An Accidental Entrepreneur

I call myself an ‘accidental entrepreneur’ because there were too many (happy) accidents that have brought me to where I am today! For me, the battle to become a doctor began soon after the realization at the age of 15, that even though I was the best cadet in NCC Navy at the Modern School, New Delhi, I could not join the National Defence Academy to become a fighter pilot in the Navy, as I was mildly myopic. I did not have Biology as a subject in school as I had a mistaken belief that by studying the alternative subject Geometrical Drawing, I would be better able to chart the course of the ship, in this case an aircraft carrier. My indifference to anything medical probably started when as a little boy. I used to be foxed as to why my father – late Dr S K Lal, a renowned Pathologist – would kill the rabbits that I loved playing with, in our house that also had my father’s pathology laboratory. I learnt it later that the rabbits were sacrificed to study their ovaries after they were injecting with a lady’s urine for the only available pregnancy test at the time – the Friedman Test.

As things turned out, I took over the lab after the untimely demise of my father in 1977. At that time, I was a lecturer in Pathology at Armed Forces Medical College (AFMC), Pune, and the Assistant Warden of the boys’ hostel. When I joined my father’s pathology practice, I thought that I knew everything that needed to be known in pathology. One can imagine my disbelief when I discovered the shortcuts and cutting of corners that were taking place in lab testing. So, it was no surprise that my first couple of years in private practice were completely spent in making home brewed reagents for biochemistry and other tests. This involved ordering raw material from abroad, as imported reagents or for that matter anything imported was banned in India, using single pan mettler electronic balances, using very sensitive pH meters, surveying the market and installing the latest spectrophotometers, single well gamma scintillation counters, pipetting dangerous radioactive material by mouth, as the hand-held automated pipettes were not available in India at that time, and many such mundane laboratory chores. And thus started my indoctrination in the beautiful world of private pathology practice.

The blood test is the most frequently prescribed investigation in medicine. In fact, diagnostic testing is the bedrock of modern evidence-based medicine, where 70% of all medical decisions are taken on the basis of lab reports. Today, Dr Lal PathLabs is a household name and the largest lab diagnostics chain in India with a network of 280+ clinical laboratories, 4,000+ collection centres and 9,000+ pick-up points across 1,500+ cities. Last year, we served over 20 million patients, processed 50 million samples; servicing one hundred thousand patients per day. In the ongoing covid pandemic, we have already performed more than 3.5 million RT-PCR tests. I could not have imagined this when I took over the reins of the lab in 1977.

Having inherited my father’s entrepreneurial spirit, I was not satisfied with only the routine working of the business. I had a strong zeal to introduce new tests, more accurate testing methods, sophisticated high-end equipment, and cutting-edge technology that could benefit patients and their doctors. This in turn revolutionized the Medical Diagnostics Industry in India.

Looking back at this journey of more than four decades, some game-changers that shaped my entrepreneurial journey, Dr Lal PathLabs’ expansion, as well as the Indian diagnostics industry at large, include:

• In 1981-1982, I made a mark in diagnostics when I introduced thyroid and other hormones testing for the first time in a private lab in India. Soon after, we introduced lipid profile for diagnosis of heart and blood pressure related ailments.

• In 1982, I brought the first auto-analyzer in North India, but not without a great struggle. I had placed an order for the Ames Auto Pacer Autoanalyzer and applied for an import license, which took more than a year to come through. While the machine cost approximately INR 3,25,000, the import duty was 90%, which was reduced to 60% with a special permission from the Delhi government. The first time I saw the analyzer, I instantly knew that something was wrong as I saw it being carried in a single carton by one porter. The machine was supposed to weigh around 50 kg. My hunch was right, and it turned out that the carton contained only the spares and accessories. The machine had still not been shipped. Once the machine actually arrived in Delhi, an ordeal of several visits to the customs office started to persuade the Chief Collector of Customs to release the consignment since the full import duty had already been paid and the import licence utilized. Since then, we have been able to introduce many such analyzers in India, especially in the 1980s and 1990s, not only for the first time in India, but the first time across the whole of Eastern Europe, Middle East, Africa, and South-East Asia.

• Another milestone for that year was when I introduced ‘franchising’ for the first time in healthcare in the world. I stumbled on the idea quite by accident. Access to quality health services has been a long-standing challenge in healthcare and this bothered me. I thought, if hospitals could collect samples and send them to our lab for testing, why couldn’t we collect samples elsewhere and bring them to the lab for testing. This was how I conceived the idea of setting-up franchisee collection centres. Building on this concept, today, the collection of samples from patients’ houses, what we call ‘Home Collection’, is becoming increasingly popular, especially in the on-going Covid pandemic. We have carried out more than 10,000 home collections in a day all over India. The core of this model was built on my philosophy of SAFE – (Simple, Accurate, Fast and Economical) Testing.

• Another major breakthrough came when we conceived India’s first healthcare software – a Lab Management Information System (LIMS), in 1986. It took me and an IIT-trained software specialist eight months to develop, but with this we were able to fully computerize our operations – registering patients, organizing test flows, generating and printing reports. Our first computer was from EIKO – an IBM-based desktop that had a hard disk memory of 20 kb! Later, in 1999, we deployed the world’s most prestigious Triple G laboratory software (LIMS) known as Ultra – it gave us a bi-directional interface and provided connectivity with our collection centres. We continue to invest heavily in digitization as I am confident that digital health will be pivotal in solving most of the challenges in healthcare.

• Over the years, we have focussed on ensuring quality diagnostics tests are available for people in India and now offer more than 5,000 tests and panels. We have a state-of-the-art National Reference Lab in Rohini, New Delhi, a Reference Lab each in Kolkata and Bangalore, and a third one coming up in Mumbai. We also house the largest Histopathology and Nephropathology departments in the world. Our Histopathology department processes up to 1,400 biopsy samples a day. We also have South Asia’s only electron microscope in a private lab.

All of this helped us stay ahead of the competition in a sea of about 3,00,000 labs that are currently operational in the country. Unfortunately, a large proportion – about 47% – of the players in the diagnostics field standalone labs are operating without adhering to any quality protocols; these constitute the un-organized sector within the diagnostics service industry and can be called ‘testing shops’ rather than pathology labs. Diagnostics has also emerged as one of the fastest growing service verticals in India, valued at USD 9.5 billion, with an estimated CAGR of 11% over the next five years. Increasing income, ease of access to testing, rising awareness about health monitoring, preventive and wellness testing, coupled with high incidence of lifestyle diseases – that now account for 65% of all deaths in the country – are factors that have been instrumental in driving the demand for diagnostics services. However, at a national level, we are still far from providing quality essential diagnostic services for all at affordable prices.

Further, being in the business of healthcare, self-imposed ethical conduct becomes especially important. With the life-or-death stakes, sensitivity of healthcare data as well as ease and experience of the patient is of paramount importance. We must always put the patient first and ensure that quality healthcare services are delivered at all times.

The last two years have been challenging for all due to the pandemic. But, at the same time, everyone has witnessed the important role that health, healthcare system, healthcare professionals and providers play in nation building. I hope our learnings from the pandemic are not forgotten easily and that the younger generation strives to improve health and wellbeing of all. In the coming years, the healthcare industry will emerge as a lucrative field for professionals and entrepreneurs.

I have three key points of advice that I would like to give to the younger generation:

1. Never fear failure: Remember that in every failure there is a very strong learning that will propel you to success in your next endeavor. Never let the fear of failing refrain you from trying. A good example is that of Thomas Alva Edison, who invented the light bulb after 10,000failed attempts.

• Develop and fine-tune your own idea – Keep It Short and Simple (KISS). Most successful ideas of the world are fairly uncomplicated. Identify your passion and embark on a journey of life-long learning. Keep yourself abreast with what’s happening in your field and how you can make a difference.

• Focus more on health than wealth: I am genuinely concerned about the rising incidence of lifestyle diseases or the non-communicable diseases (NCDs). These include diabetes, hypertension, cardiac disorders, cancer, liver and kidney ailments, lung diseases and strokes, especially in the younger population. One must exercise at least five days in a week and stay fit, eat right, and watch out for any warning signs by getting yourself tested at least once in a year. In addition to your physical health, also look after your mental health and wellbeing. For this, I recommend practicing spirituality or meditation by constantly repeating God’s name (or any mantra) which brings inner peace and keeps away psychosomatic diseases.

Oprah Winfrey said, and I quote, “The big secret in life is that there is no secret. Whatever your goal, you can get there if you’re willing to work.” I truly believe that those who put in sincere efforts eventually succeed, whatever profession you are in. Never let the fire in the belly die!

• The article was originally published as Cover Story in Career Ahead January 2022 issue.