What is a good death? Raihan Faroqui

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Hi, Rayhan. Thanks for joining me today. I've been looking forward to this quite a bit. I know we've been talking for the past few months. If you can start with a brief introduction and then we'll get right into it.

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Yeah, thanks so much for shot for having me on. My name is Dr. Rayhan Farooqi. I am a NYC based health tech startup entrepreneur with expertise as an operator, advisor and consultant.

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I've worked in healthcare and health tech for the last eight years. And by training, I am an internal medicine physician. I am now non-practicing and I'm also a published neurology researcher.

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As a startup operator, I currently serve as head of medical affairs at Guaranteed. We are a VC backed startup. We've raised about $10 million total in the last year, both a pre-seed and a seed round. And we are scaling tech enabled in-home hospice care delivery, modernizing the end of life care experience.

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Perfect. Thanks for that introduction. I think let's start with your childhood and talk me through about school. Were you good at school? What did you want to be when you were five, when you were 10, when you were 15 and your paths to medical school and residency?

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Yeah, leave it to a brown guy to talk to me about my childhood. So I have spent most of my life in New York. I was born and raised in Rockland County, really nice NYC commuter suburbs. I come from a healthcare family. My father is now a retired respiratory care provider.

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I have cousins who are physicians, dentists, pharmacists, nurses, therapists, and everything that you can think. My mother is a childcare provider. She's a businesswoman. I learned a lot from her in terms of hard work and kind of ethical behavior.

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I had a very traditional childhood as a son of immigrants. We grew up working class. Both my parents worked really hard. My dad, growing up, he pumped gas during the day. He went to school at night. And my mom took care of other family's kids, kind of un-glorified workers.

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I think that taught me a lot about the value of hard work and your very typical South Asian immigrant parents' dreams that we're going to work really hard, but we want to provide you with the best education, the best resources as possible.

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So I kind of grew up with that environment. My parents immigrated from Bangladesh and settled in this area. I went to some great public schools in Rockland County. I graduated from a top ranked high school in the state. I was super nerdy growing up.

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I took all of the difficult classes and courses. I come home from school, do homework. It was just really prized for me to be a top student. And it's something that I relished. I enjoyed being an academic even from that age.

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Some of my fondest memories include my mother taking me to the library, checking out every book that I could get my hands on, reading voraciously from a young age. But having a really wonderful childhood, I have two amazing younger sisters.

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Sure, we had our battles when we were younger, and they both work in healthcare. Now one is a speech language pathologist and one is an occupational therapist. So yeah, I think growing up, it was expected for all of us to do really well academically.

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And healthcare was always, I think, in the cards for some of us, because of my dad's job as a respiratory therapist. And my mom's dreams of having us work in healthcare and providing for other people, helping people out.

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And I think for me personally being part of a kind of close knit spiritual community, I grew up going to the mosque, kind of going there every week, kind of listening to our teachers speak about the value of service, of kind of salvation, really being rooted in selflessness,

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you know, helping others actually helps yourself. And that's really the purpose of life. So I think at a very young age, you know, family, faith, personal motivation, I knew I wanted to help others and kind of clinical medicine was one very tangible pathway of doing that.

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Okay, perfect. So you do all this hard work, you get straight A's, like any good Brown kid. You know, growing up the options for me were doctor or doctor, and I chose doctor.

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Oh, great. So you were not given the wonderful options of engineer or lawyer. Great.

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I was not. It's a story for another day. You find yourself in residency and you worked very hard to get here. Yeah, gone through struggles, I imagine. And shortly after your residency into the world of entrepreneurship.

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Yeah, talk me through that journey that decision, what brought on that transition? And what factors? Yeah, do you feel there are certain personalities that do well in medicine? And how does that transfer over to entrepreneurship?

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For me, it was a messy journey, if I will be radically honest with you, I had a vision for myself as someone who had multiple academic and professional interests. And as an undergrad student, I went to Cornell, in many ways, a very toxic environment.

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Lots of high achieving folks who were double and triple majoring depression, drug use was rampant on campus. And it was hard. You know, I think having imposter syndrome. Do I belong? Am I going to make it? Is real.

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Having a sense of loss, not knowing if I'm going to make it was transparent. I think at the same time, I, you know, minored in international relations. I've always had an interest in politics and political campaigns.

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Lots of my friends know that. I also had a real interest in terms of business and entrepreneurship. I was very different compared to a lot of my friends who were premed, who were biology, research, volunteering, just heads down and I was I was very different.

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And I surrounded myself with folks who now work in tech and consulting and finance, they got jobs at Goldman Sachs and Google and my premed friends that didn't hang around with kids like that, but I did.

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And many of those folks are my closest friends now. And I think that like surrounding myself with peers who were very different academically and had different passions had a lasting impact on me. But I think at that time, especially as an undergrad, I realized that, Hey, look, I do want to practice as a fitness physician, but I also want to do other things in my life.

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And that to me was indicative of there's another chapter that will be written and I didn't know how or what form that would take. And if you kind of fast forward to medical school, I was actively searching for health tech startups to work with to work for.

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But the seeds really were planted much earlier. And when I was an undergrad, I took a entrepreneurship class in our business school with first year MBAs, me and two friends. We kind of entered a kind of pitch competition and our idea, which was halal frozen foods, ended up winning the competition.

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And I remember the professor at the time saying, Hey, you guys should, like really work on this. And I'm like, I'm going to go to med school, like I'm not launching a launching a business right now. But, but I knew at that at that stage still like that bug was not going to go away.

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At the same time, I knew I had to supplement my education with learnings from other industries, whether that was business, engineering or tech, and I knew that was going to be important in my journey.

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Okay, perfect. Thanks for sharing that, Rayhan.

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Talking about imposter syndrome, I think it's a sign of self reflection and introspection. How do you define success? And the way I want you to think about this question is imagine your five year old coming to you and asking you, Dad, what is success? How do I know I'm successful?

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Would you tell him or her?

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Yeah, I think about this a lot. I think, you know, success is understanding being who you think you are.

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What I mean by that is, I think kind of self actualization is really important in the journey of life. When you're younger, as you're figuring out your identity and your purpose, you oftentimes tell a story of yourself to yourself. That's not true.

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And a lot of people do that, not because you're being manipulative, or you have ill intention, you're lost, or you're confused. On the flip side, you're in the process of exploration and self discovery.

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And I think when I was young, I told a story of myself to myself that was not true. And what I've really felt is that when you take that story of yourself that is not true, and then you tell that to other people, there's a fundamental misalignment, and that results in stress, confusion, a real lack of purpose in your life.

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And I felt that I've succeeded, because in the last few years, as a lot of my kind of messiness in terms of like, who am I as a person? What is my purpose in terms of my career and profession? What is my impact? How do I serve people?

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There has been a fundamental alignment of that story. So that story that I tell to myself, and that story that I tell of myself to others is now one. And that to me is ultimate success, where I feel a lot of gratitude. I feel a deep sense of purpose. I wake up incredibly energized, because there is that alignment.

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Okay, perfect. Let's dig a bit deeper. What was the story you told yourself before? And what's the story you tell yourself now?

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That's a great question. I used to tell a future story of myself. I would say I'm a doctorpreneur, but it wasn't necessarily true. And I know you and I have talked very candidly about failure. And I graduate from an Ivy League school.

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I think I'm hot, four letter word. I'm not sure if I can curse here. And I wasn't. I had a lot of elitism. I was pretentious. I think when I look back, I actually was not proud of the person that I was at the time. And I think a lot of my behavior was probably not cool.

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And I struggled academically. I got lots of B's and C's, and my report card was not great. And I actually did not get into a US medical school, which for me was humiliating. But at the same time, it was, I think, a necessary.

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It was a necessary lesson in humility. And looking back in hindsight is the best thing that ever happened to me. You know, it made me really hungry. It proved to me that privilege is real. But that hard work is irreplaceable.

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I went to a school in the Caribbean, where there's a lot of stigma, especially when you're seeking residency in the US. And I just I worked really hard. I turned off all of the social stuff that I prioritized in college. And I, yeah, I just I worked really hard.

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And I studied all day and socialized very little. And it was it was awesome. It was incredible. And I felt like a sense of freedom, which is a weird thing to say, I still look back on that time fondly, where, like, I'm sitting at my desk in the library.

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I'm just I'm going hard, right. And all of pharmacology and physiology is literally in my brain, I'm writing down mechanisms and pathways. And it was awesome. And just kind of dedication to your craft.

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I felt incredible, like in those moments. So I think when I look back, it's, you know, it's being a Caribbean medical student, it's not being this incredibly kind of smart person. It's matching into not my first year program.

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That was not the story that I was telling people externally. So I think internally, I, I felt, I felt uneasy. I was definitely depressed for a lot of that journey. I felt, yeah, I felt misunderstood. And, you know, I would tell people, well, you know, my, my goal one day is to practice, but then do something else.

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They're like, you're crazy. You're out of your mind. Like, why are you spending all this money going deep into debt? This doesn't make any sense. So I think from the outside, I heard a lot of no, you can't. And from the inside, I heard a lot of, like, you're never going to get there.

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Okay. Yeah. It's a, I think a lot of people who go to Caribbean med school, such as myself, I went to one as well, struggle quite a bit with imposter syndrome and defining success with USM Lee board scores.

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Yeah. Isn't a success. I think success is when your day is complete in itself and you are looking forward to more days, but you don't feel like you're missing out in the day in itself.

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Let's talk about your first non-clinical job from what I can see here is a bio show.

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And how did that come about? And how was your experience there?

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Lesson number one, the power of networks. If you remember, I mentioned, I grew up in a very tight knit mosque community, third year of medical school. I asked one of the elders, you know, how is your son doing? I'm living in Brooklyn.

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He's like, Oh, right, honey, you gotta go meet up with him. You know, he's working on a cybersecurity startup. That's point number one. So I just go to meet with him. And then I have a chance encounter where I'm like, Hey, look, man, I'm looking for opportunities.

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And he's like, Oh, you have to meet my friend, Neve. She is the CEO of this really cool, like meta genomics infectious disease startup called Biosha. And I'm like, cool. He's like, Hey, I'm happy to introduce you. Right? Yeah.

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Yeah. chance encounter number two, I didn't plan any of this, right. But I think what I plan was I was curious, I asked questions. And I was always really open to meeting people and kind of taking people tape taking people's, like introductions and directions, even if there wasn't a tangible, like outcome, right?

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Yeah. Oh, you know, my friend, dude, he connects me to Neve, because they went to high school together, right? Power of networks. And, you know, we we hop on a phone call. And she's like, right, hon, I think you're great. You're wonderful. And she hired me as an intern.

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And I, you know, so I worked with her on clinical research, on market research, it was my first taste of what business development or growth at a startup looked like I had, I had no clue, I had some kind of academic training, right? In terms of entrepreneurship and accounting and marketing, but this was my first taste of what being an operator, right, might look like. And it was a blast. You know, I was interviewing clinicians, and I was interviewing people.

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And it was a blast. You know, I was interviewing clinicians, I was asking them, hey, you want to buy this thing? What proof points do you need? I was talking with our engineers and data scientists on, hey, how do we build a report of antibiotic resistance? I'm like, oh, wow, that's awesome, man, right?

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I was working on some really next generation technology, you know, using artificial intelligence to sift through whole genome sequencing data, right, building a microbiome profile of bacteria, virus and fungus from any human sample, right, whether it's stool, urine, blood, like, this is dope.

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Right. So it was a taste of the future. And I just I started learning what venture capital meant, you know, fundraising rounds, customer acquisition, you know, terms that were at that time foreign to me, that were now I'm using them every day right every week.

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But it was it was an immersive experience. And I didn't really know where it would lead, but I knew that I loved it.

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Okay, perfect. Let's talk about how to sell into health systems. And I know this is

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part of it. Yeah.

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It's a very big topic. And it's something new founders who are not in the clinical world struggle with quite a bit.

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Yeah.

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What are some of your tips into how to get in touch with decision makers?

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How to best find the balance between patients, providers, and payers?

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Yeah.

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Sure. Yeah, I think kind of just continuing the story with Biosha, you know, they they raise around, and then they hire me full time. I leave residency.

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And that was four years ago, and I haven't looked back.

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I think what I've learned at kind of a couple of companies where I've served as an operator, I now advise three startups, I launched my own consultancy called Connectify Health, connecting startups to investors, connecting startups to customers.

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It's really about playbooks, right? It's learning fundamentals about

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like US macroeconomics, like healthcare macroeconomics. It's learning about all the learning about all the misaligned incentives.

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Once you learn the fundamentals, you learn, like, the misincentives, you actually then learn how you can make money, but then how you can actually make the system better.

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What I typically say is kind of also putting on my, like venture capital hat, right, my investor hat.

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In healthcare and health tech, really, you've got to pick, you've got to pick an arm, right, you're either SaaS or your services.

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And if you're SaaS or software as a solution,

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typically a higher margin space, which investors, especially venture capital love, because it's easy to scale.

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And there's a real appetite from customers to buy that type of product.

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So, you know, if it's high margin SaaS, you know, there's an opportunity to sell that SaaS B2B or business to business into enterprise customers, which are hospitals and health systems.

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And, you know, typically that SaaS is priced differently. It can be per user SaaS feature set pricing.

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You know, there's various features. So I'm paying for that in a tier manner. It could be consumption or utilization SaaS, right? The more you use it, the more you pay for it, the less you use it, the less you pay.

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And, and there's a real appetite from, you know, individual hospitals, but larger health systems that are now buying, you know, SaaS platforms built by digital health startups, you know, everything from front end scheduling, higher off, you know, patient experience, right, video telemedicine, patient chat, all the way to EMR, you know,

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patient documentation, kind of backend billing, coding, RCM, kind of top layer, you know, data analytics, interoperability. There's a lot of SaaS that's out there that's required to modernize our healthcare infrastructure.

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I mean, typically for a lot of hospitals and health systems, like the first SaaS that they bought was EMR, right? Right. So in the US, that's, you know, Epic, Cerner, you know, eClinical Works, Athena Health, EMR was built for coding and billing, it was not built for clinician workflow, right?

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So we've now seen lots of SaaS companies that are either building on top of EMR, on the side of EMR, or they're building newer EMR companies, you know, transparently, right? And they're also then selling into not just health systems and hospitals, they're also selling into other digital health care delivery organizations that are on the services side, right?

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So we're now kind of seeing different, different customers, you know, emerge, if that makes sense. So there's this the B2B kind of SaaS market.

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Then if you're kind of on the services side, thinking about, well, who's the customer there, right? It's typically it's the employer, the health insurance payer, right? Kind of your more kind of B2B to C motion.

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Typically, a lot of that upstream was, hey, go direct to consumer, right? D2C, B2C, right? Run some Facebook and Google Ads, acquire customers online, sign them up for a service, get a couple of hundred paying customers, right? Kind of your, your typical kind of a monthly subscription, yearly subscription, and then provide some type of service, right?

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Whether it's telemedicine, virtual care, patient education, pharmacy delivery, you know, so on and so forth. So we've saw we saw a lot of that like direct to consumer channel really pick up in the beginning of the pandemic.

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But we've now seen a lot more activity with like your kind of B2B to C channel, right? It's like I'm selling into employers for employees, I'm selling into payers for beneficiaries. And then also pharma, right?

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Pharma is also a buyer of digital health products. And it's oftentimes not top of mind for a lot of digital health builders, right? I mean, we count pharma as a provider, kind of similar to hospitals and health systems, they're buying SAS, right? And, you know, pharma, they want to, you know, they want to make and sell drugs.

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And in the making of drugs, they're doing clinical trials, they're doing patient recruitment. So if you have data on patients, especially patients with rare diseases, and you can actually help enroll them into clinical trials, pharma will pay you a ton of money, you know, to do that.

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And then on kind of the selling of drugs, if you have platforms where you have lots of patients and you have lots of physicians, right, who are being marketed to buy pharma to sell the drugs, to prescribe the drugs, they're going to be paying for advertising all day long and other kind of like pricing models.

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So, and those are kind of your general customers that you can sell into.

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If you were to start a company or launch a company right now, and I know you just joined a company and we'll talk about that in a bit.

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Yeah.

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What vertical would you focus on? Would you focus on bundling services together? And what I'm trying to get at is, there's a lot of new startups focusing on clinician workflow, and improving it, collecting our history for us doing patient follow up.

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But there is no direct billing codes, generally, at least for collecting our history for us.

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Is that a space you're interested in? And what would your advice be to someone who is in that space?

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Yeah, you know, I,

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like, so I typically think we're in the early innings of innovation, which means that, look, I mean, we are still 10, 20, 30 years away from shifting this very archaic analog, still paper first system in many ways.

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You know, I think this world that many of us are building and kind of imagining towards is still a future world, right? So why I'm saying that is that I am still very bullish on digital health infrastructure companies, you know, who are kind of building the roads, the bridges and the tunnels.

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So, you know, EMR data is siloed, right? So I am bullish on interoperability, fire, HL seven, how do we build better just bridges between siloed platforms? I am also just bullish on data and analytics, like, cool, we now have data going back and forth.

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How do we make sense of that? Right? clinicians don't like data, they like decisions. Yeah.

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So I think decision intelligence is, is something that I am really like in the future, very bullish on, right? So I think when you talk about workflow, and I think that's where we're getting to, we're getting to a place where, how do we make EMR data, but then other data sources, claims data from payers, you know, subjective patient and family data, right?

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So like, I don't really care about remote patient monitoring, like, you know, a stream of blood pressure and blood sugar, that doesn't mean much for clinicians. But I think what what's meaningful for us is, hey, what's the most important thing for us to do?

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So yes, I'm a human being. I'm like

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Can't you accept, can I make an intervention, musical change, like

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interventions even human risk to us? Like I would actually love to see a patient

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create cloud motivation to figure out what to do and I think it's best to put events together between means of measure that we need.

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Which is killing.

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Yeah, so there's situations where health equipped walnut is, you know, contributing to a person's health or then you really end up with the fact that we're like, what can you do?

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First of all, where do I order a lab?

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When do I order an imaging?

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Where can I make a diagnosis?

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Where can I change a medication and so on and so forth?

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So those are the decision points

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that I believe really smart platforms can build.

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And there's a wonderful space of CDSS, right?

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Clinical decision support software.

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And a lot of these platforms right now are,

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they're sidebars in lots of web-based EMR.

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And they're aiming to kind of build some of that

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at the point of patient care workflow

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where now I am charting in the EMR.

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I have this intelligent sentient thing on the side

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that is flagging certain things I'm typing

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or it's bringing forth some really deep data point

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from a visit last year.

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And then it's telling me something that is not top of mind.

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And now it's actually offering some recommendations

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and suggestions in terms of decisions.

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I think that is the world that we are building,

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but we're not there yet.

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Interesting.

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It will be important to whoever does this

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is not to contribute more to alarm fatigue

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because we get way too many notifications as it is.

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Yeah, yeah.

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And I think that a lot of that is really version one, right?

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Notifications and alerts, which is noisy, right?

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I think the signal will be,

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hey, we have ingested all of these data points, right?

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And now I'm telling you, Rashad,

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this is a decision you should make.

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Do you agree or not, right?

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That is the world where we actually can free up

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clinicians, administrators from typing, right?

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And being so kind of plugged into our pagers

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and portals and whatnot.

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And that can really free us to kind of really work

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on those complex decision points that we are trained for.

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Yeah, I think this is not specifically a medical

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or a technical issue.

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It's more of a regulatory political issue.

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You are a big proponent from what I've seen

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of patients practicing at the top of their license.

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Yeah, so talk to me a bit about that.

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Yeah.

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And I am as well.

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I think if patients accept,

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with ownership comes accountability.

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Right, yeah.

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There should be a shared liability model.

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If someone says, I have a UTI, I've done a depth stack

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and it confirms it.

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I would like this medication and my renal function's okay.

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They should be allowed to have that medication.

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The worry there is people will abuse that system

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and use it for opioids or stimulants.

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Do you think that is a significant worry?

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Should we be worried about that?

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And what are your frank thoughts?

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And I'll give you one more thing.

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In Portugal, after they decriminalized drugs,

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there's been known to be a steep decline in drug usage.

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So just because things are available

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does not necessarily mean people would use them.

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Yeah, agreed.

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We need safeguards, we need a process.

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We need workflows that make sense.

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I am not in favor of decentralization

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without regulation.

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I can provide further context around this.

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I was recently in Las Vegas for the Health,

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the conference which gathered 10,000 plus

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health tech innovators and kind of speaking with

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kind of friends and kind of change makers.

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I think what I realized is that like,

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there are really big macroeconomic problems right now

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that are being discussed,

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but we're not talking about the solutions to address them.

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What I've been talking about kind of mostly ad nauseum

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is that look, we have increasing care demand

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across all verticals and demographics,

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but especially amongst our aging population.

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Polychronic, polypharmacy patients,

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three, four, five chronic diseases,

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they're on seven, eight, nine medications.

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These are the sickest, riskiest, most expensive patients

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in our collective health systems,

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whether it's the US or Canada.

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And when I think about those patients specifically,

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but really any other patient, right?

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And especially like patients with chronic disease,

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the problem on the supply side is that as demand for care

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is going up like this,

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the supply of providers is going like this.

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So there is a gap and that gap is the biggest problem

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in our system.

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A lot of people talk about cost.

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I am not of the thought that cost is going down

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or will go down, right?

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I am of the thought that look,

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in the US healthcare is approaching 20% of GDP,

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it'll probably becomes 25% of GDP.

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And I don't think that's a bad thing, right?

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But I am not of the thought that we will meaningfully

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be able to decrease cost, right?

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I am on the opposite side of like quality, right?

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How do we improve quality?

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But a lot of that quality depends on supply

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of existing providers.

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And what we are seeing and the pandemic accelerated that

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is that physicians, nurses, mid-level providers,

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therapists, aides are leaving the profession.

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We are not building more nursing schools, medical schools,

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residency programs and fellowships, right?

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These are usually federally funded,

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federally mandated programs.

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So like, yes, we will need a generational change

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in leadership from the top.

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Folks who realize that,

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well, we've been talking about provider shortages forever

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and we're not doing much about it, right?

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That is still our biggest macro problem.

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And in the US, for example, last year,

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10% of all physicians left the clinical workforce.

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That is an alarming statistic.

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And we keep hearing,

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and it's not just older folks who are retiring,

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it's people in their 40s and 50s, right?

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So what does that mean?

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I think what that means is again,

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what we in digital health can do is,

250
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there's really only one of two solutions

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the way that I look at it, right?

252
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Like telemedicine is a tool, it is not a solution, right?

253
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It requires a physical person on the outside,

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physical person on the other side

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that currently does not exist, right?

256
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So the way that I look at it,

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there's really one of two macro solutions.

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Number one, we need to build a new industry,

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a new workforce of non-clinical frontline staff.

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You know what?

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Yeah.

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I'll just say one thing.

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Vinod Khosla of Khosla Ventures,

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that's his vision as well.

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Yeah.

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And I think his vision is that the people

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who are in the industry will be actors.

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Right.

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But sorry, I'll let you continue.

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Right, and again, this is not,

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and I think a lot of the folks in venture, right?

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Vinod Khosla, Himant Taneja,

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and his theory of health assurance,

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his work at Lavongo and the work at General Catalyst,

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he's the only one who has this idea of,

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the only way that prevention works is that we are,

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again, building this newer workforce of folks

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who are keeping us healthy at home

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so we're not utilizing the system, right?

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And are they liable for the care

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the same way we are when we prescribe pre-dense?

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So I think liability comes next.

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And why I say that is that,

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people are going to be more the non-clinical folks, right?

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So I think we've seen at various digital health

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care delivery startups, it's the care navigator,

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the care concierge, the patient engagement specialist, right?

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So these folks are like customer success, right?

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They're being hired from retail, consumer,

290
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like non-healthcare, hospitality, right?

291
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That is traditionally what we have lacked, right?

292
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It's that understanding of consumer, right?

293
00:36:59,080 --> 00:37:01,200
I think is a good thing, you know?

294
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Like clinicians and practices,

295
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we're not trained on that, right?

296
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Like why do we have a waiting room?

297
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A waiting room is antithetical to ideal consumer experience.

298
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Right?

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There is a tension there between what the patient wants

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and what's best for them.

301
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That tension doesn't really exist

302
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in the hospitality industry or the food industry is,

303
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if I want my food, my steak cooked more,

304
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cooking more.

305
00:37:29,680 --> 00:37:30,520
Exactly.

306
00:37:30,520 --> 00:37:34,000
You know what, we do have those ethics in clinical medicine.

307
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What's the first ethic?

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Autonomy.

309
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Yeah.

310
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So, I mean, autonomy really means like,

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hey, I want what I want.

312
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So our job should be facilitating that autonomy,

313
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but we still have paternalism.

314
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We know better than you.

315
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So there is no true autonomy in medicine, I would argue.

316
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And there is no true informed consent because, you know,

317
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we go to school for 12 years.

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It just cannot exist.

319
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And we can go deeper into this.

320
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Yeah.

321
00:38:00,960 --> 00:38:05,120
I would ask you, would there be balance

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between what the patients want and what's offered to them?

323
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And if there is a balance or a line in which they say,

324
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okay, you cannot get more morphine

325
00:38:13,560 --> 00:38:17,160
or you cannot get antibiotics for this viral infection,

326
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even if it might have some anti-inflammatory properties

327
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and help a little bit.

328
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Yeah.

329
00:38:22,680 --> 00:38:24,080
Where is that line?

330
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Who decides where that line lies?

331
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Because right now we decide.

332
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And again, then who's, you know,

333
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I get stuck on liability when I think about this.

334
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And I think that's why it hasn't happened.

335
00:38:35,560 --> 00:38:37,120
Yeah, you're wrong.

336
00:38:37,120 --> 00:38:38,880
I don't, you're not wrong,

337
00:38:38,880 --> 00:38:40,280
but I think to kind of provide some more,

338
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and we'll get back to liability,

339
00:38:41,520 --> 00:38:43,040
but I think to provide some more context

340
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around my previous point where first is like this workforce

341
00:38:46,680 --> 00:38:49,680
of non-clinical staff, right?

342
00:38:49,680 --> 00:38:53,200
The second part is, well,

343
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how are we enabling self-service?

344
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This idea of, you know,

345
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patients are craving education

346
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because they want to treat themselves.

347
00:39:04,880 --> 00:39:07,480
And that is not going away by the way, right?

348
00:39:07,480 --> 00:39:10,640
So the world that is a reality right now

349
00:39:10,640 --> 00:39:12,640
that I think a lot of clinicians understand,

350
00:39:12,640 --> 00:39:15,160
but just don't understand the implications of is,

351
00:39:15,160 --> 00:39:16,800
there are people going on TikTok

352
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and going on Google and self-treating,

353
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and that will only continue with platforms.

354
00:39:22,080 --> 00:39:25,680
So I think the correct way to guide that is say,

355
00:39:25,680 --> 00:39:27,560
hey, that's wrong, don't do that.

356
00:39:27,560 --> 00:39:32,160
It's more of let us build platforms to enable you,

357
00:39:32,160 --> 00:39:35,840
I think to your point with proper liability,

358
00:39:35,840 --> 00:39:39,160
safeguards and regulation, right?

359
00:39:39,160 --> 00:39:41,760
So what I mean by self-service is this idea of,

360
00:39:41,760 --> 00:39:43,440
how do we enable patients to practice

361
00:39:43,440 --> 00:39:46,000
at the top of their license, right?

362
00:39:46,000 --> 00:39:50,960
Which means education, rich multimedia,

363
00:39:50,960 --> 00:39:52,880
evidence-based information,

364
00:39:52,880 --> 00:39:54,280
which is sorely lacking right now.

365
00:39:54,280 --> 00:39:57,840
Like that content exists, right?

366
00:39:57,840 --> 00:39:59,960
But it's not being delivered

367
00:39:59,960 --> 00:40:02,120
to patients at their fingertips, right?

368
00:40:02,120 --> 00:40:04,000
And where are people? They're online, right?

369
00:40:04,000 --> 00:40:07,080
They're on TikTok, they're on Google, they're texting.

370
00:40:07,080 --> 00:40:10,600
Like that is where, you know,

371
00:40:10,600 --> 00:40:13,920
the ethos of evidence-based clinical medicine needs to be.

372
00:40:13,920 --> 00:40:17,360
And right now it's siloed at conferences,

373
00:40:17,360 --> 00:40:21,120
it's in publications, right?

374
00:40:21,120 --> 00:40:24,640
It's sure, like your clinician in the visit

375
00:40:24,640 --> 00:40:28,440
is telling you that, but in one ear out the next, right?

376
00:40:28,440 --> 00:40:32,800
So that is where digital health through SMS-based workflows,

377
00:40:32,800 --> 00:40:37,120
through kind of automated CRM type platforms, right?

378
00:40:37,120 --> 00:40:41,000
Where we can text, we can email, we can remind.

379
00:40:41,000 --> 00:40:43,000
I think that is the connective tissue

380
00:40:43,000 --> 00:40:46,440
that is currently missing that we need, right?

381
00:40:46,440 --> 00:40:48,720
To enable that to happen, like, you know,

382
00:40:48,720 --> 00:40:52,240
just provide people with information that is trusted,

383
00:40:52,240 --> 00:40:53,080
that is vetted.

384
00:40:53,080 --> 00:40:55,200
So I am not in the wilderness, right?

385
00:40:55,200 --> 00:40:58,400
I am given a diagnosis that is earth-shattering.

386
00:40:58,400 --> 00:40:59,240
Yeah.

387
00:40:59,240 --> 00:41:00,680
Want education and information.

388
00:41:00,680 --> 00:41:02,400
And I'm not getting enough of that

389
00:41:02,400 --> 00:41:04,360
from my very busy provider

390
00:41:04,360 --> 00:41:06,800
in the 12-minute visit that I had, right?

391
00:41:08,400 --> 00:41:11,240
Yeah, I have way too much to say about this, Rehan.

392
00:41:11,240 --> 00:41:13,240
I'm sure you do.

393
00:41:13,240 --> 00:41:16,320
I think, I do think this is the future.

394
00:41:16,320 --> 00:41:18,000
I think it needs to happen.

395
00:41:18,000 --> 00:41:21,960
I am not convinced patients, in my experience,

396
00:41:21,960 --> 00:41:24,600
and I may be biased because I work in urgent care a lot,

397
00:41:24,600 --> 00:41:27,600
and that is the bulk of my patient experience,

398
00:41:28,520 --> 00:41:30,880
I am not convinced they would be happy

399
00:41:30,880 --> 00:41:32,360
with being kind of shown,

400
00:41:32,360 --> 00:41:33,600
okay, this is your diagnosis,

401
00:41:33,600 --> 00:41:36,440
these are the treatments we'll offer you at the end.

402
00:41:36,440 --> 00:41:39,840
Like, currently we're practicing medicine

403
00:41:39,840 --> 00:41:42,600
to maximize billing, reduce liability,

404
00:41:42,600 --> 00:41:47,360
which partly is to make sure patients are satisfied.

405
00:41:47,360 --> 00:41:50,200
I think a strictly evidence-based system

406
00:41:50,200 --> 00:41:54,960
will leave patients more dissatisfied from what I can see.

407
00:41:54,960 --> 00:41:56,880
And I would love to be wrong on this

408
00:41:56,880 --> 00:42:00,120
because I think there's so much room for increased access.

409
00:42:00,120 --> 00:42:02,640
I don't know, I don't disagree with you, right?

410
00:42:02,640 --> 00:42:07,240
What I think, what we are slowly seeing the building of

411
00:42:07,240 --> 00:42:12,240
is a hybrid model where there is shared decision-making

412
00:42:13,280 --> 00:42:15,920
and shared liability, right?

413
00:42:15,920 --> 00:42:19,320
What I imagine is, yes, there's patients,

414
00:42:19,320 --> 00:42:21,920
but then there's also peers,

415
00:42:21,920 --> 00:42:23,880
and there's also family and caregivers.

416
00:42:23,880 --> 00:42:25,960
So how do we enable family to practice

417
00:42:25,960 --> 00:42:27,840
at the top of their license, right?

418
00:42:27,840 --> 00:42:31,760
We have a caregiving crisis, right?

419
00:42:31,760 --> 00:42:34,360
There is unpaid labor, right?

420
00:42:34,360 --> 00:42:36,880
So do I imagine the payers actually paying family?

421
00:42:36,880 --> 00:42:37,720
Yeah, I do.

422
00:42:37,720 --> 00:42:40,560
And I think that is kind of the logical extension of,

423
00:42:40,560 --> 00:42:42,960
look, we have provider shortages,

424
00:42:42,960 --> 00:42:47,960
who can we pay to help patients be safe at home, family,

425
00:42:48,440 --> 00:42:50,120
duh, or the people who are there?

426
00:42:50,120 --> 00:42:53,000
But again, how do we enable those folks through education,

427
00:42:53,000 --> 00:42:54,960
through support, through resources,

428
00:42:54,960 --> 00:42:56,760
through these types of real-time platforms?

429
00:42:56,760 --> 00:42:58,440
Then how do we also share that liability?

430
00:42:58,440 --> 00:43:02,000
And I agree with you where, you know,

431
00:43:02,000 --> 00:43:05,200
if there's platforms where, okay, cool,

432
00:43:05,200 --> 00:43:09,080
I have self-diagnosed, I am now taking this medication,

433
00:43:09,080 --> 00:43:10,760
but something went wrong.

434
00:43:10,760 --> 00:43:12,040
Who are we gonna sue?

435
00:43:12,040 --> 00:43:13,440
Am I suing myself?

436
00:43:13,440 --> 00:43:14,720
Exactly.

437
00:43:14,720 --> 00:43:16,680
Yeah, look, I think yes,

438
00:43:16,680 --> 00:43:17,840
I think there will have to be

439
00:43:17,840 --> 00:43:19,880
these new kind of newer liability frameworks

440
00:43:19,880 --> 00:43:22,400
where I am signing waivers and I'm saying,

441
00:43:22,400 --> 00:43:26,560
hey, look, you know, I cannot sue this AI algorithm.

442
00:43:26,560 --> 00:43:28,640
I cannot sue the company that made this.

443
00:43:28,640 --> 00:43:29,600
I can't.

444
00:43:29,600 --> 00:43:32,640
And I think that is this newer contract,

445
00:43:32,640 --> 00:43:34,880
this new kind of shared decision-making.

446
00:43:34,880 --> 00:43:36,680
And I agree with you where, you know,

447
00:43:36,680 --> 00:43:40,840
the brother of autonomy is liability and responsibility.

448
00:43:40,840 --> 00:43:42,720
No, I completely agree.

449
00:43:42,720 --> 00:43:45,000
I would love to see that in a marketplace.

450
00:43:46,120 --> 00:43:47,640
I hope I'm wrong.

451
00:43:47,640 --> 00:43:51,760
My initial instinct is people would not accept that

452
00:43:51,760 --> 00:43:54,120
because generally people don't wanna accept

453
00:43:54,120 --> 00:43:57,000
their own faults and if they made a decision

454
00:43:57,000 --> 00:43:59,680
bad for themselves or worse for their loved one

455
00:43:59,680 --> 00:44:01,160
or for their child.

456
00:44:01,160 --> 00:44:03,480
Let's talk about guaranteed.

457
00:44:03,480 --> 00:44:06,600
Let's talk about, give me a brief introduction

458
00:44:06,600 --> 00:44:10,280
on guaranteed is and what you're most excited about

459
00:44:10,280 --> 00:44:14,360
and some obstacles you foresee guaranteed facing.

460
00:44:14,360 --> 00:44:15,320
Yeah.

461
00:44:15,320 --> 00:44:19,080
So, you know, death is guaranteed.

462
00:44:20,320 --> 00:44:25,320
And the reason why we chose the name is a good death

463
00:44:25,680 --> 00:44:28,200
is not necessarily guaranteed.

464
00:44:28,200 --> 00:44:32,720
So, you know, you can't choose what happens to you,

465
00:44:32,720 --> 00:44:36,720
but you can choose, you know, what to do about it.

466
00:44:36,720 --> 00:44:40,440
So, I think that is the way that we are looking at

467
00:44:41,480 --> 00:44:45,240
kind of reframing conversations around death and dying

468
00:44:45,240 --> 00:44:50,240
and imagining a more modern end of life care experience.

469
00:44:50,920 --> 00:44:55,920
One that is radically different from your picture of,

470
00:44:56,280 --> 00:45:00,600
you know, a frail, you know, aging person

471
00:45:00,600 --> 00:45:04,120
who's in a hospital gown, hooked up to an IV,

472
00:45:04,120 --> 00:45:06,840
you know, in a like desolate and sad room.

473
00:45:08,000 --> 00:45:11,480
What we are imagining as a kind of disruptive consumer brand

474
00:45:11,480 --> 00:45:12,720
is the exact opposite.

475
00:45:13,880 --> 00:45:17,960
It's colorful, it's full of life, right?

476
00:45:17,960 --> 00:45:20,880
We're helping you die better, right?

477
00:45:20,880 --> 00:45:23,160
So this idea of die how you live,

478
00:45:23,160 --> 00:45:24,640
but that really means we need to find out

479
00:45:24,640 --> 00:45:26,000
how you want to live.

480
00:45:26,000 --> 00:45:29,640
And the way that we look at end of life

481
00:45:29,640 --> 00:45:32,400
is about honoring your wishes,

482
00:45:32,400 --> 00:45:36,800
your desires and your demands, autonomy, right?

483
00:45:36,800 --> 00:45:40,200
Idea of learning from consumer,

484
00:45:40,200 --> 00:45:43,560
which is tell us what you want and we'll do it.

485
00:45:43,560 --> 00:45:47,560
And that's really what the best hospice care should be.

486
00:45:47,560 --> 00:45:51,280
Yes, we talk about pain management and symptom management,

487
00:45:51,280 --> 00:45:55,280
but those are more of the tools and the modalities.

488
00:45:55,280 --> 00:45:57,880
It's not the purpose, right?

489
00:45:57,880 --> 00:46:02,800
Yeah, you know, in my experience and I've taken care

490
00:46:02,800 --> 00:46:06,240
of quite a few people, patients in their end of days,

491
00:46:06,240 --> 00:46:09,360
there is tension between staying alert, aware

492
00:46:09,360 --> 00:46:11,160
and reducing pain and suffering

493
00:46:11,160 --> 00:46:14,320
because of the medications we use can cause drowsiness.

494
00:46:14,320 --> 00:46:17,080
A good death for me, and for our listeners,

495
00:46:17,080 --> 00:46:19,680
euthanasia actually means good death in Greek,

496
00:46:19,680 --> 00:46:24,600
although the word has different connotation in our culture.

497
00:46:24,600 --> 00:46:29,520
A good death for me is where my autonomy is maintained

498
00:46:29,520 --> 00:46:30,640
for the very last second.

499
00:46:30,640 --> 00:46:33,960
A good death for me is euthanasia, being frank.

500
00:46:33,960 --> 00:46:38,960
And I go on my own time, date and where I want to be.

501
00:46:40,760 --> 00:46:43,200
What is a good death for you, Rehan?

502
00:46:43,200 --> 00:46:46,800
And how do you phrase that conversation with patients?

503
00:46:46,800 --> 00:46:50,000
Yeah, I wanna be very clear that, you know,

504
00:46:50,000 --> 00:46:52,640
we definitely respect your thoughts and wishes.

505
00:46:52,640 --> 00:46:54,880
We look at it a little bit differently.

506
00:46:56,000 --> 00:47:00,920
You know, our philosophy at Guaranteed is simple.

507
00:47:00,920 --> 00:47:05,920
Everyone deserves to live and die with dignity and comfort.

508
00:47:06,920 --> 00:47:11,520
So our health affairs are deeply personal,

509
00:47:11,520 --> 00:47:13,840
and it's not shaped just by medicine,

510
00:47:13,840 --> 00:47:18,120
but it's also by our lifestyle, culture, faith,

511
00:47:18,120 --> 00:47:20,760
personal ethics and more.

512
00:47:20,760 --> 00:47:25,040
So, you know, euthanasia, you know,

513
00:47:25,040 --> 00:47:27,400
that may be a desire, right, by some,

514
00:47:27,400 --> 00:47:30,160
but that is not the way we are looking at the sum totality

515
00:47:30,160 --> 00:47:32,000
of human experience, right?

516
00:47:32,960 --> 00:47:37,240
So for us, this idea is that we need to be radically personal,

517
00:47:37,240 --> 00:47:39,960
inclusive, and very hands-on,

518
00:47:39,960 --> 00:47:41,800
but really kind of celebrate those differences.

519
00:47:41,800 --> 00:47:45,080
And we have not seen that previously

520
00:47:45,080 --> 00:47:47,120
with end-of-life care, right?

521
00:47:47,120 --> 00:47:51,400
And one example, for example, is spiritual care.

522
00:47:51,400 --> 00:47:55,760
You know, there is a diversity of, you know,

523
00:47:55,760 --> 00:47:59,080
faith and non-faith at the end of life.

524
00:47:59,080 --> 00:48:02,280
So we should be providing folks who are trained

525
00:48:02,280 --> 00:48:05,320
in both modalities, and that's currently not available

526
00:48:05,320 --> 00:48:06,560
in our system, right?

527
00:48:06,560 --> 00:48:11,560
You're lucky if you get a chaplain, right?

528
00:48:11,800 --> 00:48:13,920
Part of a really good, you're even luckier

529
00:48:13,920 --> 00:48:16,760
if you can say, hey, I am X, Y, and Z faith.

530
00:48:16,760 --> 00:48:19,880
I am looking for X, Y, and Z, like spiritual counselor,

531
00:48:19,880 --> 00:48:20,720
right?

532
00:48:20,720 --> 00:48:22,960
So that is the way that we are thinking, you know,

533
00:48:22,960 --> 00:48:27,480
in terms of choice and optionality, if that makes sense.

534
00:48:27,480 --> 00:48:28,840
No, that makes sense.

535
00:48:28,840 --> 00:48:32,360
What are some obstacles you see for guaranteed

536
00:48:32,360 --> 00:48:34,360
on their growth trajectory?

537
00:48:35,280 --> 00:48:37,360
I think there's lots of obstacles in terms

538
00:48:37,360 --> 00:48:40,600
of the healthcare system that we are operating in right now.

539
00:48:40,600 --> 00:48:41,440
Yeah.

540
00:48:41,440 --> 00:48:46,440
We have a fractured medical system, opaque information.

541
00:48:46,800 --> 00:48:50,680
You know, we're operating in a for-profit space

542
00:48:50,680 --> 00:48:53,640
that is light on regulation.

543
00:48:53,640 --> 00:48:56,960
There are bad actors at play here.

544
00:48:56,960 --> 00:49:00,760
There's lots of suspicion around hospice.

545
00:49:00,760 --> 00:49:03,400
Frankly, lots of providers who are not palliative trained

546
00:49:03,400 --> 00:49:05,120
don't trust it.

547
00:49:05,120 --> 00:49:08,600
And that's partially due to bad experience, right?

548
00:49:08,600 --> 00:49:13,040
So we are up against a lot and we are,

549
00:49:13,040 --> 00:49:17,320
I think our biggest barrier is stigma, you know?

550
00:49:17,320 --> 00:49:20,360
Talk about death at a dinner party and see what happens.

551
00:49:20,360 --> 00:49:21,320
Yeah.

552
00:49:21,320 --> 00:49:25,520
So, you know, it causes fear, you know, it causes anxiety.

553
00:49:25,520 --> 00:49:30,520
So I think for us, there's like a wider societal reframing

554
00:49:30,880 --> 00:49:32,280
that we need.

555
00:49:32,280 --> 00:49:37,280
And I think the way that we do that is we try to relay that.

556
00:49:37,280 --> 00:49:42,280
Like we are a care company that makes those tough moments

557
00:49:42,280 --> 00:49:43,120
easier.

558
00:49:43,120 --> 00:49:45,840
So let's start with having conversations there, right?

559
00:49:45,840 --> 00:49:50,520
And then we can delve into our hybrid care model, right?

560
00:49:50,520 --> 00:49:54,640
How do we do, you know, self-service, virtual care,

561
00:49:54,640 --> 00:49:57,240
in-person care, like that stuff comes later, right?

562
00:49:57,240 --> 00:50:00,480
When we talk about the technology that we are building here.

563
00:50:00,480 --> 00:50:03,720
But I think it's really just around conversations

564
00:50:03,720 --> 00:50:08,720
and having that consciousness about my end

565
00:50:09,080 --> 00:50:12,080
happen much earlier than it's happening right now.

566
00:50:12,080 --> 00:50:13,680
And then those discussions happening

567
00:50:13,680 --> 00:50:16,200
in non-medical spaces, right?

568
00:50:16,200 --> 00:50:17,800
That is the struggle, right?

569
00:50:17,800 --> 00:50:20,680
It's not, you know, your typical hospice is getting referrals

570
00:50:20,680 --> 00:50:24,400
from, you know, skilled nursing facilities,

571
00:50:24,400 --> 00:50:28,400
assisted living facilities, health systems, hospitals,

572
00:50:28,400 --> 00:50:30,160
outpatient practices, right?

573
00:50:30,160 --> 00:50:32,040
That is how a lot of the business happens.

574
00:50:32,040 --> 00:50:36,520
However, people are still choosing where

575
00:50:36,520 --> 00:50:37,720
to send their loved ones.

576
00:50:37,720 --> 00:50:41,160
And, you know, you have a community of people

577
00:50:41,160 --> 00:50:42,480
who you trust.

578
00:50:42,480 --> 00:50:46,360
So how are we talking to those folks that are trusted?

579
00:50:46,360 --> 00:50:49,800
It might be your church pastor.

580
00:50:50,640 --> 00:50:53,320
It's the barbershop owner.

581
00:50:53,320 --> 00:50:55,760
You know, it's the person, you know,

582
00:50:55,760 --> 00:50:58,480
you see at the grocery store.

583
00:50:58,480 --> 00:51:01,480
It's your friends, your family members.

584
00:51:01,480 --> 00:51:03,400
These are non-clinicians, right?

585
00:51:03,400 --> 00:51:05,440
Those are the people you trust.

586
00:51:05,440 --> 00:51:07,880
And if somebody is like, hey, look, you know,

587
00:51:07,880 --> 00:51:11,200
I saw this really awesome service or I use this for mom,

588
00:51:11,200 --> 00:51:12,640
you should take a look at them.

589
00:51:12,640 --> 00:51:15,800
You are much more likely to follow that recommendation

590
00:51:15,800 --> 00:51:18,520
than actually going online, Googling something,

591
00:51:18,520 --> 00:51:19,680
reading all the reviews.

592
00:51:19,680 --> 00:51:22,400
That still happens, right?

593
00:51:22,400 --> 00:51:25,640
But, you know, so there's various, I think, modalities

594
00:51:25,640 --> 00:51:27,560
of having those discussions, right?

595
00:51:27,560 --> 00:51:30,520
That is outside of our general clinical system.

596
00:51:30,520 --> 00:51:31,440
Okay, perfect.

597
00:51:32,440 --> 00:51:35,240
Rayhan, if you had $10 million

598
00:51:35,240 --> 00:51:36,920
in your bank account tomorrow,

599
00:51:36,920 --> 00:51:39,240
and maybe you already do, I don't know.

600
00:51:39,240 --> 00:51:41,800
I don't, but yeah.

601
00:51:41,800 --> 00:51:44,360
What would you do differently the day after?

602
00:51:45,960 --> 00:51:48,600
Yeah, in terms of innovation?

603
00:51:48,600 --> 00:51:50,680
In terms of your life personally,

604
00:51:50,680 --> 00:51:51,840
would you- All my life, yeah.

605
00:51:51,840 --> 00:51:53,480
What is the end goal for you?

606
00:51:53,480 --> 00:51:55,320
What are you working towards?

607
00:51:55,320 --> 00:51:56,160
Yeah.

608
00:51:56,160 --> 00:51:58,000
And how do you know you've arrived there?

609
00:51:58,000 --> 00:51:58,840
Yeah.

610
00:51:58,840 --> 00:52:02,000
And being an innovator of companies

611
00:52:02,000 --> 00:52:05,280
and working along great entrepreneurs,

612
00:52:05,280 --> 00:52:06,560
or is it something more personal,

613
00:52:06,560 --> 00:52:08,440
like you would retire on an island

614
00:52:08,440 --> 00:52:10,720
and catch fish all day?

615
00:52:10,720 --> 00:52:11,560
Sure.

616
00:52:12,520 --> 00:52:15,440
You know, I already feel like I've made it.

617
00:52:15,440 --> 00:52:18,080
I don't feel that, you know, I will make it.

618
00:52:18,080 --> 00:52:21,520
And I think that that philosophy has served me well.

619
00:52:21,520 --> 00:52:24,920
I am very lucky to work at a company

620
00:52:24,920 --> 00:52:28,840
that has been funded to some degree.

621
00:52:28,840 --> 00:52:31,400
But I think personally, you know,

622
00:52:31,400 --> 00:52:33,720
for me, it's all about service and impact.

623
00:52:33,720 --> 00:52:35,320
How am I utilizing that money?

624
00:52:35,320 --> 00:52:36,560
And money is a tool, right?

625
00:52:36,560 --> 00:52:38,200
It doesn't really mean much

626
00:52:38,200 --> 00:52:41,000
if I can't empower the right people

627
00:52:41,000 --> 00:52:42,480
and build the right processes

628
00:52:42,480 --> 00:52:45,320
and the services to scale that money.

629
00:52:45,320 --> 00:52:46,960
So that could be philanthropy,

630
00:52:46,960 --> 00:52:49,960
that could be backing underrepresented founders,

631
00:52:50,760 --> 00:52:53,640
that is charity, right?

632
00:52:53,640 --> 00:52:55,840
It is just helping, you know,

633
00:52:55,840 --> 00:52:57,680
enable folks who are already working

634
00:52:57,680 --> 00:52:59,760
on really difficult problems,

635
00:52:59,760 --> 00:53:03,160
whether that's poverty, malnutrition, housing,

636
00:53:03,160 --> 00:53:08,080
like it's really basic, simple things across the world, right?

637
00:53:08,080 --> 00:53:11,280
I'd love to give back, you know, to South Asia,

638
00:53:11,280 --> 00:53:14,320
give back to my homeland, like where my parents came from.

639
00:53:15,160 --> 00:53:17,840
Education is always very top of mind for me.

640
00:53:17,840 --> 00:53:20,800
So I think I would ideally use that money

641
00:53:20,800 --> 00:53:23,880
in various ways to give back.

642
00:53:23,880 --> 00:53:26,600
Do you have time for one more question, Rayhan,

643
00:53:26,600 --> 00:53:27,880
or do you have to go?

644
00:53:27,880 --> 00:53:29,400
Yeah, sure.

645
00:53:29,400 --> 00:53:32,200
So this is an idea I've been playing around with

646
00:53:32,200 --> 00:53:33,480
about identity.

647
00:53:33,480 --> 00:53:36,840
Our identities and things we identify with,

648
00:53:36,840 --> 00:53:41,840
you know, brown, male, Southeast Asian, religion,

649
00:53:41,920 --> 00:53:46,120
they empower us, but they also divide us.

650
00:53:46,120 --> 00:53:50,000
What are your thoughts on these different identities?

651
00:53:50,000 --> 00:53:52,760
And do you think the goal should be,

652
00:53:52,760 --> 00:53:54,120
and this is what I think the goal should be,

653
00:53:54,120 --> 00:53:58,720
is for race, religion, countries to essentially not exist

654
00:53:58,720 --> 00:54:01,480
because I see them as a divisive force.

655
00:54:01,480 --> 00:54:03,560
And this is based on my experience in childhood

656
00:54:03,560 --> 00:54:05,960
where there were a couple of riots I was involved in

657
00:54:07,040 --> 00:54:12,040
where there were people out to kill my kind of people

658
00:54:12,920 --> 00:54:13,880
in India.

659
00:54:13,880 --> 00:54:16,120
So I have a very biased view on this

660
00:54:16,120 --> 00:54:17,520
and I recognize that bias.

661
00:54:17,520 --> 00:54:21,760
Let's start with an easy one or an easier one.

662
00:54:21,760 --> 00:54:23,720
Do you think countries should exist?

663
00:54:24,560 --> 00:54:25,920
I don't think they should,

664
00:54:25,920 --> 00:54:28,160
but because I think it's a made-up concept

665
00:54:28,160 --> 00:54:30,320
and doesn't make sense to me.

666
00:54:30,320 --> 00:54:32,400
And then let's go to a harder one.

667
00:54:32,400 --> 00:54:36,080
And I won't pick on race or religion

668
00:54:36,080 --> 00:54:38,480
because that's a much longer conversation,

669
00:54:38,480 --> 00:54:41,200
but I will ask you, do you think gender should exist?

670
00:54:42,080 --> 00:54:44,800
These are really weighty questions.

671
00:54:44,800 --> 00:54:47,440
I think I look at things slightly differently.

672
00:54:48,600 --> 00:54:53,600
I think the purpose of difference is for knowledge,

673
00:54:57,200 --> 00:55:01,920
empathy and connection and ultimately unity.

674
00:55:03,840 --> 00:55:08,840
We are all reflections of the beauty on this world.

675
00:55:08,840 --> 00:55:13,840
Yes, there is ugliness and trauma and tragedy,

676
00:55:13,840 --> 00:55:17,000
but that is also required to understand what is beautiful

677
00:55:17,000 --> 00:55:19,800
and what is good and what is right and what is just.

678
00:55:19,800 --> 00:55:21,880
So I think our purpose is to know each other.

679
00:55:21,880 --> 00:55:25,240
So difference is beautiful and to be celebrated.

680
00:55:25,240 --> 00:55:29,240
What I believe is that oftentimes it's about

681
00:55:29,240 --> 00:55:31,640
understanding humanity and universality.

682
00:55:32,920 --> 00:55:34,920
That does not mean conformity.

683
00:55:34,920 --> 00:55:39,920
So I can be from X country and you can be Y country,

684
00:55:40,640 --> 00:55:42,040
but we can be united.

685
00:55:42,920 --> 00:55:45,320
And I think in history, we have seen examples

686
00:55:45,320 --> 00:55:50,320
where there are superseding types of unifying parameters

687
00:55:52,200 --> 00:55:55,240
where folks, they're a part of a greater good.

688
00:55:55,240 --> 00:55:56,840
They're a part of a greater collective.

689
00:55:56,840 --> 00:55:59,960
And I think that's a very human,

690
00:55:59,960 --> 00:56:02,840
it's a very, it's a very, it's a very,

691
00:56:02,840 --> 00:56:06,920
it's a human, it's one of our essences.

692
00:56:06,920 --> 00:56:08,800
We were created to connect.

693
00:56:08,800 --> 00:56:10,880
We were not created to be lonely.

694
00:56:13,120 --> 00:56:15,120
One definition of loneliness is also,

695
00:56:15,120 --> 00:56:16,880
it is a separation from yourself.

696
00:56:19,000 --> 00:56:21,200
Yeah, so this idea of you actually need to connect

697
00:56:21,200 --> 00:56:23,800
to yourself, but once you connect to yourself,

698
00:56:23,800 --> 00:56:26,400
you understand who you are, then you have to actually,

699
00:56:26,400 --> 00:56:29,400
there's a requirement, I think, to connect to others,

700
00:56:29,400 --> 00:56:32,640
to understand creation and to understand purpose.

701
00:56:32,640 --> 00:56:35,520
But that requires an understanding of difference.

702
00:56:35,520 --> 00:56:38,240
But then really seeing that difference is not,

703
00:56:38,240 --> 00:56:41,120
that is its form, but that at our elements,

704
00:56:41,120 --> 00:56:42,240
we are actually all alike.

705
00:56:42,240 --> 00:56:45,280
Like you and I are mirrors of each other,

706
00:56:45,280 --> 00:56:47,720
and all of these kind of superficial, I agree,

707
00:56:47,720 --> 00:56:52,720
kind of societally constructed labels of I and you,

708
00:56:55,640 --> 00:57:00,080
American, French, he or she,

709
00:57:00,080 --> 00:57:04,520
these are not helpful.

710
00:57:04,520 --> 00:57:07,400
I like to quote the famous Rumi who said that,

711
00:57:07,400 --> 00:57:11,720
there is right and then there is wrong.

712
00:57:11,720 --> 00:57:13,840
There is right doing and then there's wrongdoing,

713
00:57:13,840 --> 00:57:15,360
but then there's a field.

714
00:57:15,360 --> 00:57:17,840
Let's go hang out on the field, right?

715
00:57:17,840 --> 00:57:20,480
So that's the way that I look at it,

716
00:57:20,480 --> 00:57:24,360
that I wanna see beyond just seeing, right?

717
00:57:24,360 --> 00:57:27,240
There's connection of the heart, there's connection of souls.

718
00:57:27,240 --> 00:57:29,680
Now we're getting really kind of philosophical

719
00:57:29,680 --> 00:57:33,840
and spiritual, but these are just the clothes that I wear.

720
00:57:33,840 --> 00:57:36,200
It's an artificial dress that I'm putting on,

721
00:57:36,200 --> 00:57:40,400
but I think our purpose really is to know each other.

722
00:57:41,680 --> 00:57:45,800
But I think those differences are educational though.

723
00:57:45,800 --> 00:57:50,160
It helps us to kind of understand the beauty of creation.

724
00:57:50,160 --> 00:57:51,480
Do you think there is a soul

725
00:57:51,480 --> 00:57:53,160
or do you think we are pathways

726
00:57:53,160 --> 00:57:55,160
and algorithms connected in a middle?

727
00:57:56,720 --> 00:57:59,280
I do have to hop, but look,

728
00:57:59,280 --> 00:58:02,560
that might be a great part two of the podcast.

729
00:58:02,560 --> 00:58:04,000
It was great hanging out, Rehan.

730
00:58:04,000 --> 00:58:05,280
We'll have to do it again.

731
00:58:05,280 --> 00:58:06,200
Yeah, wonderful.

732
00:58:06,200 --> 00:58:29,200
Thanks so much for having me on.