Dr. Brian Cole operates on professional athletes for a living. Four out of five people who walk into his office will never be operated on at all.

He is an orthopedic sports medicine surgeon at Midwest Orthopaedics at Rush, a professor at Rush University Medical Center, and team physician for the Chicago Bulls, the Chicago White Sox and the Joffrey Ballet. He has published more than a thousand articles, he has spent twenty five years building the evidence base for cartilage restoration, and in 2025 he won one of the biggest research awards in orthopedics for his work on joint preservation.

He also trademarked the phrase "spare the scalpel," which is an unusual thing for a surgeon to build a practice around.

Gina and Dr. Cole have worked together for more than twenty years, and this is a conversation between two people who send each other patients. It is less an interview than an argument they both already agree on: that the hardest part of this work is never the operation, and that most of what shows up on a scan was never the problem.

In this episode:

• Why no more than twenty percent of the people in his office will ever have surgery, and what the other eighty percent get instead
• The first question he asks a patient, which is not where it hurts
• Why he says nobody has ever felt better or been cured by an MRI, and what a two page scan report actually tells you
• The seven million people over sixty five walking around with a rotator cuff tear they will never know about
• What actually predicts whether physical therapy works, which is not the size of the tear
• Why ACLs almost never tear in the first quarter, and what film of NFL knees showed when they went looking for different mechanisms
• What PRP and stem cell injections really do, from the surgeon who chairs the board that governs their ethical use
• Gina on baseline testing, and why the only jump height that matters is the one you had before
• A Volkswagen body with a Ferrari engine, and the fourteen year old brains making adult decisions
• Why he thinks of himself as a waiter, and what he wants you to do before your next appointment

Dr. Brian Cole practices at Midwest Orthopaedics at Rush in Chicago.

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