Ask HN: Non-hacker doctor wanting to start a health startup. What should I know?

Hi,

Former physician (nephrologist) here. I quit medicine in 2008. I find your question a little confusing. Like others I question why you want to learn how to code. I mean, I guess it comes down to what your plan is. I realize we are on hacker news but startup doesn't always equate software company.

Uptodate was started by a Burton Rose, a nephrologist. I don't know the history of that business, but I doubt he sat down and coded the website himself.

Presumably, the value of you working on a startup is related to your medical background, and the expertise that entails. Not spending long hours of not-much-free-time trying to learn how to become a mediocre programmer. I don't see how your changing the world is going to be based on your programming skills.

The converse situation would also make little sense. "I'm a skilled programmer of age 35 who wants to create a medical record start up. I'd like to learn how to diagnose patients in my free time..."

My interest is in more tech-based medicine (iOS, web, practice software, etc).

The consensus seems to be that I focus on deepening my domain-knowledge and forgo getting involved in the technological side.

Thanks for your response.

I'm a physician also (pathologist). I would encourage you to learn how to code. I decided to learn python about 3 years ago. It took me about 6 months before I really understood a lot of things (object oriented programming, in particular took a long time to grok). I mostly started with the goal of being able to knock together some little gui fronted databases and other things that would make my life a little easier. Now I mostly fart around with Django, javascript and Java (Android). I'm also learning C because I realize that I have a lot of holes in my fundamentals.

I don't want to discourage you, but I think that there are a huge number of roadblocks to creating a disruptive start-up that we usually see on HN in the medical world. Firstly, doctors are not the folks who are making the decisions about health care IT. The hospital IT depts are running that show, and in my limited experience they have no interest in supporting open-source or services that don't come with a big support contract. They would like to be able to point the finger to an outside company if things go south. Secondly, HIPAA and HITECH are going to be a big problem for small medical startups. A single breach or unauthorized disclosure or security hole is going to potentially sink your business.

I would encourage you to learn to code. It's definitely accessible for tech-oriented physicians and the wealth of community resources in the open source world makes it pretty easy to ask questions if you get into a bind.

Do you want to create a product to serve a market, or do you want to learn to code? These, while related, are very disparate problems.

I would suggest you find a technical founder that shares your vision for wanting to help make people's (hopefully the niche you're aiming at) lives easier.

You have experience that many (almost all) hackers lack: you have real experience working in a field and have identified a product/market that people want/need. Focus on that. Build user stories on what you want to create. Make diagrams of the interactions. Feed your vision to someone you respect that can make it real.

Unless you are extremely interested in the core of technology, you will likely find writing up a completed product exceptionally difficult. Writing code can be difficult, but it can be even more tedious. I'm not sure I have any way to express exactly how tedious many of the tasks that go into a release really are. This is why shipping a title is so important in some fields (eg: games). It is also why it is so important to find a technical founder who deeply cares about the market segment you're after.

Thanks for your reply.

I ultimately would like to create a product/service to serve a market; although, I can't say I don't have an itch to get into code.

One reason as to why I posted this is because I wanted to hear from hackers whether a physician with nothing more than domain-knowledge would be able enough to provide significant contribution to a growing startup. I've lurked about for some time and have noticed a stigma against non-hackers looking to start up.

But your post is reassuring and encouraging.

So short answer -> you will be able to provide significant contribution! I would recommend also trying to get your head around things that are possible in code rather than coding itself, so you are able to analyze scenarios. e.g., keep a table of patients and medications on the server, serve reminders on the doctors smartphone, call up best rated doctor, or whatever. Also, try to understand what is not possible, e.g., automatic algorithm to diagnose (too complicated).

If you're reasonably strong in mathematics, you can learn to code basic concepts pretty quickly. Unfortunately, there's not shortcut to learning to code _well_. But that's okay - at a super early stage, being able to assemble a prototype that will never go live could still be very valuable.

That said, I'm not sure learning to code is the best use of your time. Given how murky health care is, an inside knowledge of the industry should be immensely valuable to a startup, especially when it comes to demonstrating formidability and landing early biz dev relationships. You might be better off working on on the ins and outs of daily business, inbound marketing and fundraising, so that you can support your team while they build whatever it is you set out to build.

Focus on user experience and interaction design first. Learn to code not with the intention of building the app yourself, but with the intention of becoming familiar with what is possible with today's current technology and technologies which will become commonplace in the near to mid term.

Why?

Because as Wayne Gretzky said, you need to skate to where the puck is going to be and not where the puck is.

Where the puck is going to be is eliminating a lot of what doctors routinely do today by putting the tools in the hands of consumers.

90% of what general practitioners do today is simply glorified pattern matching. And they do an imperfect job at that. Computers are much better at pattern matching than humans for most tasks. The problem in the field of medicine is that we lack the tools to take the input from patients and put them in a form that is usable for most patients.

iPad tools designed by doctors for laypeople to use are going to be the single most disruptive force in medicine IMHO. Creating iPad apps for doctors will be a far second or even a largely temporary category of apps. What I would be skeptical about is apps made by doctors for doctors. There are certainly going to be good ones out there, but I expect many to suffer from the "designing it for me and the way I work instead of the designing it for doctors and the way all doctors work" problem.

Start looking at everything you do as a doctor and start asking the possibly painful question: "How could what is possibly with today's technology possibly replace the work I routinely perform?"

You want to learn to code to learn what is possible.

Forget learning to code, it's probably a waste of time and you'll miss the boat. Your medical background is by far your strongest asset.

I suggest you find yourself a technical co-founder or someone that would be willing to work on a prototype with you. Even if you have the means and are willing to pony up some capital having someone technical that cares about the idea and end-product is pivotal to your success. Additional capital can speed up the process of course.

Why you shouldn't learn to code? The medical field is one that a hacker alone can't crack. Sure we can figure out what a user is looking for when we're designing a flight search interface - but if the end customer is a physician, being an actual physician is a huge advantage, both in designing the product and in speaking the same language as the customers (assuming they are also physicians).

>>__whether doing such a thing would be feasible at my age (learning to code, etc), and whether my current educational background and training would be sufficient a contribution to a founding team__

Last time I checked, this field had no age bar. Honestly, you're most welcome to shake things up. If you have the vigor, which your post says you do, you can do it. Also, the support from communities like HN is amazing and worth giving a try.

HN also has a contractor list https://spreadsheets.google.com/ccc?key=0AlD_6iEb8Ed9dGs3clV...

Try learning at least a bit of coding so that you can communicate clearly when you find a technical co-founder. Also preparing a document or something similar to introduce domain specific terms to the potential technical co-founders should be useful.

You won't be coding it yourself, you'll be showing it to fellow doctors to get feedback.

Learn the basics of user research, usability testing etc.

I would also dive into the existing apps, existing industry and analyze its weaknesses/strenghts.

I just quit my job to work on my startup ideas. I'm very interested in the area of Health. Email me at railsnoob at yahoo dot com - I would be interested in hearing where you think the pain points of the industry are and your ideas.

I would recommend you pair up with someone technical who will help build the solution and provide guidance to learn the technology if that is what you want. If you are located in the Dallas area email me.

A strong relationship with someone who knows every bit of the regulatory system involved with health care would be a good idea too.

Are you in the NYC area? If so, email me using the contact info in my profile. We may be able to work together on something.