When did you first know you wanted to be a doctor?

My interest in the medical field began in high school in Japan, where I worked as an athletic trainer. This role involved being on the sidelines during games, helping student athletes with both training and injury management. Whether it was treating injuries or preventing them, I found the work incredibly rewarding. It was exciting to learn about the human body, biology, and physiology, and then apply that knowledge to real-life situations.

However, a pivotal moment was when my grandmother had a stroke. I was deeply affected by the way the doctors interacted with my mother as she cared for her. There were both good and bad interactions, and from observing these, I vowed to provide the best care possible, not just to the patients but also to their families.

What was medical school like for you? Did it meet your expectations?

Medical school was probably one of the best times of my life. The material we learned was fascinating and directly applicable to real-life situations, which made everything we studied seem very relevant. Learning about the medical aspects of things, for lack of better words, was cool. I made good friends, and everything I did felt purposeful, contributing towards my goal of becoming a doctor. Even the extracurricular activities, like participating in community health clinics, were aligned with this common goal. Reflecting on it, while it wasn't easy, the journey was incredibly rewarding.

Was there anything in medical school you didn’t like?

Yes, one aspect of medical school that I struggled with was the lack of creativity. This realization was probably one of the main reasons I decided to join an innovation club. I had this persistent itch to create and develop something new, an opportunity that medical school and conventional medical practice does not typically offer. In medical practice, by definition, you're expected to ‘practice’ what you've learned by repeating the same procedures and treatments, rather than innovating or developing new methodologies. This absence of creative development was something I found to be a limitation.

How did you decide on a Physical Medicine and Rehabilitation (PM&R) and what exactly is that specialty?

That's a great question. PM&R, also known as Physiatry, is a specialty that often faces an identity crisis, primarily because it doesn't fit neatly into the organ-specific categories that define most medical fields. While pulmonologists focus on the lungs and ophthalmologists on the eyes, physiatrists focus on the function of the body as a whole, which can seem a bit abstract.

My genuine interest in PM&R was sparked during a rotation in trauma surgery, where I encountered a patient with a traumatic brain injury. Over an eight-week period, I witnessed his remarkable recovery, from being unresponsive in a coma to walking around and playing basketball. It was truly inspiring to observe the PM&R team's role in his rehabilitation, focusing on recovery and functional improvement. It reminded me of my grandmother's stroke and the potential to make a significant impact on patients recovering from such traumatic events. This connection to my personal experiences and the rewarding nature of the work were decisive factors in choosing PM&R as my specialty.

So, how was residency?

Residency was probably the most challenging period of my life for several reasons. As I've mentioned, PM&R is a specialty that's hard to pin down, and there's a bit of ambiguity around what we actually do, which can be frustrating both for those within the field and those we interact with professionally.

However, the most disheartening part of residency was dealing with the constraints imposed by laws, regulations, and the necessity of negotiating with insurance companies. These barriers often prevented us from providing the level of care we desired for our patients and highlighted some of the systemic issues within healthcare that can hinder patient care.

There were aspects of PM&R that I genuinely appreciated. The specialty offers unique insights into brain and spinal cord injuries, areas that are not as deeply covered in other medical fields. I also enjoyed the sports medicine component, which aligns with my interests in physical function and rehabilitation.

How would you reimagine PM&R, at its best?

At its core, PM&R has the potential to profoundly change lives, especially for those facing the challenges of spinal cord injuries, brain injuries, and other debilitating conditions that result in chronic pain and limitations. These are complex conditions that require specialized knowledge not just for acute medical management but for long-term rehabilitation and quality of life improvement.

The strength of PM&R lies in its holistic approach. We're uniquely positioned to assess and address a patient's needs comprehensively. This includes not only the immediate medical and physiological aspects of their condition but also their functional and emotional well-being. We can make significant contributions by evaluating a patient's living environment, determining necessary adaptations and equipment for independence, managing pain, and coordinating physical therapy to enhance their quality of life.

However, to fully realize this potential, we need the freedom to practice our specialty as it was meant to be practiced. This means having the ability to spend adequate time with each patient, accessing necessary resources without the constraints of current systemic barriers. In my ideal vision, PM&R would operate with greater autonomy, allowing us to tailor our care to the individual needs of each patient, thereby maximizing their recovery and well-being.

What are the current barriers to practicing medicine in the way that you envision?

The primary obstacle is resource management, both in terms of what I can offer as a physician and what resources are available to the patient. Even if I were to allocate ample time and resources for each patient, many patients themselves lack access to the necessary resources for their rehabilitation and care. Coordinating these resources demands a significant effort, involving collaboration with social workers, municipal governments, and insurance companies.

The challenge is compounded by the realities of healthcare economics and regulation. The system's heavy regulation is partly a response to past abuses, such as Medicare fraud, which necessitates a balance between oversight and the provision of care. However, this balance often translates into a resource allocation problem, where spending time or resources on one patient is often not feasible.

From a practical standpoint, spending two hours with a patient, conducting thorough assessments and coordinating care, is not economically viable under the current payment models. Even with insurance reimbursement, the rates do not cover the costs associated with such comprehensive care. This economic constraint significantly limits our ability to deliver the kind of personalized, intensive care that would be most beneficial for our patients.

In essence, the barriers we face are multifaceted, involving a mix of economic, regulatory, and logistical challenges that prevent us from practicing PM&R in the ideal manner we envision.

When people say the healthcare system is broken, what do they mean?

This is a complex topic. The system encompasses many stakeholders, including patients, insurance companies (both private and governmental), pharmaceutical companies, healthcare facilities, and healthcare providers. There are numerous stakeholders involved, and none of them have aligned incentives; they all have different goals. From a physician's or patient's perspective, when we refer to the "system," it seems that resources are not adequately allocated to patients and the physicians who care for them.

The core issue is resource allocation; a significant amount of resources, including money, is funneled into areas that are perceived not to be the most efficient. For example, when you see companies like United Healthcare making billions annually, it highlights how control over decision-making and lobbying power can influence how money is spent, making it difficult for individual physicians or patients to effect change.

One perspective is that the resource management problem stems from inefficiencies, many of which are due to the privatization and employer-based nature of insurance plans in the United States. These systems have substantial overhead and require extensive paperwork due to varying regulations and requirements across different companies and states. This bureaucracy, including governmental procedures, introduces significant inefficiencies.

You decided to leave practicing medicine for tech. What made you want to make that jump?

It was, honestly, a perfect storm. I was utterly amazed by the capabilities of ChatGPT when it first launched and almost immediately recognized its potential in various aspects, including healthcare. I was frustrated with the bureaucratic work surrounding my clinical practice, and at the time I remember Louie and I starting to talk about different applications of AI and how they would revolutionize the current state of healthcare delivery. But it really wasn’t until Will, who was a good friend from Rice University, joined our discussions that ignited the spark for Cosign AI. We interviewed with YC with one of our earlier ideas, and even though we were eventually turned down, going through that process made me certain that we can accomplish what we are setting out to do. I think, one way or another, I was heading down the entrepreneurial path, but all of us coming together was the final push I needed to leave my clinical practice.

How can we help our healthcare system?

When we compare the sleek efficiency of companies like Google, Apple, and Microsoft, particularly the polished experience of using an iPhone, to the healthcare system, the contrast is stark. Healthcare, whether we're talking about clinics or hospitals, seems to operate with outdated methods; we're still reliant on pagers, a technology from the 1980s, showcasing an overall inefficiency not just in paperwork but also in operational, clinical, and management tasks.

However, I believe there's an opportunity for transformation. If we could align healthcare with the speed and efficiency seen in the tech sector, significant improvements could be made. The healthcare system is mired in competing interests, but at its core, it's about the transfer of information. This includes patient status, doctors' assessments, plans of care, and the interaction between healthcare providers and insurance companies. The current system heavily relies on documentation for communication and decision-making regarding reimbursement, which does not directly contribute to patient care.

For patients, the primary concern is the outcome of their care, not the paperwork behind it. If we could shift focus to what genuinely benefits the patient—medications, procedures, therapy—we could achieve better outcomes. The promise of AI and technology is to streamline and enhance the process of information collection and transfer, potentially revolutionizing healthcare by making it as efficient and user-friendly as an iPhone. AI has the potential to upgrade the "engine" of healthcare, moving it from outdated methods to more modern, efficient practices.

How does Cosign AI stand out in the crowded field of health AI companies?

Our healthcare system needs all the help it can get. I’m happy to see so many people who share the same vision as us. Ultimately, the key to success in this crowded field is to develop a product that delivers unparalleled value. Physicians and healthcare leaders are discerning; they recognize and appreciate genuine value, and we are dedicated to providing the best experience possible.

At the core of our approach is the ambition to offer more than just scribing and history-taking services that are prevalent today. We believe generative AI has the potential to transform care delivery across the healthcare system, enhancing efficiency in every aspect. This advancement aims to reduce redundancy and facilitate better communication among all parties involved in patient care, setting Cosign AI apart from other health AI companies.

So do you see yourself going back to healthcare once you fix it?

Absolutely. I believe that healthcare delivery will become significantly more gratifying when we can concentrate solely on our patients—formulating assessments, plans, and sharing what we believe will benefit them, without being bogged down by administrative tasks. The essence of being a physician is deeply rooted in these meaningful interactions. By eliminating the extraneous burdens, not only can we enhance our efficiency and see more patients, but we can also potentially increase our earnings. This streamlined approach will allow us to focus on what truly matters, making the practice of medicine more enjoyable and rewarding.