Starting a business is a time-consuming and arduous venture, one filled with risk and every uncertainty. Pursuing this during medical school is a whole different story. My name is Parth Shukla. My friend Neal Dharmadhikari and I started our first business together in medical school called Perfect H&P. It’s a history and physical template notebook you can find on Amazon designed for medical students, nursing students and physician assistant students and residents to use on the wards. We launched in late 2015 and so far, we’ve sold in over 25 states. We broke even, created larger margins, donated wholesale profits, paid our rent and helped out a ton of learning students. The best part? We had no idea how to do any of this just six months ago.
Let me preface by saying that I’m no business expert. I don’t know much about stocks or markets or equity or any of that great stuff. I’m just a guy with a few ideas. And as it so happens, I made a great business partner in a friend of mine who also had a few ideas and things worked out for us. Here are some of the more important things I learned along the way.
Sometimes, there are no guidelines.
In medicine it often feels like there’s always a right way to do things. There’s a set of robust, research-backed, evidence based medicine-driven guidelines for the management of nearly every disease and patient you can think of. Stray away from the guidelines and you’re at risk of harming the patient, damaging your reputation and battling an uphill lawsuit. Though there are stylistic differences, there is usually some agreed upon, “correct” way to do things that has been proven to be most effective in managing patient care. There are rules.
This sort of all goes out the window when you create something yourself. Even in our example of a notebook, there’s no right way to do anything. It is hard to immediately imagine how many decisions go into producing a notebook. It’s just a notebook, after all — not a Macbook or a smartphone or an electric car. But every last detail is scrutinized and agonized over for hours. There are a hundred different parameters that suddenly come into action, each more confusing than the next. Consider the size, the color, the logo, the name, the cover thickness, the cover material, the cover gloss, the paper quality, the paper thickness, the back cover material, the binding material, which physical findings are highest priority, the order of the physical exam, how to condense the review of systems and a hundred other binary yes/no decisions that can change the final product. A great many of these listed variables change the production cost and economics of selling a finished book, but every single one of these change how you feel when you use the product.
When you finally hold our book, all you see is the finished product — a polished book with a clean logo and intuitive template that fits just right into your coat pocket. It looks so simple from the outside, almost un-inspiringly uncomplicated. And that’s exactly how you want it to feel. You don’t want to think about all the thousand decisions that came into play in its design. You just pick it up and know how to use it.
The fact remains that there is no right way to get to this point. There is no right color to use for our logo that might appeal better to medical students. There is no correct number of pages. There is no research telling you ring-bound books sell more than spiral-bound books in the medical student population. There are no guidelines. You don’t know what you’re doing and nobody is there to tell you. You just sort of get a good feeling and roll with it. This was one of the toughest things to learn and for me personally to get used to. Sometimes, there are no guidelines.
There is no such thing as being too busy. There are only priorities.
In medical school we tend to kid ourselves into thinking we’re the busiest people on the planet. That we don’t have time for our friends, family, sport interests or even sometimes, our relationships. It’s not entirely our fault, of course. Everyone shoves this down your throat from the moment you enter school. There are dozens of Internet memes and TV shows that caste this idea in bronze. They tell you to get used to sacrificing and that this is what being a doctor means. And in a lot of ways they’re right. Medical school is a busy time and sacrificing is part of the game. But in a lot of ways, they’re also wrong. Yes, you’re busy. But you’re not being death-gripped by your classwork to hold you hostage from the other important things — the things that really matter to you.
Even in the faintest light of your free time, there are ways to prioritize in order to make just about anything happen. I am not, by any means, saying that starting our business is a prime example of this — do not dismiss this as some holier-than-thou finger-wagging blog post. In fact, the example that inspired me was the unique group of medical school colleagues I had who were also parents. They play a whole different game. For them, that was priority number one, their children were their lives. Medical school was something they just happen to do. I can hardly think of any comparable example. Go ahead and try telling a medical school parent how busy you are.
There were times when Neal and I naïvely wondered if we would have time for any of this. I was in my surgery rotation and Neal was in medicine when we launched. It was hardly a time to start anything, or so it seemed. But the capital “T” truth is that there is never going to be a right time.
Don’t tell me you’re too busy unless it’s true. There are medical students who raise kids and don’t have food on the table and care for their sick parents and I have seen even them succeed in medical school. That is testament enough. If it’s high enough on your priority list — whether it’s work or research or family or a relationship — there is no such thing as being too busy.
We all live in a box.
It is easy to get used to the idea that we are confined to a certain set of rules. As medical students, we’re great at following rules. We are some of the most compliant and orderly people there are. If there is an assignment, we get it done. If there is an exam, we study hard. If the professor yells to be quiet, we stay quiet. We tend to believe that if we just keep our heads down, keep moving, and playing the game, things will turn out great. Study hard, do research, show interest, learn what you can and don’t think too much. That’s the unspoken mantra of medical school. Follow the rules and stay in the box and things will work out.
But there was one big moment for me early on in this whole project that changed how I thought about this. It happened in the midst of my medicine rotation while I was eating lunch in the hospital cafeteria. A student from a different medical school, who I had never seen before, passed me and in his coat pocket I noticed our notebook. This was huge. It was like a strange dream I was having. Here was this guy I had never met before, integrating and using my book in his daily rounds and student life. Unknown to him, I had contributed to his world. I changed something for him, however small. I added to his box.
This was a powerful feeling. Everyone lives in a box that you can contribute to and change. The ways we learn to do things are just made up by other people. Every medical treatment was at one time a completely new idea before it was added to our guidelines. The things we learned in class and on the wards were all just products of other human beings no different from us. To know that you and I, in our complete ordinariness, can change this was a tremendous lesson for me and a feeling I’ve never had before. I’m not sure how big this business will grow or if I may pursue another venture down the road, but I do know that this feeling is one I can’t help but chase. We all live in a box. A box that can be changed, however small, even by just you and me.