Frederic Llordachs: “I resist thinking that it is not possible to treat patients better”
[A note from the interviewer: Is this interview too long? Don’t think so. It is interesting and meaningful. It is relevant and it pays off to be read. Let’s stop trying to change the world in a tweet. We want to learn from the bests – at Ticbiomed we give them the freedom to express themselves. Our businesses’ digital transformation is worth 5 minutes of our time.]
He’s a jack-of-all-trades physician and businessman. Frederic Llordachs-Marqués (Barcelona, Spain) is a passionate innovator, co-founder and partner of Doctoralia, the leading global platform that connects healthcare professionals with patients in more than 20 countries. Besides, he’s eHealth manager at ACES, collaborator at ESADE, Health 2.0 Barcelona chapter leader, Barcelona Health Hub Ambassador, mentor for startups, husband and father of two.
Today in A leader in 7 questions, at Ticbiomed we are more than happy to leave the floor to Frederic, the preacher man of digital health.
1. Who is leading digital transformation in healthcare? Who should be leading it?
Patients are the ones taking the lead in digital health. They are demanding what they see it’s working in other sectors and, in fact, this is part of the current problem – in any other sector you have digital tools at your fingertips, but in healthcare it scares us.
To the question who should be leading it, the answer is; the sector, that is, healthcare professionals, healthcare organizations, insurance companies… The sector is in a kind of “wait and see” attitude, although it seems they are beginning to wake up.
Let me share an example. We have been working at Doctoralia for 10 years now, I have been talking to insurers for 5 years and nobody has paid any attention to me. The sector’s answer? No, well, we’ll see about that… Everyone “will see” but, in the meantime, patients are using Doctoralia and that’s the key. If you do something useful, people will use it.
2. The relationship between doctor and patient is evolving and Doctoralia’s success is an example. Still, changes are not easy. Do you find more barriers in healthcare professionals or in patients?
When it comes to innovating in the doctor-patient relationship, the main barrier is in the healthcare professional. Professionals are trained to do things and treat cases always in the same homogeneous way, according to certain knowledge that we know that works on most occasions.
In order to change from one therapy to another, many things have to happen – many studies, many people involved. Even so, it is difficult for us to stop prescribing that medication or that antibiotic that we are used to or were told to use in our training period. We are conservative par excellence and we do well, but that extends to everything. We are conservative in our job, in the way we do things (paper and pen!), in not changing suppliers, in how we treat people… even doctors always tell the same joke in the same situation. We are very uniform. This makes us predictable, and so are our results.
The problem is when you want to do something that you know works in other sectors – e.g. making an online appointment or users writing reviews-, and you want to extend it to a sector like healthcare. I consider myself a preacher for conviction, for business and, above all, because I resist thinking that it is not possible to treat patients better; and that we can not give them tools that already exist in the 21st century. Healthcare organizations are still in the 20th century.
A little detail: the only two fields in which fax is still used are healthcare, for procedures such as authorisations, and the legal sector because everything has to go with bureaucracy. We still live as we did 20 or 30 years ago! And the rest is… try, push on. I wish everyone who thinks this way would do their bit, because little by little we would move towards the 21st century, which is basically doing more with less.
3. We have heard you speak on many occasions that healthcare professionals should prescribe links and apps to patients. What has to happen for this to arrive and be seen as normal?
What has to happen is that this practice should be normalized so that we will stop talking about it. It’s like digital healthcare; that one day we’ll simply be talking about healthcare. How can it be normalised? Based on new revolutionary tools? No, on the basis of a change of mindset. On the basis that we healthcare professionals believe that it is the best thing for the patient. As we voluntarily prescribe people after a heart attack to walk 10,000 steps every day, we can also tell them to buy a cool little bracelet being sold in many stores quite cheaply. This way I could, as a doctor, look at it every day or even receive its information. We are talking about standardising things that patients often already have.
I said a change of mindset because I do not think it is a generational change. I see young doctors and I’m in shock when they talk about being close to the person, stating that machines and technology take us away from the patient. This doesn’t have to go like this. Having trains between cities doesn’t keep us away from each other, on the contrary. Something different is that you make a mistake in the direction you take and go in the opposite one, or you just want to use the train for everything. But if you know where you’re going, and the limitations it has, technology can help us a lot in our work. Technology is a means to an end, not an end in itself, and this is what we are having trouble transmitting. Maybe those of us who are into new technologies in healthcare should reconsider how we make people in the sector understand that all this should serve to treat patients better and also feel better treated.
4. In addition to being a doctor and an entrepreneur, you are a mentor. What are the most common mistakes that digital health startups make?
Startups are often product-centered and entrepreneurs fall in love with their developments. The product starts small, gets bigger and becomes a monster that no one has tested before; many times they don’t face the market until it’s too late. The market is not “the market”, it is the person who is willing to pay for it or who is going to push your product to satiety for someone to pay for it.
Many times this falling in love attitude digs a hole and the startup gets stuck in it. And all of a sudden the resources run out, you look up, and you ask the market “what do you think of the hole?” The answer is “I didn’t want a hole, I wanted a tower”. Well, “I’ve run out of money, I’ve spent it all on shovels”, you may answer. And that’s the problem with a lot of startups. Failure is a lack of critical customer contact – you have to be able to accept criticism.
To sum up: one thing is to make inventions, which is technology, and another thing is to make innovation, which is to bring it to the market. We get lost, then it’s hard to sell.
5. One of the barriers for startups in digital health is that strategies do not work the same in health as in technology. How should the teams be like in eHealth companies?
It’s related to the previous question – there is a lack of business model and clarity about who is going to pay for your product. Therefore, a well compensated team has to have someone who is in contact with the real world, with the client from outside.
In Spain there are very good technologists, but often the teams lack health workers, insurers, patients; ultimately, people who tell you who is going to buy it for you.
6. Doctoralia has a worldwide presence. Latin America is one of your main markets. Are there big differences among countries in their predisposition to use technology in health?
In Latin America, patients value technology more than in Spain. They see it as a facilitator of access to healthcare, because their public healthcare is usually very weak, not like the Spanish one (we are lucky and we are sometimes not aware of it).
There, “good” healthcare is private, and having information, having access to doctors, getting to them first, not remaining in the bottleneck of calls… All of that is highly valued. That’s why we have great success in countries like Chile, with 1.5 million users every month; in a country of 9 million people it’s a huge figure. We also work in Mexico, Brazil, Argentina, Colombia… It’s very powerful.
But, above all, the big issue is the difference in the mentality of healthcare professionals. As they are entrepreneurs, as they are people who live off visiting patients, they know they have to invest in tools that bring them closer to the patient. They know they have to have a defined and clear digital identity. They know they have to have a personal relation with people. They know they have to strengthen the opinions of patients about them… The difference becomes evident when they touch your pocketbook.
I consider myself a liberal doctor. I think that we doctors have lost out in the Spanish healthcare design. Everyone admires the English healthcare model (which, by the way, is broke because of hospitals), but there family doctors are self-employed or they set up partnerships among them in agreement with the public healthcare system. In Spain, everything is intended to become part of the public system, with the exception of the Catalan model of subsidised hospitals and the EBAs (private healthcare providers), and the cooperatives of family doctors.
In Spain, we health workers are civil servants in order to reduce the costs of public health, but we have allowed ourselves to be mistreated so much by the public system. In the end, strikes come, medicine becomes a little unionised… Medicine wasn’t about that, because then you stop giving the service to the patient. People were doctors by vocation, dedicated to the patient, and if you were a good doctor you had patients and you earned your money; if not, you had to learn to treat the patient better. Now, for the sake of the system, the essence of the doctor has been lost. This doesn’t happen to dentists, for instance. Nobody discusses their profession and they get paid. But they have to face other issues.
A current challenge is patient management, expectations, delays in services … Do we expand the system? I believe that the public healthcare system has to change for the good of the patient and must do so towards tools such as Artificial Intelligence and telemedicine to, among other things, reduce costs and increase services. If 30% of Spanish doctors retire in 10 years, this deficit will have to be alleviated. That’s why we have to wake up and do it now.
7. We end with Frederic… as a patient. What technology/apps do you use to manage your health? Which one is not yet offered by health systems but you would like to see incorporated?
I’m a Fitbit lover – so much that I’ve tried Apple Watch and I didn’t like it. I’ve had 3 Fitbit wristbands and I’m doing great, for example, on the subject of sleep. It is important to know if you have had a bad night, because sometimes we are not aware of the lack of rest and low quality of our sleep. And also in terms of walking. Walking 10,000 steps a day does have an impact, and having a quantifier is worth it. I also use a heart sensor when I do spinning in the mornings. In fact, when I get to the office they tell me you have done spinning today because I arrive on fire!
Anyway, the ideal thing, and what I think we aspire to, is that all this information we generate could be integrated somewhere and be useful to doctors. I know that there are psychiatrists who use Fitbit to measure whether their patients with depression have taken their medication or not. The bracelet detects people who have spent two or three days with little activity, staying in bed, etc., which as a doctor can help you identify a relapse. There are sensors that are inexpensive and, for 6 euros, could be extended to the whole population by prescribing and controlling. There would always be the one who would cheat by putting the Fitbit on the dog but, jokes aside, making the population aware that they have to be careful goes beyond words. They must know that our “heart race takes place every day”, going up the stairs or getting off the bus one stop before yours, having to walk a bit on foot. Quantifying it helps us to be aware of these habits and boost our care.
Therefore, I don’t think we should wait for a super tool to come out; let’s use the ones that already exist for medical purposes. I want the doctor to tell me if I’m doing well, badly, if I have improved on this, if I have lost 3 kilos because I walked 10,000 steps a day… this is what reinforces patients. It is said that people give up on bracelet after a month, or after 3 months; this happens if we don’t see a use for it. If you give it a real use, with that connotation of treatment and relationship with your doctor, if there is someone on the other side giving you feedback, it is very useful. Healthcare professionals are supporting prevention and trying to help people to have healthier routines, and here technology allows us to close the circle. These small changes have an impact on the health system, both in terms of prevention and in terms of changing the mindset of the population.
One example is Iceland, where in order to avoid the high rate of alcoholism among adolescents, they began to force children to play sports until they were 16-18 years old. Compulsory. Of course, when you have to get up to train, the night before you don’t go out because you know that the next day you’re going to be devastated. You stop drinking, you train, and in the end you’re healthy. After very few years the rate of alcoholism fell in young people. And, on the other hand, there you have Iceland in the Eurocup in semifinals, in handball they are killing it… a country of 300,000 inhabitants. Crazy. Sport as a lever for health through conscious decisions. And that’s what I miss. It’s not the tool, it’s the knowledge. Somebody please take doing things with this data seriously.
Frederic in 7 tweets:
The greatest benefit of digital health is:
Improve people’s health and quality of life.
Keep the best ideas even if they are not yours.
All of Game of thrones. I have enjoyed them very much. After reading them I watched the series and so on.
All superheroes’ ones. I love them, I can’t help it.
A superhero (and why):
Ironman, because he’s a guy who doesn’t have superpowers, what he has is intelligence and bravado. He creates technology and from there he becomes a superhero. (It’s true that what he does have are unlimited economic resources, but he uses them to be a superhero, not to buy premises and buildings to set up Zara stores).
Any from Sinatra.
The beaches of Tarragona, which fortunately have not been discovered by the general public yet. (Wow, maybe I shouldn’t have revealed the secret…).
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