MedicalPhysician Q&A

20 Questions with Dr. Cosima Gretton, Health Technologist

Dr. Cosima Gretton is a medical doctor and product manager at Karius, Inc., a biotech startup specializing in infectious disease genomics. She is also a Technology Entrepreneurship Teaching Fellow at UCL, where she is currently designing and delivering a new health care pathway which would guide entrepreneurs through the UK healthcare system, and a fellow at the Digital Health Forum, which brings together industry, academic and clinical experts in digital health. Furthermore, she is a mentor for Startupbootcamp’s healthcare accelerator.
In 2011, she co-founded the AXNS Collective, a science communication company which is looking to advance public engagement in neurology and psychology with the help of scientists and artists.
Dr. Gretton obtained a degree in Experimental Psychology from Oriel College, Oxford University (2009), followed by her medical degree from King’s College London (2015). While at medical school, she studied at the University College London (UCL) Mobile Academy, which supports individuals with new business ideas. She also studied at the Silicon Valley think tank Singularity University, where her team founded an at-home salivary diagnostic start-up called Mitera.
She most recently worked as Product Manager at Outcomes Based Healthcare, designing and building a research app to gather smartphone sensor data for diabetic patients; as a technical lead for RADAR-CNS at the NIHR Biomedical Research Center, a project seeking to find predictors of relapses in a number of neurological conditions; and as a digital health innovation consultant.
Dr. Gretton has written a number of featured articles for The King’s Fund, WIRED Magazine, and KQED Science, and has been published in the International Journal of Geriatric Psychiatry.
When did you first decide to become a physician? Why?
I first decided to become a doctor in the second year of my psychology degree. My initial intention was to do psychiatry, which I think I would still do at some point, but I’ve deviated from that, for the moment.
How did you choose the medical school you attended?
I wanted to stay in London, and Kings [College London] had a fast track, four-year program which was highly recommended.
What surprised you the most about your medical studies?
I think I found it quite frustrating because you learn a lot of information by rote and there was very little room for exploration or curiosity unless you were pursuing academic research. That’s why I ended up setting up AXNS while in med school, a science communication company that worked with the arts to communicate around brain disorders.
Would you specialize in psychiatry in the future?
If I were to choose a specialty, I would go into neurology or psychiatry. My main interest is in the mind and the brain. I have always been interested in emergency medicine, but I would find the lifestyle a bit too difficult to manage in the long term.
Tell me more about how you first got involved with start-ups?
I started with an internship, and then came out to the US to attend Singularity University. I fell in love with California, [which is] why I’ve now moved to America. I’m now taking a break from medical practice, to work full-time with a start-up.
Has being a doctor met your expectations? Please explain.
I found the social side of it very satisfying. By that I mean managing complex social situations, negotiating with families, thinking holistically about patients. There was often opportunity to do that, particularly when working with the elderly. In terms of where it didn’t meet my expectations: I was most recently practicing in a tertiary hospital in central London, and as a junior doctor in central London, you are very much an admin clerk. The amount of documentation and the poor quality of the software systems with which you’re expected to work every day was frustrating.
What do you like most about being a doctor?
What I like most is the opportunity to witness first-hand and deal with the ethical and philosophical questions that arise on a daily basis. You get to problem solve because there aren’t guidelines or protocols, every situation is different; those were the parts I found most fascinating.
What do you like least about being a doctor?
The NHS underappreciates its staff for the effort and the work that they put in. I think we’re seeing that in the anger at the junior doctor contract. That wasn’t just about the contract. The outrage was twenty years in the making. I have a friend who was doing a 24-hr shift on Christmas Day, and all the shops were shut and the canteen was shut. He realized that there was no food he could buy, he reported this to management and they said: “Well, I guess you could go and eat some of the patients’ food, you’ll just have to wait to see if there are any leftovers”. It’s not the way to treat the staff members that essentially keep the hospitals running.
What do you like most about being involved in healthcare technology and entrepreneurship?
It’s an exciting field, there are new things coming out all the time, and there’s a constant flow of new challenges. You have an enormous amount of responsibility – especially with a start-up, no one knows how to do your job or how to do the job of the company.
What do you like least about being involved in healthcare technology and entrepreneurship?
It’s all uncertain, so it’s very different from medicine, which has been around for centuries and has very clear job descriptions and roles. Sometimes, that can be quite stressful, because you need to find a way through something, but it’s very satisfying when you solve it.
Describe a typical day as a doctor—walk me through a day in your shoes.
On a general medical ward, I would come in at 8. You’d have alternate shifts between admissions and routine ward rounds. If you were on an admissions shift, you’d go to A&E, where they’d referred a patient to us for admission, meet the patient, take a history and examination, and document findings. You’d cross-check with the A&E history and examination, and check that A&E had done initial management. Once they were stable and clerked in on the admissions ward, I would go and keep collecting patients from A&E and clerking them in. At the end of that shift, we would do a ward round with the consultant who was on admitting. The consultant would review each of the patients we’d clerked in. Each of the doctors would present the patient’s case and their management, and then the consultant would agree or disagree with the current management. We’d continue or change plans, or discharge them. In between all of that, you’re doing all the “jobs”. You’re making a list of all the things you need to do, including drawing blood, taking a patient down to X-ray. On the days when you’re not admitting, the patients who’ve stayed longer would be reviewed on a general ward round each morning.
Describe a typical day as a healthcare product manager—walk me through a day in your shoes.
There is no typical day; you are defining the day yourself. You might have a meeting that one of your colleagues has called. You might have an interview that you set up with a customer. You might call a meeting randomly because you realized you need to get the team together to make a decision on something. A lot of it involves coordinating activities and timelines, then balancing that with protected time for you to actually do some of the work. For example, I’m currently conducting user research: I work with the lead designer and head of clinical studies and we would brainstorm all the questions we want to ask in order to test our hypotheses around which products we should develop next. Then we would come up with a list of questions, review them a few times, get feedback and then eventually gather together a list of customers, potential people we could talk to. In the case of Karius, these are infectious disease doctors. We would reach out to them via email, asking if we could have some of their time for an interview to find out about how they would perceive the tests, how they might use the tests, what type of things they would prefer. This is not a sales pitch; this is research enabling us to improve product development.
On average, how many hours a week do you work?
I probably do 12-hour days in the office, and sometimes work from home in the evening. I often work about 6 hours on a Sunday. In a start-up there’s no overtime, it’s all hands on deck to try and get the company off the ground.
How many weeks of vacation do you take annually?
In America, they take very limited vacation compared to Europe, but we have something called unlimited vacation. This is recent a trend in Silicon Valley. It’s basically the recognition that, as long as you’re getting your job done, there’s no reason to be counting days. You should be responsible with the amount of vacation you take. Interestingly, people tend to take the same or less vacation with that kind of policy.
How do you balance work and your life outside of work?
I’m not that good at it. My partner is better at it and keeps us both in check.
What types of outreach/volunteer work do you do?
In England, I used to volunteer at a local school to help them apply for university. I’ve just moved country, but there is a great local service I’ve recently reached out to that supports teenagers and young people with job interview practice.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
I would say I should have written more papers. If I were to do med school again, I would secure more publications while I had so much free time.
How did you seek out opportunities outside of medical school?
I largely created my own. For AXNS, I had an idea and I did it, because I realized no one was going to hire me to do that kind of thing, as I was a medical student, not an art curator. I printed a business card which the words “art curator” on it and contacted a lot of people via email. People were very friendly and helpful and tended to respond.
As for Singularity University, I had a drink with a good friend of mine three days before the application deadline. I’d never heard about it before, but she basically said: “You should apply to this program”. I was in a good position to do it because I had some experience with start-ups, I was doing medicine, so it aligned quite well with my interests at the time.
From your perspective, what is the biggest problem in healthcare today? Please explain.
I would say it’s the workforce, the attrition and loss of doctors. Granted, I’m a guilty party, but a significant proportion of F2 doctors are not continuing on with medical training this year. In the NHS, and globally, there is an emerging health technology field that is taking doctors out of practice. I think the NHS needs to treat its employees better, brand itself better, and give opportunities for people to innovate within it. There is an interesting program called the Clinician Entrepreneur program, which is run by Tony Young, and that’s a good opportunity to maintain clinical practice, while being able to innovate and build a technology product. I didn’t pursue that, as my plan was to move out to America with my partner, but I would come back and work in the NHS again, for sure.
What part of medical training itself prepared you best for health technology involvement?
Medical school gave me insight into a domain that is changing rapidly and I’m very excited to be a part of that and to try and improve the system.