RX4_podcast_Dr. Nadine Hachach-Haram, Founder, Proximie: Audio automatically transcribed by Sonix

RX4_podcast_Dr. Nadine Hachach-Haram, Founder, Proximie: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Narrator:
ForbesBooks presents: Entrepreneur RX, with Dr. John Shufeldt. Helping health care professionals own their future.

John Shufeldt:
Joining me this week is Dr. Nadine Hachach-Haram, a surgeon, lecturer and clinical entrepreneur, Nadine is a co-founder of Proximie, a health technology business that uses augmented reality to allow world's top surgeons to virtually transport themselves into any operating room. Dr. Nadine, welcome to the podcast!

Nadine Hachach-Haram:
Thank you so much for having me. It's a pleasure to be here!

John Shufeldt:
And I'm really on the rise, when I really started researching your background, I watched your TED talk. I'm like, oh my gosh, this is so cool. So about 11 years ago, I started what's called MeMD, which is this virtual health care portal. And in that, you know, the time like that all this is so cool, we're treating patients virtually. And then I saw what you're doing now, like, you know, wah, wah, give it, give people a some background to what Proximie does because in my sort of research, I'm like, OK, that's so badass.

Nadine Hachach-Haram:
No, it's very kind of you. And look, at the end of the day, every little helps, as they say, you know, we're all here to try and make a difference for patients. But perhaps I'll start by telling a bit of my story and kind of how I got onto developing Proximie. My background really started as a surgeon. I trained as a reconstructive plastic surgeon. And I was really interested in, you know, how do I help restore form and function for patients? How do I help them have a better quality of life? Whether it's from congenital deformities but more broadly, as I expanded my career towards cancer reconstruction. Now, like many surgeons before and after me, we're always thinking about how can we continue to make impact? And so I got involved for, in global health, for about 10 years, working as a surgeon on global health initiatives all around the world with organizations looking at supporting and building capacity in many different countries. How do you build sustainable models of surgical care? I also spent time working with medical device companies because I was really curious about how do we continue to launch and bring new devices and new products to market so that us as surgeons could deliver these in an accelerated way to help patients. I think at some point it just became very clear to me after about 10 years of all these initiatives and all these different hats I was wearing is that we were still really struggling with scaling expertise. There were still patients going to one hospital having a very different experience to others. This high amount of variation in care and variation access was still just commonplace in surgery all around the world. And I think it kind of culminated around 2014. And there was, these publications around the Lancet Commission that was talking about five billion people lacking access to safe surgery. And at that point, I just realized that it almost, you know, I was concerned that it didn't matter how many countries I traveled to or how many operating rooms I went to, that the problem was so big we needed to think of a different way to solve that. Maybe because, you know, as a child, I was a gamer. My dad was a computer engineer. So naturally I was interested in technology. And so I started to think, what could that interface look like? Now imagine a world where operating rooms were connected and surgeons could simply by using a phone or a tablet or computer, virtually scrub in and collaborate and share best practices and enable this continuum of surgical care all around the world, democratized, accessible, and enhanced. And so that really took me on that journey of discovery, started to look at a lot of different things that are out there and eventually realized that nothing really fit the bill. And so I had to build it myself for, you know, by extension with a great team of engineers. So it was really the kind of the birth of Proximie and this idea that we could bring together the best of human expertise and the most advanced technologies to try and really change the paradigm in surgery.

John Shufeldt:
Well, I mean, CNN dubbed it the future of surgery, which after, you know, you're watching it and watching the TED talk, I can see exactly why they did it. You know, it seems like you've become really a force multiplier. I work in a, you know, kind of quanternary tertiary care center for neurosurgical procedures. And one of the things, you know, I always think about, gosh, if you can't come here but still need this very difficult surgery, what do you do? Well, now I know the answer. I mean, you use Proximie, you have someone like you who's coaching somebody else on the best practice. Is that what it was for?

Nadine Hachach-Haram:
I mean, it's a great, great example that you describe, because what we realize is that across systems and across health care, there's a heterogeneity of expertise, a heterogeneity of setups, and so what I really wanted to do is to design something by surgeons for surgeons, this idea that it's not just about a moment in time that I need to dial in and support you, it's more how do we digitize the surgical experience. So to give you an example, historically, when we used to learn and trained in surgery, there was this very common mantra, which was "see one, do one, teach one", you know, we all trained that way. And it was really where the genesis of surgery, this idea that we'll work, we'll communicate, we'll collaborate, we'll stand together in operating rooms and we'll get on our way. And I started to think about that in the context of perhaps other industries and how we could learn from other industries and maybe sports is a simple one that we can look at, you know, that idea of pre-game, during the game and post-game and how that's all connected through video, through, through methodology. And so I wanted to change that "see one, do one, teach one" to what I call the three P's: prepare, perform, and perfect, so that in any point cases are happening, people can dial in to learn to gain knowledge and share best practices to coach and mentor, if that's helpful, and to ultimately scale expertise beyond the four walls of a hospital. And you're right, you may work in specialist quaternary centers where there are a handful of experts that are treating a huge catchment area. How do we start to redistribute that resource? Having one expert sitting in one place able to support four, five, six, seven centers to make sure that patients can get care closer to home? And I think that is the bit where you really are trying to think about scale, access and improving the quality for everyone.

John Shufeldt:
That's on your TED talk! So it was a perfect description. So on your Ted talk, you are doing, like an ACL repair and you are kind of guiding the surgeon that, I am saying this right? And how to actually do it, I know it was a demonstration, but is that how it works or is it more, hey, I'm a third-year surgical resident, I can dial in and see how an expert like you performs reconstructive surgery? Or could it be both those things?

Nadine Hachach-Haram:
It's both and everything in between. Because what's really exciting is that surgery is a continuum. We never stop learning in surgery. So whether you're a first-year medical student, you're a resident or you're a surgeon at the top of your game, we're constantly going through that cycle. I'm preparing. I'm performing, I'm perfecting. We can use the Proximie platform, either in life cases where I want to dial in and see what others are doing or I want to dial in to give suggestions and inputs because we're all learning from each other. It's that reciprocity of learning and enhancing our skill set. But we also can record every single interaction into a library, a fully hipper and GDPR compliant library where team members can go back and review that case together, overlay and demonstrate anatomical tools to talk through that case, talk about the things that went well, things that could be improved, how do we start to accelerate learning in a way that's more digitized and more meaningful? And the interesting thing is surgery is not binary. It's not about doing one thing or the other. We do it all. We're, in any if you look at any surgeons week, they're doing anything from learning to training to coaching to acquiring new skills, to looking at new devices. And it's a continuum. And so being able to be that platform that is powering every operating room or cath lab and so is engaging surgeons across the continuum, whether it's a first-year medical student or, you know, retiring and post-retiring because you still have something to give, I think is the beauty of all this. And a couple of years ago, Atul Gawande published an article in The New Yorker talking about the importance of surgical coaching and enhancing and continuing to review your skills. And since then, again, Caprice Greenberg published some great papers on it, too. And it's really something I believe in, that there's a continuing need to digitize and we need to connect for the long haul of surgery to improve and enhance that for everyone.

John Shufeldt:
So, so that's another great, great explanation. So Proximie, could you actually, quote-unquote, lay your virtual hands on the patient through robotic surgery, or are you really there more as a armless coach and advisor, or can you step in and say, no, let me show you how to do it?

Nadine Hachach-Haram:
It's a great question. So you can't remotely move any of the devices, but you can definitely overlay your hands. So what we've built into this is an immersive multisensory experience. I think what's key is that there's a number of key functionalities that really make this so unique and different than what's ever been out there. And this comes from that purposeful design. Firstly, we are hardware agnostic or hardware neutral. We can work on any device in any operating room, whether it's a sophisticated robot or a small tablet and a webcam, we can deliver that experience. We know that health care systems are heterogeneous. And so we want to make sure that we can work with whatever devices are in there. We can stream up to four high definition feeds, four native camera views or device views from any OR, with ultra low latency and low bandwidth requirements. So that experience is very, very seamless as I'm sitting on my computer. I can see four views. It could be a scan, it could be some imaging, it could be the team and how they're working together in the room, and it could be a close up of the operative field. And then the great thing about that is on top of that, we use augmented reality using my tablet or my computer, I'm able to layer my hand and merge the image of my hand onto the surgical view, and so in the operating room, the team can actually see my hand on the screen making gestures and movements that are demonstrating the steps and procedure, working with them say, no, I would probably go a bit in this direction and drawing out potential plains of dissection or incision markings or plans or pointing out certain anatomical structures that one should look out for, that ability to put your hand in, and as we say, virtually scrub in is a game-changer because it changes that paradigm from just the communication to an immersive experience.

John Shufeldt:
So I saw that as a, last part of your TED talk when they removed the tumor and the surgeon goes now it's three centimeters, but okay, do a three point five centimeter to make sure you get the margins. You think the next iteration of this, because it makes so much sense to me, particularly with low latency, do you think the next iteration of this is that you can actually also control the robot from like, OK, let me, let me give this a shot?

Nadine Hachach-Haram:
I think the opportunities here are endless. I mean, we see I think those have already been attempted and historically there were challenges with connectivity and others. And as we start to see the advent of 5G and space tech and low orbiting satellites, this is going to change. I also think there's a big future around the potential of machine learning and knowledge sharing. How do you take that cutting edge computer vision and artificial intelligence to really start to build insights, curate insights for the future of health care? You know, it's one thing to take knowledge from that experience, it's another to be able to feed knowledge and learnings back into the system to unlock value not just for that surgeon, but for all the the participating stakeholders, whether it's the hospital, whether it's supply chain, whether it's other factors that are essential in an operating room. I mean, I hope you haven't spent time on it, but if you have, you'll see that there are many, many stakeholders and that, it's the hospital, the payers, the insurers, the surgeons, the learners, the device companies. It's complex. But if you're able to bring a solution that's powering the operating room and unlocking value for all these stakeholders, and I think the opportunities are limitless. And we're only just scratching the surface of where this can go. And we think about truly, truly digitizing the operating room and that experience.

John Shufeldt:
So I'm an EMDoc by training, so I haven't spend much time on the OR other than craft thoracotomies when I ran the patient up there and met the surgeon or in medical school. But I recently had an acoustic neuroma removed in a 10 hour procedure and I went to California because I knew that neurosurgeon and he was a specialist in skull base. But I remember thinking, wouldn't it be great if he can take his knowledge, stay in L.A., I can stay in Phoenix and have somebody here to do the surgery. But I have his years and years of knowledge and expertise doing skull base surgery to help them with the dissection if through augmented reality, basically make the incision here, cut here, this is before I knew Proximie existed. You know, if I had known two months ago I might be in a different position.

Nadine Hachach-Haram:
I mean, it's a, it's, I'm glad to hear that you're doing so well. And, you know, it's a tough surgery to go through. But know listening to you, it's, it sounds like you've come on the other end very well. I have a very similar story to that, actually. And I'm glad you shared that because it really crystallizes down to human stories. All of this is really about using the sum of modern experience and the combination of humans and machines to make a difference. And so a few years ago, my mother also had a really difficult case. She'd suffered many years of complications of a laparotomy. And I won't bore you too much with the details, but it left her with a pretty bad abdominal wall defect. And she had a bad hernia. She was in and out of hospital all the time because it was uncomfortable and she didn't really want to live that way. She was quite fed up with it. And so she said to me, I have two options. I mean, my local doctor is really good. I trust him, but he's not done many of these. But he's, he's a good surgeon and he's he's comfortable in the operating room. But at the same time, I know that there's these experts overseas who have done many, many of these. I have one option is to fly overseas, similar to your story was to fly to that expert. But the other option is I can stay close to home, close to my support network, my family, the doctor I trust and have built a relationship with over the last few years and have that expert dial in and support him. One, it means I get to remain home with my family, but two, hopefully he'll get up skills so that he can be more familiar with more of these for future patients. And so that's what we did. And it came from her. She insisted on having Proximie and having an expert dial in remotely. And they worked together through that case. And a few hours later, she was on the wards and five days later she was at home. She's now living life to her fullest. All those challenges she's overcome now, and it's because of that power of connectivity and using Proximie to bring experts together. And I think from that story, hopefully what I'm sharing is that this is truly the ultimate litmus test. If you're willing to put your own mother through this, then you really believe in the potential. And it was so great to see her driving that desire as well, and I think you've described a very similar situation. Wouldn't it have been great if I could stay close to home and have that expert dial in?

John Shufeldt:
Wow, that is an amazing story. So let me ask a question now so I know a lot of surgeons, obviously, did you have any, did you have a difficult time convincing this surgeon that he or she would need the extra help during the first complicated case? Because some of the surgeons I know and this is true about all physicians they're like, I know it all, you got, there's, there's nothing I'm going to learn over a computer, for God's sakes, in the middle of surgery, is that been a challenge for Proximie and for you?

Nadine Hachach-Haram:
I think fundamentally what we need to recognize is that what are the challenges often in these? It's about change, it's about behavior change. It's not about talking about this technology stock or that technology stock, is how do we win hearts and minds and how do we convince the surgical community that there's a new way and a different way of doing things that could benefit and allow us to all scale our expertise? Well, it comes back down ultimately to value and the value proposition. What is clear for us as surgeons is that there is an increasing gap between the number of surgeons who can deliver care and the patients who need it. There just aren't enough surgeons to deliver that care. So we have to think more broadly about how we solve that and how we bridge that gap. The second thing is being a clinician and a scientist versus putting evidence behind it, it's really trying to ensure that you have a problem that you're solving. And it's not a solution looking for a problem. It's a very early on in Proximie's journey, we published a ton of evidence around the value we were bringing, the ability to accelerate skill acquisition to help doctors collaborate and share best practice, reduce the time to training that we could enable and enhance access to care. And all of that is important because when you're going in and talking to a surgeon about the potential of this future way of doing things, they're going to ask well, well, how or why? And having that evidence and having those use cases in those champions are key. But I'm not naïve to the fact that, you know, surgery has been done. It's traditional. We've been doing things the same way largely for many, many years. And so this is going to take some time. And so when I started off this journey a few years ago, I didn't come out with the product immediately. I actually spent two years putting out thought leadership pieces. My TED talk is one example, publishing papers, writing white papers on what is the future surgery going to look like? It was only as I started to really see the momentum around it that we really launched in 2019 and then we started to see a doubling quarter on quarter and adoption people willing to see the value of it. And then in 2020 of course, just as covid hit, it went from being a potential future way of doing things to the only way to do things. And we accelerated our user base by ten times, the number of cases went from, you know, a thousand cases to over eight thousand cases. And we went from twenty five hospitals to close to three hundred hospitals. So there's a fundamental element of behavior change and sometimes you need a strong catalyst as well. But the final thing I'll say is, it kind of takes you back to a book I read years ago called Crossing the Chasm, and it was really thinking about how do you enable that behavior change and how do you start to look at your users as in different segments? And it became clear to me that when I look at surgery, it's going to largely come down to four-kind key groups. You're going to have you're really, really keen early adopters that will try anything. And those are great because you learn a lot from them. You get a ton of feedback and you can continue to enhance your product accordingly. Then you get your second group, which become your best champions that want to see some evidence, want to see that problem really being solved and the evidence behind it and they become your biggest advocates, validated credible advocates for what's going forward. Third group are kind of the late adopters, but they get there eventually. And we're seeing a lot of that happening, of course, accelerated since covid. And you may have a small group that will never adopt this new way of doing things, and that's OK, too. They might either need a bit more time or may decide that they want to stick to more of their traditional models. We hope that over time they will change. But there has to be an acceptance that not everyone is the same. And we need to make sure that we're tailoring our messaging and our approach to those different behavior groups.

John Shufeldt:
Let's back up it for a second. So have you've been entrepreneurial for quite a while or it seems like you literally walked up to the plate, swung at the ball and hit a home run, I mean, you started this five years ago. You're doing a eight thousand surgeries a year. I mean, covid obviously accelerated it, but it seems like you're killing it. Was this your first time at bat?

Nadine Hachach-Haram:
Well, thank you very much. This is, I am a first time founder, as they say. So this is my first foray into entrepreneurship. I guess I've always been interested in problem solving. That's probably partly why I'm a surgeon, but also in my nature. But it was really it just I made that decision in 2016 that I was really going to go for it. You know, quite frankly, the, the story of Proximie started in 2014. I was looking at how I could try and solve this problem and initially built it up more as a bit of a curiosity factor for me. Can I solve this problem? Let me try and see if I can build a solution, did that, tested it in a number of countries, got some great feedback and it was a couple of years later when CNN caught wind of what we're doing and as you said, published it. Could this be the future of surgery? And at that point, I sat with my husband, who comes from the finance world, and gave me some great advice early on and said, look, I think you're at this really important point where you have to make a decision. Do you want to be an entrepreneur and innovate in that way or not? And that's a big commitment. But it just I could see no other way. I found I felt it was a duty that I had to do this. And it's been a great learning experience. I'm sure many first time founders and founders in general will talk to it. It's never a straight line, as they say, but it's just been great to have so much support across the industry and a willingness for people to see the potential of this.

John Shufeldt:
Well, I mean, so first off, congratulations, because you've clearly hit it out of the park. And being a first time founder, I've been a multi time founder. And I know you make it look easy. And I'm sure it was, you know, struggle along the way in which, you know, it's, everybody says you're an overnight success, yes, and I was 30 years long, but you certainly did something right. You actually there's a quote of you that was so Steve Jobs-esk, I have to read it back to you and get your thoughts on, and feel free to fact check it. Here's your quote. The biggest things in life have been achieved by people who, at the start, we would have judges crazy, and yet if they had not had these crazy ideas, the world would never make progress or worse for. So that's the Steve Jobs, basically 1984 commercials, you know, hats off to the innovators or the crazy people. When did you start thinking like that, because I have to tell you, not many people think like that.

Nadine Hachach-Haram:
No, I mean, thanks, and yes, I remember that quote very well. You know, I think for me the there's a, there's a challenge, the challenge was so big, you know, and I think when you when you're in that position, the greatest challenge is making the decision to kind of start in the first place. I think that, that's key, you know, being able to be brave enough to have such a big idea that requires so much kind of courage and tenacity and being willing to take that leap and say, I'm going to do it. And I think, you know, that really knowing that we could solve a problem, having those big ambitions are key. I won't lie to you, many people said, oh, you can't do it. It's too big for a practicing surgeon. It's too big for a first time CEO to solve. But I knew inside me that this had to be done. And I had the that belief and that ambition was just so much bigger than me to do it. And, you know, it's, it's been definitely continuing, you know, it continues to be an enlightening and compelling experience. But I would agree with you, it's never easy either. You know, it's definitely got its ups and downs. But those things make you stronger, right, they they push you to continue to, you know, every time someone knocks down and says, no, you can't do it, that's impossible, it's like, well, I'm going to show you, we can do it. We will do it. And it's that perseverance and that tenacity. I think that's that's really essential.

John Shufeldt:
It is. I've got a sign on my wall that says, it's a Winston Churchill quote, never, never, never give up and boy, if you don't have that as an entrepreneur, it's going to be a very short ride for you. And you clearly have it. So if you look at all the, I'm sure you don't know them all of top of your head. But give me an example of one or two of the times where you go to bed at night and you go, thank God I did this because someone's life was changed or saved by some rock star surgeon helping a neurosurgeon out who may not have that experience, but the patient benefited for it and probably saved her life.

Nadine Hachach-Haram:
It's such a great question and, you know, there's so many of them, I'll give you two examples. And firstly, on that point, I kind of say to my kids all the time, I say, you know, if God forbid, I died tomorrow, I'd die a happy person because I knew that I made impact and I was able to touch people's lives, you know, and in any, whether directly or indirectly through our work at Proximie, and, you know, I think the ability to think about those stories are what drive all of us, you know, at Proximie the whole team were very mission-driven. You know, what we do every Monday on our company stand up as we start with a mission and vision story. Let's talk about a case or story where we were able to change a patient's life. And I think back there are many, many examples. But one that kind of really resonates with me was, it was right at the height of covid. It was early. It was around kind of April-May time here in London. Everything was pretty scary and unfortunately, there was a patient, a young man, 30 plus years old, who had metastatic testicular cancer. He'd gone through chemo, radiotherapy. And unfortunately, this tumor had really spread and was wrapped around the vessels in his abdomen. Now we've got great surgeons in the hospital I work at. And normally with this kind of extensive spread, they would have done an open procedure for him to make sure they can get full clearance and access everything. But because they were so concerned that it was covid, all the hospitals were, you know, it was everywhere that keeping him in for two weeks in hospital meant he had a pretty high chance of catching covid and that could really affect his potential quality of life or even increase, decrease the chances of surviving it. And so they reached out to us and said, look, there's a top expert in this procedure out in Seattle, Dr. Jim Porter, and he's a good colleague of ours. And we've worked with him in the past. We want to dial him in and we want to do this robotically. And so Dr. Jim Porter dials in from Seattle in his, in his living room with, you know, in his, in his nightgowns, I think it was still the middle of the night for him. And he dialed into this case and they worked together really hard for a few hours and they were able to clear the cancer. This patient went home at day two, day three and was on the news giving an interview like six, seven days later, looking really, really well. And now he's made a full recovery and he's doing incredibly well. And I remember watching that interview on the news and crying because I thought, you know, it's that kind of human impact that made me start Proximie in the first place. And I think Mo is just a phenomenal young man who knew exactly what he was getting into. We walked him through that the doctor would be dialing in remotely, they'd be working through this, and he just felt so privileged to have been able to have that opportunity given to him. So I think that story is one that I look on quite often.

John Shufeldt:
Wow. Yeah, so that was in Seattle and they were operating in England?

Nadine Hachach-Haram:
Yeah. So the doctor was sitting on his laptop in Seattle and he was supporting a robotic case in England. And he was guiding, giving suggestions the way the doctor in London describes it, it was like having a coach in the tent, in the wings, like a tennis player.

John Shufeldt:
Yeah.

Nadine Hachach-Haram:
Just having those small kind of nuggets of tips and tricks of how to, if that kind of evolves through the steps faster, more effectively. And sometimes it's just knowing you have someone there. I mean, a lot of times, you know, knowing that there's a second pair of eyes, a colleague there with you just gives you that extra level of comfort.

John Shufeldt:
Oh, totally, I mean, there's been plenty of times on practice I'm like, kind of, I just wish I had someone else over my shoulder saying, hey, do this a little different, think about this because it does, it gives you instant peace of mind.

Nadine Hachach-Haram:
Correct. Correct.

John Shufeldt:
It's a two heads. So what's it like? So, you know, I've been doing this for a while as a EM physicia-entrepreneur. What's it like as a surgeon-entrepreneur? Do you think the mind set's the same for both of them?

Nadine Hachach-Haram:
I think that's a great question, and I think if we look back at the genesis of surgery, you know, you'll remember those pictures of a number of surgeons sitting around this like in an amphitheater type setting, watching a surgeon or team in the middle doing a procedure. I think surgery has always been predicated on this idea of like communication and collaboration and co-presence to some extent, which was a limitation. But we've always been looking at innovation and innovating procedures, right, how can we continue to deliver care to our patients? How can we enhance surgical skills? How can we refine these skills? How can we refine devices that can help us? You know, look at the advent of robotics or laparoscopic surgery. In plastic surgery, the things that we can do now in reconstruction with free flap and microsurgery. It's incredible. And so I think naturally surgeons tend to have that innovative spark because we're always trying to evolve and innovate in our procedures. It's also why the amount of knowledge we have to learn in surgery now is exponentially bigger than what it was before and will continue to grow. So I would I would probably say that some of those inherent skill sets were things that I already had being a surgeon and working through and evolving my skill sets. But I think it's that kind of, you know, that continued drive and perseverance above and, above and beyond everything else that is critical as well.

John Shufeldt:
Yeah, which, which, you know, really goes hand-in-hand with medicine and particularly hand-in-hand with surgery, it's a constant, constant pursuit of excellence. Speaking of excellence, one of the things that entrepreneurs probably don't love to do and I certainly love to do was fundraise. And I understand you guys just went through a series of fundraising last year. Now, you know, you had, you had literally the coach in your ear with your husband being in finance. But what was that process like for you? Was it, was it as painful as it is for me, which was like, oh, I hate this?

Nadine Hachach-Haram:
I think., but I don't know anyone, I don't know any founder-CEO who enjoys fundraising. I think it's part of the process and part of the job. The plus side, of course, you get to meet a lot of great people in the and network and and hear different insights, feedback is always helpful, good or bad, but it's definitely hard work. And, you know, thankfully, we've gone through two, two rounds of fundraising. But I'm sure, like many others, you do have to kiss a few frogs before you find your prince. And, you know, we had to go through that for sure. But we've been very, very fortunate to have some pretty cool investors who are very supportive of what we're trying to do. Some on the institutional level, but some even on the individual level. People like Curtis Chambers, who was the CTO of Uber, and in a number of other people who, you know, Tim Draper and others who were really passionate about supporting entrepreneurs and helping them succeed in their dreams and their ambitions as well.

John Shufeldt:
It's, did you have to go through people who were like, because I surely did like. No one will use us, I don't understand, and you have to sit down and slowly go through the thought process in the, in the deck or do people seem to get it right away? They're like, oh, yeah, this makes total sense to me?

Nadine Hachach-Haram:
I think it's a combination, I mean, in some cases, and that's probably also sometimes a reflection of how I was pitching it, too, but, you know, sometimes I pitch in and I don't think they even recognize, like the world of surgery, let alone how this could evolve it, so you kind of have to really walk it back and say, this is how an operating room works, people work. So sometimes I had, it had to go to that level. But at other times and as I refined my message to make it more straightforward, it got better. I think sometimes we do this where we are so in it, like we're right in the weeds of it because we would eat it, we'd breathe it, we'd sleep it, you know it's all consuming, right, when it's your business and it's your company that you're starting, that you sometimes assume that others are going to just get it as quickly as you get it. But you've had years to think about it and they've had five minutes to meet you. So it's that kind of realization that maybe you need to take your time and walk through. And I think areas like health care are more complex. And so sometimes that means a bit more time to explain.

John Shufeldt:
The, okay so, in February, you posted that five thousand people watched a Proximie live event over two day, what was that about?

Nadine Hachach-Haram:
Yeah. So one of our surgeons at the hospital is a great urologist who's very passionate about education and training and recognized that there was you know, we need to invite more people into the operating room we need to kind of unveil this clouted environment in the OR people don't know what happens in there. How do we kind of raise awareness? How do we train more people, more medical students? How do we encourage medical students to choose surgery as their career as opposed to any other specialty, which, of course, we need many more of. And so he started running some of this, every Friday he would do cases and every, on Saturday when he was operating and invite residents, medical students, trainees across the country to dial in and spend the day with him in the OR. And he does that pretty much, not maybe so than to number five thousand, but on a weekly basis, he's doing that now with medical schools and trainees and it's great. He loves it. It's a great way for him to show them what he's doing, talk them through the anatomy, talk them through the decision-making, which patient to operate on, which ones not to, how they got, you know, look at scans and images and overlay them onto the surgical field to bring that understanding of both the anatomy and the scans, as well as the actual case that's happening on the table. It's great when when you see surgeons adopting that at pace and when you were able to raise awareness of what Proximie can do to so many other observers as well.

John Shufeldt:
Can you imagine going to medical school? I mentioned a lot of pre-meddy kids and I remember in anatomy, Dr. ..., in multiple colors of chalk, drawing the anatomy of the femoral triangle. And I can't draw it all. And I met him through LinkedIn, I took it home, I like what the hell that I just draw because it looked like, you know, like a doghouse. But can you imagine going to medical school now and seeing some top-notch surgeon perform surgery with overlain anatomy and explaining while they're doing it, you know, literally from your living room? What a leap in education! These young med students must be over, you know, what I went to zillion years ago?

Nadine Hachach-Haram:
I mean, it's incredible. I was telling a bunch of medical students the other day, I don't know why I really struggled understanding the difference between a direct and indirect inguinal hernia. It's so obvious.

John Shufeldt:
Oh me too.

Nadine Hachach-Haram:
But I just couldn't, I'd look at the pictures, like but I can't see this in 3-D. What does this look like? And it was only when I went to see my, just the first one, the penny drop, I was like, oh, that's what it is. I think that ability to bring that translational experience of the OR and the patients to medical students who can assimilate knowledge that they've heard in lectures to knowledge they've seen in anatomy books and cadaveric training to actual real life surgery. It's such an incredible continuum and they must feel so excited about learning that way, you know. I hope we can continue to enhance and add more features that make that learning ever more, ever more exciting.

John Shufeldt:
Yeah, I mean, this literally could be, not only Proximie doing what you're doing, but also literally as part of a medical school curriculum. It's like, you know, here's fifty OR cases, this is part of your gross anatomy lab because what a way to learn anatomy. I mean, you're literally learning anatomy as somebody is being operated upon. That's totally awesome.

Nadine Hachach-Haram:
We had a, we had a doctor do a ton of series around head and neck anatomy, which for those who studied medicine will know that's, you know, it's, it's complex, it's very, if you look at the neck anatomy and a neck dissection, there's a lot that goes in there.

John Shufeldt:
Oh, yeah.

Nadine Hachach-Haram:
And so he was able to run videos of his cases and then overlay anatomical images and structures to give students this understanding of like important landmarks, how to move through the different layers and understand the anatomy through that process. And it was some of the most amazing sessions I've ever seen. I kind of went back and said, I'm learning stuff here as well again, and I wish, I wish I had this in medical school.

John Shufeldt:
Yeah, I just, I can only imagine, how much more I would have learned, so I had the chance a few years ago, actually 14 years ago to meet Ruth Bader Ginsburg, sat down, got a chance to talk to her, judge in the Supreme Court, total rock star. Now, you were listed as one of the 50 women change in the world, along with Ruth Bader Ginsburg and Melinda Gates. So now I can say I've talked to two of the 50 women change the world. What does that make you feel like to be in the shadows and not in the shadows, one of these people who are saying, you know, you're changing lives, you're changing the world for a better place, that's got to be incredibly cool.

Nadine Hachach-Haram:
I mean, I have to say, it was a very, very special day. I'm a big fan of Ruth Bader Ginsburg and many, many of the women on that on that list from the scientists like Melinda Gates and others. It's truly a privilege. And, you know, it's always great to get that validation that the work and the hard work that we're putting into this is making a difference. A true honor, I have to say. And definitely it was a very special day at home with the family. My parents and my sisters were very, very touched by it.

John Shufeldt:
That would be one of those dropped the mic moments where I think that, as you said to your kids and I'd say it's when I say the same thing, if I die today, I would've accomplished what I'm trying to accomplish and I'd be the happiest that guy in the world because I feel like I've created value. And certainly you can say that. OK. Last question. So when you look back at it and think of yourself while you're in medical school and you would you'd be changing lives, at least in that frame of reference, I think, know one patient at a time, and now to fast forward, you're changing eight thousand plus a year, did you ever imagine where you are today back when you were in medical school? Do you ever think you'd have this, this reach and this impact on the world?

Nadine Hachach-Haram:
I mean, definitely never imagined that I would be here today, having, achieved what we've achieved at Proximie. I remember, you know, in the most of it, we went into medicine because we wanted to make that difference, right, every patient that we change, and whoever's life we'd change, it affects us. It empowers us. It makes us want to do more. It, it makes us feel that we have this ability to really, really change people's lives. And so, you know, I always had that drive of this needs like, how can I, how can I do more? How can I help more? How can I make a difference? And it's probably why I got involved in global health. It's probably why I started to do other activities alongside my clinical practice, because there was this constant inherent need to do more, do more, do more. And so it's, it's, it's just amazing to see over the last few years how many more people we've managed to touch. And I think that's the beauty of this being that kind of surgeon-entrepreneur, that ability to have that one to one every day at a time. But the ability to have that global reach as well is something truly humbling. And I'm very, very proud of the team and where we've been, where we've got to so far.

John Shufeldt:
Dr. Hachach, this has been, this has been wonderful. Where can people learn more about you and more about Proximie? And I want to know, of course, where I can invest, but that's a whole nother story.

Nadine Hachach-Haram:
Sure. Well, please just go come to our website www.proximie.com and they can find me on LinkedIn as well.

John Shufeldt:
Perfect. And we'll put that in our show notes. Nadine, it has been a, literally, an honor, to have you on the podcast. Thanks for the great work you're doing. You are totally saving lives and reshaping the delivery of health care, and I literally could not be more excited about the future for you and the patients you touched. So thank you now.

Nadine Hachach-Haram:
No. Thank you so much. I've really enjoyed this conversation and it's been so fun and a real pleasure to meet you. And please, please stay in touch and maybe we can have a chat again and a few months time.

John Shufeldt:
I'd love to. Thank you so much.

Nadine Hachach-Haram:
Thank you.

Narrator:
Thanks for listening to Entrepreneur RX with Dr. John Shufeldt. To find out how to start a business and help secure your future, go to JohnShufeldtMD.com. This has been a presentation of ForbesBooks.

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