Life of a Doctor-CEO

Of course, and thanks for having me. It's always great to talk about life as a medical student — the amazing opportunities it provides, but also the up-and-down journey that comes with it.

When I was a teenager, I didn't necessarily want to go into medicine. I was more interested in business. But I did a piece of work experience at Ealing Hospital, on a cardiology ward, with a really passionate F1 doctor. He showed me how what we're learning in the classroom was really applicable in real life, and also the amazing impact you could have — someone who'd had a heart attack, just giving them some relatively common medications, could allow them to live a very independent, quite healthy life from that point onwards, and radically improve their life expectancy compared to what otherwise would be possible. It was amazing to have my eyes opened to that. I then applied to medical school, went to undergrad, and I think got quite caught up in the books.

All of the science behind medicine — biochemistry, pharmacology, anatomy — I really enjoyed. I loved the opportunity to understand how different parts of the body work, and how on the frontiers of science you can be quite creative: you can come up with hypotheses for the areas we don't yet understand, how different parts of cells and physiology might piece together.

At the same time, I became very involved with different societies — working with charities, and eventually running them. Ones that supported students to visit older people and people who were housebound, so they could have greater companionship and links to the community; ones that organised events funding students in countries such as Malawi through their training, who otherwise wouldn't be able to afford it. That gave me real insight and exposure to a more managerial role in healthcare, and the impact a person can have by working in teams and guiding or leading them to have a broader effect on people's lives.

Because I think sometimes in medicine you can become very focused on the opportunity right ahead of you — clinical practice, serving in clinic, looking after the patient in front of you. But there are so many other avenues a medical student can pursue: academic research, where what you find can have an impact on many people; working in charities and nonprofits; or having a more innovative, technology-driven view of healthcare and being involved in startups. That breadth is something I'm really passionate about, because I think it's possible to thread some of those opportunities together and have a really exciting, compelling, but also profoundly impactful role in healthcare. My time in medical school definitely had lots of twists and turns — I probably went into it thinking I'd become a surgeon, and I left it in a very different position.

Yeah, I think it still does. In every medical school the course might be structured differently, but the core is the same: understanding the human body and the science behind it, spending time with clinical teams, looking after patients. Those are the key building blocks of any medical degree. But it's what happens on the sidelines and the frontiers that can be most exciting.

I did my undergrad at Cambridge, and yes, it was quite academic in its focus, particularly in the first couple of years. But I still had the chance to meet students from other backgrounds studying other courses, to get involved with different societies, and to try to get involved with some research. That already started to get the creative juices flowing and had me exploring avenues of healthcare and medicine which, before medical school, I'd never really thought about.

It's hard to pinpoint. As a general principle, I tried lots of things, and I also failed in a lot of different ways — but those difficulties and the experiences that didn't work out were the ones I learned from the most, and, looking back, were perhaps the best learning experiences.

I studied abroad for a year in the US, on the East Coast, and became involved with a research project. I was working day and night comparing health systems from Europe to the US, because at that point Obamacare was being rolled out, and a key policy question was whether the insurance changes — where a much greater proportion of the population had to get insurance — were the right way to go. Looking at other models such as Switzerland and Germany provided a lot of insight: universal coverage, or approaching universal health coverage like we have in the UK, is a clear way to improve the health of a population, reduce inequalities, and is overall economically very justifiable.

But ultimately that piece of work didn't even get published. We'd originally aimed for a top journal like the New England Journal of Medicine or JAMA — I was working with a Harvard Business School professor and also someone who formerly ran the Swiss health system. It didn't get into those two journals, and then priorities moved, the political climate changed, and it wasn't as timely as we'd hoped, so we moved on. But through the relationships I formed with the senior researchers — and with the Swiss-based professor who not only led the Swiss health system but had also been vice chair of the WHO early in his career — he later gave me other opportunities. Having seen my commitment to learn despite sometimes making mistakes, he supported me in getting roles with the WHO and with the Swiss government, which I learned a tremendous amount from and which served as key stepping stones in my career.

That's an example of building collaborations that last well beyond medical school. A specific project may not work out over a couple of months, but it's thinking about the long term that counts. The collaborations I forged with the WHO and the Swiss government only came about when I was a doctor, after I left medical school — even though a lot of the effort went in years before. You never know where things are going to land, but forming a robust network and demonstrating that you're committed, that you use the right values, that you work hard and try to learn fast — that can be invaluable, even if the project itself doesn't work out.

Even if a project doesn't work out, it's how a person goes through challenge and adversity that shows their true colours. If you're persistent, if you don't give up, if you keep looking for new solutions or explore other opportunities, it shows you've got a can-do attitude and that you're resilient — both key characteristics to succeed and make waves in any sector, but especially in healthcare, where innovating or pioneering often involves going against the grain. Showing those qualities to the people working with you, who may have access to many other opportunities, can be the most important takeaway from a given project. If a project is a dud, sometimes that's okay — because if you prove yourself and demonstrate you can be an effective partner, those people will come back to you when they have an opportunity or another project they think you're right for.

Even if a project doesn't succeed, ensuring you've still got a collaborative relationship with the people you were working with — one that's still fit for the future — that's what the priority should be. And in medical school, you're at the very beginning of your career; some of these relationships last a lifetime. I still have research projects with the F1 I did work experience with when I was 16. It's been a decade and a half, and we're still working together — spanning charities, nonprofits, research, quality improvement, and a lot of publications. That collaboration has borne great amounts of fruit.

Investing for the long term when you're at the beginning of your career is really important. It can be easy to get caught up with short-term goals — you've got exams at every corner, job applications for foundation jobs a few months away — and you want to tick off the relevant boxes. But healthcare is a lifelong contribution; working as a medic is a multi-decade career. So at the beginning, really try to sow the seeds that set you up for long-term success.

Just like with friends, you're not going to get on with everyone. But there'll be some collaborators where things click and you think, wow, this person's a great inspiration, there's an amazing amount I could learn from them — but I also believe I could contribute to their projects. That's a win-win, and those are the collaborations you want to nurture.

Those are relationships where you want to catch up regularly where possible — update them on how things are going, while seeing if they've got any other projects to work on together. There will also be collaborations that don't work out, and they can be quite difficult to salvage. But it's always possible to have a coffee and a positive catch-up even if a project hasn't worked out, so both people leave thinking warmly about what happened, even if the outcome wasn't the desired one. At the beginning of your career, it's important to be collaborative, to work with as many people as you can, and to keep people on side.

Just before that — while I was studying in the US, my neighbour was working for a VC fund focused on health tech investments. This was back in 2011–12. He got me to start advising them on the different deals and companies they wanted to back. That gave me a great insight into the power technology has to revolutionise healthcare. This was a time when companies like Airbnb, Uber and Facebook were all really taking off, changing the world on an almost monthly basis. I thought, what if technologies like that could have a similar impact on healthcare? That could be revolutionary — for people's lives, for the way we practise medicine.

At a very granular level, I was supporting my friend on the different health technology investments he was thinking of making, seeing how these companies were trying to pioneer very specific parts of healthcare. And that's another long-term collaboration — I still work with him now. When I came back to the UK, I was really passionate, and actually dead set, on using innovation in healthcare for the better — for the health system, patients, healthcare professionals and other key stakeholders.

Then, quite serendipitously, after practising as a doctor and being involved in different innovation and research projects, I started to work with Simon Stevens, the CEO of the health service, advising him on how the NHS could better embrace new technologies — ranging from digital products and apps, through to data algorithms, through to devices. Because the NHS is under tremendous pressure: demand is only increasing with an ageing population and more long-term conditions, and yet the funds available remain quite limited. So how can we do more with less? That's only really possible by doing things differently — and that's where innovation fits in. Technology is more affordable than ever. People can be at home on their laptops and cook up an app that helps someone with their diabetes management or their CBT treatment.

It's amazing how democratised healthcare has become by virtue of the internet, digital and data. I thought there was a real opportunity for the NHS to become an ecosystem that allowed entrepreneurs and innovators to thrive and build these new solutions. That's what I worked on at NHS England — I co-founded a number of programmes there, such as the NHS Innovation Accelerator, trying to support entrepreneurs in scaling their solutions across the NHS to benefit patients but also reduce costs.

After that, I trained in public health, got my membership, and saw an opportunity in elderly care. I'd supported many technology startups working with the NHS, from small ones to multinationals, and I noticed a lot of these solutions focused on younger or middle-aged people. They weren't really focusing on older people with multiple health conditions — who represent the majority of the disease pressure and the majority of costs for any health system. And yet the amount of digital intervention had been minimal. That struck me as a mismatch.

At the same time, working on the front line, I could see older patients ping-ponging in and out of hospitals because they kept getting recurrent urine or chest infections, or had falls at home or in care homes. In many cases these could have been prevented with better support in the community — the person could have been better looked after with better outcomes, and the NHS could have saved funds and alleviated pressure on the front line. Putting this together, I decided the area where I saw the most opportunity to make an impact was elderly care.

So I co-founded a company called Cera, which is what I run now. We wanted to use technology to bring a new model of home care, where we organise for carers to look after older people in their own homes — keeping them well and healthy there, ideally increasing the amount of care delivered in the home so that health deteriorations and hospitalisations can be prevented, all driven through technology.

We launched Cera three and a half years ago and have grown incredibly quickly. We now have over two and a half thousand employees and about 23 offices across the country — we're in England and Wales, and about to expand to Scotland. We've taken on about $90 million of investment from capital partners across the world, and we're one of the largest health technology companies in the UK and Europe by employees and revenues. It's been a rollercoaster journey.

It's also great that we've been able to step up significantly in the effort against COVID-19. Even today, I'm very happy to say we've delivered over 1.2 million care sessions during the pandemic without any COVID-19 deaths under our care — even though we're mainly looking after older people, and deaths amongst older people, particularly in care homes, have been a real issue in the UK. Through the power of technology, Cera has been able to provide a higher-quality service and really serve the older people under our care.

Simon and I hadn't met before, but we'd had a phone call when I was in the late stages of medical school. I cold-emailed him when he was working in the US, saying it'd be great to get some advice — and I was quite persistent, nagged him a lot. Then a couple of opportunities came up to work with him as he started his new role in the NHS. I applied, and was pretty lucky to get that job as a senior fellow, advising him in the very early days of his tenure as CEO on building a five-year roadmap for the NHS — the Five Year Forward View.

I was there from the very first meeting we had on that — identifying the different work streams, the conditions like cancer, mental health and diabetes that we thought were real priorities, all the way to leading the innovation, research and technology parts of the Five Year Forward View, outlining the steps for the NHS to become an ecosystem that supported innovators. From that, building programmes with Simon, learning from him as a leader, identifying challenges people on the front line and patients were facing, and trying to solve them using technology. It was amazing — but I was thrown in the deep end. I'd just finished F1. I'd never spent a day in policy or politics, and I didn't really know much about management or large organisations. I had to learn the hard way in many respects.

Everyone had to start somewhere — most people in healthcare were medical students, junior doctors, management trainees or student nurses at one point. So they really empathise with individuals who are ambitious, keen to learn, and committed to improving the health system, and they understand you may want advice from people who've made mistakes themselves.

When you email or call someone, what's important is conveying a sense of passion and motivation — why you're reaching out to them, and why healthcare or medicine is something you really enjoy. That sense of purpose, that sense of drive, is key to get across. And if there are things you've done in the past that reflect your commitment to the health space, communicate them.

What I'd also add: if you've got a specific question or two, outline them. Say, "I'd really like to pick your brain about this," or "I'm at this point in my career and I'm thinking through what to do next — I'd really appreciate your advice. I know we haven't spoken before." It's helpful to articulate that, so the person understands your motivations, can see you're serious, and can see what you want answered and how they can be most helpful. It also helps if you bump into them in person — at a conference, or if they're speaking somewhere and you go up at the end, or if someone can introduce you. And be persistent: sometimes it takes quite a few phone calls or emails, but it's almost always worth it.

As medics, we understand the academic background to medicine, the interactions with patients, the communication skills to support patients through their journey. The areas where we can learn more are, firstly, how we work in teams. If you think about people in large companies, consulting firms, or even sports teams, there's a lot of emphasis on how they collaborate. Studies have shown that when doctors and clinicians are given team training, it can dramatically improve patient outcomes, particularly in surgery. When you jump into policy, you're liaising with many people across a very large organisation — which isn't something medics are necessarily familiar with, given we're more used to smaller, multidisciplinary teams on a ward or in a GP practice.

That team-training element links to understanding the importance of culture and leadership — how to become an effective leader of a larger organisation, understand where stakeholders are coming from, and align them behind a policy change. The other part where medics can grow is understanding the health of populations. We've seen during COVID the massive population-health impact — introducing behavioural change, social distancing, even lockdown measures. With smoking, obesity, lifestyle-related conditions, it's clear what the impact of population health is. At a policy level, understanding the needs of a population and the tools to improve it — in hospitals, in communities, or supporting people in managing their own lifestyles — is really important.

So jumping from a frontline role into policy, the two areas I had to grow into most quickly were working with stakeholders and larger organisations, and appreciating the health of populations — what the drivers are, and what levers we can pull to help people live more healthily and transform a health system, rather than focusing specifically on the person in front of me.

The patient in front of you involves understanding their symptoms and history, running diagnostic tests, communicating effectively, working out a management plan, and supporting them over time. At a system level, you're still thinking about the individual patient, but you're also considering health inequalities, different demographics, and how the different parts of the system connect. How do primary care and GP practices work with hospitals and specialist services? How do hospitals collaborate with social care and care providers? How can we encourage all these organisations to work more effectively to drive improvements in patient care? Sometimes the person on the front line thinks what they're doing is most appropriate, but when you step back and look at the whole picture, it may not be congruent with where we want to take healthcare.

Technology is a great example. When you roll out a new technology, there are wrinkles to iron out, parts of the user experience not yet figured out. Rolling it out on day one may not be beneficial for the patient — the patient and clinician have to get used to it, taking time out of their day when they could be seeing patients.

But across a three-, six- or twelve-month horizon, that technology is better for the patient and better for the population — because, say, the doctor can track the symptoms of multiple patients at once, so their time is better utilised and they can be more proactive. There are trade-offs between the individual and the system, and it's important to understand both so those trade-offs can be made effectively. More recently we've had very difficult discussions around COVID-19 at a national level — even around herd immunity. At the beginning there was confusion and decision-making around whether people should become more infected, because even if more individuals are affected, if you reach herd immunity that's beneficial for the population. Eventually the decision was made to go into lockdown — arguably we could have gone sooner — but it's some of those difficult trade-offs and complexity that's important to understand and move on quickly at a national or regional level.

It's been a really steep learning curve, and this is my first startup, which made it even steeper. At the beginning it was myself and our co-founders doing everything between us — calling the carer, meeting them, seeing the older person we were looking after, manually organising shifts, meeting investors to raise funds, doing spellcheck on the website, negotiating the office contract, figuring out which co-working space we'd be in for the next few months.

As we grew, our roles became more strategic — setting the direction, outlining the strategy. Hiring is extremely important, because every single person you bring in affects the organisation's DNA. In a small company, every person makes a big difference, so getting hiring right is extremely important. Working out the right structure, budgeting, the allocation of resource — that becomes more of the priority, along with managing the core team through regular catch-ups.

Then, as the company reaches its next stage of scale — from tens of employees to hundreds or thousands — it's impossible for me as CEO to be everywhere at once. It's not like before, when I could meet every single person we hired, be in every interview, be in the majority of meetings.

It becomes much more about achieving scale, and scale can be achieved in three main ways. One is setting the culture. Two is having clear processes and protocols. Three is technology. A lot of my effort goes into these, and for me personally it mainly goes into the first — setting the culture. Because if the organisation has the right culture and the right values, people know what the North Star is. They can make decisions themselves, day to day, without me having to give guidance. Of course, if there's a complex decision, I'll be involved, and I'll be there for the people I manage directly. But across 20-plus offices, if people know what the compass is, they can make decisions much more effectively and in a much more scalable way. I'm then not slowing the organisation down — I'm enabling it. So a huge amount of focus goes into building culture, ensuring people are aligned, setting the right leadership tone and cadence, and empowering people so they feel safe innovating and taking risks, but also delivering great care.

When it comes to processes and technology, that's where having the right people and expertise comes in — building processes that blend traditional best practice from the care sector with best-practice product development and data science, so people have protocols and know what to do depending on the situation. And thirdly, technology: we're honing and developing ours every single day, releasing new features every week. That technology is instrumental in allowing Cera to scale effectively and fast. But the biggest one is culture and setting the right tone.

That's been a massive learning curve, because even when I was working in policy, I wasn't responsible for setting the culture — I was more a recipient of it. As a frontline doctor and medical student, it wasn't something I really thought about. I'd complain about the culture in NHS hospitals, but I didn't think about how I could make it better or what my role was in it. I was much more focused on, okay, I've got this OSCE in a few weeks, or this audit I'm interested in. But now, if you really want to build an organisation and an ecosystem that scales, that innovates, that almost runs itself, having a great culture is crucial.

Good questions — very specific, not so easy answers. One: people need to know what the mission is. Ours is to support older people in living longer, better lives in their homes. Everyone needs to understand that's what we're trying to do — it makes decisions much easier. Should we expand into an area focused on younger people? Well, our mission is older people, so that's where we want to be. Should we be buying care homes? We support people in their own homes, so that's what we focus on. That one-line mission centres people in terms of what they do and the strategic decisions they make — and it motivates them, because they all know we're transforming the lives of thousands of people every day.

Then, what are our values — the values we base decisions on? Being innovative and pioneering; demonstrating good leadership across the organisation. Even if you're a carer, being a role model against Cera's values helps change other carers' behaviour. If someone sees a colleague going the extra mile, being creative — thinking, "this part of the app wasn't working, I'm going to contact the tech team myself and suggest they fix it," rather than "I can't be bothered, I'll just go to the next visit" — that small difference in behaviour helps the whole organisation improve. We get immediate feedback from the front line about what's wrong with our product, we action it, and that translates to a better service and better-empowered carers, who in turn deliver better care.

Beyond that, a practical example: every two weeks we have a company-wide call, where every single member of the organisation dials into a Zoom with the leadership team, and we answer questions directly from them. That's really important — it gives people complete access, so if they have concerns, regardless of where in the country they are, they can raise them easily in a relaxed forum. It also flattens the organisation, so everyone feels part of the same team — not talked at, but part of a family, a mission, a movement. That small difference of a fortnightly company-wide makes a big difference culturally.

Even in how I try to behave in meetings — when someone comes to me and says, "I'm not sure what to do, this is the problem we're facing," rather than just giving them the answer, I help them think through how to solve it, to be innovative. That means when they deal with their own colleagues and teams, they're more likely to adopt that approach, which helps them be more creative — a key part of working at Cera and how we're different from other care companies.

Netflix are big on this. One of their biggest differentiators is that they focus almost exclusively on culture — their strategy is their culture. When they think about the next five years, they don't think about revenue or product milestones, or even new movies; they think about the milestones they want in terms of culture.

What do they want their people thinking about, focused on, saying about the organisation — that comes first. Then they talk about what the company itself is going to do. That focus on people, even in a technology-driven company, is so important, because fundamentally every organisation has people at its core. The more you empower them and encourage them to think differently, the better — and the way to do that is through culture.

It's the difference between walking into a hospital or care home with a top-down, bossy, micromanaging manager telling their team exactly what to do — where no one enjoys it and no one's ever going to say "I saw this issue and here's a creative way to deal with it" — versus the other side, where people come to work because they love it, they feel they can be creative, and they feel comfortable identifying challenges, because healthcare is full of them. If they don't know how to address something, they can talk to someone who can help.

Every organisation goes through ups and downs. In the COVID-19 period, unfortunately many companies have had to let go large numbers of staff. That's not great for culture — it's very difficult. People feel demoralised, feel their jobs are at risk, look elsewhere, productivity goes down. It's a negative cycle, and many companies have had to go through it. Even at Cera there have been times we've had to part ways with team members. The reasons vary — it could be financial, or the company changing shape, going from one business model to another, which means the team has to change shape. The company scales, and the capabilities needed at a senior level evolve — you need leadership team members who can scale with the organisation.

Whenever those changes happen, they affect culture and team morale. One of the tests of leadership is leading a team through those difficult times so they stay motivated and understand what they're working towards, and you get through it successfully. There are a lot of analogies with sports — a team that's 2–0 down, or not performing, or where a key member leaves. The captain, the manager, the team have to pull together to catch up and still succeed. Otherwise it can go from one negative to a worse one. So yes, there are tensions between culture and people versus the strategic needs of a business — and that's where leadership can be tested the most.

Of course. As a startup where you're moving quickly, trying to set up experiments and trial new product features, sometimes you'll do something on a shoestring. You launch a new product that looks quite glitzy, but really all it is, is someone on the phone line picking up and offering a new service. If someone wants it, they phone someone else who orders that product and has it delivered to the home. Is that scalable? No way. But if you're trying to rapidly prototype and see if something works, you do it in a very light-touch way first, see if people are interested, and then explore how to build it for scale. Otherwise you fall into the trap of investing tons of resource, energy and money into solutions, teams and products that never get used.

You might build IT infrastructure a million people could use, but never test whether a hundred people would be interested — and then when you go to market, the whole thing falls apart. Unfortunately, IT programmes, particularly in healthcare, suffer from this. People build products that frontline staff or patients don't even want to use, invest tons of money, and it goes down the pan because adoption is completely missing. It's really helpful not to build for scale, but to see if people are interested, see if there's product-market fit, and then level up gradually.

With our technology, we've gone through multiple evolutions. Initially it was an MVP — good enough for a few people, but definitely not fit for hundreds or thousands. Then we built a completely new version, and again a new version. That happens because there are different phases of scale and growth, and it doesn't always make sense to build for where you'll be in three or five years' time.

One of the difficulties of my role is that on one hand I'm trying to support people in being creative, but on the other I have to, more times than not, shoot down ideas and say no. The risk when you're growing quickly and there are lots of opportunities is that the organisation boils the ocean — and if everything is a priority, then nothing is. That's where discipline comes in: saying no, we're not going to pursue those five exciting ideas, we're going to focus on our core, get that right, show it working in the numbers with people raving about our product — and after that, we'll move on to the exciting ideas. But for now, we're putting them on the shelf.

Even Apple, which is massive, has done this. Steve Jobs said the iPad as an idea actually came before the iPhone — he saw it as a product concept, but said, no, this isn't the right time; let's work on the phone first and come back to the iPad. And that's what he did. They were very sequential: the iMac when he came back as CEO, then a new laptop system, then the iPhone and disrupting the phone, then the iPad. Even Apple has been disciplined in how they've staged the opportunities they pursue — one by one, rather than all at once.

No, I'd absolutely say no. To be a good leader in healthcare now you do need to be disruptive — not a dick, but disruptive. You need to think of new ways of working, because the traditional ways of running health systems, even practising medicine, just don't work anymore.

That's why during COVID we've seen this tremendous push towards telemedicine — and I personally think it's here to stay. We're seeing the role of AI, and people having to change what they focus on. Where patients used to be treated predominantly in hospitals, healthcare in most countries is now moving to the home — it's more convenient, cheaper, and gives better outcomes. Many parts of healthcare are at an inflection point, radically changing, and healthcare leaders have to embrace that. They have to be willing to rattle the cage and challenge their teams — otherwise some of these organisations may not be around, certainly not in the same way, in five or ten years.

We're going through the same shift retail went through ten years ago, when it became heavily digitalised. Many companies missed the boat. In the early 2000s Walmart looked closely at Amazon and missed it — look at where those companies are now. Look at Motorola, at Nokia, disrupted out of the market by smartphones from Apple, Samsung and others; or very traditional ones like Kodak, which now barely exists; or Blockbuster, who even ten years ago thought Netflix was a joke that would get nowhere. Healthcare is going through that change right now, and in ten years the players in the health and care space will look very different. Leaders have to be willing to embrace that change, whilst at the same time building a culture that embraces it — that's creative and innovative, rather than doing more of the same.

The best part is that I can have an idea on a Monday and by Friday it's a real thing in the company. I can say to the product and development teams, or marketing, or operations, "I had this idea over the weekend, can we do this — and for some reason it's time-sensitive, so can we get it done this week?" And it actually happens. Within a matter of days we've launched a new campaign, a new website, a new piece of technology, all going at full speed.

At the end of March and in April, we saw what was happening to people as they lost their jobs. So within days we said, okay, let's build a campaign to recruit 10,000 people into Cera and get them jobs on the front line. Within literally days we launched it in the press, did a ton of marketing, and rebuilt our entire recruitment platform so it was automated, digitalised, and could cope with those volumes. Before it was smaller-scale; this was much heavier-duty. We were getting hundreds of people applying to work for us every single day. It was lightning-fast, and it was awesome to lead that as a CEO.

The hardest part is that we've reached a size where Cera has very competent, experienced leaders across the company. That means whenever a real problem lands on my desk, it's a really hard one to solve — a complex issue they haven't been able to sort out themselves. It'll usually be a thorny issue that blends our technology with regulation and something happening on the front line, which may also have reputational or partnership consequences. Or it involves one of our key stakeholders — investors who may want to take the company in a certain direction that our management team don't think is right, but who own a chunk of the company. That's a thorny issue to manage out. So the hardest part is that the most complex problems land on my desk — but those are the ones I learn the most from, going back to what we talked about earlier: that project that didn't work out at all, that I thought was a complete waste of time, but that I learned from and whose collaborations are still with me today.

If you've already got a startup or an idea, the three things early-stage investors look for are: one, a great team. Every early-stage company goes through ups and downs, changes its business model, changes its product, over and over until something works. In healthcare, because we're working in a regulated environment with lots of stakeholders and dealing with people's lives, it can take much more time to reach that ultimate solution that works, scales fast, and that people love. So the team is ultimately what people bet on. If your background's in medicine, having a team that complements your expertise is really important. My co-founder Marek was from a technology and commercial background — he'd built a company before, studied computer science, predominantly a software background — so we were quite complementary, as were the other members of our team. Make sure all four corners are covered and as strong as possible: someone with a financial background, an operational background, a technology background, and ideally someone who's built a company before and has that track record.

The second thing is having technology, some form of IP, and differentiation. Technology is having an unprecedented impact on every sector.

Nothing has transformed our world as much as digital and, potentially, data — arguably ever; I'd put it up there with fire, electricity, the wheel. So using technology to transform part of healthcare, and building an MVP or product that can do that, is important. And there you want to be specific — don't try to boil the ocean. Look for a specific problem you understand really well, a specific disease pathway, and a solution that solves it. Even if it's basic — it could even be booking appointments. There are companies that digitalise the appointment-booking problem in healthcare that are massive, multinational, really revenue-generating. It doesn't have to be completely life-changing, but it can solve a key problem where technology has a powerful role.

The third is traction. The more traction a company has, the more de-risked and attractive it becomes for investors — and the more negotiating power you have. When you talk to investors, a number of things come up: the valuation, the terms.

Those terms and the valuation will work better for you if you have more robust traction and more demonstration that people want — and will potentially pay for — your product. That takes time. So think of creative ways to fund a startup in the meantime: maybe people don't get paid as much at the beginning, maybe they work other jobs at the same time, maybe there are grants to apply for, or friends and family who can contribute. The longer you can do that, and the more traction you build, the bigger the impact on your negotiating power and the funding you can secure. It's most sensitive at the early stage — the valuation of a company in its first 12 to 24 months changes much more than in the next 12 to 24. So if you can postpone raising, doing so as long as possible will help you maximise your own ownership and get the terms you want. Unfortunately, there are examples where companies don't have much runway, they're low on funds, and investors know it.

They use it against you — they turn up the heat, the terms aren't as great, and as a founder you lose a lot of control over your own company. It's almost impossible to move back from that, and making a decision when you're distressed or rushed is never going to be a great one. With investors, it's a long-term partnership — it's not like hiring someone who may leave or you may promote. Once an investor joins your company, that's a very permanent relationship. So it's really important to think through who you're bringing onto your shareholder base and your cap table.

One challenge, particularly in the health and wellness space — and doctorpreneurs are actually less susceptible to this — is creating solutions to problems that don't really exist. On the App Store there are 300,000-plus apps in health and wellness. How many actually get used? A fraction — probably a percentile are widespread, at scale, with sustainable business models.

The rest are interesting ideas people thought would make an impact, but then don't get adopted, so they struggle, get disowned, and people move on to the next idea. It's really important to build solutions for problems people are actually facing. Doctors are in a great position, because they see those problems firsthand, day to day. Then I'd take it one step further and say build solutions that can actually be sustainable. There are innovative companies in health technology that ultimately aren't really businesses — they're burning tons of cash with no clear path to becoming profitable. Businesses ultimately need to make some kind of money; that's the underlying premise. More recently there are deeply unprofitable companies that get listed and have some success, but we've seen those valuations get knocked heavily — Lyft, Uber, even Casper, the mattress company. They list at one price and then get knocked massively within months, because they don't necessarily have sustainable models and more mature investors find it difficult to buy in. That's why coming up with solutions to real problems, with real business models underlying them, is so important.

I read a book called The 4-Hour Workweek by Tim Ferriss years ago, and it was awesome — I think you and I have talked about it before. Tim Ferriss is kind of a life coach; he has one of the most-read blogs and most-listened-to podcasts in the world. His premise is that he ran a business on four hours a week of work, and spent the rest of the time on holidays, going to Thailand, doing things he enjoyed — a very sustainable lifestyle, while still making a contribution and an income.

He has a number of principles that let him be more effective with his time: delegating more rather than micromanaging; really prioritising as robustly as possible and being disciplined about it; delaying things that aren't a priority, or saying no to opportunities that aren't worth pursuing at that point. There are a number of hacks and recommendations in the book, and they had a major impact on my own productivity. In medical school I could never quite get down to four hours a week, but it helped me be way more thoughtful with my time and do a lot more in parallel — being a medical student, but also working with organisations, academic research projects, and even writing a book at the time. Some of it doesn't apply, of course, but there's a lot to take away.

The other thing I'd say is that getting into a habit and a routine is really helpful. The less you have to think about day to day, the more you can reserve for the really difficult, complex problems that require your full focus.

That's why you'll see a lot of leaders — Mark Zuckerberg, Steve Jobs, Barack Obama — wear the same clothes and eat very similar food every day. It minimises the number of decisions that aren't going to move the needle, that they can essentially automate, so they can focus on the things that really require their attention. It's almost an analogy to automating the back office of a company: the more you can automate and digitalise, the more the company can focus on being innovative and creating value in ways it hadn't thought of before. It's the same for your day-to-day — when you get up, what you eat for breakfast, what you wear, when you go for a run, what you read in the evenings, how you spend your weekends. By automating it and making it as routine as possible — it may sound boring, but your productivity shoots up dramatically. That's also something Tim Ferriss picks up on.

That's a good question — not one I've thought about too much. My family moved from Sri Lanka during the civil war, and they went through a lot of hardship, both in Sri Lanka and when they started out in London. My parents had to uproot and leave everything there — it was a really difficult experience — but they taught me the importance of persistence, hard work, commitment, loyalty, and trying to have high integrity in your work. Those values, that way of working, did set me up for being quite driven and ambitious as a teenager and at university.

I also really love what I do, and that helps a lot. To be honest, I was a pretty lazy person when I was younger.

When I was around 12 to 17, I was pretty lazy and all over the place. If you look at the reports from teachers, they were pretty bad — quite a few Cs. People would say, "are you sure you want to go into medicine? Are you sure you don't want to consider something a bit less competitive?" If you go to my primary school reports, they probably didn't think I'd even go to university. So I was not the most disciplined and hardworking person when I was younger. But when I went to university, I really loved what I was doing, and that helped motivate and drive me. And now, working in a company where I can make an impact and see it so clearly — coming into work on a Monday with an idea, and it so quickly becoming something real out there in the world affecting people for good — that is tremendously motivating and gives me almost all the drive I need.

If there's an opportunity you're hesitant to take, and it's on your mind at the moment — I'd recommend just taking it. At medical school I ran into a lot of different opportunities and pursued most of them, even though a lot of them didn't work out. But I don't regret any of them — I learned from every single one.

By pursuing opportunities in many different fields, even when people at the time were thinking "how's that relevant to what you want to be in the future?" — because at medical school lots of my friends were laser-focused; one wanted to be a cardiologist, so everything he did was cardiology-related; another wanted to be a gynaecologist, so everything had to be gynaecology-related, or it was a waste of time — but for me, in the direction I've gone, I look back and all those times working in charities, in innovation, in academia, have all come together. All of it is useful to me on a weekly, if not daily, basis.

As an entrepreneur, you bring those skills together, especially in healthcare. You bring the academic lens, where it's important to understand how to evaluate a new innovation or product.

If you worked in a charity or a medical student society — guess what, you're working in teams all day long in a startup, so you bring that together. If you understood the academic part of medicine and how to communicate with patients, use that too, because you'll deal with patients as you go through product development and try to understand their needs. Bringing that together is what entrepreneurs do every single day. So if you want to be innovative or pioneering, definitely try these more left-field opportunities, because medical school is where you get the time and chance to do it. When you become a junior doctor it's much harder — you've got your day-to-day job, and trying to spend a few weeks with a startup or a couple of months with a research unit is difficult.

Don't get caught up in planning your entire career in your first few years at medical school, when you've got decades ahead of you. Medicine is moving so fast — I definitely don't know where it's going to be in ten years, so trying to say where you'll be in twenty doesn't really make sense. Try that opportunity you might otherwise be hesitant to do, because medical school is the best time to do it, and you'll learn something from it.

No, I think we've covered a lot — it's been a great discussion. I just hope it helps. When I was a medical student, there were lots of times I wasn't sure what I was going to do in the future, and that worried me. If someone had just told me, "actually, it's not something to be concerned about — don't worry, it's completely normal, lots of people go through it," that would have helped. And actually, if you weren't a medic, that's what everyone goes through. We're hiring people at Cera who are in their 20s, 30s, 40s, even 50s, changing careers. So for medics not to know what they're going to do in their early 20s or 30s — 10, 20 years down the line — that's completely normal. Don't worry about it. Focus on enjoying what you do, finding what you're passionate about, and exploring different opportunities so you can learn as much as possible while you're in medical school — because that's what medical school is about.