Part 2: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 28, 2016

We hope you enjoyed Part 1 of our interview with Dr Gregory Sam of Conduit Health. His telehealth psychiatry service provides nationwide consulting services which benefit rural and remote or mobility-affected communities. Consults can be done from the comfort of a patient’s local GP clinic or residential care facility, with no sign-up fee for GPs, and bulk-billing for patients.

Greg hopes to expand one day into other areas of the globe. Learn more about his journey below.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

How did you go about funding your project?

I’m a big fan of lean startups. Not needing huge capital. Also a huge advocate of self funding. Conduit Health was completely self funded. I was confident I could make the business model work.

I didn’t seek outside funding. There are alot of strings that come with outside funding, and you’re suddenly answerable to the government or your VCs (venture capitalists) or your angel (investor), and I didn’t want to do that. So I self funded everything. The benefit of the lean startup was, it didn’t cost me anything. I set my budget and said, “this is what I have to work with, what can I do with it?”

I started my company in the garage at home and a small office– which used to be for boys’ nights! So I said, no more poker nights, and converted it into an office. Conduit started from there. No overheads, no rents or anything. Yes, it was a home, and my wife helped me with marketing, pictures- I remember days sitting in the back office packing thousands of letters to send to GPs nationally- just me and my wife. More and more, big successful companies have that kind of beginning, they don’t have the multimillion dollars to spend at the start.

Sometimes you have to be able to sacrifice the ego and go, I’m doing the secretarial work. I typed up letters for my psychiatrists. I needed to do all this for the company, and if I didn’t have the money to employ a secretary or typist, I’m doing it. It’s rewarding at the same time, you get to see the company growing. From one referral to multiple referrals a day.

You must be critical of what you do. I always think, is this the right thing to do? Reflect and analyse, ask, “in terms of the business strategy, is this a good idea?” Not being complacent, “oh I can spend all this money now,” it’s about growing your business. Some people create meaning without making money.

Often if a company has created meaning, they then create money. But often people focus on making money first.

What got you interested in entrepreneurship in general? 

Wanting to make a change on a larger scale, to create something and grow it organically. And it’s exciting. Hard to describe the feeling but it’s a huge challenge. Something that can consume every moment of every day. But very rewarding. 

What sort of doubts or worries did you come across?

I didn’t study business. The difficulty within the medical field is, there aren’t many entrepreneurial people. I keep thinking of so many examples where my medical colleagues have such great ideas but don’t have the support or environment to foster that development. 

And I think taking myself out of that comfort zone,being with my business friends, listening and learning from them, really addressed those doubts.

One thing I know is that I’m a doctor, I know the medical part as well as the business side of things. Psychiatrists I work with feel comfortable with me because I know what it’s like to be a psychiatrist, I know the difficulties they face, I know what it’s like to treat patients. Whereas if it’s a purely business person,  you wouldn’t know what to give the patient, or how to be a psychiatrist, you’d possibly be like “oh it’s good for business, let’s do it.” That’s my advantage.

I think a lot of doctors should see it as an advantage, “I’m in business but I have a medical background.” So my doctors and nursing staff, they all understand. Which is why I’m all for doctors getting into business. As a doctor you would be able to empathise, with a business heart.

The other fear was, I got into medicine to be a doctor, and do my clinical training and be a psychiatrist. The path is very set. Once you start thinking of deviating from that, it’s quite scary. The reality is, actually it’s very refreshing. Because all we’ve known for ages is patients, medicine, being a clinical doctor. So actually, its very liberating.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

 One of the problems when starting out with telehealth is the many barriers. Like technology, for example, Internet speed, willingness to try out technology, video technology, and costs.

I thought, what are all the barriers? One by one, I addressed them and ticked them off. We bulk bill, so patients don’t pay. GPs win because patients get seen by specialists for no sign-up fee. Patients win because they don’t have to travel. Psychiatrists win because they don’t have to have room fees, which can amount to $70-80K a year. It’s an untapped market. Lots of patients need help. Whereas the metropolitan market is completely saturated. So we’ve tried to knock down all these barriers, and create a win-win situation for everybody. 

I think less so that people choose entrepreneurship, more so entrepreneurship chooses people. I think about ideas all the time. There are all sorts of naysayers who will come and tell you it’s not going to work. Why does this person say it won’t work, and how do I prove them wrong? I take what he says, think of the meaning behind what he says, and maybe he’s thinking it won’t work for xyz reason, how do I address xyz?

I think more and more power to doctors who become entrepreneurs in the medical field, or outside of medicine. So that studying medicine doesn’t become this one-track path, you will see patients and that’s it. People can become disillusioned by it, it’s so straight, the path doesn’t have any chance to vary. Yes, medicine does offer many specialties to choose from. But it’s still so contained like a nucleus, and no one’s thinking of addressing the outer shells.

Specialty training itself is all-encompassing. It will suck your life dry so that you just focus on training and that’s it. Same thing happened to me til I failed a few times, then you step back, and I said I don’t want my life to just be about training and fellowship. I want it to mean more, and that’s where the value is. 

Did you have a mentor?

 I had a few different mentors for different things. I try to draw upon the things that I want to gain.Positives and negatives. I draw analogies with badminton training. I had a coach for 6-12 months, and I drew as much as I could their positives. A certain coach would be good on physical stuff, another would be on mental aspects of the game. Same with psychiatry training. One would be clinically good so I’d take those aspects off them. Another had a good lifestyle setup, so I wanted to draw upon that.

For a business, it’s more offsite. I’m a member of business groups. The guy who did my websites runs an IT company in Malaysia, from a business perspective I love bouncing ideas off him, and learnt lots of things from him.

It’s important to be able to have many mentors for different things, because there’s a risk, if you follow just one person, you absorb all their flaws, and are unable to see their flaws. That’s a risk in medicine, too. 

I also learnt heaps from watching talks by Guy Kawasaki and Elon Musk and a few others. 

Part 3 will be released soon! In the meantime, if you’ve got any comments or questions about our article, comment below.

You can view Part 1 here and visit Conduit Health here. 

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please email enquiries@conduithealth.com.au. Conduit Health is also on Facebook

Highlights from the Digital Health Show, Sydney 2016

First published April 19, 2016

The Digital Health Show Conference and Expo at Sydney showcased a broad range of international digital health ideas. Presenters from medical and non-medical backgrounds shared their innovations via onstage panels and roundtable discussions. 

As Elaine Saunders of Blamey Saunders said, “Today, digital health is much more than reading off the internet or doing Telehealth.” Creating meaning through innovation, and marrying this with a viable product, generates synergy between patients’ and practitioners’ best interests.

Some themes that emerged from the Conference: 

  1. Digital health should unify shared goals for both practitioners and patients. Thomas Goetz (USA), former executive editor of Wired magazine, spoke of the difference between Passive Data (eg. phone sensors for pedometers), and Active Data (voluntarily entering your weight after stepping on a scale) in health. “Active data could potentially be more meaningful,” he said. His startup, Iodine, a search engine for side-effects of prescription medications, utilises active data through its Start app. Start lets users enter improvements and side-effects they experience from their antidepressants, generating a flowsheet over time that can be shared with their doctor.

 

2. Digital health can improve patient compliance and education by tracking goals and milestones on apps. This personalises each patient’s therapy; and potentially improves patient outcomes, speed to recovery, and reduces relapse rates. ImAblegamifies stroke rehabilitation via smart device apps, making participants 16 times more productive; DorsaVi’s ViMove wearable sensortracks lumbar muscle movement and posture to aid rehabilitation and avoid workplace injury; TrackActive’s exercise prescription app holds an exercise database so users can recall their prescribed exercises by video or saved instructions rather than on loose paper. Clinicians appreciate the integration of these apps and devices into their workspaces, improving interactivity between clinician and patient even outside of appointments.

 

3. Novel technologies can be integrated smoothly into user-friendly devices. Quanticare’s Footprintsoptical sensor can be attached to walking frames to analyse a person’s gait; ResApp uses the speech recognition technology behind Siri to diagnose respiratory infection via cough; Respirio uses nanotechnology to detect the presence of Influenza A and B in twenty minutes. Quanticare was founded by a physiotherapist, and Respirio by an Emergency Department physician, showing how inspiration from the frontlines of healthcare can inspire creativity.

4. Improving workflow. More innovation and more data can create more headaches for clinicians and workplaces struggling to manage the deluge of data. Medtasker aims to solve these problems by providing a secure platform for clinician communications at hospitals, meaning that clinicians will be able to locate the patient accurately, and triage pending tasks according to urgency.

5. Integrating convenience for patients and practitioners. Dr Noel Duncan of SiSU Wellness demonstrated SiSU’s health check computer station, which has previously been positioned at Crown Casino and Priceline pharmacies. Performing blood pressure, weight, BMI and heart rate checks via ultrasonic height scanning and bioelectrical impedance, it is partnering with the Stroke Foundation to conduct free blood pressure checks at Priceline pharmacies nationwide this month.  Dr Alan Greene (USA), Paediatrician, TED speaker and Scanadu founder, began his Australian visit by diagnosing an ear infection 7000 miles away in the States via telemedicine. He estimates that 90% of his interactions with patients occur outside his office. Although the American systems of telehealth differ to Australian models, Dr Greene’s talk painted an ideal picture of where digital health is heading for patients’ and practitioners’ benefits.

Overall, the DHS was an enjoyable experience, and for a newbie to the startup world, it gave a great overview of companies and founders who are realising their visions of creating a better world through digital health. It also gave me a better idea of the workings of startups and the stages that health startups go through to be approved in Australia and the US, such as prototyping; proof of concept clinical studies; and building a great team.

Other clinicians who attended similarly had a positive experience.

Dr Akshat Saxena from CancerAid said that “it was a nice mix of professionals, and a good place to link up and see what’s going on around Digital Health.” 

Dr Andrew Yap from Medtasker agreed that “it was a great opportunity to showcase Medtasker with other emerging healthcare companies. We made some great contacts and attendees were really enthusiastic about how Medtasker could improve patient safety and hospital efficiency. We want to thank the Digital Health Show organisers for all their efforts and we’d be keen to attend again next year.”

Dr Nelson Lau, GP who attended the DHS for the first time, felt that “it was a really informative event. The main talks gave an interesting overview on some of the potential pathways that digital health will branch out to in the future, while the roundtable sessions were a great opportunity to network with peers and have more informal discussions on collaboration possibilities. The exhibition hall was an interesting place to discover and play with emerging new technologies and platforms and it’s exciting to be at the forefront of the oncoming wave that will be sweeping over healthcare as we know it.

It was impressive to see so much time devoted to Geriatrics and devices for the ageing population, which we’ve featured in a separate post here.

The Medical Startup attended the Digital Health Show with a courtesy pass.

Did you also attend the Digital Health Show? Got any comments? Leave them below. Subscribe to our mailing list for future post updates.

Innovations for Aged Care and Senior Citizens at the Digital Health Show

First published April 19, 2016

 

The Digital Health Show Conference and Workshophad some standout projects aimed at improving the lives of the elderly and more vulnerable in our communities. Innovation for our ageing population will help integrate our society’s communities, improving wellbeing across all age groups. Here are some highlights:

 

1) A/Prof Valerie Gay and Dr Peter Leijdekkers of UTS showed how their community model, Le Bon Samaritain, links elderly residents in the community with “Good Samaritan” neighbours who are alerted via smartphone app if the resident is in distress, via a Red, Yellow and Green light system. Using “tech to empower communities,” this will help engage neighbours with often isolated members of the community. From our experiences working primarily with the elderly, we’ve seen many preventable hospital admissions occur during heatwaves, floods and falls, and feel that systems like these will help improve safety in our communities.

2) Philip Goebel, Physiotherapist and co-founder of Quanticare technologies, demonstrated the Footprints sensor, that attaches to a user’s walking frame and analyses gait during everyday use. The Internet of Things Innovation World Cup Winner at Barcelona, Philip created Footprints in response to the feeling that “our healthcare system is very reactive; focusing on fall detection, rather than indicator of cause.” Footprints uses an optical sensor which analyses gait via spatio-temporal gait metrics. The data generated can assist with prescribing mobility aids and falls risk management.

 

3) The ePAT (Pain Assessment Tool) for Dementia uses facial recognition software assess pain accurately in dementia sufferers, who often cannot verbalise their pain. Founded by Professor Jeff Hughes, former head of Pharmacy at Curtin University, he described how, by using the inbuilt cameras on smart devices, ePAT can assess facial pain cues at the point of pain onset, as well as non-facial pain cues. The benefits for dementia sufferers and their carers, will extend to more accurate pain management in hospitals and the community, and is being looked into with pre-verbal children.

4) Eureka ConnectionA/Prof Helen Hasan, Information Systems specialist from the University of Wollongong, hosted a workshop discussing Eureka Connection’s vision for bringing computers and smart devices to senior citizens. Starting with the Illawarra region of New South Wales, Helen’s passion for bringing tech literacy to seniors through home visits, community centre stations and education was reflected in the videos of seniors who were awed at sending their first email, receiving their first Skype call, and joining their first Facebook community group during a seasonal flood. As the elderly are at more risk of injury and isolation, tech education to encourage connectivity and social integration helps their wellness and physical health. Giving advice on how to set up a computer or smart device; selecting the right device for their needs, making it user-friendly by, for example, enabling large text; and helping them to reload credit and find hotspots are just some of the things this ambitious project hopes to achieve.


What are your thoughts on these projects for seniors? Comment below.

The Medical Startup attended the Digital Health Show 2016 on a courtesy pass. See our other highlights from the Digital Health Show here.

Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health: Part 1

First published April 26, 2016

 Dr Gregory Sam is a consultant psychiatrist who founded Australia’s first bulk-billing telehealth psychiatry consulting service, Conduit Health, in 2014. Focusing particularly on rural and remote communities, Greg currently runs Conduit Health along with his private practice work in the city. In this three-part interview series, Greg kindly shared his tips for success, the road to Conduit Health, mixing business with medicine, and rising from failure.

Image credit: Dr Gregory Sam

Image credit: Dr Gregory Sam

How did you get the idea for Conduit Health?

I think the idea started during my rural rotation of training in 2009. It was often a whole-day affair to see these clients, 4-5 hours’ trip each way, and that was disheartening to see people suffer so much. It’s supposed to be easy access. But they had to wait ages before seeing a psychiatrist.

So I aimed to fill that gap.

I started because I was so frustrated at the way things were.

I found so many deficiencies in rural mental health care, and thought, how do I improve things? There area lot of difficulties and shortcomings in the system. I was always into tech stuff. So I tried to think of the amalgamation of the healthcare and mental health care sectors. Telehealth was in its infancy then. So I thought, why can’t we assess the patient through telehealth conferencing?

I struggled to get through my exams, failed 3 or 4 times, and started to get a bit disillusioned about my career in general. I wasn’t sure why I wasn’t getting through. A lot of thoughts were going through my head. Is this the life for me? Should I be changing careers? A whole heap of stuff. But I thought, there’s still good things I can do in this field, whether it’s as a registrar or consultant or not. I’ve learnt a whole heap about my specialty through this. 

How long did it take you from having the idea to taking action, alongside your clinical work and studies?

Honestly, a few years. My idea has been since 2009, and it’s very tempting to get distracted by training. I was so focused on training that all these other things I could do fell by the wayside. I had the idea for a few years, but only started something solid in 2014.

I think 2014 was when overcoming all the inertia of starting a business occurred, planning and actually doing things. 

Failing my exams gave me that opportunity to start thinking outside the box. I took 3 months off work to have a break. I think that’s the best thing I did during training. I focused on badminton and other things I like doing, and started to make moves on my company. I had meetings with colleagues and friends in business, picked their brains, tried to absorb as much as I could from them, both guys and girls, to understand what it’s like to get into business. My business friends said, “it sounds like a brilliant idea, why don’t you do something about it?” So that gave me a kick to start.

When I went back to work, I left business for awhile and focused on passing exams. Once I passed, during our year of Advanced Training, I set learning goals on things like, “I want to learn more about drug and alcohol,” and other goals which I did in my day job, and also focused my energy on Conduit Health. That’s when the wheels started turning.

2015 was the launch date. Our first consult was February 2015, so 2015 has been a big year in that it’s a startup, and for most startups it’s about sustaining that growth, so 2016 is another big year. A lot of planning happens with regards to how to continue that growth, otherwise it’s too tempting to have a firework effect where it starts then fizzles up. 

Overcoming inertia is hard, but once you overcome it, things start rolling, and you can’t stop.  It’s a lot of commitment but so rewarding, more rewarding than my day job. I find treating patients rewarding, I can help them and their families as a psychiatrist. Whereas with Conduit Health, I’m helping so many more people across the country. We’ve had referrals from far and wide, from every state, and remote locations like the Kimberley and the Great Barrier Reef. I’m working with primary health networks (PHNs) across the country to expand our reach. 

How does a typical consult run?

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Either the psychiatrist dials in (from their location), or the patient (who’s hosted at their GP clinic) dials into us, then the psychiatrist introduces the consult. We need to say at the start that we’re doing it via teleconferencing, that there’s no one else in the office, and check who’s in the office. This sets the scene so the patient can understand that there are no unseen people in the room. We discuss confidentiality, unless risks in which case we need to notify particular people. It’ll go between five minutes to an hour, we state our aims, then start the diagnostic interview.

The video quality is quite good, but if there’s any lag or dropout, we disconnect and call back. We check at the start, “can you see me? Can you hear me?” We check camera position so the webcam points directly at the patient and so the patient can see us. We also make sure it’s appropriate, eg. the psychiatrist is in a quiet isolated room, not at the beach. We set rules for our psychiatrists. They use the Conduit Health backdrop. 

Sometimes a mental health care nurse will be there. We offer to GPs, if you want to be present for the whole assessment or in the last 5-10 minutes, you can. Some GPs stay for the whole interview, others come in the last 5 minutes and ask the psychiatrist, “what’s your diagnostic impression and what’s your plan?” They can get immediate feedback, (and sometimes help with scripts and so on).

We also get constant feedback from other GPs. My role is partly to ask patients and GPs, “how are you finding the process? Can we make things better for you?” Constantly evolving the company.

One benefit of Conduit is confidentiality. You don’t need to go into a psychiatric facility where everyone knows it’s a psychiatry facility, and sit in a waiting room with other mentally ill patients. Patients have said that’s a benefit, so people don’t have to know they’re seeing a psychiatrist. In a way that’s also bad. We’re not trying to promote stigma of mental health, but unfortunately this is a barrier to receiving care.

How did the name Conduit come about?

I was building a house at the time, and working with the builders, one said, “I want to dig a tunnel under your garden to create a conduit for your electrical wires to go through.” Also from my cardiothoracic surgical rotation in med school, “they harvest the conduit” in bypass surgery, and they explained what a conduit was to me. I then thought about what Conduit Health does, it takes away big distances and gaps.

The logo is a bridge, to embody bridging gaps.Suddenly, 300 kilometres to go to an appointment doesn’t matter anymore. It’s a link, a conduit, from point A to B. So patients don’t have to travel.

I don’t think telehealth will replace traditional face consults, but it can address geographical barriers.

Would you expand Conduit to non-psychiatry services?

The immediate next need would be psychology. It would be great to have psychologists who can do tests and consults. But at the start, I want to focus on psychiatry. Some companies have one of every specialty, but I want to focus (for now). If there is demand later on, for say, neuropsychology, social work, we will expand to fill the need.

What about your plans for aged care?

A big arm we’re developing in 2016 is to work with residential aged care facilities. There’s such a huge need, patients can’t often go see a psychiatrist. Aged care services are often floundering, “can we get the psychiatrist to come here?” but not many psychiatrists want to do that to see one or two patients, it’s not feasible. But we can go in and have a session there, and it’s immediate. So 2016 will be a big year for Conduit Health Aged Care branch. We want to expand to all the big aged care facilities. 

To learn more about Conduit Health, click here

Stay tuned for Parts II and III of Greg’s interview, in which he discusses his business inspirations, his insights on failure, and running a business as a medical professional. 

Upcoming Event: Melbourne Knowledge Week 2016

First published March 22, 2016. 

The City of Melbourne has just announced its exciting program for Melbourne Knowledge Week, from 2nd-8th May, 2016. If you’re looking for inspiration or want to learn about emerging technologies in medicine, healthcare and beyond, our top picks for Medical Startups and entrepreneurs are below.

Bio 3D Printing
This session promises to explore the future of 3D printing in medicine, health, and related fields.

What Makes A Place Age-Friendly?
This free event will invite discussions on designing buildings and centres with different age-groups in mind. You can have a say in how our ageing population will need to be better facilitated into new housing, community, industry and health developments.

How To Make Apps That Matter
If you’re interested in app creation in the medical space, this free workshop’s for you. For people of all backgrounds and levels, no tech experience required.

Augmented Reality Case Studies: Neurosurgery and Beyond
An introduction to Augmented Reality and its potential applications in medicine and surgery.

Life in the Cyber-Physical World
Deakin University is letting its robots and emerging technologies interact with workshop participants, thus enabling discussions on the ethics of FitBit and other new technologies that cross between health and consumerism.

Breast Cancer: New Research, Future Treatments
Open to the public, medical and non-medical attendees will get to learn about the Walter and Eliza Hall Institute’s latest developments in breast cancer research, and future areas of development. There will be a chance for questions, and a tour of the Institute which can be booked prior to the event.

Accelerating Health Innovation through Imaging
A talk on biomedical imaging and the physics behind it.

Develop, Protect and Profit from your Idea
A must-attend free seminar on Intellectual Property for startups.

Massive Community Maker Day
An all-day event to conclude the festival, where you can meet other makers, have a go at 3D Printing, learn about soldering, build a robot, and create a wearable.

View the full program for Melbourne Knowledge Week here