Surgeon-entrepreneur Dr Devi Shetty of Narayana Health believes even regular mobile phones have enough power to make medical diagnoses. “You just need the right data, that’s all,” he says in this Outliers podcast from November 2017. Shetty, a champion of affordable healthcare, has been exploring technologies such as 3D printing, artificial intelligence and intelligent software algorithms for delivering more efficient services. He believes that in a few years it will become legally mandatory for doctors to take second opinions from software before starting treatment.
Thanks, as always, to Kanika Berry for transcribing this conversation. Read this lightly edited transcript of the podcast.
Pankaj: Welcome to Outliers. Today, I am sitting with someone who is more a disruptor than an outlier. At least, I believe that. Welcome to the Outliers podcast, Dr Shetty.
Dr Shetty: Thanks.
Pankaj: We have with us Dr Devi Shetty, who is, of course, known as a pioneer and a disruptor in transforming the healthcare industry in India. I first heard about what you were doing, mostly the conversations were around affordability and things like that, but I thought we could quickly focus on some of the life lessons that you could share with the listeners of this podcast in solving a very unique India problem. You know, it’s not really sexy building India-focused solutions. So what are some of the life lessons in building Narayana Hrudayalaya (now Narayana Health) and where you are today?
Dr Shetty: See, the problem of the healthcare industry is, if you look at all the big multinational Indian IT companies in Electronic City, in front of no technology company will you find a poor man sitting with this child and saying, ‘I want free software.’ Whereas, in front of any hospital in most developing countries, which account for nearly 80% of the world’s population, there are always people begging doctors to save their child or loved one. This is a reality because our governments, without exception, have failed to offer healthcare to the citizens. And we can ignore it, right. The choice is yours.
But imagine a situation as a doctor, as a heart surgeon. I see 60-100 patients every day in my outpatient, there are times I have seen 120, 130 patients. Added to that, I need to do at least one or two heart surgeries. Most of my patients are little kids on a mother’s lap. You examine the kid and you tell the mother that her baby has a hole in the heart. She has only one question. When I tell her that the baby requires some operation, she has only one question. You know what the question is? It’s not about is it safe or when is he going to, or how big is the scar. It’s all about how much it is going to cost. And when I tell her it’s going to cost Rs 60,000 or Rs 80,000 or Rs 1 lakh, which she doesn’t have, that is the price tag on the kid’s life. You come up with Rs 80,000, you can save your kid’s life. You don’t have Rs 80,000, you are going to lose your kid. This is what I do from morning till evening, putting a price tag on human life. This is what every doctor in every developing country does from morning till evening, putting price tags on human lives.
There is something wrong with the way this world runs. If you give legally the right to put price tags on human lives to people like us, we have failed as citizens of society. Then we talk about human rights violation. If you take a gun and shoot someone, it’s murder. But people who have been given all the rights to officially manage the healthcare of countries, when they don’t do their jobs, it is not human rights violation!
So we are asking the wrong questions. Now, is there a solution? There is a solution. I strongly believe that within the next 10 years, India will become the first country in the world to disassociate healthcare from affluence. India will prove to the world that the wealth of the nation has nothing to do with the quality of the healthcare its citizens will enjoy. India will do it because healthcare is not limited by finite components. Suppose the Indian government decides to offer a free car to every citizen, you can’t do it because a car is made up of finite components. It is made up of steel, which god doesn’t make anymore. Whereas healthcare is offered by people, and people are replenishable. And fortunately, we produce 26 million of them every year. We can actually manage the healthcare of the whole planet but we have to look at it in a different context.
Pankaj: You made another very interesting comment. Last year, I was reading something where you said that in 10 years, people will take permission from software before they do treatments, something like that, healthcare software. What did you really mean by that?
Dr Shetty: I believe that smart software will make smarter diagnoses than doctors in the next five years, and it will become legally mandatory for a doctor to take a second opinion from software before starting treatment. It will become legally mandatory in the next 10 years.
Pankaj: What is the basis of this conviction?
Dr Shetty: What is our job as doctors? We make diagnosis. How do you make diagnosis? What is so complex about that? There are only 6,000 diseases you can suffer from, and diagnosis is made based on history, right? That you are talking of symptoms. Then the science, that is what we elicit. Then there are lab reports. You can only complain about 25,000 things to the doctor, you can’t complain about anything more. And there is a similar number of findings I can elicit by examining you, whether you are anaemic or whether there is a swelling. There are only 50,000 signs and symptoms and there are about 100,000 lab reports and images. We just link it and here are the diagnoses. That’s what we do. So essentially, diagnosing a problem is not like infinite kind of data. It is finite.
Pankaj: That’s why you think software could do that.
Dr Shetty: Hundred percent. The kind of things a software does today, whatever the diagnosis, even a very cheap mobile phone has enough power to make a diagnosis. You just need the right data, that’s all.
Pankaj: What will the doctors do?
Dr Shetty: Software will help doctors not make mistakes. A doctor today can treat patients whom they can touch. That means you have to be physically sitting in front of a doctor. A dermatologist in Bengaluru can’t treat a patient in Delhi, but with good EMR (electronic medical record) and online healthcare, a doctor sitting in his bedroom can treat patients in any part of the world. So, a doctor will become more efficient, a doctor will become more productive, a doctor will become safer. So patients will be happy with the services.
See, over 25 years ago, there was fly-by-wire available in planes. A plane could take off and land by itself without a pilot, but would you like to get into a plane without a pilot? You respect how good a technology is, but you wouldn’t do that. So you don’t want to be treated by software.
Pankaj: How much do you think about things like artificial intelligence, where they are saying you can replicate the human brain, the power of it, and what it can do. What do you think about this?
Dr Shetty: See, when people come to me with all these esoteric ideas about what healthcare can do, it’s a good thing. I want young people to think that way. But I am mainly concerned about what we don’t have, about grassroots healthcare delivery. In a world where 99.99% of the people have no EMR, there is no data. I see big companies coming up, building artificial intelligence for all kinds of algorithms; for everything you need data. It is like, people are building all kinds of fancy vehicles but nobody is building the roads, right! So this is where we are. First, let’s build the road, then when the data comes, these are all minor details.
Pankaj: Are there questions on ethics also when you talk about data and EMR? Lots of people are not aware of how that data can be used by companies. As a practitioner, as an entrepreneur, how much do you think about that?
Dr Shetty: These are major issues — data privacy and, you know, these data — but I hope we don’t go in similar lines as the US has. No innovation in healthcare in IT, in EMR can happen in the US because of the fear of data privacy and litigation and other issues. A technologist, if he has to build an application for use by a doctor and with the wow effect, you must realize that if your product doesn’t dazzle me, I am not interested. If you give me a product with a big manual, I will throw it on your face. First of all, you realize that we run a regulated industry. I will decide whether I want to use it or not. You are not making a consumer product, so you have to make everything that suits my requirement. If you don’t come up with a product, I am not going to use it. So you have to build something out of the world for a doctor.
If a technologist has to come up with that kind of a product, he should have free access to patient data and the doctor’s consultation room, sitting with the patient. That is not possible in the US because of litigations and other problems. So, in a country where patient data is more sacred than a patient’s life, no innovation can happen. So we have a great opportunity in India, we can make mind-boggling products.
Pankaj: The other thing I wanted to know from you, like you rightly said, you perform surgeries, and on the other hand, you are an administrator, too, you are an entrepreneur. How do you balance these two roles, that of an entrepreneur and a practitioner?
Dr Shetty: I honestly don’t take part in administration. I love my patients, they give me all the joy, and I am privileged today, I can say that I don’t look after the administration. There is a very good team of people who do the job. I give the general direction. I strongly believe that technology will dramatically change everything that we do, and we have to move in that direction. It may be very premature but we have no choice. My job is to essentially think about the future and make my organization and my country future-ready.
Pankaj: Final question. You know, people talk of science fiction that will become reality tomorrow. In the things that you do, and you are talking of the future, what are the 3-4 things that you believe don’t exist today but could happen?
Dr Shetty: Whatever I am predicting, it is not rocket science because we can see that. See, healthcare really doesn’t need a tool that doesn’t exist. We have to put all the tools together and make it work to help people, that’s all. Everything that is required for wonderful healthcare delivery is already available. It is just that we haven’t put it together. Yes, that is what is required and that is going to happen.
Pankaj: Thank you so much for your time. Really enjoyed talking to you. Thank you.
Dr Shetty: Thank you.
(Kanika Berry has a Masters in Business Administration and has been a communications specialist for over eight years.)