From Medicine to McKinsey to Main St

This is post 1 in a series highlighting my journey from physician to consultant to entrepreneur

I write this in a period of reflection — when I try to figure out what’s next for me as I reflect on my career to date.  My calling is the fixing of our broken health system.  However, as but one individual, how to do so in a way that allows me to build something of immediate value while taking care of my family is a complex challenge.  My goal is writing this is to help highlight my somewhat strange career path, as I’ve been contacted by a number of physicians at all stages of their careers. My professional journey started with the choice of physiological sciences as my undergraduate major at UCLA.  Physiology taught me a number of things — most importantly the concept of homeostasis

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Homeostasis (from Greek: ὅμοιος, homoios, “similar”; and ἵστημι, histēmi, “standing still”; defined by Claude Bernard and later by Walter Bradford Cannon in 1929 + 1932^[1]) is the property of a system, either open or closed, that regulates its internal environment and tends to maintain a stable, constant condition. Typically used to refer to a living organism, the concept came from that of milieu interieur that was created by Claude Bernard and published in 1865. Multiple dynamic equilibrium adjustment and regulation mechanisms make homeostasis possible.

Physiology activated a dynamic understanding of life in my engineer-oriented brain.  Where other fields point toward magic bullets: specific molecular targets, solve-all frameworks, etc; my training and orientation focused on how complex pathways interacted in a dance…and that all of the players needed to be aligned in what they were trying to accomplish to achieve change without triggering massive unintended consequences.  This education helped me understand that if there are multiple moving parts trying to keep things within ranges, then magic bullets were unlikely to work…you need to make sure solutions took into account how the rest of the players in your system would react to changes made.

Little did I know that this would be an amazingly helpful perspective as I looked at getting things done in the business world. UCLA was an amazing education for me.  As a member of the honors collegium, I learned to spend time with my professors and get the messy view of science that never really seemed to emerge in the classroom or from textbooks.  What I learned about science was:

• It’s an ongoing debate. You have to understand both the favored explanations and leading alternatives to really understand what your options might be
• It’s driven by consensus and politics.  When your grant funding is determined by peer review, you’re less likely to be asking for money for things that challenge the beliefs of your peers.  Hence scientific research is more often incremental than disruptive due to our current grant processes
• Just because its published doesn’t mean its right.  Things written in textbooks often don’t make sense due to internal contradictions.  Understanding to spot inconsistencies in theories is where you’ll really understand what’s going on and where new opportunities exist.  In addition, many things reported in the literature contain errors that no one ever bothers to check…but then are cited across the literature because the headline sounds nice.
• Statistical significance is not the same as real-world significance. Massive numbers of papers are published from data passing the statistical significance filter.  When you analyze the real world implications in terms of meaningful change for individuals or populations, its often underwhelming.
• Literature omits those things that went wrong. Nobody writes up papers detailing their failed experiments.  They repeat them or throw them away.  Therefore anything written up will have a bias toward displaying positive results that may not exist in a more objective environment