Do, Rather Than Think

Certainly. I trained as a doctor in Bristol, and did jobs in London and Cambridge as a house officer and then as an SHO in paediatrics. Then I went into clinical genetics. But I think always, through medical school and my early junior doctor years, I was searching for something. I was really searching for that fit in my career, where I felt like I was doing the thing that was right for me.

When I was in Cambridge, I did a research fellowship with the Wellcome Trust and a PhD. That was really eye-opening, because I started doing a lot of extracurricular things. I started going to the business school and the entrepreneurship centre, listening to a lot of talks by people who were spinning out businesses — some of them really deep science, deep tech, some in the medical area, a really wide range. I'd never thought about that. I didn't know anyone who'd built a business or started a business — no one in my family. But there was something so exciting about using all my medical knowledge and experience while being able to build something from scratch, create something, and potentially make an impact on a much larger scale than I could probably make seeing a few patients every day.

So for me it was this really interesting combination of everything I'd done up to that point, but with the need to learn a whole new set of skills and do something quite creative. That was really exciting. But I really didn't know how to take the first steps. I didn't know anyone who'd done it, and I didn't have any business experience, of course.

What I did is I built a network called Doctorpreneurs, and started interviewing medics who'd started companies and running events and fireside chats. That was interesting, because it kind of put me at the centre of this very early network, in the UK in particular. It gave me the courage, and it put me in the middle of things, so I got to meet a lot of other people — and it's actually through something related to that that I then met my co-founders. I also went to startup weekends and was building things with engineers. So I was exploring and trying lots of things to see what would stick, to learn, and to build connections. You open a door and opportunities open up — it was stepping stones.

Then I ended up meeting my co-founders. They were in the very first few months of working on something that was a precursor to what became Ada, and they didn't have a doctor on the team. I joined as the medical co-founder, and I've been building Ada for 10 years now — chief medical officer, and I've worn a lot of hats during that time.

If I was going through medical school or junior doctor years now, I would have made the leap even earlier, because there's just so much opportunity now. Most medics know other medics who've taken the leap into digital health, or at least dabbled in it as an advisor. It's more widespread, and there are a lot of opportunities to learn on the job in someone else's scaling company. Whereas for me it took longer, because there weren't so many examples.

I was looking for quite a long time for something that included more of a requirement for creativity — building something, designing. I used to love that stuff at school, and I hadn't really realised how much I missed it at medical school. So I was somehow searching.

It was also a little bit the environment I was in. Maybe I would have chosen a less common path in medicine, but a different one, if I hadn't been in that place at that time. The fact that I was meeting people from so many different disciplines — scientists, medics, engineers, all kinds of backgrounds — who were building companies. It's the exposure, and having some role models and seeing other people do it, that can spark both the interest and the courage and belief that it's actually possible. So it was definitely the environment at the time that really helped.

It was really a thinking process over a few years for me. It wasn't an instant, spur-of-the-moment thing. It was this gradual exploration — looking at different opportunities, having many conversations, and really thinking it through.

If I'd gone back at the end of my PhD to my registrar post, I would have had 18 months to CCT. I did have a conversation with a couple of the consultants at the time who were encouraging me to go back and do that 18 months, because they said, it's just 18 months and you'll always have it. But I realised, even in those conversations — I went away and thought about it — no, that's not the right thing for me. I've worked this out over a period of time. Even though I don't know exactly what I'm going to do next, and there's going to be a bit more exploration, I'm really sure that's not the right path for me.

For some people it will be the right path, especially if what they want to do next means there's a big advantage to keeping their hand in clinical medicine. Combining GP or being a part-time consultant with something else can be a fantastic thing to do. But I knew I needed to go all in on this thing. It would involve a lot of travel, it would be all-encompassing, and I wouldn't be able to combine it. I was a geneticist — you follow up. It's not something where you can just go and do a clinic; you have weeks of follow-up with people, waiting for test results. I just didn't see a way to combine it, and I didn't think it made sense, because I knew what I wanted to do at that point, or at least I had enough of an idea.

Finally, I could see that we were at the beginning of a really exciting time in digital health, very early. And I was just too excited about grasping the opportunity. I didn't want to waste time. I wanted to get on with it.

In the very early days we actually focused on building clinical decision support for specialists. We started with one area — vertigo — and then looked at moving into neurology, where there's overlap. Pretty early on I was very involved in user testing with clinicians, gathering that feedback, looking at the product and giving a lot of my own input: this just won't make sense to a clinician; this design instantly breaks when you think about this. So I played the role of a bit of an internal user — but of course you also have to go out and get input from external experts who'd potentially be your users or customers.

Pretty early on I started to push for gathering the information directly from patients rather than from clinicians, because clinicians just don't have the time to input all this data on top of everything else they're doing. And one of the things we realised early on was that we'd have much more impact if we put our technology earlier in the patient journey. If you're working with tertiary specialists, they get patients after several years of travelling through the system, seeing many clinicians, with unnecessary investigations and ineffective treatment. You're not having the impact you could have if the solution were in the hands of the GP.

So I was pushing for: let's go broader, and let's go earlier in the patient journey. But of course we then had to dramatically widen the coverage — the conditions we covered — and simplify it and make it really quick and easy to use. GPs maybe have seven minutes, maybe ten; in some countries one or two minutes. So it was a really interesting evolution of the product, thinking about how we make this quick and simple.

Ultimately that led us to gathering the information from patients. A GP doesn't have the time to enter this — we were testing, and we could see they weren't going to do it, which seemed logical to me given my own experience in general practice. But if you could collect that information from the patient and hand it over to the clinician in advance of a consultation, then you're saving them time rather than taking additional time. And you're doing something valuable, because they have that information up front — questions they might not have had time to ask. The patient has the time; they want to share this information. And you can potentially use that information to prioritise patients, to triage, and to send them to alternative care services if more appropriate.

So it was this evolution where we went more and more upstream, earlier in the patient journey. And as we were building that out, we thought: let's just launch this direct to the end user too. Everyone uses Google these days to search their symptoms and try to work out what they have — let's put it in the hands of the end user. We did that in parallel with building out the pre-assessment capability, and then uptake just soared. We were scaling in 150 or more countries.

The main way we monetise now is via large health systems and health insurers — this kind of digital front door: pre-assessment, care navigation, and handover early in the patient journey, navigating people into primary care, emergency care, or very often online care these days. We still have the consumer app as well. But it was a learning process, and we evolved as we learned from the market and through user testing.

Definitely. You have to align the clinical use case with a commercial use case, and align with the incentives of your customers and your users. And the incentives aren't always well aligned in healthcare — it can differ across different parts of systems and different countries. So it's something you need to think very carefully about. Clinical benefit is important, but you have to find a way to get paid, and someone willing to pay you.

The NHS can be a great partner if you're willing to really take the time and put the resources into focusing on the NHS — understanding it, tailoring your solution to its needs and the way it works, building those relationships. But it does take a really dedicated commitment over the long term to be successful there, and it can be slow. So if you want to put all of your eggs in the NHS basket, you may need to be willing to be quite lean for a long time.

There are moves towards more centralised commissioning right now for certain technical solutions, so there can potentially be big, long contracts for solutions that really show they're making a difference and are of value to the NHS. But again, it's really hard to succeed there without the relevant focus and commitment on the UK and the NHS, building those relationships, and being patient. We've done some things with the NHS, some pilots. We haven't focused very strongly on it in our early years, because I think you have to be all in to really make it work there. But we do see an opportunity, and there could be some interesting things we're doing in the year ahead, so we might well have more of a presence there soon.

I think many different personalities and people can be good leaders. There's no single way to lead effectively. I'm a very different leader to many of my colleagues in terms of my style and how I interact with people, and different approaches can work. For me, what really works is hiring people who I think are just really way better than me at what I'm hiring them to do. They're the expert, and then I place a lot of trust in them. I'm there to strategise, to brainstorm, to align, and to provide support — but they're very much in the lead on the things they're responsible for, driving and building their team and pushing that forward.

So I give quite a lot of space and freedom to the people who work for me. It's all about hiring really great people, putting them in the roles, and then trusting them, while being there to drive the alignment. But my role has changed a lot over the years. In the first few years I was wearing lots of hats and doing lots of things myself. You need to be willing to be a juggler, a bit of a jack of all trades, a master of none — an individual contributor a lot of the time across many things, as well as a leader. Your role evolves as the business scales, and you need to learn to change and evolve with it, to lead differently now to how you led early on. So it's a constant learning process.

I think it does favour being an extrovert. In the earlier days especially, I spent a lot of time out building relationships, networking, and on stage. Once we really started to scale, there were a lot of requests to do interviews and speak at events. I still get a lot, but I do fewer of them now than I did, because I realised it takes me quite a bit of energy and thinking in a way that it doesn't for my co-founder, for example, and many others who really love it and enjoy it. In certain circumstances I also enjoy it, but in others I have to be more selective and do less of it. That can be challenging when it's expected of you.

I also favour writing things down rather than speaking to the whole company, and smaller meetings and one-to-ones rather than talking at a large number of people. You can still be a really good leader and have a real impact, but you have to learn to know yourself well, adapt, and work out where you're strongest and how you can have the most impact — and be okay with saying, I do less of those things, because that's not where I'm at my best.

There are parallels between explore and exploit in a business and in your life or your career, and I do think that's true. I was exploring — divergent thinking, opening up the possibilities, looking widely, building my network — because I hadn't yet found that thing that felt like the right thing to focus in on and give my all to. But once you find it and commit and decide, it takes an incredible effort to build something from nothing and really get it off the ground.

To be honest, many people think when they're building a startup that the challenges are hardest in the earliest stages and then go away. But the truth is there are always, always challenges. As you grow, the challenges just get bigger and the stakes get higher. So you have to be very dedicated and very focused. But then, as you build a team, you start to distribute the responsibility, so it's no longer all on you the way it was, or felt to be, in the earliest stages. So you can afford, sometimes, to personally take a step back and re-explore where you should be spending most of your time. Even within this role, I have times of deep focus, really needing to drive to a particular goal, and then times of being able to step back, readjust, look around, and change things.

It very much depends on the person and the circumstances. For me, yes — because even though it's been hard, it's been absolutely exhilarating building a company, and it's really a privilege. It's a privilege to hire amazingly talented people and work with them, to use so many different parts of your brain and your experience in combination — to plan things, design things, put things out into the world, take on a lot of responsibility, and try to make a difference in people's lives. It's incredibly interesting, because there are endless things you need to improve on and get better at, as a person as well as a company. I have the clinical knowledge, but it's about applying it, and also building up an understanding of business, product, data science, AI. There are so many aspects to it. And for me, because I'm someone who loves to learn all the time, that is amazing. It just suits me.

It's still hard, and there are moments where it feels really hard, but I've never once questioned whether making that leap was the right thing for me. I know it was, and I've really loved doing it. For me it probably did go from a seven out of ten — I wasn't really cut out for night shifts and weekends. I did them, but it did feel like more of a fit for me. It's obviously going to be a very personal thing. If people are sure about something, then it's worth being brave and taking a leap, because you can always go back. There's always going to be a need for clinicians, and there's always going to be employment and interesting things you can do. If you're really sure, take that leap.

For people who are on the fence, there are now quite a lot of ways to test the water — being an advisor, working part-time with a tech company, a wide array of things. It doesn't need to be a digital health company; there are a lot of things outside the most well-trodden paths these days. There are a lot of ways to dabble and test things out without having to immediately make the full leap.

Probably the overarching theme is being flexible and adaptable — driven, able to overcome hurdles, and just keep going. It really helps to have a co-founder, and co-founders, and as you build out the team, others who — when you're struggling or finding something tough — are feeling optimistic. So it's not all on you; you can share that load a bit and cover for each other when one of you is feeling like, oh my goodness, this is a really tough challenge ahead. But you do need to be resilient. It's this combination — adaptable, flexible, resilient, determined. The needs of the business have changed a lot over the years, and that ability to flex, take on different roles, and change my role as the company has evolved has been essential.

Habits, though — that's not habits really, is it? That's more an approach to things. One thing I do all the time — but that's just me — is I read a lot. At night, I've got two small children, so sometimes it can be quite late when they finally fall asleep, but I always read. It's a way to recharge for me, and I do a lot of reflection on the business and the things I want to get better at. I read really widely, across a lot of different subject areas — many, not only but many, relating to scaling a business, building products, leadership, and so forth, but a really wide range. I find that really great, because it gives me a lot of ideas I can then try out and suggest to other people in the company. There's usually somebody in the company who's done something like this before and knows more about it than me, but it also helps me get to a level on a subject where I can have a useful conversation with that expert. That's really helped, because I didn't go to business school and hadn't worked in a business before this. So combining busy days with sitting back at the weekend and at night, reading a lot and thinking a lot — it's been great.

Goodness, I have more than a thousand books. I have so many, and I haven't read all of them, but I love being able to dip in when I'm thinking about something.

For somebody thinking about building a business, a good read is The Hard Thing About Hard Things. It shows you just how crazy things can get when trying to build and scale a business. Some of the things in it feel painfully realistic to me when I read it — it's quite extreme, some of it — so it's a really good and interesting one to read either before or early when you're building a business. Zero to One is another one. It's quite well known, but a good one to read early on.

Then it can change as you scale. There are a bunch of books relevant to scaling that would be less interesting for the very early-stage founder but more interesting once you're scaling your team. Blitzscaling is one of the best known. There's also the High Growth Handbook. There's one on scaling written by a bunch of people in the UK — founders and people in scale-ups — which I also found quite nice to read, lots of practical tips, a lot that I related to. And I really enjoyed recently Working Backwards, which is about Amazon, written by a couple of very senior employees who were close to Jeff Bezos. It's the best book about Amazon I've read. It gave me a lot of insight into how they've been so effective at churning out innovative products at massive scale, constantly building new business models and reinventing. It's a special kind of culture, but there are definitely things you can take from what they do.

If I could advise my 20-year-old self, I'd probably advise making the leap to building a startup even sooner — not that it was even on my mind when I was 20, but if I could go back and do it again, I'd have done it even sooner. And if I was advising 20-year-old medics today, if they have an interest, I'd say start getting some relevant experience in that area early, to see if it's for you.

There's so much you can do now with clubs and pitch competitions and accelerators at university — for some of these accelerators you don't even need a team; you can turn up as an individual, even pre-idea. There's a whole range of things like that, and a lot of companies looking for young talent. So I'd just get started early. I wouldn't be afraid to take a year out to do it if you feel that's the right thing, or take some hours at the weekend or at night to try building your own thing. There are so many opportunities. So I would do, rather than just thinking about it. Get trying, and then one door opens the next door, and the next door — so that leads to opportunity.