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Explained: The connection between physical health and mental health

I became a neurologist because I’m fascinated with the human brain, and after 11 years in practice, it still never fails to blow my mind — pun definitely intended.

 

There are more connections in the brain than there are stars in the universe, making the brain, not space, the real final frontier (sorry, Star Trek fans!). We neurologists have spent hundreds of years studying the brain and discovering its secrets, and there’s still so much we don’t know. Some experts even suggest that our entire reality is a construction of our brain, which might explain how my wife can remember traffic routes instantly, while I keep looking at the GPS. Maybe she lives in a map and I don’t.

 

One thing we can all agree on, though, is that both the brain and the body play an important role in everything we do and how healthy we feel.

 

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Physical and mental health are related and interdependent — one can’t exist without the other. In reality, they affect each other in many ways. If you’re physically healthy, the chances you’ll be mentally healthy are higher, and the reverse is also unfortunately true. Anxiety disorders are five times more common in people suffering from MSK conditions, and depression is three times more common.1

 

But it’s not all bad news. Studies show that 40% of members who reported depression and/or anxiety at the beginning of a physical therapy treatment report reduced symptoms at the end of it. In order to understand why this is the case, it’s important to understand how pain and depression/anxiety work together in the brain.

Pain and mental illness: a self-sustaining loop

When you’re in pain, you feel it in your body — but all the action is happening in your brain.

 

Pain is your brain’s defense mechanism: we evolved it to deal with acute injuries, like breaking a bone. When we feel pain, our brain is telling us to stop what we’re doing so we don’t do more damage. This works really well when you’ve got a broken leg, but not as well when you’re dealing with a chronic condition.

 

When you suffer from chronic pain, your brain is like a broken record, stuck on the same pain signals, repeating them over and over again.

 

Because pain happens in the brain, it also means that our perception of pain is influenced by all of the other things that affect the way we think and feel — our mood, how much we’re sleeping, and even external stimuli. When you stub your toe in the middle of a quiet day, chances are you’ll feel a rush of pain. When you stub your toe on the way to the bathroom in the middle of the night having just been woken by an ambulance, you might feel it less, because all that other stimulation is crowding it out in your brain. This all means that if you’re depressed or anxious, you’ll feel pain more intensely, which in turn can worsen your depression or anxiety.

 

When you add loss of function to that pain, things get even more complicated.

 

When an MSK condition makes it difficult to walk, bend over or lift your arm, all of a sudden, things that you usually do without thinking, like getting into the shower or loading your groceries into the car become debilitatingly painful and sometimes impossible, and this can trigger anxiety and depression, too… and those bad feelings can stop us from wanting to to the things we love, which makes us feel more depressed. If you’ve ever been confined to the couch with an injury, you know exactly what I’m talking about.

 

Over longer periods of time, this lack of movement will weaken our muscles and tendons, and at the same time decrease our threshold for pain, causing even more pain. These loops can go on for years or even decades, leading to conditions both physical and mental that get progressively worse.

Breaking the cycle

Thankfully, there’s a way to get out of this loop — and improve both your physical and mental health at the same time, no matter how far down the rabbit hole you’ve gone.

 

The first step is movement. Our bodies didn’t evolve to spend all day on video calls and all night binge-watching: they evolved to be in constant motion. Adding exercise into your day can improve your mood (not to mention your stress levels, energy levels and sex life!). If your movement program is a PT-designed therapeutic exercise program, then your chances of feeling better in body and mind increase even more.

 

The second step is to work on your mind. This starts with accepting pain as a normal part of life, and not judging it or yourself, and using tools like cognitive behavioral therapy and mindfulness techniques to smooth over the grooves in that broken record and get your brain back on track.

 

At SWORD, our digital MSK programs address both body and mind.

 

Our PTs are trained to get to the root of our members’ issues and prescribe a tailored exercise plan, and give members behavioral coaching along the way to help them think differently about their pain. Members also get access to an 8-week cognitive behavioral therapy (CBT) and mindfulness program specifically designed to help them overcome the anxiety and depression associated with chronic MSK pain.

 

To learn more about how SWORD’s solutions benefit both body and mind, fill out this form and someone will be in touch.

 

1S.R. Currie, J.L. Wang, Chronic back pain and major depressive disorder in the general Canadian population, Pain 107 (1–2) (2004) 54–60.


About the author: Dr. Fernando Correia, M.D.

Dr. Fernando Correia is the Chief Medical Officer at SWORD Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.

 

He co-founded SWORD with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.

 

Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.

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Explained

Why employers are choosing to partner with SWORD Health

It probably doesn’t come as a surprise that digital MSK is hot right now. The Business Group on Health just released their Large Employers Health Care Strategy and Plan Design survey, and once again, employers cite MSK as the top condition driving healthcare costs. Many employers are waking up to the fact that digital solutions can help them find a way out of this conundrum – 68% of large employers will look to implement a digital MSK solution by 2023. But not all digital solutions are created equal, and there’s some skepticism in the market about whether digital solutions actually work. This makes for some interesting conversations with employers in the market for a solution.

When I say I’m in Sales, people often say “you must get sick of talking.” The truth is, I don’t talk that much (and when I do, I let our product do most of the heavy lifting). I spend more of my time listening. I’ve been doing a lot of listening lately, to both our employer and health plan customers as well as partners in the consultant community. I’m particularly interested, as you might expect, in the reasons they’re choosing to work with SWORD. Here’s what I’m hearing:

100% of the care is delivered by Doctors of Physical Therapy

There are many models for care delivery in digital MSK – some providers use clinicians only, and others use non-clinicians. At SWORD, our members are only ever treated by a Doctor of Physical Therapy (DPT) – the same DPT is with the member for every single step of their journey to better health. We’ve chosen this model because it significantly reduces the risk of incorrectly identifying conditions, and because continuity of care is so important. Our DPTs are also more skilled and qualified at motivational coaching than non-clinical coaches, so the mental and emotional parts of their recovery are taken care of, too. One employee benefit consultant recently told me, “I don’t know why anyone would choose to put their members’ health in the hands of non-clinicians.”

Our medical-grade sensors deliver accurate, actionable feedback

Exercise is the cornerstone of a great MSK program, but it only works if the PT is getting accurate feedback on how the member is moving. In the clinic, physical therapists use their eyes to gauge whether their patient is moving in the right way and their hands to physically adjust their patient’s position. This feedback is vital for the DPT, because without it, they’re flying blind.

When it comes to digitizing this feedback, there are a few ways to do it. Some digital MSK vendors use wearable motion sensors, others use inbuilt sensors on devices (like the accelerometer on your phone), others don’t use feedback at all. SWORD we’ve developed wearable sensors that are more accurate at detecting movement than the human eye and the only device that’s been listed by the FDA as a Class II medical device.

These sensors give the member real-time feedback on how they’re performing, and help correct movements that aren’t performed correctly. The members’ DPT gets detailed info on how the member has performed each exercise, and they use this to modify their program as they go. Our DPTs update our members’ programs between 2-4 times per week, depending on how they’re progressing. Each member’s journey is unique, and sometimes the DPT can add exercises or make them harder, other times they need to scale back to ensure they’re able to do their exercises safely.

Our solution works for everyone, today

Finally, an MSK solution is only as good as the number of people it can help. A one-stop-shop is not just simpler to implement and manage, it significantly improves the cost savings potential.

At SWORD, our solution covers all the major joints – back, knee, hip, shoulder, neck, ankle and elbow. Almost half (43%) of our members are receiving therapy for shoulder, neck, ankle and elbow conditions – vendors that don’t have the capability to treat these conditions today are leaving those members to consider other more costly interventions, like surgery and meds.

Our solution can also treat MSK conditions at every point in the journey, from preventing and addressing acute conditions, to managing chronic pain, to rehabbing after surgery. The large majority (71%) of our members come to us with chronic pain, but for the one-third of members with acute or sub-acute pain, we’re once again giving them an alternative to expensive and ineffective treatments. 

“SWORD stood out in the number of joints supported, the PT involvement and the real-time feedback through the sensors.” – SWORD Client

Most importantly, it works.

When you add these three things together, you get the best possible results for the largest amount of people. We’re proud to say that our solution works. In clinical trials, we’ve proven that SWORD can achieve 30% better outcomes than the gold standard of care: three hours of traditional PT per week. In the real world, SWORD’s solution reduces members’ pain by 70%, making them 64% less likely to consider surgery and 36% less likely to resort to medication. 

Want to learn more?

If you’d like more insight into how SWORD’s solution compares, reach out here and I’ll get in touch.

Be well,

Kyle

 


About Kyle Spackman

Kyle’s commitment to improving health outcomes began while working as a microbiologist in the State of Utah Public Health Lab. Today, Kyle combines his business acumen with his passion for outcomes to help digital health providers make healthcare more accessible for all. He has led Enterprise Sales at Artemis Health and drove operational efficiency at the Utah Department of Health. 

Kyle holds a Bachelors in Public Health and Biology and a Masters of Business Administration, both from the University of Utah. When he’s not listening to the needs of employers and plans, you’ll find him out and about in the Utah mountains with his wife McKenna and three children.

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Explained

Explained: Why feedback is important in Physical Therapy

You may have seen images of athletes you admire wired up to various high-tech devices as they go through their training sessions. These devices are giving the athlete and their coaches and PTs biofeedback: critical information on how their body is performing, inside and out, so they can continuously evolve their training program. 

You may have thought to yourself—why do they need all these fancy devices? Why don’t they just practice in front of a mirror? 

Whether you’re an athlete trying to perform at your peak or a regular person trying to overcome pain, it’s important that you move your body in just the right way. For athletes, tiny increments in movement can be the difference between taking home Olympic gold and not even qualifying, nuances that mirrors—and our brains—can’t reliably recognize. For regular people, these tiny tweaks can be the difference between resolving pain and making it worse. Our FDA-listed sensor technology detects how a body is moving more precisely than human eyes, giving you feedback on how you’re moving in real time, and giving your PT important insight to help them guide you better. Here’s why biofeedback works so well.

It gets your unreliable brain out of the driver’s seat

The world’s best athletes have come to trust technology over their own brains for two reasons. The first is that your brain isn’t fully conscious of the way you’re moving. Once you’ve learned a movement pattern—even if it’s not the best one, or the more efficient —it becomes ingrained. Even elite athletes, whose job it is to be hyper-conscious of their movements, struggle to understand what’s really going on in their bodies. Their coach or PT can correct some of this, but only as much as they can observe.

The second reason is that our brains take time to adapt. Even if our reflexes are super quick, information takes time to travel from our eyes, ears, muscles and tendons to our brain, be processed, and travel back down. We are talking milliseconds here, but enough to render mirrors, and our own judgement, unreliable.

This is true for us mere mortals, too. If you know anyone who has been injured since they started a home workout routine in quarantine, this might be why. Watching videos on youtube or a trainer on Zoom can do wonders to motivate you to exercise, but they can’t help you correct your movements. And this is of crucial importance when you’re in pain, because your movement pattern needs to be corrected and pain changes how you move.

Our digital therapist overrides our unreliable brains and bodies by tracking exactly how you’re moving, and it’ll tell you when you’re doing it wrong. If you’ve been making the wrong move for years, the first few attempts may be frustrating as your body and brain learn new movement patterns, but eventually they’ll learn new habits that can benefit you for a lifetime.

It helps your PT see how you’re performing

If you have done in-person physical therapy, you might have taken home a piece of paper with a bunch of exercises on it. If you’re super conscientious, you may have stuck that piece of paper on your fridge and done the whole exercise routine five times a week as prescribed by your PT. If that’s you, congratulations… The problem is that you’re in a serious minority. Fewer than 30% of people actually engage in their exercise program between sessions. The large majority of us don’t do anything with that little piece of paper.

This is common, and a real point of frustration for physical therapists. Therapeutic exercise is the cornerstone of a PT program, and when you don’t do your exercises, you don’t get better. Our medical device effectively serves as the eyes and ears of your PT, allowing them to monitor your movements from afar. This is necessary for a digital solution, as it’s impossible to tell whether someone is moving in the right way through a phone camera. But unlike in the clinic, where the PT gets feedback on how you’re moving during your appointments but not between visits, our digital therapist sends data on how you’re moving every single time you complete a session. When our PTs join SWORD, many of them are blown away by the amount of feedback they get. 

Your PT can use this information to evolve your program: add or subtract exercises, and make them easier or harder, depending on how you’re progressing from day to day. Our PTs make adjustments to members’ programs between 2 and 4 times per week on average, which helps our members get better faster.

When you know you’re being watched, you perform better

Remember that exercise program your PT gave you at the clinic? When you got to your next session, what happened? Did you admit to your PT that that little piece of paper was still in your bag, untouched? Or did you tell them a little white lie? More importantly, did the therapy program work? Did you get better, or does that pain still rear its ugly head from time to time?

When there’s nobody watching, it’s harder to get motivated to put in the work—and it’s easier to bend the truth than to bend your back. Your PT will never know, right? Wrong—we always know when people are lying about doing their exercises, because they’re not improving.

But as soon as you know we’re being monitored, everything changes. All of a sudden, you’re doing your exercises five times a week. This is known as the Hawthorne effect: our tendency to work harder when we know someone’s watching. If you have a smartwatch or ring, or track your workouts on an app, you may be familiar with this effect. Does tracking your run or bike ride on Strava help you go faster? Does tracking your sleep make you prioritize it? Do you complete your workouts even when you don’t want to because every time you work out, your Apple Watch sends a notification to your friends? These are all examples of the Hawthorne effect at work.

At SWORD, our digital therapist sends the results of every exercise session to your PT, and they can not only see that you completed a session, but exactly how your body was moving through every rep, helping keep you accountable. That’s why our digital therapist is so effective. In fact, in clinical studies, SWORD’s program achieved 30% better results than conventional PT.

Want to learn more about SWORD? Fill out this form and someone will get in touch.

 


About the author: Dr. Fernando Correia, M.D.

Dr. Fernando Correia is the Chief Medical Officer at SWORD Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.

He co-founded SWORD with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.

Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.

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Explained

Three things to consider when evaluating an MSK vendor

As a Navy veteran and athlete, I’m no stranger to pain.

 

After 4 years of attending and playing volleyball at the United States Naval Academy, representing the US in two World Military Games, and three Navy deployments on Guided Missile Destroyers, I have pain in almost every one of my joints. I’ve had surgery on my shoulder, hip, and knee, and I’ve had to give up beach volleyball because it hurts too much to play.

 

I joined SWORD because I wanted to work for a company that could help people like me, who are experiencing pain every day and don’t see a way out.

 

I know I’m not alone. Musculoskeletal (MSK) disorders affect 1 in 2 Americans, and cost $190B every year – more than cancer and mental health combined. People and their health insurance companies are spending tens of thousands of dollars trying to manage their MSK conditions, but they just aren’t getting better, and so the spend keeps ratcheting up.

 

We all know by now that digital health solutions can offer a way out of this conundrum. The right digital MSK solution can improve the health of members and save employers and plans millions in unnecessary healthcare costs.

 

Most of the vendors in the market offer some combination of people and technology, and many of them claim their solution is clinically-validated. Employers are increasingly relying on you to cut through all the buzz and find the very best solution. With so many choices out there, how do you help your clients make the right one?

 

In this blog post, I’ve recapped the three things to consider when evaluating an MSK program. If you’re looking for a deeper dive, check out the webinar I recorded with Dr. Megan Hill, DPT.

Ask who is delivering the care, and how they’re doing it

There almost are as many models for care delivery in the digital MSK space as there are vendors. Some, like SWORD, use physical therapists exclusively, others use health coaches or other non-clinicians, and others still use a combination of the two.

 

At SWORD, 100% the care is delivered by a licensed Doctor of Physical Therapy. Every member is matched with a DPT who is there for them every step of the way. This is important because the risks of treating MSK sufferers with non-clinicians are too great, and because healing from MSK pain requires continuity of care from someone the member can trust, with the training to educate the member on their condition and coach them for long-lasting change.

Assess how the solution performs, clinically and in the real world

The goal of any digital health program is to get the best possible results for the largest amount of people. When you’re evaluating the effectiveness of a solution, it’s helpful to ask four questions: Is the solution evidence-based? Are there clear and trustworthy clinical outcomes? Are there demonstrable cost savings, and what is the experience like for someone going through the program?

 

At SWORD, we’ve designed our solution to work. It’s based on the three pillars of care defined by the American College of Physicians and the CDC: exercise, education and behavioral coaching. In clinical trials, we’ve proven that SWORD is 30% more effective than the gold standard of care: three hours of one-on-one PT per week (that’s a lot of PT!). In the real world, SWORD’s solution reduces members’ pain by 70%, making them 64% less likely to consider surgery and 36% less likely to resort to medication.

Determine how many members can benefit

Finally, an MSK solution is only as good as the number of people it can help. Not only does this simplify things for the employer, giving them a one-stop-shop for treating all kinds of conditions, it significantly improves their cost-savings potential.

 

At SWORD, our solution covers all the major joints – back, knee, hip, shoulder, neck, ankle and elbow. Almost half (43%) of our members are receiving therapy for shoulder, neck, ankle and elbow conditions – vendors that don’t have the capability to treat these conditions today are leaving those members without an option, and their employers footing the bill for expensive treatments.

 

Our solution also treats MSK conditions at every point in the journey, from prevention, to treating acute conditions, to managing chronic pain, to recovering after surgery. The large majority (71%) of our members come to us with chronic pain, but for the one-third of members with acute or subacute pain, we’re once again giving them an alternative to expensive and ineffective treatments. It’s important to treat all kinds of pain because unfortunately, most people will have both acute and chronic episodes, and when left untreated, acute conditions can become chronic, which can require surgery and rehab. The good news is, if you intercept with the right treatment at any point in this journey, you can break the cycle.

Want to learn more?

If you’d like more insight into SWORD’s solution and how we stack up, reach out here and I’ll get in touch.

Be well!
Ashley

 


About the author: Ashley Ortega

Ashley Ortega has led an adventurous and accomplished life and has the chronic joint pain to prove it – but thanks to SWORD, she too is on a path to a pain-free life. As SWORD’s VP of Partnerships and Alliances, Ashley leads strategic relationships with consultants, brokers and ecosystem partners. Prior to joining SWORD, Ashley held leadership roles at Virta Health, Castlight Health, and McKinsey & Company. She holds an MBA from Harvard Business School, is a veteran of the U.S. Navy and represented the U.S. Military in volleyball at the 2007 and 2011 Military World Games.

When she’s not working with consultants and brokers to bring SWORD’s clinical-grade pain relief programs to discerning employers, she’s out and about hiking, mountain biking, skiing from her current home in the East Bay of San Francisco, where she lives with her husband, Andrew, and three dogs, Teddy, Winston, and Frankie.

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Explained

Check your Sources: Tips for evaluating clinical trial results

Clinical validation is a crucial part of developing and proving the value of new healthcare solutions, but not all studies are created equal.

Clinical trials sometimes get a bad rap, and for good reason – it can be hard to understand their nuances. As a clinician, I’ve been trained to read and understand clinical studies, which makes it easier to distinguish good from bad.

Here are a few tips to help you weigh the importance of a study in your decision-making.

Ask: ‘what is this study trying to prove?’

Every clinical study is designed to prove something. But they take a long time to prepare and run, and they’re often expensive, so some researchers design their studies to guarantee results.

Make sure the goal of the study is clear, that it addresses the right questions and that the outcomes make sense in the real world. If this is not clear, the study designer or the company funding the study should at least be able to tell you why they made the decisions they made and declare any biases.

As an example, in our clinical studies on hip and knee replacement, here is how we stated the aim of the study:

“This study was designed to compare the clinical outcomes of a [digital] home-based program against conventional home-based rehabilitation after total knee replacement (…). We hypothesize that the clinical outcomes of such a program will be at least similar to those of conventional rehabilitation”.

This means that we had a hypothesis that SWORD’s program would perform just as well as traditional PT. It ended up performing 30% better!

Look for randomized trials with a control group (RCTs)

The quality of a study depends on its design.

In the digital health field, you’ll mainly find two types of studies: observational and experimental.

Observational studies follow real patients over time. Some observational studies have a control group, others don’t. While they are very useful for broad, directional feedback, there are many variables that can confound the results (especially if they have no control group) – So, be wary of evidence coming only from these types of studies.

Experimental studies, sometimes called Randomized Controlled Trials (RCTs), take the top spot in the hierarchy of scientific evidence. They compare the effects of an intervention with a control group, with random allocation of participants to reduce the chance of bias.

Make sure the control group received active treatment

Not all RCTs are of the same quality. An active control group, where you are comparing a proven treatment to the new one (for example, in-person physical therapy), is much better than comparing an intervention against a partial treatment (for example, just education without exercise) or no treatment at all.

At SWORD, our clinical studies are designed to understand how our solution compares with the gold standard in physical therapy, so our clinical trials are always RCTs, our treatment group receives the full SWORD treatment and our control group performs intensive, one-on-one physical therapy – three one-hour sessions per week.

Make sure the study is published in a credible journal

Unfortunately, there are a lot of journals that have a fraudulent or non-existent peer review process.

Look for well-established journals with high relevance in the field, as these offer more guarantees of an independent and thorough peer-review process.

It is not easy to check the credibility of a journal, but a relatively quick ways is to using this site to see where the journal sits relative to other journals in that field.

The simplest way to tell the quality of the journal is to look at what quartile it’s in (indicated by a colored square and the letter Q). The highest-quality journals have a green square labeled Q1 – this means they’re in the top 25% of all publications in their space. For example, Nature Scientific Reports, where we have published the results of our knee replacement study, is in the top quartile (Q1) in its category.

Do the results matter?

Back to square 1.

Every clinical study wants to prove something. But proving it does not mean that it matters clinically.

Many studies claim that a group of patients has improved from baseline by [x], or that there was [y] difference between the two groups. However, this difference may not actually mean anything in the real world.

Statistics can be deceptive. For example, in our knee replacement study, we found a 4.9 second difference in a functional test of the lower limbs (called Timed Up and Go) between the SWORD group and the conventional PT group, favoring our group. Is this clinically meaningful? Yes, because the Minimal Clinically Significant Difference (MCID) for this test is 2.27 seconds.

Providing context is crucial here – so make sure this was made clear by the authors, and if you’re unsure, check with them.

Need help deciphering a study?

Our clinical team is happy to help you understand the results of any clinical study. Email the study to [email protected] and we’ll help you get to the bottom of it.

Check out our clinical studies here:
Digital rehabilitation vs conventional PT after total knee replacement
Digital rehabilitation vs conventional PT after total knee replacement: mid-term results
Digital rehabilitation vs conventional PT after total hip replacement: short and mid-term results

About the author: Dr. Fernando Correia, M.D.

Dr. Fernando Correia is the Chief Medical Officer at SWORD Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.

He co-founded SWORD with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.

Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.