What Founders Can Learn From Psychiatrists
For those who know me, I’m a psychiatrist first and foremost. That’s the identity that feels most true to me: a clinician who sits with patients, listens, and tries to help them suffer less.
Somewhere along the way though, I wandered into the world of start-ups. I co-founded AVAtalk Technologies Inc. and have advised a few other early-stage companies. I never woke up thinking, “I’m a business person now.” If anything, it happened almost by accident.
Looking back, I think what pulled me in wasn’t “business” as such, but curiosity and a desire for impact. I’ve always been drawn to research and innovation, but only when they actually make a difference in real people’s lives. That, more than anything, is what connects psychiatry and start-ups for me.
A research mentor who thought like a founder
Before I ever thought of myself as a founder, I was shaped by an extraordinary research mentor: Nancy Mayo. She is disruptive in the best sense of the word and only cares about doing research that is truly transformative.
Her rule was simple:
You don’t start with ideas. You start with people.
She spent a lot of time talking to patients, caregivers, clinicians, anyone affected by the problem she was studying. She wanted to understand their pain points deeply and to involve them throughout the research process. Participants were no longer people she “studied”; they were people who studied with her.
From Nancy, I absorbed a moral compass that still guides me today:
You are privileged. You have skills. Use those skills to make the world better, because you are in a position to do it.
I will always be grateful for that.
What start-ups quietly teach psychiatrists
Being a founder is a grueling process. There is nothing glamorous about working on a product at midnight while not knowing if the next step is the right step and juggling a full clinical load.
But the experience taught me something that loops right back into psychiatry:
An idea or a product has no value if you’re not talking to the people who are supposed to use it.
The whole point of a start-up is to solve a problem. But you can’t solve a problem you don’t understand. And you can’t understand a problem if you don’t spend time listening to the people who live with it every day.
Listening and observing are not “nice to have” qualities in a founder. They are core competencies.
Paul Graham’s founders, and one missing trait
Recently, I reread Paul Graham’s essay, “What We Look for in Founders”. His essays are usually spot on, and I rarely disagree with him. In that piece, he highlights five important traits: determination, flexibility, imagination, naughtiness, and friendship.
I agree with all five.
But I do think he missed one:
Founders need to be exceptional listeners.
Lead with a question, then listen. Listen for pain points. Listen for confusion. Listen for what people don’t say as much as for what they do. Then ask another question. And another. That is how you find the real problem under the surface.
“What brings you in today?”
As a psychiatrist, the single most important question I ask is:
“What brings you in today?”
It is an incredibly simple, open-ended question. After that, my main job is to listen. When you listen long enough, patients will tell you what their pain points are, what truly bothers them, what keeps them up at night, what they are afraid to say out loud.
Sometimes their distress makes it hard for them to explain things clearly. They might feel they “don’t know” what is wrong. But if you listen with patience and curiosity, a theme emerges. From there, you ask more focused questions and gradually clarify the problem together.
That process is not so different from early customer interviews in a start-up.
Even with perfect biomarkers, I’d still ask the same question
I’m a strong believer in the future of mental health care, and I’m excited about neuroscience and biomarkers in psychiatry. Suppose that tomorrow we develop perfect objective tests that can tell us, with high precision, what a person’s diagnosis is.
Even then, in every first encounter, I would still ask:
“What brings you in today?”
Why? Because a diagnosis is not the same thing as understanding someone’s suffering.
A lab result or a brain image may tell me what they have, but not what hurts the most or what they hope will change. To be truly helpful, I still need to understand their subjective experience. That only happens through listening.
The same is true for products. You can have all the analytics, dashboards, and metrics in the world, but if you aren’t actually listening to people, you will miss the point.
Clinicians as founders: you already have what it takes
So why am I writing this?
Because I hear too many clinicians say things like, “I’m not a business person,” or “I could never be a founder.”
I don’t buy that.
Clinicians are trained to do the very thing founders often struggle with: listening deeply and making sense of complex human problems. We spend years learning to build trust, ask good questions, tolerate ambiguity, and lead teams in high-stakes environments.
These are not soft skills. They are exactly the kind of skills that build meaningful, impactful companies.
Innovation in health care often happens without clinicians at the table, which is unfortunate, because our presence is desperately needed. We understand the context, the workflow, and the human cost of bad design.
It is time for the VC world and the start-up ecosystem to recognize the unique value physician-founders bring:
We are close to the problem
We are trained listeners
We are natural leaders in complex systems
Yes, many physicians can’t or won’t go “all in” full-time on a start-up for obvious reasons. But that should not be the main criterion used to judge whether a team can execute. What matters is whether the team as a whole is structured in a way that allows for consistent, reliable execution. A physician founder can be an integral part of that, even if they are not the one writing code at 2 a.m.
If you are a clinician wondering whether you belong in the world of start-ups, here is my view: you probably belong there more than you think.
You already know how to ask, “What brings you in today?”
Now imagine asking your users the same thing and really listening to the answer.
Let’s keep the conversation going. I’m genuinely curious to hear your thoughts in the comments.
