What is the first step in starting a business?
And why clinicians make great founders.
When you decide to start a business, your first instinct is to buy things. A domain name. A high-end camera. A new software subscription. You gotta spend money to make money, right?
NO. You’re thinking in the wrong direction. I’ll spend the next 750 words explaining why.
From what I’ve noticed, there are two ways to start a business that actually works:
Spray and Pray
Search and Destroy
Spray and Pray
Spray and Pray is exactly what it sounds like. You build things. A lot of things. You ship, you iterate, you ship again. Eventually, something hits.
The poster child for this is Peter Steinberger, better known online as steipete. He’s the creator of OpenClaw, an open-source AI agent that crossed 370,000+ GitHub stars in a matter of months.
If you scroll through his GitHub, the pattern is obvious. Lots of small projects. Most of them useful. Most of them nobody noticed.
Then he shipped Clawdbot, which became OpenClaw, and it took off. On February 14, 2026, Steinberger announced he was joining OpenAI to work on agents. Sam Altman publicly welcomed him on X, calling him "a genius with a lot of amazing ideas about the future of very smart agents."
That’s the spray and pray model in one career. You don’t know which seed becomes the redwood, so you plant a forest. You stay CHEAP, you stay FAST, and you treat every shipped product as a lottery ticket that also teaches you something. As Steinberger states in his philosophy:
"Ship beats perfect" - I build tools to solve my own problems, then share them with the world. Currently exploring how AI changes everything about software development.
The catch is that this method has a hidden tax. You need the SKILLS, the TIME, and the TOLERANCE for ten flops before one lands. For most people, and especially for people with a day job, a clinical rotation, or a family, that tax is too high.
Search and Destroy
The opposite move is to find one specific problem, CONFIRM that real people have it, and then build ONLY the thing that solves it. NOTHING ELSE.
This is what Rob Fitzpatrick's The Mom Test is about. It’s a short book about how to talk to potential customers without being lied to. The framing is that everyone will lie to you about how good your business idea is, because they want to be polite. So you can't ask people if your idea is good. You have to ask about their actual life and their actual past behavior. Talk about them, not about you. The signal isn't "I would buy that." The signal is "I already tried to solve this, and here's the duct-taped mess I'm using right now."
That’s the searching part. The destroying part comes after. Once you’ve found a real, bleeding, recurring problem, you build the cleanest solution to it. NOTHING ELSE. NO BULK. NO FAT. ONLY LEAN, MEAN RESULTS.
Steve Jobs said the same thing at WWDC 1997:
“You’ve got to start with the customer experience and work backwards to the technology. You can’t start with the technology and try to figure out where you’re going to try to sell it. And I’ve made this mistake probably more than anybody else in this room, and I’ve got the scar tissue to prove it.”
The customer experience is the seed of the company. The technology, the brand, the domain name, the camera, those are downstream.
If you don't have the seed, the rest is decoration.
Conclusion
Spray and pray works if you can ship cheaply and constantly. Search and destroy works if you have access to a real customer with a real problem.
This is why clinicians are the BEST health tech founders of our era.
A clinician sits at the workflow. They watch an ER doctor click roughly 4,000 times in a single shift. They watch one hospital take 62 clicks to order Tylenol. They watch the diabetic patient who can’t read the discharge instructions.
Hence, clinicians are not guessing what the customer wants. They tend and care for the TRUE CUSTOMER everyday: the patients.
Hence, if you are looking to search and destroy, I would recommend by reading The Mom Test and going out to ask potential customers what their pain points are.