Being able to identify a need or problem in the healthcare industry takes creativity and knowledge. A career on the clinical side helps. And an advanced business degree will send you into a whole new world of insights.
But how do those insights help a health innovator navigate today’s disruptive COVID-economy and what might the future hold for an industry that’s stuck on pause?
In this episode, we talk with David Pearlstone, CEO of DICOM Director, about his involvement on both sides of the healthcare innovation equation: from the operating room to the boardroom. David speaks with candor and experience as he regales our listeners with insights, tips, and personal anecdotes.
Here are the show highlights:
- How unsatisfied clinicians can regain control of the hospitals and healthcare industry (5:17)
- The case for using the profit motive to inspire better healthcare solutions (8:54)
- How telehealth will eliminate up to 40% of doctor visits in the post-pandemic world (10:19)
- The exact moment when you should leave the healthcare industry to help more people (20:03)
- Why this economy is nothing like the economies of 2008 or 1929 (27:30)
- The real (and slightly nefarious) reason doctors won’t refill prescriptions over the phone (32:59)
I've spoken with dozens of health innovators, and nearly everyone is trying to figure out their best pivot strategy. But they don't know what to change, how to pivot, or if their new pivot strategy is the right move.
So I went into overdrive putting together a clear, actionable 5-step worksheet that will help you quickly define your most viable and profitable pivot path through the COVID crisis. And I’m giving it to you for FREE — no strings attached at legacy-dna.com/pivot
David Pearlston is a surgical oncologist and CEO of DICOM Director, offering advanced solutions in medical imaging using full-3D holographic CT scan imaging in augmented and virtual reality, secure cloud storage for imaging, and quick, simple image sharing.
As a lifelong learner, David stepped outside of his comfort zone as a physician, earned his business degree, and entered the world entrepreneurial startup ecosystem and he has not looked back.
His unique insights into the clinical and business sides of healthcare brought him to DICOM Director and fuels his charge toward the future of healthcare innovation.
If you’d like to reach out to David to learn more about DICOM, you can contact him at David.firstname.lastname@example.org, on LinkedIn at DICOM Director, Facebook at DICOM Director, or on their website at dicomdirector.com.
Welcome to COIQ where you learn how health innovators maximize their success. I'm your host, Dr. Roxie, founder of Legacy-DNA and international bestselling author of ‘How Health Innovators Maximize Market Success.’ Through candid conversations with health innovators, early adopters and influencers. You'll learn how to bring your innovation from idea to startups to market domination. And now let's jump into the latest episode of COIQ. [00:36.1]
Roxie: Welcome back, COIQ listeners on today's episode, I have David Pearlstone with DICOM Director with us. Welcome to the show, David.
David: Thanks. Thanks so much Roxie. Pleasure to be here.
Roxie: Yeah, it's good to have you. So let's talk about what in the heck is going on?
David: A lot going on. It's a crazy time as a physician myself alone, I'm not in clinical practice anymore. It's really, what's the right word? I don't know amazing. I don't know, extraordinary, unusual, once in a lifetime experiences. Obviously not a positive experience, but you know, you can't help but take a moment to step back and realize you're your living history.
David: And that's always interesting. And there's a lot to be said for people who can gain or obtain perspective in crisis situations and see a bit beyond the immediate crisis, see patterns, see trends, see why things are happening, see what could possibly happen next. I find that very interesting. [01:46]
Roxie: Yeah. Yeah. So for our listeners that don't know who you are, give us a little brief bit about your background and what is DICOM and what are you guys doing?
David: Sure. Thanks. DICOM Director is a platform. It's a software, a service platform to basically meet the challenges of the current generation of medical imaging. So this is all has to do with digital imaging and healthcare— x-rays. So all x-rays these days are done are, are digital. The problem is even though they are digital, we do not do a very good job of handling them, storing them, moving them around, giving patients access to their own information. So we have this treasure trove of information in a fairly simple format of digital format, easy to store, easy to move around. And yet we are still using antiquated techniques to do that, like printing them on CDs and things like that.
David: The other component to our business that we do with these exciting new generation of images is that we create three dimensional holographic images from any standard CAT scan or MRI. [02:50]
So it's a bit of a, a fascinating background concept of can take them out to talk about that. The way that CAD scans are done today, as of about the year 2000, this was called a helical CT and what that means is that the patient on the gantry moves at the same time that the donut moves around them. The way we used to do it was the donut went around, patient moved, donut went around patient moved.
David: Now, the patient moves and the donut moves at the same time. So rather than getting a slices of information, what we now create is a continual helical stream of data. It's why it's called a helical CT. So there is no more slices. It's actually a continual three-dimensional data set that's being obtained. The problem is we don't have mechanisms to view three dimensional images up until recently. So ever since year 2000 that we've developed helical CT, we have been looking at CAT scans, probably revealing less than 70% of the information that is actually there because we've had to artificially slice them up into slices because all we have is two dimensional television screens to look at these things on. [03:59]
David: Well now that the world has developed augmented reality and virtual reality devices that allow true three-dimensional visualizations, we have developed software that can take that exact data set, same data that's there. We're not doing anything to it and manipulating it in any way. All we're doing is not reconstructing it rather into slice two dimensional images, creating a true three dimensional image. And again, when you view this on a augmented reality virtual reality device, it's rather phenomenal. So that, that's a good lead into who am I. I spent my life as a surgeon, surgical oncologist. I ended up going to business school in 2008, which was a tremendous, wonderful experience. Opened my eyes to all sorts of insights that I just did, did not have as a physician and as a sidebar, I would encourage anybody, there's, here's an interesting sidebar for the times, a lot of discussion right now, a lot of anger, a lot of animosity on the front lines of healthcare workers. [04:58]
David: And justify, it's a very crazy difficult situation. I came up medically during the era of HIV. I, I can relate to a large degree of what it's like to fear that you may actually die from the job that you're doing.
David: But what concerns me is, is, is seeing this a lot of complaining, a lot of backbiting towards the administration of the hospitals by the clinical people. And so here's my, my answer to that. Yeah, that's right. Healthcare belongs to the clinicians. Take it back. Go to business school, learn how to do the business, cause you cannot run a hospital with an M D, trust me and take it from me. You can't, it's much more complicated than that. Go and learn and take back the industry. So that's my sidebar because a lot of people are upset, a lot of clinicians are upset about what's happening on the front lines with personal protective equipment and all of these kinds of things. And then there's a lot of complaining and a sentiment that the big bad CEOs are sitting in their mansions in Florida, while the frontline is out there dying in there. Now I'm not arguing one way or the other. All I'm saying is I hear you and I agree. And I felt that way much of my career and that's why I went to business school because I felt I could do as good or better a job or running the system as these people who had no clinical insights. So [06:16]
David: Again, maybe a bit of a hidden silver lining here that more clinically, and I don't just mean doctors, you know, respiratory therapists, nurses anybody and you've lived your life in healthcare. You see the front line, you see the clinical disease, you understand the basis of the business. Okay, you need to go learn some business skills and then you can run the business side. I say it, it's like you can't, the truck drivers can't run the trucking company. Okay. And I hate to say it, but that's pretty analogous to the way it is in medicine. Okay. We're the truck drivers and there are people who own the trucking company. If you want to run the trucking company, you have to be a bit more than a truck driver. You're going to have to learn about running the company as well as you can. And many kind of many trucking companies are owned and run by truck drivers. And that's the way it should be. Okay. Enough on that crazy topic. [07:10]
Roxie: I think that's just a great segue into you know, this phenomenon that I see happening is that there are a lot of physicians, clinicians and healthcare professionals in that, like you said, they're on the front lines, they see the problems. They are, they have an idea of how to solve it, right? Cause they're in it all day, every day. They see the patterns of what happened and they're like, this, I can solve this. And so you're seeing an influx of physician innovators and nurse innovators that are happening, right? So maybe not necessarily being the CEO of the system, but creating their own company and innovating their own solutions. You, right? [07:50]
David: Yeah, That absolutely, another way, another way to go. I absolutely firmly believe that necessity is the mother of invention and to your point or getting back to this interesting issue of the interesting things that come out of, of crisis situations. You're right. I mean paired ventilators right now there, there is something that, I mean that that's not going to go away. This idea of using one ventilator for two patients. Quick, by the way, if you told me that a year ago, I had a laughed in your face. That's it, That's the craziest idea I've ever heard that makes no sense whatsoever. But turns out it does make sense.
David: I actually still don't understand how they're going to do that, but it makes sense that's not going to go away. We will still use that technology and some smart person's going to start a company that makes these things and it's going to make a lot of money doing that. And that's not a bad thing. [08:44]
David: That's a, that's a good thing. I get into a lot of discussions about healthcare and the profit motive. It's very, it's a very interesting discussion about the role of the profit motive in healthcare is there's a strong argument that all healthcare should be not for profit because why should people make money off of other people's illness or, or wellness? Absolutely valid point. On the other hand, we've seen over and over again, we have many lessons. Do we need that the best motivator for success is the profit motive? That is what drives companies. That's what drives innovation, honestly, I'm afraid to say. So I think it's a very, very interesting discussion. But getting back to the issue of where, what will, you know, where's the silver lining to this? [09:39]
So telemedicine absolutely is, is a perfect example of that. And so here's the interesting thing I would point out about telemedicine. It's not like we invented it last week. Telemedicine's been around for quite some time and the advocates for telemedicine are certainly quite happy that their business is taking off now. Most first, let me just make this point. It's not going to go away; I think we all get that.
David: That this is the fascinating part. When this is all over and it will be over. Okay. There will come a day when this is passed us. I can promise you that. I'd never finished my story of who I am, but at any rate, when this is over, there are things, business things that will persist and telemedicine will be one of them because basically what we're finding out is 40% of the time that we go to the doctor, we actually don't really have to go to the doctor. [10:32]
We could just talk on the phone works perfectly well. And you know, I think, I anticipate my view, this is going to be a win, win, win, win, win. Okay, which is hard to come by anywhere in the world and certainly in the healthcare. But let's think about this, this average advocacy for telemedicine. Okay. The providers like it, it's a far more efficient use of their time. Right. We hear providers say all the time they get the way the systems have to get 15 minutes. Yeah., they can't possibly do it with the patient in 15 minutes. Well a lot of the telemedicine stuff, actually you can't do it in 15 minutes. So it's far more efficient. It's an easier life for them. Right. There's no back and forth to the office. I mean, just think you can set up your life as a doctor where half the day of the week, half a day a week, you just work from home doing telemedicine calls. [11:17]
So practitioners are going to like, and in particularly now that Medicare's agreed to reimburse for it, right. And by the way, they won't go backwards. That's just sort of a principle. Once they give something, it's very hard to take it back. So that reimbursement for telemedicine will persist. So in practice, you're gonna love it. Insurance people are going to love it because it's a much cheaper way to get their patients seen. It's far more efficient. You know, they're not, the insurance company's not losing anything. If anything they're gaining, they're, they're happy about it. Government's happy cause you know, everybody's getting healthcare. And ultimately I know it will save money for the system by reducing all of these visits. So CMS is going to be happy and the patient's going to be happy because it's super easy to just sit there and do this rather than get in your car, sit in the waiting room and all of those other things. [12:10]
So I think it's going to persist. And I think that's fascinating. So we can go back to my, my life story. So after I graduated from business school, I went into healthcare administration running a division and then running a department to that chunk of a hospital. And then through happenstance I actually ended up in the entrepreneur ecosystem. There is a term that I've come to love. I didn't like that word before, but it really is the best term for for this that there truly is an entrepreneurial startup ecosystem, particularly in New Haven where we are very, very strong supportive group of entrepreneurs and startups. And that's really important, I think. I think we would have a much harder time doing this if we were in such a supportive environment. So many other startups, many of the support systems that a startup needs, law firms, accounting firms, services, things like that, that are very happy to volunteer their time for free and help out startups and things like that. [13:16]
It's just a great environment and I will I'll, so I wandered into this world somewhat accidentally. And then about a year and a half ago, I met my current partner Ted and Ani and they had come to pitch this company. I was working at an incubator healthcare incubator and they had come to pitch the company and I was so blown away by it. This is a great founder story. I always want to have a good founder story.
David: I was vetting companies for incubator and they came in and showed this technology of creating holograms from CAT scans. And I was so blown away because I used to say this literally and I now say this all the time in our, our fundraising pitches that I really would be standing in the operating room, I used to specialize in liver surgery, complicated, dangerous it's operation. [14:10]
And we're doing the operation and, and during the operation you'd look at the CAT scan a few times, refer to it. And to do that, I was looking at a piece of plastic held up in front of a light bulb, literally, I mean in an operating room in the year 2020 and here's the piece of plastic put up in front of an incandescent light bulb. And meanwhile, literally at that very same moment, my children were at home at four o'clock in the afternoon playing video games that had holographic heads up displays and you know, all this stuff and voice commands. And I'm looking at passed it in front of a light bulb. And that just drove me nuts as a clinician. And we can have a really long discussion about why that is, why things are like that in healthcare. But here was the guy who came in and showed me what I'd been fantasizing about. [14:52]
So two weeks later I quit the company, quit the incubator and he offered me to be CEO of the company. So that's, that's where we are now. Here we are, a year and a half later, the company had been in existence for a while already. We're out raising money. We are on in the market, we are selling. So there's, there's a lot happening. And again, this is sort of an exciting time for us, I think. These are interesting times for healthcare innovation. It's a fun time to be in this, in this area, in the area of innovation. It's at a very exciting, cool area to be in. It's a lot more fun than being a surgeon, I can tell you that; it is. And people are extraordinarily generous. That's one thing that I'm so struck by in this world of this ecosystem continually. I cannot tell you how often this happens. [15:48]
People will come and just volunteer their, their information, their time, their knowledge, their support, their connections for no reason. Just as in to be nice cause they like what you're doing and you know, whatever. You don't see that very much in medicine. You don't see that in surgery, I'll tell you that. And, and that's happened to us a lot. We're very grateful. We have many of what we call friends of DICOM that they’ve got nothing, just that they're nice people and they're entrepreneurs too and they like what we're doing and they'll do stuff, show us stuff, introduce us to people. And I, I just, I can't say enough about how much I love the spirit of, of this world. It's, it's encouraging. [16:32]
Roxie: So David, that's exactly why I do what I do. You know, my purpose and my mission is to help innovators like you, get their innovations in the hands of the people that need them the most. And so having these kinds of conversations where we can inspire and, and we can encourage other innovators or we can share strategies and tactics to help them you know move forward and progress. I mean that it's going to take a village and you know, I think what's so fascinating is we're talking about, like you mentioned innovation and healthcare is very different than innovation in other industries. Lives are at stake and you know, it's not just like the lives of the people over there. It's, it's like our family.
Roxie: Or maybe it could be ourselves.
Roxie: And so, you know, I want to help you be successful because, because it's because it's the right thing to do and I want to fix the broken system, but I also want to help you be successful because, gosh, my family might might need, might be on that surgery table one day and the physician, like you might need to have that augmented reality 3D anacomp….ana…How do you say that? Anomical. [17:39]
Roxie: And so it's like there's a lot of, a lot of value in us doing the right thing and making a difference and improving our healthcare ecosystem.
David: I, I believe that I obviously, maybe not obviously I believe that to my core. It's an interesting question. I, I admire your optimistic view of the world. I think that there is a, and I'm not taking anything away from what you said, I completely agree. I think there are a lot of people that I know this cause I've seen it directed at me. They view this to some degree as the dark side. You're not taking care of patients anymore. Your, you know, you sold out to industry.
David: You know, all sorts of views and take it with a grain of salt. It has to do with something you and I have talked about before. I am a very big believer in maximizing your potential and maximizing your contribution to our society. This is my personal view. I think we have an obligation and if you have an obligation to do your best not for you, for the world. [18:53]
David: If God gave you, you know, if he made you the world's best basket maker and you can make a basket better than anybody else, you have to do that. That's, that's your job, that's your skill. That's what you're there to contribute. I mean, unless you hate doing it, in which case you don't have to do, but if you've got that skill, pursue it and do it. And so I think that this extends in healthcare that it's not enough, here's the statement, It's not enough to just be the doctor. If you have insights into how the system could or should work better or, or why what you're doing as a clinician is frustrating and you've got some insight about how to fix it, go and fix it. Don't, don't, don't be the person sitting in the grandstand complaining and booing and griping and all of those things. You're the smart one.
Roxie: That’s the thing. [19:44]
David: You go, go fix it. Go fix it.
Roxie: Yeah. Yeah. Get in the ring.
David: Get in the ring and do it.
Roxie: Get in the ring.
David: Absolutely. I'm a big believer in that and particularly in healthcare as you get older in your career. How can I say this? I don't want to say, you know, you might get bored, but you get to be a certain age, you've been doing the same thing in medicine for a very long time. It perhaps can lose some of its day to day fascination. That's the time to go discover where your healthcare skills can bring tremendous value to somebody else in another industry. This is my life 2.0 theory. I think that this cross-fertilization of experienced professionals is brilliant and that's the way we're going to solve problems. Take someone who's been a doctor for 30 years and go plop them in the business world and I bet you they're going to come up with interesting ideas. And and vice versa. So I love this idea of, you know, you've gotten to be pretty expert in your field, but you have frustrations about some component about the way it works. [20:51]
Well, don't give up just because you're like, well, I'm the doctor. I don't, I don't run health care, you know. Well of course you can, go get the tools, get the cred and you need the cred. That's the other thing, you know, and, and doctors are as guilty of this as anybody. Yeah, we figure what we can, we can do anything which may be true. Maybe you can do anything but, but you gotta get the paperwork. You gotta get the cred. Just walk into the board room and going, I know how to fix this. No one's going to believe you. Just like if you were somebody who walked into a room full of doctors and said, I know how to do this, all the doctors would look at you like, that's crazy! Why would you think you'd have to do it? You've never done this before. It's the same thing. They're not going to take your answer about how to fix the emergency room because they've been doing it their whole lives and you can't just walk in and go, I know how to fix it because trust me, you're going to go to school and learn about fixing it. What you're going to find is it's a lot more complicated than you think. So anyway. [21:48]
Roxie: Yeah. Yeah. Absolutely.
David: Going off on a tangent.
Roxie: Yeah. You have to have the cred, the education. I mean, that's really important. I have been helping you know, business owners for, you know, almost two decades, but and went back to school and got my doctorate in business and I learned a boatload of stuff that I didn't know before.
Roxie: Even being in the trenches for 15 years.
Roxie: And now it's like, you know, you never stop learning. [22:14]
David: Absolutely. And but I found my personal experience in business school, which I again, I absolutely loved going to business school as an adult.
David: All was just tremendously wonderful experience. Was from my colleagues, I loved having my arrogant surgeon mind changed by quiet truth, speaking people from the pharma industry. You know, needless to say, plenty of opinions about pharma and everything for the clinicians and with an attitude from the clinicians of, and of course we're right. I mean, there's no doubt that we are correct. And very quickly you are told that no, you see it from your point of view. Let's look at someone who is just as smart as you, but they spent their life in the pharmaceutical industry where they do it a little bit bit of a different approach to things. They're going to explain something to you that you never got before. You think you get it, you think you do, but you don't. [23:14]
David: And you need, I needed to be, and many of us needed to be put in our place about what we think we know about how things run and how to run something. I would got plenty of opinions about the pharmaceutical industry for sure, but I will say one thing, they're not stupid. They're definitely not stupid and they're not evil. That's the other thing. We can go off on this whole subject about evil. I truly do not believe they're evil. This is another thing about going to business school that if people have to wrap their heads around that this is a capitalist society, and until the day that somebody passes the law, that pharmaceuticals are not for profit. They're a for profit business. They have one and only one obligation make money for your stockholders. That's their only obligation. Now they may write a company mission about do good for the world, but that's the company mission statement. Okay, that's not their job. Their job make money for the stockholders. And guess what? If they do not make money for the stockholders, they can be the greatest human beings on earth. They are doing super wonderful save the world work and they don't make money for the stockholders. Guess what happens? You're fired.
David: And then all your good work that you were doing for the world ain't gonna happen cause you're fired. So [24:41]
Roxie: It reminds me of a quote that you said the last time we spoke that change equals opportunity.
David: Absolutely change is a Code word. Change is just a code word for opportunity. Anytime you hear the word change, get excited.
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Roxie: So you and I were talking about how excited we are about this time and you know, I'll just be transparent and say that having to kind of temper some of my excitement and I'm excited about everything that's happening. There's some really bad, terrible, horrific things.
Roxie: People are dying, people are getting sick. I mean people are losing their jobs, but at the same time you mentioned, and I completely agree with you, that there's a lot of silver linings. There's a lot of opportunity in the changes that are happening. So let's just talk about what is it like for an healthcare innovator right now? What are some of the opportunities that are peppered in here just in general and then for DICOM and kind of how, what do you think this is going to be for you going forward when we get beyond the COVID crisis? [26:33]
David: Sure. I say yes, change absolutely, totally agree with that. Change is just a code for opportunity. A couple of thoughts on that in, in when I, in business school, what I've, I've said this to so many people lately we learned this concept of economic shock. So the concept of an economic shock is the idea that some event occurs and it could be a fairly innocuous event, but the point is it ripples through the economies of the globe. And so that, the joke we used to make was if there's an earthquake in Mexico, the price of wheat falls in Russia. Why? But I don't know. But it does cause there's an intricate mechanisms. So that's what's happening here. Now. This is an economic shock.
David: I'm also, well go ahead and make a prediction, a positive prediction for for your listeners and I, I hope I'm right. I make no claims to be an a genius, but it seems to me that I think that this is not going to be a long standing economic hardship. And I will say, or let me put it this way, why this is not analogus to 2008 or 1929. Okay. [27:44]
David: Because those events occurred due to problems with the underlying economy.
David: And that's why those things happened. Our economy is quite strong and stable.
David: Relatively strong and stable. The things that are happening are, it is inevitable that they will impact the economy. These things are happening not because of problems with the economy itself. They're happening because of extra economic shocks. So I predict, excuse that when the medical issues of the disease have passed which six months or so, I'm guessing the economic recovery will be fairly swift. Things will go, maybe not back exactly where they were, but pretty close to it. And I think that will happen fairly quickly again, because the reasons for the economy are all still good. [28:37]
David: Or the underpinnings are still solid. So we have had economic disasters in the past because of the economics were a disaster.
David: Then it was a disaster now, this is an external force. So I think everything's going to be okay. What's it like to be an entrepreneur right now? Well, it's a bit nerve wracking because we are still in the fundraising component to our company. We're still looking for investors. We have some, but we're looking for further investments. So that's, you know, when you're a startup that that's, that's you live and die by that. That's all I eat, sleep and drink is, you know, investors, investors, investors, and obviously not surprisingly, everybody just shut down temporarily and we're just trying to figure out where, what's going on. So the first reaction [29:23]
David: And everybody just…. everybody, just went to bed for two weeks. So we had, we had pitch meetings canceled, it is very ...arrrrrr, you know like a meeting you've worked on for months to get. And the person says like, sorry, we didn't know what to do..… so, so that's, that's been hard.
David: But as the dust has settled and the dust is settling a bit now is when you know, the opportunities are being realized and I think that, you know, investors are, are, are, are getting over it and what's going to happen now I believe, so articles have been written that venture capital money kind of dried up a little bit in the short term. I think there will be a very big boom in VC cash output, sometime the next six months based on the innovations that are coming out of the crisis, people are going to see some telemedicine companies. I don't know particular anyone running one, but I imagine it's a pretty hot time right now for a telemedicine companies that are looking for investors. I would think smart investors are snatching them up pretty, pretty rapidly.
Roxie: Yeah. [30:31]
David: So again, as you said, every crisis is an opportunity. So there's an opportunity for investors. Here's an opportunity for entrepreneurs to, to push their product. And what in particular, well again, I think we had referenced earlier in this particular crisis, anything that promotes, well to be honest, in my opinion, anything that promotes a more efficient medical system, that's a bit of an overstatement. Really what it means is eliminating much of the face to face that we use in medicine. So again, a little bit of a sidebar, telemedicine. How can we do telemedicine? You can't examine the patient. How can you possibly possibly evaluate a patient without touching them? That, I mean tell ya, I went to med school in 1980 and that is heresy. [31:19]
Roxie: Right. Right. Right.
David: And guess what though now? All these articles are being written and it's actually been quite a few years now that it's been the sort of dirty little secret that people do want to say ‘Physical exams over rated’. There's really nothing. I mean between looking at them and telling them like, look down at your leg, is it still there?
Roxie: Right. Right. Right.
David: That kind of thing is, is you can get through here huge amounts. So, so this, so there is an example of a really fundamental principle of medicine.
David: Is going to change.
Roxie: Right. [31:55]
David: Because of this. And, you know, I think that's fascinating. And anytime there's change that's opportunity. Someone, here's something we haven't even talked about—Wearables. Okay. So wearable healthcare technology. Think about how that's going to tie in. Now, if my shirt can send my vital signs to the doctor, I want to be in that shirt company because now people are going to, why? Why do I care? I do anything, go to the doctor just to get their blood pressure checked. You know, I mean, that's like ridiculous.
Roxie: Right. Right.
David: Why do you get your prescription refill to get your blood pressure checked? I can't do that over the phone with you.
Roxie: Oh no.
David: You know it's ridiculous.
Roxie: So how many times I'm taking family members to the doctor so they can get their prescription refilled. [32:39]
David: Right. Right. So here's another, so again, you get down into the nitty gritty. My wife's a clinician, she's an OB-GYN. So one of the things for most clinicians, this, I don't know, annoying and annoyance is people can game the system because they will call knowing that it's after hours. And because normally a doctor does not want to refill a prescription over the phone.
David: Now, I'll give you the medical reason then i'll give you the real reason. The medical reason, well because when you're refilling a prescription, you should talk to the patient and see how they're doing and check their things and make sure it's appropriate to refill a prescription. Okay. Here's the real reason. If we just refill it over the phone, I'm never gonna make any money. Okay. Because I don't charge you for refilling your prescription over the phone. So if you're my.
Roxie: Ping. [33:26]
David: My long-term patient, right. If you're my patient that I've been seeing for 10 years for your high blood pressure, and I make you come in three times a year, just so that I can refill. If I didn't make you come in, I just, I, I would only see you maybe once a year. And that doesn't make me feel good as the doctor who's taking. Anyway, so the idea is that patients have known this for a long time that too, avoid being told, well, you have to come in if you want your prescription refilled. They figured it out. They call after hours because then there is no, it's like, well you got to fill their prescription, it's after hours, they need the medicine, you know.
Roxie: Right. Right.
David: They going to go and so you know the people sort of gaming the system. But now all that's going to go away because it was, my wife is like, you know what? Now people are, because what's happening is people are calling you off. I just need my prescription refilled and the officer's going, no problem. We'll give you a telemedicine appointment. [34:23]
David: Like Oh no, I just need my prescription refilled. Oh no, that's all this, it's just a phone call to tell him. But guess what? Now the physician can bill for that visit.
David: So it's, it's fascinating the little nitty gritty about how this is a good thing. This is a good thing for healthcare. Now this, this is a doctors are really upset. Oh you know, you know I'm losing all this office visits cause know people just call in and they want it, their prescriptions refilled or they just want their question answered over the phone. Like, Oh, you know, it burns when I, when I urinate, I think I have a urinary tract infection. Can you just call me in a prescription? Well, that really should be a doctor visit. I mean, let's face it, you're calling in, they're going to treat you and there's no billing for that. [35:03]
Roxie: Yeah, right.
David: That's it. You called, there's no bill. That's a little unfair.
Roxie: Right Right.
David: So now it's like, okay, now everything is a telemedicine visit. So again I think who knew, who knew that this was going to solve an interesting billing quandary for healthcare providers? My wife's very happy now. She's like, it's great. No more people calling in just to get their prescriptions refilled.
David: After hours. Everyone's told, Nope, you gotta make a telemedicine appointment. [35:26]
Roxie: The awareness, right? So the awareness of the technology. So telehealth or telemedicine, you know, there's a certain, maybe a certain awareness of that, maybe more so than like artificial intelligence in healthcare. What's that? Or virtual reality and augmented reality in healthcare. What's that?But when I think we're a thrust as a, as a whole into the greater adoption of these technologies that have been available for a while that there's a certain, like you said, we don't come back from that awareness.
Roxie: Now all of a sudden it doesn't seem so foreign. And I kind of had a taste of, it's convenience, it's scalability, it's efficiency and. [36:07]
David: That's a good way to put it. Like if I little taste of its convenience and its scalability and I like it.
Roxie: Yeah, yeah.
David: That's very true. That's exactly, that's, that's perfectly said. I agree. You got a little taste, it tastes good and the great thing is it tastes good to everybody.
David: That's the funny thing.
David: I usually say it's good to one person. It's just good to the doctors, the patient, the insurance company. Everybody likes this.
Roxie: Right. Right.
David: That is a rarity of medicine. You know, I, I think about when we talk about please redirect me, I can talk for a long time about this stuff. I think this is fascinating. These, these issues. Yeah, we were talking about innovation in healthcare and adoption and how things happen. And so in this case, a very valid technology is being pushed due to an external economic shock. [36:55]
David: That's interesting. Let's look at one of the, it didn't happen that way. Laparoscopy. Okay. So not too many people realized. People seem to think that laparoscopy was invented in the 1990s late eighties, early nineties, which is when we started doing it. Right. That's when we started doing laparoscopic cholecystectomy.
David: Well, the reality is laparoscopic laparoscopy was invented in the 1930s. Okay. Gynecologists had been doing laparoscopy forever.
David: And they had always been looking at general surgeons like, Oh, why you guys are doing that crazy big incision? Well, we do. We do stuff. A little teeny tiny incisions. I don't know what you guys are doing. Why, why, why, why? For 30 years didn't penetrate.
Roxie: All those scars.
David: Couldn't get a good unit, and then all of a sudden one day, I don't know why. I mean there are papers have been written as to why, but all of a sudden it caught, and then what happened? We went from zero. You went from never heard of that operation to Oh my God, I better be doing 10 a week. Now contrast that with robotics. Okay, so here's robotics, which was the exact mirror image in my opinion, which is to say it didn't actually provide any advantage. It just was fancier. [38:12]
David: Okay. Whereas laparoscopy provided a huge advantage and didn't, wasn't fancy, it already existed and we resisted that. Now here comes something that's super fancy, which means expensive, complicated, and didn't actually really have any reason why it was better. And to this day people still struggle to prove why robotic surgeries are better. And yet there was none of this 30 year lag for that to be implemented. Within two years hospitals went from, don't even know what a robot is to have to have one. And how many of those have to have one? It sits in a corner with lab coats hanging on it cause nobody uses it. I just fascinated by these things, why some things take off for good reasons. Others take off for wrong reasons. Somethings don't take off even though there's good reasons. So I'm, I'm fascinated by the whole. [39:12]
Roxie: On the show. We talk a lot about the technology adoption curve right.
Roxie: In those first few segments of the market, those innovators, early adopters.
Roxie: And you know, Jeffrey Moore wrote a book on crossing the chasm and then you've got those other two segments, the early majority, the late majority and health innovators in the trenches, you know, trying to get through that adoption curve. And then you have like what you called us, economic shock. That's like, Phewww, I wonder, you know how I cannot wait to explore over the next few months in the few years of how this is impacted that technology adoption curve, how many innovators are in the trenches just beating their head against the wall, trying to cross the chasm.
Roxie: And now all of a sudden they're shooting across the chasm like a freaking rocket. [39:59]
David: And no one came to understand why.
Roxie: Right. Right.
David: Yesterday I was a poor schlub, nobody ever heard of. Now I'm like, I'm being interviewed on CNN and I've invented the greatest thing since sliced bread.
Roxie: Yes. Yeah. Can we figure out that secret to success and can we manufacture that for everyone to be able to get their innovations of the hands of the people that need them the most?
David: Actually, when you figure it out, I’m in.
Roxie: All alright, let's do it. So David, you know, I get the same impression that you like. We are so passionate about these topics. We could talk for days and I want to spare our listeners that for this particular episode.
David: Good idea.
Roxie: We can always do another one. So as we wrap up here, what wisdom, lessons learned advice do you have for fellow health innovators that are in the trenches right now? [40:51]
David: Well far be it for me to give advice. I'm much better at receiving advice. Don't give up. You know, there's a million corny expressions, but I got to say they're all true in our County when it's always darkest before the Dawn. Yeah, you got to fail five times before you're going to succeed. All this is, it's all true. It's so true. It's true. I have terrible days. Believe me, I wake up some days and go, what am I doing? Oh my God, can I go back to the operating room? You know, whatever. And other days I wake up just absolutely excited about what's going to happen. Hang onto those good days. Don't let the, don't let the bad days overwhelm you. If you're an entrepreneur or you're an innovator in healthcare, I'm guessing you're a pretty clever person because you didn't get there without being that way. And if you're not clever, hang in there man. Hang in there. Just remember Jeff Bezos didn't make a profit for 20 years and he's now the richest man in the world. [41:45]
Roxie: Can you say that again, David? I listeners need to hear that twice.
David: Amazon did not make a profit for 20 years. 20…20 years, he lived, beg, borrow and steal, man. That's it. I hear. Well, you can finish up with this. This is one of my, I'm a big fan of Jeff Bezos. I don't know anything about him personally. I know maybe a complete schmuck, but I just, his business founder's story is a great story and I, I really, this is probably one of the most important things that speaks to me. He was interviewed some years ago about why, how it was that he decided to start Amazon. Most people may not even remember, Amazon started off selling books.
David: It was all, it was about online books had nothing to do with yogurt. So anyway, books and so he was working in Wall Street. He was just a Wall Street guy and he very quickly realized as did many, many millions of other people that the idea of digital books made sense. [42:42]
I just seem to make sense. It's talk to the early eighties as I guess that makes sense. Even millions of people thought of that idea, but here's what he said. He said, you know, somebody is going to do this. Somebody is going to create the digital book platform, create selling books online, and I do not want to be the guy five years from now still sitting here in my Wall Street office going, damn, I could have done that. I thought of that. Why didn't I do that? So that's what I call my Jeff Bezos moments.
David: This is a Jeff Bezos moment. Don't miss your Jeff Bezos moment. Don't be the guy who two years from now when this is all over, looks back and go …Yeah, I, you know, I thought I was, I thought about telemedicine and I had a whole grid thing going on, but I dunno. Couldn't get around to it. Didn't think it would work. I didn't have the self-confidence, whatever. It is your reason, you just didn't do it. But now here you are two years later and you're looking at somebody else who did do it.
David: The person who didn't do it, here's my message— They are no better than you are.
Roxie: Yeah. [43:43]
David: They are not better. They're just maybe a little, excuse me, Ballsier something, but they're not better. They're not bad.
Roxie: Yeah. Resilient, resilient, resilient. You know, this is, this is a knockdown that a lot of us are facing and we just have to continue to get back up. That's what I hear you saying. Get back up,
David: Have faith, have confidence. If you see that trend, if you see that Kindle happening and you know it's, you know in your heart it's going to happen. This is how I feel. And honestly this is why I'm in what we do. I know in my heart we will use holograms in medicine. I know I'm dumb. I could be wrong. I'm very possible, I'm wrong. And if I'm wrong, my whole thing goes out the window and I admit defeat and go home.
David: But I am so sure of this. Then I kind of don't care. I mean, I'm like, I'm so sure this is going to work that all I gotta do is just find my way around, man, just hang in there. Just do it. You know, just do the best to kinda hang in there because I know this is going to be a thing. And so that's all you gotta do is then just if you're, if you have confidence in your business plan, in your idea, all you gotta do is stay in the game. . [44:55]
Roxie: Amen. So David, how can our listeners get a hold of you if they have…
Roxie: Questions for you?
David: Well, here's my home address. I said, please, I'm very reachable anytime. But my email email@example.com I'm on LinkedIn, I'm on Facebook, I'm on and DICOM Director is on LinkedIn, on Facebook, on Instagram, on Twitter. We're on everything. We have our website, www.dicomdirector.com which I apologize, it's not very good right now, but we're working on, it's going to get better in the next couple of weeks, but again, please firstname.lastname@example.org or just email@example.com and I'll get it. And I really love to talk as you can see. So and I love entrepreneurs and I love sharing experience, so please, anybody reach out. I love it. And if you're in the New Haven area sometime in the future, not now, please come by where we are. Again, we work in a really tremendous space in New Haven, Connecticut called District, which is founded by a guy named David Salinas, who's a tremendous entrepreneur and it's just a really cool entrepreneur space. So if you're ever around, please come by and visit after all this. [46:04]
Roxie: Thank you so much, David. Appreciate your time today.
David: Thanks for actually really a pleasure. We'll talk soon. [46:10]
Thank you so much for listening. I know you're busy working to bring your life changing innovation to market, and I value your time and your attention. To save time and get the latest episodes on your mobile device automatically subscribe to the show on your favorite podcast app like Apple podcasts, Spotify and Stitcher. Thank you for listening and I appreciate everyone who's been sharing the show with friends and colleagues. See you on the next episode of COIQ. [46:38]