Dr. Brian Cole on a physician's intuition

Orthopedic Sports Medicine

Managing patient care takes surgical skills that extend beyond the operating room. Orthopedic surgeon at Chicago's Midwest Orthopedics at Rush and team physician for the Chicago Bulls and Chicago White Sox Brian Cole, MD, shared his thoughts on a surgeon's intuition on DocThoughts with Nirmal Gosalia.

A majority of cases Dr. Cole sees never make it to the operating table because there are more viable nonsurgical options for treatment for their condition.


"As an orthopedic surgeon the majority of things we do are nonsurgical," Dr. Cole said. "You have to say 'Look are their nonsurgical options?' … As a sports medicine specialist most of our decision making is based on [whether] a patient need treatment, and if they need treatment, is there a nonsurgical option? If there isn't, surgical intervention can be very gratifying."


For Dr. Cole, diagnosing injuries is as much about providing the right care plan as it is performing any sort of treatment.


"Intuition and the visceral component of making decisions is largely based on intuition. Nothing really replaces the experience and the repeated interactions that we have," he said.


For example, when Dr. Cole has a consult for a rotator cuff tear, the patient may have had the tear for decades before it was ever diagnosed. Despite the occasional ache or pain, the patient may have been just fine; in those cases, Dr. Cole knows the best treatment, may be no treatment at all.


"One has to understand the natural history of disease states," Dr. Cole said. "If we understand it's actually okay to live with something and we're not going to cause a disservice or harm to the patient downstream or they may not end up in any different place if they neglect their problem [no treatment is an option]. One has to use your intuition and a visceral, intangible decision-making process rather than just focusing on a test."


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