Hi. I’m Stepa Mitaki. I’m a product person and an entrepreneur. I’ve been working in 🏙 govtech for eight years and currently work at a UK-based 🏦 fintech startup Silverbird while building a new company in 👩🏼⚕️ health tech on the side.
Morning Walk is a personal weekly newsletter where I share some musings on tech, digital healthcare, working on startups, productivity, some nerdy stuff and an occasional share of reflections on the war and how it feels being Russian at this moment in history.
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📝 Why mental health should be a part of core primary care
Two years ago, I started noticing some issues with the skin on my face. My nose, forehead and cheeks were getting red. Some pimples appeared here and there. It was getting worse and worse. A couple of the wrong diagnoses later, we found that I had a long-term skin condition called rosacea (something similar to acne). As part of my treatment, I was imposed quite a few limitations from now on. No alcohol, no saunas, no fat and spicy food, no junk food, and no sugar, especially white chocolate. The first couple of points were relatively easy to obey. I don’t really like alcohol that much. Saunas are nice, but it’s not like I can’t live without them. The same applied to fat and spicy food. But the sugar part was an entirely different kind of beast.
Limiting sugar for the first couple of days was easy, but it quickly became unbearable. It wasn’t like I ate chocolate every other day before, not at all. But I wanted it more badly because I was told I couldn’t have it anymore. I felt that enormous longing in my body; it was an actual physical sensation somewhere around my legs.
The moment I broke my diet and it got worse. Over the next several months, I’ve been fighting this massive longing for sugar with various successes. I tried some substitutes, tried lots of habit-changing techniques, and introduced cheat days, but overall it felt super stressful.
But then, some kind of a revelation happened to me. Obviously, it wasn’t just the discipline. My problem with sugar was somewhere way deeper. It was mental. I needed to find some deeper root causes of this behaviour. Fast forward months of self-reflection and working with the therapist, I figured it lies in childhood trauma. When I’m not limited to food choices, I eat more healthy (and this restriction behaviour of mine applies only to food for some reason). I still haven’t been able to cure my sugar addiction entirely, but it got much better. There are days when I voluntarily don’t want sugar, even if someone offers me a bite.
And then it hit me. The root cause of some of our physical health issues is, in reality, in our minds. I got rosacea after undergoing some significant stress at work. Then it got worse because I couldn’t stop eating sugar. But in reality, I could have avoided it in the first place if I had been stronger mentally.
There are many other examples. The best example is probably overweight. When someone wants to fix their weight issues, they often work with some sort of physician, nutritionist and fitness trainer. There are plenty of success stories of people getting into shape with this setup. But add to this care team mix a mental health therapist, and I’m sure the success rate would be much higher. Because no matter what your doctor says, you still have to follow her recommendations, and sometimes it takes some behavioural changes to do that.
The idea of therapy-led primary care is relatively novel as far as I know. There is some research done in that field, but not many healthcare providers are practising it (as far as I’m aware).
The idea was very well put in the Out-of-Pocket newsletter last year:
Behavioral health (BH) still sits outside core primary care. Though access to BH services is increasing, and more primary care startups like OneMed and Tia are offering therapy alongside their primary care services, BH is fundamentally an “add on” service, often accessible only via referral. This feels very contrary to the massive amount of evidence for the mind-body connection and the increasing BH load in the US.
I believe there’s an opportunity to re-think how behavioral health is integrated into primary care, where a therapist would be the intake point and “quarterback,” with PCPs and specialists reserved for truly clinical work. There would be several benefits, a major one being the ability to induce, track, and improve behavior change around health, which health-tech has struggled with. There would be more opportunities for “lower licensed” professionals to offer care (like social workers and coaches) and ideally decreased reliance on medication and procedures to address common health aberrations.
The mental health therapist could be introduced in two ways:
As an essential member of a care team alongside a physician.
As part of the physician’s expertise (making him truly the Jack of all Trades)
Last fall, I experienced this firsthand as a patient working with a great general practitioner who was also a licensed therapist. That has transformed the way I see primary care now.
Implementing this (especially at scale) is another vast topic to discuss, but we must consider this possibility. I believe there might lie a significant improvement of our primary care.
👩🏼⚕️ Health tech things
Health care is a team sport, but passing the baton often fails
Care delivery consists of many smaller parts. Even if we are talking about primary care, there are gazzilion tiny steps in the patient journey. One of them is specialist referrals. I always considered specialist referrals a pretty straightforward deal, but this piece examines this process in full detail, breaking it down into five smaller steps. And it turns out each step inhibits in itself plenty of opportunities for separate startups.
Research suggests that about 25% of specialist referrals are likely to be clinically inappropriate. These inappropriate referrals are a significant contributor to the overutilization of health care services and rising costs.
Paige Announces Collaboration to Deploy a Novel AI-Based Biomarker Test for Advanced Bladder Cancer in Clinical Settings
I wrote about using voice biomarkers to diagnose mental health issues previously. Now the new thing emerges. Apparently, we might be able to diagnose bladder cancer using some AI-based biomarker tests 🤯
👨🏻💻 Other interests
In-Depth: External monitor support & Stage Manager on iPadOS 16
I’m a diehard fan of an iPad, and it’s been long overdue since iPadOS has some major enhancements. Well, not anymore. The Stage Manager on iPadOS 16 is another significant step towards making the iPad truly a laptop replacement. Can’t wait to get my hands on it.
In my initial testing, Stage Manager feels like the best window management system Apple has ever put on the iPad and perhaps the most accessible window management system Apple has ever proposed on the Mac.
Beyond the Tablet: Seven Years of iPad as My Main Computer
Speaking of the iPad, this piece from Federico Viticci is the best explanation of why I love the iPad so much and why I believe it is in no contest with MacBooks. The article is from 2019 but is still relevant to these days.
At a fundamental level, after seven years of daily iPad usage, I believe in the idea of a computer that can transform into different form factors. The iPad is such a device: it gives me the freedom to use it as a tablet with 4G while getting some lightweight work done at the beach, but it becomes a laptop when paired with a keyboard, and it turns into a workstation when hooked up to an external display, a USB keyboard, and a good pair of headphones. For me, the iPad is the ultimate expression of the modern portable computer: a one-of-a-kind device that morphs and scales along with my habits, needs, and lifestyle choices.
Poised
This new product calls itself an “AI-powered communication coach”. You set it up on your Mac, hook it up to your video conferencing software (Zoom or Google Meet), and examine your communication skills, pointing out where and how you could improve.
I’m not too fond of the execution of the privacy side of it (they record your camera and upload it to the cloud), but otherwise, it works well so far. It watches for confidence, filler words, pauses, speech clarity, pace, rambling, energy, vocal variation, inclusive language, questions asked, interrupting, encouragement and even your overall emotions. I’m impressed so far.
That’s it for today. Thanks for reading. Until next week 👋🏻
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