum effect. If that's through technology, which I love, then so be it. For me it's about where I can have the most impact. So I haven't set any definitive answer as to where I'll go in the next couple of years — it's essentially wherever I can have the most impact on human health.