What I Want to Do, What I Have to Do

Time that feels painful now often becomes a precious memory later. By the same token, moments of triumph can turn out to be the start of unexpected trials. Not getting into the hospital I wanted was a setback in the moment, but in another sense it was a stroke of luck. Only then did I begin to ask, in earnest, what I truly wanted. I stopped worrying about how I might look to others and listened instead to the voice that rose from deep inside.

I kept asking myself what I wanted to do—and why. One thing became clear: I still wanted a life that helped people who were ill. If possible, I wanted to help as many people as I could. The truth was, I didn’t long to be in a consulting room. What I wanted pointed me toward drugs—medicine in the literal sense. People say a single good drug can save countless lives. For me that isn’t just a saying. Every night before bed I swallow a few warfarin tablets with water to keep going. Someone devoted a lifetime to developing that drug, and I am its beneficiary. I decided to throw myself into drug research and went looking for a place where I could do it.

That is how I ended up back at my medical school, in the department of pharmacology. As I’ve said, medical education is broadly divided into basic science and clinical medicine. Clinical medicine is what people picture when they think of doctors—internal medicine, surgery, and the like. After residency there you become a board-certified specialist. Basic science, which includes pharmacology, is centered on theoretical research; in truth it looks more like natural science than what the public thinks of as “medicine.” It’s a very different path from the one most physicians take. But none of that mattered if I could study drugs. At twenty-seven I became a graduate student and returned to school.

My first tasks in the lab fell into three broad buckets: reading papers, doing molecular biology experiments, and running animal studies. Reading meant keeping up with the torrent of publications in my field and building the theoretical footing for experiments and manuscripts. Molecular biology—those lab scenes you see on the news where someone is pipetting into tiny tubes—was about understanding life at the molecular level and connecting it to what we observe in the world. Animal studies tested how phenomena confirmed at the bench actually play out in a living body.

In graduate school I engineered a virus that would produce an antidepressant, then used animal models to see whether it worked. One example: we induced depression in mice by dropping them into a tank of water, then drilled a small hole in the skull and injected the virus designed to produce an antidepressant, and watched for changes in behavior.

Paper reading, molecular work, and animal experiments were all steps toward the next goal: writing papers. In truth, “research” in graduate school largely meant doing what it took to get manuscripts written. It didn’t take long to realize this wasn’t the work I’d imagined. I began to doubt how all the ivory-tower sparring in piles of journals would help people outside the lab trying to live their lives.

The more time I spent in grad school, the less I cared about publications. Staying late to run experiments when I wasn’t even curious about the results felt miserable. For someone else, this might have been endlessly exciting; to me it was tedious, grinding labor. I tried to persevere in the name of drug discovery, but the process was far from what I’d pictured.

Economists talk about “sunk costs”—resources you’ve already spent and can’t get back. Those costs can be time and effort, not just money. The hours and energy I was putting into graduate school were exactly that. Sometimes the best way to avoid a bigger loss later is to ignore sunk costs now. People rarely do. Instead, they pour more time into ventures already shown to be wrong because they’re trying to recover what’s gone. Richard Thaler called this the “sunk-cost fallacy.”

I was neck-deep in that fallacy. I knew better than anyone that pharmacology research didn’t fit me, yet I couldn’t walk away because the time and effort I’d spent felt too precious to abandon. My heart had left already, but I lacked the courage to make a decision that, on the face of it, would “waste” what I’d invested—even though quitting when I first knew it wasn’t right would have saved me greater loss.

I revisited why I’d wanted to study drugs in the first place: I wanted to make something that helped the sick. Was drug research the only road to that end? Surely there were paths I didn’t yet know. Around then, I saw a glimmer of possibility in an unexpected place: the internet. What if there were a space online where patients could ask questions and doctors could answer? It struck me as something many people might find useful, and the idea alone set my heart racing.

From that moment, after my lab day ended, I poured every free minute into building a medical Q&A website. I’d eat dinner, rush back to the computer, and code until I saw dawn through the window. By day I was a grad student; by night I was a web developer.

It was my first time building a site. I hadn’t learned web development systematically; I looked things up as I needed them, and I made plenty of mistakes. But if there’s a will, a way opens. After barely a month of fearless tinkering, I had a respectable medical Q&A site. Anyone could post a question about a health concern.

One major problem remained. Patients would post questions for their own sake—but why would doctors bother to answer? A real Q&A site required doctors’ participation.

Begging doctors to contribute clearly wouldn’t work. People move when there’s something in it for them. I needed to make it beneficial for doctors to answer.

An idea came while I was browsing portal sites. Blogs were just beginning to take off on the big portals. With a few clicks, anyone could carve out a public corner for their thoughts. Doctors were no exception; many were launching blogs and promoting them. “That’s it,” I thought.

On our site, when a doctor posted an answer, a short bio line would appear right below it with a link to the doctor’s blog. People with health questions would ask; doctors eager to reach readers would answer.

As so often happens, solving one problem revealed another. Even with a clever hook, we didn’t get the response I’d hoped for. From a doctor’s point of view, it only made sense to participate if lots of people would actually see the answers. We hadn’t set that up well.

To fix it, I launched a new “Medical Column” section. Doctors could publish accessible essays on their specialties for general readers, and—just like the Q&A—their bios linked to their blogs. Then I submitted the column to the country’s two dominant portals—let’s call them N and D.

A small miracle followed: our pieces started appearing on D’s front page almost daily. Tens of thousands of people clicked through to read, and many of them followed the links to the authors’ blogs. I still don’t know exactly why a fledgling site’s content got such frequent placement; maybe the novelty of doctors writing directly caught an editor’s eye.

Word spread among physicians that writing for the Medical Column helped with outreach, and submissions poured in. The Q&A side picked up too. Readers who arrived via portal headlines discovered the doctor-answered questions and thought, “Oh, this exists?”—and began posting. From vaccines to post-cancer-surgery care, topics piled up with answers attached.

At that point I decided to leave grad school. There was no reason to hesitate. I was done writing papers I didn’t care about. Exactly three years in, I met my advisor, told him respectfully that I would be leaving, and said I didn’t need a degree—I wasn’t coming back anyway. He suggested I might want one, just in case. In the end I received a master’s by writing up what I’d already done, without returning to the lab.

Now I got serious about building an online medical-consultation service—the first step, really, toward the telemedicine I’d always envisioned. I’d long been convinced telemedicine would be part of medicine’s future, for good reason. In a civilized society, caring for the vulnerable is basic decency. Yet healthcare still fails that test in important ways.

We treat it as normal that sick patients must drag themselves to wherever the doctor waits comfortably. Because it has always been so, we assume it must remain so. I couldn’t accept that. The relatively weaker party—the patient—should be able to meet the doctor where the patient is. If it’s unrealistic for doctors to visit each patient in person, there should be something at the patient’s side that stands in for the doctor.

Working with software developers, I packaged our consultation service into a smartphone app. In 2010 smartphones were just entering the mainstream, and even developers were new to the platform. We banded together simply to pioneer something new. We listened to users, adding features and refining what we had: the ability to snap a photo of a rash and send it to a doctor; or, when a user posted a question, pinging the computers of physicians at nearby clinics using GPS—little things, but all new at the time.

The app spread like a brushfire among smartphone users. It became clear I couldn’t do it alone, so I founded a company. “Company” might be generous: we set up a few desks and computers in a small studio apartment. We worked and slept there, focusing everything on building better care.

Once the app was on its feet, we needed revenue. The first priority was to avoid violating medical law. If you want to go far, nothing matters more than staying within the rules. In particular, we sought legal advice to ensure we wouldn’t run afoul of provisions banning for-profit patient inducement (Article 27(3) of the Medical Service Act).

Our answer was a “local priority” program. We granted a limited number of clinics priority in handling consultations for a given neighborhood and specialty. That tapped directly into the desires of private practitioners to gain an edge over competitors in the same building or block. Doctors were willing to pay several million won a month to “own” local questions.

Member clinics popped up nationwide. We grew to twelve employees. Revenue was steady; our model had low fixed costs, so margins were healthy. Within a year we moved from the studio into an office with its own little garden. Best of all, we could raise salaries. Each day made the next look brighter.

And yet something nagged at me. We were growing fast, but the trajectory felt wrong. I asked myself: Have I built a telemedicine system—or just a marketing tool for doctors? Am I truly helping patients in desperate need? Will I regret growing the company this way?

The problem, ultimately, was me. I held a medical license but lacked meaningful clinical experience. My understanding of, and access to, the wider healthcare system had limits. A twelve-person startup is nimble and efficient at making money, but woefully small for tackling the enormous machinery of healthcare. As a medical marketing play we were beginning to show promise; as telemedicine proper, we had obvious ceilings.

One night I stayed alone in the office after everyone had gone and sat quietly with my thoughts. I remembered my early months in graduate school. Not long after starting, I’d sensed I was on the wrong road. I ignored that inner voice and drifted for three years. This time I didn’t want to repeat the mistake.

I decided to shut the company down. Better to close something I’d built than let it stand as a vehicle for profit alone. If someday I took a role in telemedicine again and my earlier company was busily chasing revenue, who would believe my intentions? I chose to end it and keep the experience.

A question returns at every stage of life: When the work before you isn’t truly yours, should you end it decisively—or persist in the faith that diligence is rewarded?

If the difficulty comes from inexperience and you still want, someday, to do the work well, then persistence is right. If you don’t have a different calling tugging at you, staying put can be wise. We tend to like what we become good at, and we become good by keeping at it.

But if you believe you’re in the wrong place and you’re lingering only because of sunk time and effort; if your true desire points elsewhere; then you need to leave—now. If you keep muttering, “I’m not meant to be here; I’ll do something else someday,” while phoning in the job you have, there’s nothing to discuss. Avoidance and self-deception only raise the bill you’ll pay later.

In my late twenties I went to graduate school in pursuit of what I “wanted.” I soon realized it wasn’t what I’d imagined, yet wasted three years dithering over the time I’d already spent. Later I found my way back to something I genuinely wanted, started a company, and grew it. But even while doing what I wanted, I learned that to do it right there were things I had to do.

Across graduate school and startup life I finally identified the two essentials I lacked for the work I had to do: clinical experience and a systematic organization. My journey toward those two had to begin. And by then I was no longer in my twenties; I was stepping into my thirties.