The worse fight I ever had with a doctor was in the middle of a design brainstorm. Less than a week old, our newly formed project team had been tasked to "blue sky" brainstorm solutions to a medical challenge. Our brilliant attending physician tossed out the first idea. I then spent the next hour fighting off tears of frustration as I all but begged him to produce a second one. Having run dozens of brainstorms in years previously, I used every trick I knew to pull a “stuck” engineer away from their first, perfect idea. I failed.
Calling a break, I stepped outside into the cool fall night to catch my breath. I’d been on teams with similar challenges before. Like capital and time, a broad supply of ideas is life blood for a startup. Not securing enough of all three is incredibly risky. I had had this fact drilled into me my entire career. It was then that I had an incredibly obvious but profound insight.
Doctors are not engineers.
This medical colleague was an attending physician who excelled at extreme life and death situations. He was trained to make snap decisions with absolute authority. He had never, while performing his profession, stopped to ask himself, “Are there five other ways I could do this?”. In his experience, there was only one right way, to be found and implemented as rapidly as possible. This is exactly what he did in our brainstorm.
My own profession has a much more protracted decision-making process. I usually have months and years to settle on the final solution. My risk is not immediate life and death but becoming invested in the wrong solution path too soon, based on too little information. To prevent this, engineers and designers constantly question assumptions, collect feedback and pursue multiple lines of inquiry simultaneously.
Armed with this understanding, I went on to spend 6 amazing months with that doctor and project team. I know that my experience was not unusual. While incorporating users into the design process has been preached in design circles for decades, there is little practical guidance on how individuals with fundamentally different training can work together effectively.
My favorite projects of the last several years have focused on doing just that. I have been reworking classic medical device design and engineering material to better train physician entrepreneurs. I believe doctors, like any sufficiently experienced professional, should understand how their tools are developed and tested. As I have gotten to know my “students” better, I have come to a second obvious but profound insight.
Not all doctors are the same.
Again, laughingly clear to those within the profession, rarely acknowledged to those outside. Not all doctors are trained to respond in the same way as my earlier colleague. Some doctors excel in highly ambiguous situations where solutions carry as much risk as the disease (oncologists, experts in complex immune disorders and psychiatrists, for example). Some are clinical generalists; some are highly specialized. Some balance research and practice in giant university hospitals, while others replace hundreds of knees like clockwork in out-patient clinics. Doctors work in urban areas, retiree hot spots, remote rural farmlands and warzones. Their expertise is as varied as the patients they treat.
New medical technology cannot succeed without doctors being actively involved in the development. And yet, for product teams to work successfully with doctors, they need to understand my two “obvious” insights:
Doctors are not engineers. Not all Doctors are the same.
This means that a medical professional’s ways of working, communicating, and thinking will be quite different from what most product teams are used to. Not better or worse, just developed for a different context. At the same time, how a doctor can best contribute will evolve as a product matures. While several functions may be performed by one individual, it is far more likely that multiple doctors will be needed to supply all the roles. Having a single medical genius supplying all clinical knowledge for a medical device is like Tony Stark single handedly designing and building his Ironman Suit. It only works in Hollywood.
After working with both startups and doctors at startups for a number of years, I’ve found that new medical products need approximately six different types of doctors. The six roles are a way to simplify what startups need at each stage of the design process and what kind of doctor can provide it.
Administrators are critical to early need finding and problem definition. Medical care is complex, and pain points that are felt in the surgical suite or exam room often start far away in hospital stock rooms or insurance offices. When entrepreneurs are assessing new challenges to pursue, they need broad organizational expertise that will help them track root causes. Administrators are doctors who has been at the point of care, but also juggled human resources, purchasing, facilities, and billing. The more stakeholders a problem touches, the broader the perspective needed to understand that problem.
The Creative Generalist
Once the Administrator helps you shift through the noise around a pain point, you need a flexible, eager mind that is already looking for solutions. Creative Generalists are the practitioners most likely to become entrepreneurs themselves, playing with spare parts on their kitchen tables and possibly filing a patent or two. They are scanning the latest products at the trade shows and discussing “what ifs” with colleagues over late night drinks or early coffee. They have the rare ability to perform best practices with their patients, and to quietly question or improve them in their off-hours.
The Data Nerd
Data Nerds are the gate keepers to the most critical data a design team needs. They quantify patients into numbers, which are in turn used to make critical design decisions. What is the tensile strength of the blood vessels being cauterized? What are the most common chemical compounds found in spit? How might developmental factors affect bone density readings under different imaging modalities? This is not an individual who will throw out whatever common answer was given in a medical textbook, but can chase down the original studies, critique them and obsessively guide the data’s proper use.
The Indication Expert
While the design and engineering teams are working on the technology, the Indication Expert is working out the “nuts and bolts” of the medical procedure. Some new products can be exchanged with their predecessors with little change in technique. Other products require the development of completely new types of surgery or diagnostic procedures. You need a doctor with deep understanding of the options, risks and patient characteristics that guide specific technique decisions. They will work closely with the engineering team, deciding what challenges can be solved with the product itself, and what will be left in the hands of the practitioner.
The doctor who invents your technology and the doctor who will prove it safe often have directly opposing personalities and points of view. In my own profession, I often say “brainstorm like you can do no wrong, test as if you can do no right.” The confident flexibility of the Creative Generalist must give way to the ruthless perfectionism of The Scientist. Scientists are planners, fact-checkers, and rigid process followers. It is their iron-clad trial data that will secure your product’s path through regulatory and reimbursement.
Once the product makes its way through the technical and scientific gamut, the skills needed change again. This time, it’s social skills. Beautiful clinical data is powerful, but it takes the gregarious, passionate Evangelist to make sure the medical world knows about it. This is the individual who (in the days before mobile devices) would have the “golden rolodex”. They have direct lines to major health leaders, Hospital CEO’s and advocacy groups. They have both the reputation and connections to rapidly establish the new product’s credibility in the market.
I have met amazing individuals who fall into each one of these groups. For product teams and doctors to work well together, what the product team needs and where the doctors excel must align.
Many thanks to Uli K. Chettipally, MD., MPH for the many conversations I’ve had with doctors through InnovatorMD, and to Priti Dugar of BlinkPad, for inspiring me to think beyond how doctors can support new tech in general, but exactly when and in what ways.