MDAware: Upgrading Clinical Judgment

MDCalc
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MD Aware is the official podcast from MDCalc, the trusted clinical decision support platform used by millions of physicians worldwide. Each episode explores the science, research, and real-world practice behind clinical decision-making. From the evidence powering today's most-used calculators to the emerging tools shaping tomorrow's care, MD Aware gives clinicians the context they need to make better decisions at the bedside. Whether you're a med student, a seasoned specialist, or a researcher building the next generation of clinical tools, MD Aware is your inside look at how evidence becomes practice. MD Aware is produced by MDCalc, celebrating 20 years of upgrading clinical judgment.

Episodes

  1. 1d ago

    Guideline-Directed PE Care: The Management Tools You Need at the Bedside

    In this episode of MDAware: Upgrading Clinical Judgment, Dr. Joe Habboushe talks with Dr. Eric Steinberg about what happens after a PE is diagnosed — and why the field has spent decades obsessing over finding the clot without giving equal attention to what comes next. A conversation about risk stratification, disposition, and why not all PEs deserve the same treatment. This episode picks up directly from Part 1, where Dr. Habboushe and Dr. Steinberg covered the diagnostic tools for PE. Here, the conversation shifts to management: once a patient has a confirmed PE, how do you decide whether they go home, to the floor, or to the ICU? Dr. Steinberg walks through why a PE causes damage through strain on the heart rather than through the lungs directly, and why hypoxia is a misleading early signal. Dr. Habboushe and Dr. Steinberg also unpack why a low mortality score isn't the same as a green light for discharge, how the Hestia criteria closes that gap, and what the Bova score adds for patients who need a higher level of care, including when it's time to activate a PERT team. What You'll Learn Why a PE doesn't cause hypoxia on its own, and why waiting for low oxygen levels can lead clinicians to miss how sick a patient really isWhy the simplified PESI (sPESI) score has real blind spots when used alone, since it measures all-cause mortality rather than PE-specific riskHow the Hestia criteria pairs with sPESI to answer a more practical question: is this specific patient safe to send homeWhat the Bova score predicts, and how it helps guide decisions on escalation, intervention, and when to bring in a PERT teamWhat treatment options exist beyond standard anticoagulation, including catheter-directed thrombolysis and mechanical thrombectomy, and when each is appropriate Links & Resources MDCalc: mdcalc.com Follow MDCalc on LinkedIn: linkedin.com/company/mdcalc Follow MDCalc on X/Twitter: @MDCalc

    Guideline-Directed PE Care: The Management Tools You Need at the Bedside

  2. 6d ago

    Guideline-Directed PE Care: The Diagnostic Tools You Need at the Bedside

    In part one of this two-part episode, MDCalc cofounder and CEO, Dr. Joe Habboushe, talks with Dr. Eric Steinberg about how to actually diagnose a pulmonary embolism — and considering scenarios in which the biggest risk in PE workup may not be the disease itself, but the testing we order to find it. A conversation about pretest probability, when a CT scan does more harm than good, and how to use clinical tools without losing the judgment they're supposed to support. Dr. Habboushe and Dr. Steinberg have been talking through PE cases together for close to two decades, since Dr. Steinberg was a resident under Dr. Habboushe's supervision. Their conversation was prompted by new multi-society PE guidelines, released this year, which spotlight eight clinical tools out of the 36 PE-related calculators on MDCalc. In this episode, they focus on the diagnostic side: how to establish pretest probability, when the PERC rule applies and when it doesn't, and why the D-dimer test causes more confusion than almost anything else in emergency medicine. Dr. Steinberg and Dr. Habboushe also walk through a common misconception about the YEARS algorithm, why age-adjusted and altitude-adjusted versions of these tools exist, and what it actually means to communicate a low-risk result to a patient who came in expecting a scan. What You'll Learn Why scanning every patient isn't the safe default, and how incidental findings and false positives can cause more harm than the small risk of missing a PEWhy the PERC rule is a one-directional tool: failing it doesn't raise a patient's risk, it just means the rule no longer appliesHow to choose between Wells and Geneva based on clinical experience, and why Geneva's objectivity makes it a better starting point for traineesWhy the D-dimer's negative predictive value, not its false positive rate, is the piece most clinicians misunderstandWhy the YEARS algorithm is often mistaken for a pregnancy-only tool, and what its flexible D-dimer threshold actually does Links & Resources DVT and PE Tool Collection MDCalc: mdcalc.com Follow MDCalc on LinkedIn: linkedin.com/company/mdcalc Follow MDCalc on X/Twitter: @MDCalc

    Guideline-Directed PE Care: The Diagnostic Tools You Need at the Bedside

  3. Jul 1

    Who's Responsible When AI Gets It Wrong? | Dr. Sarah Gebauer on Healthcare AI Governance

    In this episode of MDAware: Upgrading Clinical Judgment, Dr. Graham Walker talks with Dr. Sarah Gebauer about what responsible AI in healthcare actually looks like — and what happens when the technology moves faster than our ability to govern it. A conversation about values, accountability, and why the physician-patient relationship still has to be at the center of it all. Dr. Gebauer and Dr. Walker co-authored the MDCalc Physician's Charter in 2023, one of the earliest attempts by a group of practicing physicians to define a set of shared values for AI in healthcare. In this conversation, they revisit that document; what it got right, what it underestimated, and what a 2026 update would need to address. From the re-identification risks hiding inside "de-identified" data, to the tension between building accurate AI and protecting patient privacy, to the question of whether a sycophantic model is ever the right tool for a clinical setting, the conversation covers ground that most AI discussions in medicine still aren't touching. Dr. Walker and Dr. Gebauer also look at where healthcare institutions are making real progress on AI governance, why rural hospitals may be further ahead than most people assume, and what it actually means to roll out a new tool responsibly — in medicine or anywhere else. What You'll Learn Why HIPAA's definition of de-identified data may no longer be adequate in an era when AI can re-identify patients from surprisingly little informationHow the tension between diverse training data and patient privacy creates an ethical challenge the field hasn't fully resolvedWhat questions healthcare systems should be asking before adopting any new AI tool, and why workflow fit matters as much as clinical accuracyWhy AI sycophancy, models trained to be agreeable, could be a meaningful problem in clinical and patient-facing settingsWhat a 2026 update to the Physician's Charter might need to address, including AI agents, foundation models, and tools that operate entirely outside the physician-patient relationship Links & Resources MDCalc: mdcalc.com Physician's Charter: https://physicianscharter.ai/ Follow MDCalc on LinkedIn: linkedin.com/company/mdcalc Follow MDCalc on X/Twitter: @MDCalc

  4. May 13

    Assessing Surgical Risk in Cirrhosis

    In this episode of MD Aware: Upgrading Clinical Judgment, host Dr. Shazia Siddique sits down with Dr. Nadiem Mahmud, Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the University of Pennsylvania, to explore one of the most clinically impactful new tools now available on MDCalc: the VOCAL-Penn Score. Designed to predict postoperative mortality and cirrhosis decompensation in patients with liver disease, the VOCAL-Penn Score addresses a longstanding gap that has challenged hepatologists, gastroenterologists, and surgeons for decades. Dr. Mahmud walks through how the score was born out of real clinical frustration with existing tools like the MELD score, Child-Pugh score, and Mayo Risk Score, all of which frequently produced wildly discordant estimates that clashed with clinical intuition. The VOCAL-Penn Score takes a more comprehensive approach, incorporating surgery type as a key variable and delivering four distinct outputs: 30-day, 90-day, and 180-day postoperative mortality risk, as well as 90-day risk of cirrhosis decompensation. Now used by more than 50,000 clinicians annually across the globe and endorsed by both the American College of Gastroenterology and the European Association for the Study of Liver Disease, the tool is reshaping how clinicians approach surgical risk conversations with their patients. Dr. Siddique and Dr. Mahmud also dig into the common misapplications of the score, what a VOCAL-Penn 2.0 might look like, and why the move to MDCalc represents a major step forward in making this tool accessible to the four out of five US clinicians who already use the platform every day. What You'll Learn How the VOCAL-Penn Score improves on older cirrhosis surgical risk tools by incorporating surgery type and delivering four distinct risk outputs to support shared decision-makingWhy there is no single hard cutoff for proceeding with surgery, and how a 15% projected 90-day mortality threshold can serve as a trigger for preoperative liver transplant evaluationCommon pitfalls when applying the score, including using outdated lab values, applying it to unsupported surgery types, and failing to calculate risk for both laparoscopic and open surgical scenariosWhat a future version of the tool may include, such as broader surgery categories, additional cardiometabolic risk factors, and more diverse patient populations Links & Resources MDCalc: mdcalc.com VOCAL-Penn Score on MDCalc: mdcalc.com VOCAL-Penn Score original site: vocalpennscore.com University of Pennsylvania Gastroenterology and Hepatology: pennmedicine.org American College of Gastroenterology: gi.org European Association for the Study of Liver Disease: easl.eu Follow MDCalc on LinkedIn: linkedin.com/company/mdcalc Follow MDCalc on X/Twitter: @MDCalc

    Assessing Surgical Risk in Cirrhosis

  5. May 13

    Grading the Calculators: Inside MDCalc's Quality Rating System

    In the inaugural episode of MD Aware: Upgrading Clinical Judgment, co-hosts Dr. Shazia Siddique and Joe Habboushe, co-founder and CEO of MDCalc, pull back the curtain on one of the most ambitious projects in MDCalc's 20-year history: the Quality Rating System (QRS). Designed to help clinicians quickly identify the most evidence-based and clinically relevant tools at the point of care, the QRS represents a major step forward in bringing transparency and rigor to the hundreds of clinical decision-making tools available today. Joining the conversation are two distinguished members of the QRS Advisory Board: Dr. Helen Burstin, CEO of the Council of Medical Specialty Societies, and Dr. Joseph Wright, Chief Health Equity Officer at the American Academy of Pediatrics. Together, they discuss how the QRS was developed using a Delphi consensus methodology, why professional society endorsement matters more than most clinicians realize, and how embedding fairness and bias detection directly into the rating criteria could reshape how clinical tools are built, validated, and used across diverse patient populations From busy emergency departments to routine office visits, the QRS promises to give every clinician the confidence to reach for the right tool at the right moment. Whether you're a frontline provider, a researcher, or a guideline developer, this episode offers a compelling look at how raising the bar for clinical tools can ultimately translate into better outcomes for every patient. What You'll Learn The four core domains of the QRS, including importance, scientific soundness, fairness and algorithmic bias, and usability, and why each one matters at the bedsideHow the Delphi consensus process brought together clinical experts to iteratively refine the rating criteria against real-world calculatorsWhy professional society endorsement is a key signal for clinicians, and how the QRS could push societies to keep their guidance more currentHow the QRS can fuel future research by identifying gaps in evidence, surfacing potential population-level harms, and encouraging multi-institutional collaboration Links & Resources MDCalc: mdcalc.com Council of Medical Specialty Societies (CMSS): cmss.org American Academy of Pediatrics (AAP): aap.org Follow MDCalc on LinkedIn: linkedin.com/company/mdcalc Follow MDCalc on X/Twitter: @MDCalc

    Grading the Calculators: Inside MDCalc's Quality Rating System
  • 5 Episodes

About

MD Aware is the official podcast from MDCalc, the trusted clinical decision support platform used by millions of physicians worldwide. Each episode explores the science, research, and real-world practice behind clinical decision-making. From the evidence powering today's most-used calculators to the emerging tools shaping tomorrow's care, MD Aware gives clinicians the context they need to make better decisions at the bedside. Whether you're a med student, a seasoned specialist, or a researcher building the next generation of clinical tools, MD Aware is your inside look at how evidence becomes practice. MD Aware is produced by MDCalc, celebrating 20 years of upgrading clinical judgment.

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