One of my most memorable moments from medical school was during my rotation in a psychiatric hospital. Unlike traditional medicine, you’re unlikely to figure out what is going on by sticking the patient with needles. Instead you learn to listen for inconsistencies that might indicate a delusion or hallucination.
On one occasion, I was taking a medical history from a well-kept man on a psychiatric ward who wouldn’t have looked out of place in a law firm or investment bank. That was until he started to describe, in all seriousness, that “agents” had been tailing him for weeks. Apparently, he had been assigned a top secret mission to penetrate a cult and was on the verge of uncovering a major conspiracy.
While delusions of this kind sound impressive, it wouldn’t be unusual to hear similarly grandiose stories from a startup founder.
Self-confidence to the point of delusional seems to be a common trait amongst successful founders. Later stage founders often admit to having no idea what they were getting themselves into when they first started their company.
Monzo founder, Tom Blomfield, put it succinctly in an interview, “Like any founder, I had a huge dose of naivety. If I knew then, the amount of pain and heartache involved, I would never have done it.”
As a founder myself, it’s not difficult to empathize with Tom’s perspective. Being an entrepreneur is gruelling experience and in the words of Elon Musk is comparable to “chewing glass whilst staring into the abyss”. My running theory is that you have to either be a masochist (like most second-time founders) or delusional (like first time founders) to face those odds.
But there are times when a healthy dose of naivety can offer clarity and enable you to challenge long-held assumptions. Sometimes it’s the unconventional and even ludicrous ideas which turn out to have the most legs. When you adopt that view, it’s suddenly easy to explain why most industries are disrupted by outsiders.
My own experience building Quit Genius is a prime example. When we looked at the addiction epidemic ravaging America, all everyone seemed to be talking about was the “provider shortage”. The conventional wisdom seemed to be that we had to wait a generation to train more providers. Yet back-of-the-envelope math showed that the problem seemed to be less of a shortage and more to do with providers not geographically being in the same place as their patients.
That led us to question why we couldn’t solve the provider mismatch problem by building an addiction clinic that is 100% virtual and accessible from your smartphone wherever you are. While you’re at it, why not turn the model on its head by tying fees to performance rather than service delivery.
It turns out that this is exceedingly difficult to do. The healthcare ecosystem is vast, complex and dominated by rent-seeking middle-men, regulations and gatekeepers with misaligned incentives and unequal balances of power. Any sane person would give up before they started.
But coming from the outside, we had no idea about any of this. So we worked the problem and with unyielding persistence created the thing most people said could never exist.
Perhaps it’s a necessary function of innovation and progress to have a small group of deluded people in a population willing to bang their heads against a brick wall. Every once in a while, the wall crumbles and something interesting happens.