By Elizabeth Hofheinz, MEd, MPH
Orthopaedics This Week
November 17, 2008
Although one of his titles is “Head Team Physician of the Chicago Bulls,” Dr. Brian Cole examines bodies, not heads. Had he taken another tempting career path, however, he might have been doing just that.
Explains Dr. Cole, Professor in the Departments of Orthopaedic Surgery and Anatomy & Cell Biology at Rush University Medical Center, “I was born in Chicago to a father in the tool and dye industry and a mom who spent her time as a homemaker, in real estate, and in interior decorating. Early on I was an enthusiastic athlete who would come home and park myself in front of the TV to watch the very funny “Bob Newhart Show.” This led me to think that I might have a career in psychology or child psychiatry. I was fascinated by what others think about and thought it would be great to help people problem solve, in particular by providing structure to the way they think.”
Modes of thinking would also come into play in Brian Cole’s selection of a career. “I had figured out in high school that the only path to medical school was via a report card with good grades,” says Dr. Cole. “So as of seventh grade I buckled down and went for A’s. I entered The University of Illinois in 1981 and tried to sort through my multiple interests; I graduated with a degree in psychology and biology. When I began my medical studies at the University of Chicago Medical Center in 1986 I became interested in academic research and was intrigued with the science behind OB/GYN and infertility. But over time I came to see that the field most consistent with my own thinking was orthopedics because it is action-oriented and direct. I liked the fact that orthopedics addresses specific problems in otherwise healthy individuals, and it offers very tangible solutions that provide relatively immediate outcomes. I could see that neither psychology nor OB/GYN would provide me with the same sense of accomplishment and satisfaction.”
Also in line with his appreciation for action-oriented, direct arenas was the world of business. Dr. Cole: “Three years into medical school I decided to take advantage of a University of Chicago program that offered medical students the opportunity to get an MBA with an emphasis on health administration. I could see that there were changes in the works as far as healthcare funding and thought I should know more about these important things that were going to be affecting our field. It was also attractive to me because I obtained a scholarship and was able to apply the electives earned in medical school, allowing the program to be completed in one year.”
Returning to medical school in 1989, Brian Cole would have his first exposure to the rigors of publishing and presentations. “I worked alongside a Ph.D. in behavioral sciences, Dr. Wiley McNabb, on research looking at reducing ER visits among lower socioeconomic people with asthma. My first publication was with Dr. McNabb, and this experience gave me my first chance to do a presentation in a public setting.”
They say you can’t have it all. Perhaps. But Dr. Cole learned that if orthopedic surgeons approach things correctly, they can have a stimulating clinical and research career. “In 1990 I did a one-year general surgery internship at Loyola University Medical Center in Chicago, followed by an orthopedic research fellowship in metabolic bone disease at The Hospital for Special Surgery (HSS) in New York. My research mentor at HSS was Dr. Joe Lane, an expert in oncology and metabolic bone disease who proved that a full basic science research career and clinical practice were indeed possible. I worked with him doing animal research on orthopedic implants, an experience which led to my first few orthopedic publications.”
Dr. Cole continues, “In 1992 I began an orthopedic residency at HSS-Cornell Medical Center, a high-volume hospital with great leaders in the field. One of these was the Chair, Dr. Russell Warren, a man of supreme intellect. He was a terrific role model as far as the ability to function in a variety of environments and manage people in a professional, sensible manner. Dr. David Levine, a spine surgeon with whom I did research on healthcare economics, also helped shape my career. He had quite a different slant towards business and knew a lot about saving money in hospitals. We applied our findings to HSS and were successful in reducing the cost of orthopedic implants across vendors. In addition, we implemented strategies that would help the hospital become more uniform regarding pricing and in general trim the budgetary fat. It was also during this time that I met my future wife, thus enhancing my East Coast experience.”
A lifetime athlete who followed the accomplishments of orthopedists who focused on athletes, Dr. Cole undertook a sports medicine fellowship beginning in 1996. “I chose The University of Pittsburgh and decided to concentrate in shoulder and knee surgery. I was attracted to the less invasive techniques that were being put forth and could see that this was the way of the future. One of my three fellowship mentors was Dr. Freddie Fu, who taught me how to manage people, treat international visitors respectfully, operate efficiently, make quick decisions, and delegate responsibly. Regarding this last point, I mean that one should not simply identify anyone in the room and hand that person the task. Responsible delegation means finding the right person and then following up to ensure that the job was done to the same standards that you would have applied. This approach also helps your relationship with that coworker because it says to the person that you thought enough of him or her to give them that task…you’re not just dumping on them. From another mentor, Dr. Chris Harner, I learned how to evaluate and manage patients in an office setting. He was very practical about how he approached real-life issues in the office; he also taught me how to manage complex knee problems in the operating room setting. Dr. J. P. Warner was a stellar surgeon who instructed me on how to think about and manage complex shoulder problems. This fantastic program propelled me ahead five years; i.e., from the first day after my fellowship ended I felt that I had already been in practice for five years.”
Having had such a thorough learning experience at “Pitt,” Dr. Cole now thinks quite a bit about what he wants to impart to residents about fellowship selection. “I let residents know that they should choose a fellowship that is high impact from a clinical perspective. Fellowship is a perfect time to see how much and how quickly you can learn. From a patient perspective, I ask residents and fellows to remember that they should make decisions not just for their patients, but with their patients. Each person is different and we must make decisions not just by the pathology. You may have the same pathology in two different patients, but each needs to be cared for differently. For example, two patients may have pain and weakness but one of them is responsible for an elderly parent or a handicapped child and can’t take time off to do long-term physical rehab. Treatment must be a partnership where you say, ‘Here are your options. Let’s discuss which one would best fit in with your life.'”
Thorough with patients and with the written word, Dr. Cole was named Editorial Reviewer of the Year for the Journal of Knee Surgery in 2007. He is also an author of more than 150 peer-reviewed publications. Dr. Cole is among those focusing on driving the field forward by encouraging high-quality research. “The number of people who submit articles for publication is increasing, so it is especially important that they understand what is considered to be high-quality work. Generally speaking, the rigor with which submissions are being reviewed is increasing. And not only is the field itself becoming more demanding of this exactitude and thoroughness, but also as the public becomes more educated, they too are more interested in high-quality studies. Case series are less and less appropriate and desired; instead, we are looking for level 1 prospective, randomized double-blind controlled trials. That is what the future, including the insurers, demands.”
Dr. Cole, Section Head of Cartilage Restoration at Rush, has long been fascinated by this slow growing connective tissue and the possibilities for its healing. “My interest in this area began during my residency when I treated young patients with cartilage problems. Because they were too young for knee replacement, I would have to instruct them to reduce their activity levels as there were no good surgical solutions available to treat their cartilage problem. This was frustrating for them and me both. Beginning in residency and continuing in my fellowship, I studied and learned techniques for cartilage transplantation. When I came to Chicago, I furthered my efforts in this area by organizing a cartilage program. I have recently published my seventh sports medicine textbook, more than half of which deals with cartilage; I have also published approximately 70 articles on cartilage research. In my lab we investigate animal models that evaluate the safety and efficacy through preclinical trials, working in part with the support of NIH funding. Our Ph.D. researchers are simply the best at problem solving. When I first started at Rush I had a full-time coordinator track cartilage patient data so that all patients’ information was in the database before their operations; the patients are then followed for six months and each year after. We now publish results on every cartilage procedure, with a minimum of two years of follow-up in peer-reviewed journals.”
Asked how he would utilize a substantial grant were it to be provided, Dr. Cole notes, “I would first fund the continuation of our clinical staff who track our patients’ progress and clinical outcomes. Continuing to investigate just how our patients do, for example, following cartilage transplantation procedures is critical to furthering the decision-making in managing patients with a difficult problem. I would also fund preclinical basic science work that investigates issues which relate to either soft tissue healing such as that required in rotator cuff repair or the area of cartilage transplantation. Funding has become increasingly difficult to obtain (e.g., from the NIH, etc.), and use of this type of funding would support the ongoing efforts of our basic science team.”
And with an M.B.A., Dr. Cole knows the value of using funding in a smart, responsible manner. “Running a medical practice is like managing any other business in that you follow the same financial principles and must be service-oriented. Customer service is called for at every level, from the minute the person walks into the office until he or she is discharged from the practice. The M.B.A. has opened windows into other areas of the field. For example, I am now the CFO of our ambulatory surgery center, I consult with orthopedic companies on market size and product development issues, and I help to guide VC funds in the healthcare space. Having the degree, knowing the vocabulary, and having financial experience all convey a sense of credibility that is useful in certain situations.”
As Head Team Physician for the Chicago Bulls and Co-Team Physician for the Chicago White Sox, Dr. Cole has a unique perspective on teamwork. “This gratifying work, which balances out my career, has taught me that a team physician doesn’t just deal with the athletes, but with the entire system surrounding them. Team owners, general managers, coaches, agents, trainers, and strength coaches…all play a part and affect how decisions are made. As for the process of treating an athlete, in general when there is a player with an injury, it requires an evaluation much like any orthopedic injury. Decision-making then increases in complexity based upon where a player is relative to the season schedule (i.e., pre-, early, middle, end, or off-season). In addition, early discussions about treatment ensue with the player, his or her agent, the trainer, the general manager, coach, and even team owner. We always do what we believe is in the best interest of the player. The timing of treatment can, however, depend upon input from a variety of individuals in addition to decisions made based upon the magnitude of the problem. Fortunately, the organizations that we deal with are respectful and foster decisions that ideally suit the player and the organization simultaneously.”
Reflecting on the outlook for the future of orthopedics, Dr. Cole says, “I am hopeful in that I see continued efforts to make decisions based upon high-level, evidence-based level 1 research, which is performed in a rigorous, prospective and comparative fashion often randomized to different treatments. In addition, we are becoming increasingly able to perform basic science research in the area of biologics that will prevent or delay the need for joint replacements in otherwise young and active patients. What discourages me the most is the difficulty in obtaining research grants to support these important research efforts.”
When one of Dr. Cole’s patients tells him, for example, that he fell on an “ego bump,” there is no need for explanation. “I’m a ski enthusiast, spending about three weeks each year on the slopes. I also love climbing, and I recently trained for and climbed a technically demanding mountain in Washington state. In addition, my priority is to spend as much time as possible with my children (Ethan 9, Adam 7, and Ava 3) and wife (Emily). While traveling I bring along a good non-fiction book for the inevitable waiting periods between flights or activities.”
Dr. Brian Cole collaborating with patients and bringing professionalism and thoroughness to the field.
Reprinted by permission Copyright © 2008, Orthopaedics This Week