In this episode of The Underdog Physician Podcast, I sat down with Mark Leaning, founder and CEO of Directed Systems Ltd, to explore his journey from engineer to healthtech entrepreneur. Mark shared how his passion for applying systems theory to medicine led him to build multiple startups focused on improving real-world care, culminating in the creation of DS Aware, an FDA-cleared smart software that helps anesthesiologists maintain cardiovascular stability. We discussed the challenges of selling innovation in healthcare, the importance of interdisciplinary teams, and how startups must adapt their value propositions across global health systems. Mark also offered insights on the transformative role of AI in clinical decision-making, balancing family and entrepreneurship, and the core lesson he’s learned: stay close to your users, listen deeply, and let evidence and empathy guide innovation.