Our oath: Cause not condition (Salutogenic, functional tech’)

An entirely new approach to functional healthcare, powered by Vala.

In Finland, the word Vala means ‘Oath’. It’s why we chose the name for our company; because we are dedicated to practising ethical, functional medicine. Our doctors took an oath to do the right thing — to ‘do no harm’ — and help people to reach their full potential.

But Vala is more than just a set of doctors practising medicine over screens. Our doctors are how we deliver the service, but at our core, Vala is also a group of individuals driven by a shared belief that living the best life possible can be achieved through honest reflection, clear objectives, consistent effort, incremental change, community support and trust in the scientific method. For four years now, we’ve been designing an entirely new approach to primary care, one that focuses on using assistive-technology to find and adjust the why, not just fix the what. The next phase of development (which I’ve nicknamed Project Oath) is going to be our most ambitious yet, and I’m delighted to have some great partners and supporters in the wings + a growing base of Vala members to help drive us forward.

Functional beyond buttons

On the surface, Vala would look like any other telemedicine provider — You register, you book, you pay, you see one of our qualified doctors through glass rather than face-to-face. But when you have an appointment with us, Vala is doing much more than that, and the way in which we’re starting to develop our technology stack might surprise you. I’m also keen to stress that we’re so much much more than just a marketplace.

The parts of the whole

The Vala platform has three distinct pieces to it; The Member Experience, the Functional Layer, and the Doctor Experience.

(In the coming months I’ll be forming dedicated teams focusing on each of those three parts — more about that coming soon)

The member experience is designed to be easy, the doctor experience is designed to be efficient… but I want to write a little bit about our functional layer, because that is where all the fascinating stuff is happening. The invisible stuff. The seamless and smart stuff. It’s also why I’m so excited to have joined the company, at this time in their gestation. Because now the business has been growing steadily, and offering a highly regarded service, we get to start flexing our functional muscle.

The Vala approach to medicine has always been very ‘functional’. Our doctors and physician associates (PAs) try to take a systems-based approach to healthcare that focuses on identifying and addressing the root cause of disease, illness or mood-dip, and not just the condition itself. Each symptom or differential diagnosis may be one of many contributing factors to an individual’s illness. We get thousands of requests a week that can be dealt with very quickly using traditional medicine, and we’re regulated and licensed to do that, just like your local GP. But more often than not we encourage our members to come back regularly so we can help them to continuously adjust and evolve their lifestyle in order to stop the condition occurring again in the future. By identifying the stress-factors, and tuning the assets for health and well-being, we believe we can really start to empower people, and not just fix them.

We want to help people find a better quality of life, help them find the causes of good health, create self-reliance, talk about their health more, and encourage life-style adjustments as well as, or instead of traditional medicine.

It’s the primary reason we offer membership as a business model — Pay once, visit us often.

One condition, many causes / One cause, many conditions

It’s not uncommon that a diagnosis can be the result of more than one cause. For example, depression can be caused by many different factors, including inflammation. Likewise, a cause such as inflammation may lead to a number of different diagnoses, including depression. The precise manifestation of each cause depends on the individual’s genes, environment, and lifestyle, and only treatments that address the right cause will have lasting benefit beyond symptom suppression. Which is the other reason we spend a lot of time talking with our members during consultations, rather than rushing them to a conclusion. We ask questions and listen.

I first got interested in this approach during my work with James. We’d spend a long time talking about the root causes of some of his discomfort, not the disease itself. As he’d learned over time what all the detrimental factors were, he was able to adjust his environment, his diet, and his very thought processes. But to be able to do that kind of functional analysis very rapidly, you would need to be collaborating with the type of technology that can learn and evolve with you.

Our approach to ‘Salutogenic’, functional Tech’

Because we focus as much on factors that support human health and well-being, than just the factors that cause disease (pathogenesis), we’re also using our data to help our members understand their relationship between health, stress, and coping. We want to support people in finding a sense of coherence across meaningfulness, manageability and understandability.

Everyone’s relationship with their health (physical and mental) is a continuous variable; the “health-ease versus dis-ease” continuum.

I’ve started to think about that functional space between Member and Doctor as our kind of Salutogenic Tech’ layer.

The word “salutogenesis” comes from the Latin salus = health and the Greek genesis = origin and was first coined by Aaron Antonovsky, a professor of medical sociology. Antonovsky’s theories rejected the “traditional medical-model dichotomy separating health and illness”. We don’t reject traditional medicine, we practice it, but we do believe that somewhere between the two is the sweet spot, and that’s where modern data-driven technology can start to play a crucial role.

How are we powering our middle layer? For starters we have a big advantage over traditional healthcare companies because all of our consultations occur through digital channels (video, call or chat). It’s within this functional layer of technology that we’re going to be able to translate conversations from any language into any language (let people be themselves!), offer real-time subtitles for the deaf or hard of hearing. We’ll also help our doctors write their notes so they can focus on looking a patient in the eyes during a consultation, rather than down at the keyboard.

But it also means we’re able to analyse (ethically!) our conversations and start to find patterns, or make inferences on what the causes of a rash, or a cough, or a mental health concern might be. We can do that by spotting keywords as our doctors ask the questions. Our hope is that we can start to identify potential causes in at least 8 out of 10 conditions we treat.

Our middle ‘Salutogenic Tech’ layer allows Vala to be;

• Health orientated, rather than disease orientated.
• Member centred, rather than doctor centred.
• Preventative rather than fixated on early detection.
• Holistic rather than treating everyone the same.
• Focused on individual biochemicals and not just diagnoses based on symptoms.

Also, when members engage with out doctors over the Vala platform, the middle layer is always learning. Looking for functional patterns or causes. Finding stressors or life factors. It’s helping create plans that our doctors can review and learn from. Or in some cases creating plans that our doctors can review and reject, which is also how we’re training our middle layer to get smarter — The human is very much in charge here.

We use our middle layer to help collect the facts around the story so that our doctors get a wide-angle view of what can otherwise on the surface seem like something run-of-the-mill. We’re interested in the antecedents, any triggering events, and the mediators or perpetrators. You’d be surprised how few of our competitors in this space take the time to find this stuff out, most hear the problem and then prescribe a medication within 5 minutes, literally transferring the traditional GP experience online.

We’re focused on helping members and doctors to understand goals using our platform as the glue that holds it all together. The Salutogenic, data-focused layer really only kicks in to high-gear by listening, and I want it to help our doctors;

• Identify predisposing factors (antecedents).
• Identify the triggers or triggering events.
• Identify the perpetuating factors (mediators).
• Identify clinical imbalances or disruptions in the organising physiological systems.

You won’t know it’s there, it won’t get in the way.

Also, by using the middle layer to apply logic and weighting to a members goals, we’re able to help with the prioritisation of goals. At the end of the day, it’s our members mental, emotional, and spiritual perspectives that are of primary importance in working out the next steps, and the data layer is a guide for both member and doctor towards those goals; but it never dictates them.

Continuous, incremental improvement and adjustment

Is it possible that at some point our platform will be as good as our doctors at identifying those functional causes? Maybe. But I’m not focused on that. I’m much more interested in having it listen to the doctors as they’re asking the questions, and our members when they answer. But true to our label, our oath is that those prompts, plans, observations and automations will never be wholesale replacements for human-to-human care, merely used as a support system for our staff. Think of the Vala platform as a really focused PA for every one of our doctors. It helps our doctors learn and grow, and it helps our members spot things to discuss with the doctors. It’s about continuous, incremental improvement.

Taking this approach to our technology usage is interesting. More often than not our doctors will often recommend more sleep and relaxation, exercise and movement, subtle changes to diet and nutrition — Modifying personal lifestyle factors is a great type of medicine for many! Natural language processing is also helping us to identify what stressors in life might be contributing to a problem or condition.

Having that ongoing dialogue approach also allows our tech, and our members to learn what relationships need loosening or strengthening in some aspects of life. Those could be your physical or emotional relationships; it could be your relationship to money or alcohol; it could be something as seemingly unconnected to your health as your relationship with work. The more conversations you have with us, the more intelligent that relationship with Vala becomes — which is also why I decided to build in the Unlimited model into our offering. We want people coming back to chat to our team as often as they want, not feel rushed to describe something in 10 minutes like the NHS limits cases too.

Help before we know we need it

It’s no secret that my interests have always sat in this concept of help-giving technology. Systems that enhance the very best parts of humanity rather than erode them. Products that do better things, rather than things better. Now through the functional, salutogenic technology layer in the service proposition, we can do that. Exciting times.

But let me finish this little insight into what goes on behind the scenes at Vala, by coming back to our name again. The oath. Medicine and care were never built around technology or tools; those were added in later on to make the job of the doctor easier. It’s an augmentation. Why? Because ethically, it would be dubious to flip the relationship with healthcare from people using tech, to tech using people. So our oath is always that our Salutogenic layer, and approach is a tool, a learning layer, not a direct care-giving layer. I can understand why some of the big tech-led health businesses want to codify care, but I personally find is quite unethical. The roots of healthcare have never changed — But the demands on healthcare have. Only by working with technology and data to continue life-long learning, and supporting our doctors to be better professionals, and our members to be better, healthier people, can we really make a big difference.

More coming soon. For now, I would encourage everyone to come and try out this new approach to primary care. You’ll find your relationship not just with medicine changes, but with yourself. Feel free to use my code ‘valaCEO50’ when you book an appointment after you’ve registered with us, you’ll get your first consultation with 50% off the normal price.

If you’re interested in being part of a healthcare evolution, one focused on ethical, functional, and game-changing technology then please get in touch to discuss how we can work together.