Dr. Andrea Davis (00:01)
Hello and welcome back to Expect More with Dr. Andrea. I am so excited to introduce my guest this episode, Dr. Sean McMillan, Chief of Orthopedic Surgery, amazing innovator, excellent surgeon. I've had the good fortune of doing some or sharing in some of his work in rehabbing for many, many years now and the outcomes are always so, so good and the conversations are even better. So Dr. McMillan, thank you for coming.
Dr. Mc Millan (00:07)
Thank you.
Andrea, thanks for having me.
Dr. Andrea Davis (00:29)
Yeah, man, so please, let's tell everybody your prestigious history. I feel so lucky to have you on and pick your brain a little bit. So lay it out there.
Dr. Mc Millan (00:38)
I appreciate that. Yeah. So
listen, I'm a central Jersey kid. If you believe in central Jersey that ended up in South Jersey, been down here with a lords and then virtual for the last 13 years. And it's been really cool sort of cultivating orthopedic sports medicine practice in the region. You you and I see a lot of the same patients take care of five schools in the area.
Andrea Davis (00:45)
you
Dr. Mc Millan (01:01)
⁓ Really just good kids, good families. And it's fun, know, everything from sideline coverage to getting them back on the field through the operating room. we talk about the different people that walk into your clinic and my office. It's people like me and you that try to feel like we're still young. ⁓ And it is that 16 year old kid who tears her ACL and starts to wonder if they're ever going to play again. And then you and I, you know, and others work together to get them back there and get their head out of the.
out of the sand and back on the field. And that's a lot of fun, you know?
Andrea Davis (01:32)
No, it's what's kept me in the game 25 years and still keeps bringing me back for more. And the fact that there's medical professional surgeons like yourself that continue to pour into their patients, what I like to refer to old school medicine where you listen, you pay attention, your head's not in the computer all day, we're not treating and treating, you're really trying to find a way to help them. that's been, and I've had the pleasure of watching
You've gone from small practice to large practice to larger practice. So you've kind of run the gamut in the healthcare field, I think at this point and watched that landscape shift a whole lot, especially over the last maybe six years or so. Do you feel that as much? I mean, we feel it like crazy on the PT side, but do you feel that as much in your world?
Dr. Mc Millan (02:22)
Yeah, it's, you know, listen, from a 30,000 foot view, I've been in the same spot, but you know, organizations get acquired and change hands. And you know, the biggest thing that never changes is the patients, right? So every time, you know, something changes with administration or you get a new partner, or in my case, you know, 30 new partners as we grow, when you see a familiar face, a patient who's been with you eight, nine, 10 years, or they come back with their kid.
Andrea Davis (02:33)
Yeah.
Dr. Mc Millan (02:47)
That is the sort of grounding point to life, right? At the end of the day, when the exam door shuts and it's just you and the patient in the room, when you get to the operating room and you get the green light to sort of make incision, that's when nothing else changes. And that's really the perspective I think we all try to keep because we know this medicine changes for good, bad or indifferent. It's changing. You can't fight it. You got to embrace it. But the one constant is, patients will seek out.
they want to be treated by, whether it's for therapy, whether it's for surgery. And that is the biggest thing that's changed in 13 years is the informed consumer that really wants what they want. They will wait six weeks to see one of us. They will, by all means, refer everyone they know from their church, from their work, if they do good work. But they will take the social media and also give their thoughts if they're not happy, right? So it is really a different age that we live in right now, but I love it.
Andrea Davis (03:17)
Yes.
I love it too and I think the intelligently informed patients are really awesome to work with. I feel on our side of things too, on the rehab side, it's just more challenging to filter through some of where did you hear that, where is that coming from? ⁓ But the ability to collaborate with surgeons like yourself make our job so much easier. So it's always easier when the work is clean, like post-surgical work is clean and good and.
you know, minimal worries about infection or all the things, but when the recovery starts going faster with some of these newer techniques that are available in our world, I've been doing this 25 years, you have to adapt, really adapt and change because the timelines are changing and protocols, expectations shift a little bit and nobody ever really tells you in PT. Hey, by the way, we're doing a robotic, you know, la la la.
and you're gonna see this, this and this. So it's something that's definitely, I find exciting and keeps it fresh on my side of things.
Dr. Mc Millan (04:42)
Yeah. And it's our job too. So you and I know this. I have a website and I put my rehab protocols on there, but they're, um, they're meant to be able to run the gamut of very fast recovering patients and very slow recovering patients. if anyone in the world were to pick up that protocol, they could rehab someone. But how many times have you or one of your colleagues texted me? Um, and that's the other thing I think everyone, everyone in South Jersey has my cell phone number. So, but it's good, right? You can text me and say, Hey, John Smith is.
Andrea Davis (05:03)
Lots.
Shoot.
Dr. Mc Millan (05:11)
doing great, can we do XYZ in their rehab? I'm like, yeah, do it. Or I'll be like, well, we'll pump the brakes even though they're doing great because of this. But I think that communication that, you you're not afraid to reach out to me and I'm not afraid to, you know, adjust on the fly if a patient's doing well because of the feedback you and your team give. I mean, that's awesome. And patients eat that up. I mean, they love when there's communication between a therapist and the surgeon. There's no, you know, he's on a pedestal or she's on a pedestal. It's like, we're here and we're just trying to get you better.
Andrea Davis (05:39)
No, man. I mean, that's one of my favorite things about you. Like ⁓ as medicines progress and as the landscape, as we're saying, has shifted, like you've stayed pretty, like pretty true to things, like never, you know, too busy to answer a text. Like you'll always, you know, shoot back like, Hey, you know, my, my favorites are, Hey, speaking at a conference in 10 minutes, can I hit you later? And I'm like, yes, sorry to bother you, but ⁓ yeah, no, never goes ignored. And I do agree with you. I think that's a big part of, ⁓
Dr. Mc Millan (06:00)
Yes. All good.
Andrea Davis (06:08)
why patients keep coming back because you allow that accessibility and are super open really and can adjust. The only way you can adjust is if you know your medically sound in your training and the background and you know what to expect. So somebody throws you a curve ball, like you're very quick to respond on your feet and not ⁓ making us feel stupid really. And not once have you yelled at us and I've been yelled at in my 20s, I was yelled at a whole lot by a few. ⁓
Dr. Mc Millan (06:37)
Yeah,
no, no, no yelling here. I'll tell you a good yelling story. So in my first year or two of practice, ⁓ let's be fair, we're all, you jittery, we're all nervous. We're, you know, we're scared. I was doing a surgery and it was taking me a long time and I had an instrument that was broken and ⁓ I went to do something and it made my case more difficult. Right? So like a little two year old, I took the device and I threw it on the ground. was like, never get this to me again. First time I ever yelled, kind of yelled.
Andrea Davis (06:38)
much appreciated for that.
Dr. Mc Millan (07:07)
last time I ever yelled because I talked to my mom every night and I'm driving home and I'm telling her, you know, I had a rough day and yell our mom, everything came out okay, but you know, I threw this instrument and I'm thinking she's gonna give me the, you know, it's okay, honey, I love you thing. And she's like, you're gonna go in tomorrow and you're gonna apologize to everyone. She's like, and if I ever find out you yelled at someone, I was like, never again. But yeah, so yeah, here I am. I think I'm a big shot surgeon and you know, my mom still gets to yell at me, you know, in my 40s, you know, so.
Andrea Davis (07:27)
I love that!
Hahaha!
Dr. Mc Millan (07:36)
But it's proof that we don't stray far. And I still respect my mom, my dad, so I'll do what they tell me.
Andrea Davis (07:43)
Yeah, no, my mom's my billing manager. So try that one when you're trying to get something passed on the books. I want to buy, nope. Hey, I want to buy this piece of equipment. No, you don't. I'm like, oh, okay. So talk to me about the like innovate, like what are your favorite innovations you've seen maybe in the last five years? Like, I feel like there's been a lot, like I know the bear is one for sure. Is there anything else that comes to top of mind that you've seen that's really significantly shifting things?
Dr. Mc Millan (07:50)
Yeah, so again, you know, just speaking selfishly in the sports medicine world, love biologic advancements, meaning like, how can we take what we're good at and biology? Because look, at the end of the day, the body wants to heal itself and how can we accelerate it? And I did masters research back in med school on biology, trying to make ligaments in rabbits actually heal quicker. And you fast forward a decade later, that same research was then
Andrea Davis (08:15)
Yeah.
favorite.
Dr. Mc Millan (08:39)
really the foundation of where we started putting these patch augmentations on rotator cuffs to make them heal and regenerate. for me, anything I can do biologically to make rotator cuffs heal quicker, to make ACLs heal quicker, that's where I'm at. And we've published a lot. And one of the things, Andrew, that whenever a surgeon does something new, we all know the adoption curve, right? You're either you're behind, you're way in the front, or you're somewhere in the middle, kind of never want to be on either spectrum.
Andrea Davis (08:43)
Mm-hmm.
Dr. Mc Millan (09:06)
But whenever you do something new, everyone looks at you kind of like screwy-eyed, like, you know, what are you doing? That makes no sense. So I've always put my research where my mouth is. So if I want to do something new, I'm researching it. I'm taking a road trip to go find the surgeon who started it. I'm doing my own bench research. We're publishing papers. You know, we're well over, you know, 60, 70 peer publications in the last couple of years. We've done, we were part of the Bayer III clinical trial where we looked at how to restore the ACL rather than.
Andrea Davis (09:11)
awesome.
Dr. Mc Millan (09:36)
reconstruct it, can sew it back together and add biology to it to make it heal. It's amazing. It's great. We're publishing all over the place on that right now. So I think the innovation in using the body to heal itself and we're just doing a good job of pushing it along. ⁓ It is huge. I remember God, yeah, I had to be maybe in fellowship. We're talking about, you know, how, how good we are as surgeons and someone says, you know, it doesn't matter if you're a good surgeon or a bad surgeon, you just got to give the body a chance. And I was like, kind of like whatever.
He's like, no, seriously. He's like in the 1600s, someone fell out of a tree and broke their leg or broke their arm. They weren't putting rods inside their arm. was basically survival of the fittest, right? Either the body healed or it didn't and they died and got dysentery, right? So, you our job is to avoid dysentery on our patients, but give them a, give them a running start with a good surgery and let the body do the rest and get out of the way. And I think that's, that's it. You know, we're not God. We just happened to do a good job of getting God to do the job.
Andrea Davis (10:16)
Right.
Right, right.
Yes, please.
I mean, I think part of it too ⁓ is that once you know something, right? Once you experience it in medicine and you think you can truly affect that change, once you know, it's very difficult to unknow. And once you start seeing it and applying it, and I agree with you, innovation, you don't wanna be behind, you don't wanna be ahead, but you kinda wanna be open to being ahead. Because we had a lot, when we started doing wireless sensors was the first foray into rehab tech application, and nobody...
Like, are doing that? You don't get paid more for that. you doing that? How can you not do that? When you start looking at ACLs and the retail rates and the contralateral side being injured and at risk, all the things it's like, once you know, you just have to help people ⁓ accelerate and educate. And you do that amazingly well. I mean, you were out there.
Dr. Mc Millan (11:22)
Yeah, no, listen,
we talk about this all the time. There are patients that will say, if you tore something, who would you go see for this, right? Forgetting insurance, forgetting everything else, forget driving, where would you go, right? And then why? And how many patients end up at your doorstep because of that? Because look, at the end of the day, you and your team have been dedicated to advancing in science, not just doing the same thing that CMS or Horizon or Aetna says you should do, right?
Andrea Davis (11:30)
Mm-hmm. Sure.
Dr. Mc Millan (11:51)
And I think that's the difference. And also it's really about customizing the recovery to the patient, right? You so one of the things that I pride myself on is I don't just do the same surgery for every patient. I sort of look at their needs, right? Like if John Smith comes in and says, I need to go back to work in six weeks because I got to provide for my family. I can't take six months off or whatever it is. We devise a surgery with an understanding of what everything is for them. And you guys are the same way, right? It's like, all right,
Maybe you only get 10 PT visits, right? We're gonna make those 10 PT visits count. Or, you know, I need to get back quicker. What can we do early on to get things going? And we'll put some of the other stuff on the back burner for now. I think asking the patient, what are your goals rather than you setting the goals for them, I think is really huge. you know, bravo to you guys for doing it.
Andrea Davis (12:39)
Well, I mean, back at you, because I love hearing that perspective from a medicine side for sure. And what you're, ⁓ you know, trying to achieve for the patient. And that's the feedback we get and why people are always, you know, so complimentary of you that you're just a regular kind of guy that's got a big brain. That's usually, well, super long time, but you've done some interesting work with overhead athletes. spend some time. Do you still go back and work with some of the professional teams like you did?
Dr. Mc Millan (12:56)
We just went to school for a long time, that's all, you know, so.
Yeah, so
we trained at University of Massachusetts with Brian Busconi and he's been great. He lets us all come back every year for spring training, get to do some physicals, see some of the players. And then the really cool part is, and we were just talking about an athlete offline, you and I, from doing that, we see a lot of pro athletes in the off season or locally when they come home, they got an injury, want another opinion. So it's great. And that doesn't have to be a pro. How many college and high school athletes do we see that get them to the pros?
So yeah, we do a lot with overhead athletes.
Andrea Davis (13:38)
Yeah, and you take that approach like, ⁓ you know, for professional athletes, higher level athletes, and you apply it, you're like basically applying it to the masses as well. I mean, modifying expectations and whatnot, but the treatment strategy and thought process doesn't really change, right? From ⁓ the elite pro athletes to like regular person coming in from work with a rotator cuff, other than expectations. Like you're not lowering what you provide because they're not.
you know, playing in the MLB.
Dr. Mc Millan (14:07)
No, it's,
listen, everybody's got something they want, right? Like obviously nobody wants to hurt, right? But you know, how many, this is a time of year where everybody's like, I want to play golf this summer, right? Well, how am going to do that? Right? So we even talk about, you know, return to play protocols for golfers, right? Like my 60 year old guy is like, look, I just need to be able to go out there with my buddies every other Tuesday and play. And we'll talk, right, listen, everything you're gonna do for six months and I'll even give them a cheesy note for their friends.
Andrea Davis (14:17)
Yeah.
Dr. Mc Millan (14:33)
you're going to tee everything up in the fairway. I don't want you taking any chunks out of the ground. You do that, I'll let you play. And we're going to use nine irons, pitching wedges, seven irons, no drivers. So we're changing what they're doing, but we're meeting in the middle. And we set that expectation at a time. And I'll talk about that stuff. I always like to ask a patient, what are your hobbies and what do you want to do before we do surgery? Because it gives me an idea of what they want to get back to you. Because how many times are patients
Andrea Davis (14:40)
Mm-hmm.
Mm-hmm. Yeah.
Dr. Mc Millan (15:02)
afraid of a surgery because they're thinking in their head like, my daughter's getting married in six months. I can't be down or I'm getting a grandbaby or I want to golf. If you ask what life events are coming up, just take two seconds and you know what it is. You can then shape their recovery, surgical or non-surgical, around that. And that'll make them feel like, all right, I'm going to be able to do what I want because otherwise patients leave your office and they go home and you never get that feedback. You just can't understand why they didn't come back. It's like,
Andrea Davis (15:09)
Yeah.
Dr. Mc Millan (15:30)
They did not like you. It's just they were afraid they wouldn't be able to do what they have to in six months. And life is always busy. No one ever has that clear horizon where like after this, you know, January, I can do whatever I want for the next year. There's always the next hurdle. So I think, you know, getting them on track with what they want is important.
Andrea Davis (15:42)
Right, right, Right.
No, I mean, it's usually important because otherwise what happens, right? They go and make their own rules. They'll go and make their own rules and then figure out that, ⁓ you know, wait, that's not working. So it's much easier to meet them where they are. I know when I had kids, I was adamant coming from a sports background myself, coached at a division one level, played in college, adamant that my kids were not gonna play all year round. Not gonna do it, no way.
I've got a daughter who's a freshman in high school. She plays softball and guess what we're doing, doc? We're playing all year round right now. So instead of like the narrative in my naive mind was I'm gonna change the, you know, change the culture or whatever. On my side of things, rehab side, I'm trying to meet people where they are and understanding that they are doing this all year round. We know in the research, we know in the literature. I mean, everybody talks about it.
Dr. Mc Millan (16:19)
Will you? Let's go. All right, go for it.
Andrea Davis (16:42)
Overuse, overuse, overuse, but nobody's adapting to it. We're just identifying that there's a problem, but what are we going to do to address this problem? You know, have you shifted like anything with that mentality? Like not the mentality, but you know what I mean? You know, January through December, you know, they're coming in pictures, especially with overuse stuff. They're not, they're not appropriately shutting down. Like have you had to change your approach with that at all?
Dr. Mc Millan (16:58)
Yeah.
No, I think it's an honest conversation. That's really all it is. Cause look, there are kids that go year round and they're fine, right? And there are kids that go year round and aren't. So if my, you know, five foot two, 106 pounds soaking wet kid comes in and he's pitching six days a week and his elbow hurts, you know, I kind of have the conversation like maybe your body's not meant for that, right? ⁓ I talk about alternatives, but look, the reality of it is, and it's kind of a sad state of things. Generally when someone comes in like that,
Andrea Davis (17:30)
Love that, yeah.
Dr. Mc Millan (17:38)
They've seen three or four other doctors beforehand just looking for someone to give them the answer they want. So I'm just pretty honest with things. And I tell them, look, if I were to tell you, you're going to be better for it if you did something else, maybe they'll do it. Maybe they won't. It's rare that dethrowing athlete needs surgery. hear about Tommy John all the time. We hear about laboral tears and rotator. It's rare that the throwing athlete needs surgery. It's less than 3%, less than 5%.
Andrea Davis (17:52)
Mm-hmm.
Dr. Mc Millan (18:07)
So those that come in thinking they need surgery usually don't they just need good rehab Not even sometimes over overuse stuff. It's it's disuse the bad external rotation bad shoulder girdle muscles awful trunk rotation at their core you know if I got a picture that comes in and you know, he's got a little bit of a you know, we'll call it soft midsection I can tell you right now when I start doing their trunk rotation stuff. That's where they're dragging their arm through the zone because
Andrea Davis (18:31)
Mm-hmm.
Dr. Mc Millan (18:36)
So just getting them on a core program will help their shoulder velocity a ton, right? So it's identifying it in being honest, but being nice about it. You don't have be rude about it and saying, look, if you do this, we can change that. And that's where, and again, I keep tooting your horn. feel like I should be on your payroll. But again, ⁓ some of this stuff that you do in other places near you do with ⁓ pitching examinations and throwing motions and looking at trunk and arm rotation, I think is huge because
Andrea Davis (18:52)
I love it! Keep going!
Dr. Mc Millan (19:06)
Patients, much like anyone, can relate to numbers. If you can see that someone's supposed to have a certain amount of arm angle or arm strength and you're 20 % less than what it should be, that explains a lot, right? It's not just me telling you, this is what's going on. They need to see a tangible number. And then with the rehab, they need to see that number change, whether it's motion, whether it's strength, whether it's rotation. Those changes fuel someone to continue on a plan that ultimately lead to the right answer. And I think that's important.
Andrea Davis (19:36)
No, it's massively important. Another big thing, thoracic extension, like lacking that rotational component and then thoracic extension when you're talking about scapular dyskinesia, which nine times out of 10 is like the first identifiable thing when they have a pictures have shoulder elbow pain. It's like, how's rest of you moving? True or false? Your legs have ⁓ anything to do with the fact of the strain on your shoulder. that be true, right?
Dr. Mc Millan (20:02)
Right, exactly. Right, you're right. Yeah. Right, true. Yeah, of course.
Yeah.
Andrea Davis (20:06)
Yeah,
but yeah, but you should see like the eyes like, what do do for legs? What do mean? It's my shoulder. I'm like, come on.
Dr. Mc Millan (20:14)
Right. But again,
it's, listen, if I bring my card to a mechanic, I don't know anything, right? but at end of the day, like, so it's more about, to your point, explaining anything in a way that, I always ask a patient, if you were to walk out of here, could you explain this to someone at home, right? And if they can't, I'll try to re-explain it differently, whether it's drawings or whatever it might be, but understanding equals buy-in equals good results. If you talk at a level,
Andrea Davis (20:20)
True, yeah!
Mm-hmm.
Dr. Mc Millan (20:44)
that is either so high that no one can understand it or condescending that no one wants to hear it, it doesn't get through. So I think it's very much just about like, here's what's wrong, here's how we're going to fix it. You got to trust me because this is what I'm good at. And whatever you're good at, I'll trust you on later on, right? Teach me how to bake a cake, teach me how to change a tire. I don't care. I think that sort of buy-in works really well with people.
Andrea Davis (20:51)
Mm-hmm.
Yeah.
Talk to me about ⁓ non-negotiables for you, for yourself. Like when we talk about medicine and, you know, I have a few non-negotiables for myself, is just like, you know, consistency, how I talk to patients, making sure you put them first. Is there anything that like comes to mind for you that you ⁓ like kind of said early on or even later on in your career that I'm like, this is kind of like my North Star, this is what kind of keeps me coming back and keeps me on the right path, so to speak?
Dr. Mc Millan (21:34)
Yeah, I mean, honestly, it's touch with the patients, right? So we are so busy. You know this, right? And I try.
Andrea Davis (21:40)
Yeah, yeah. Well, you
guys are way busier than we are. Like we have time, you do not.
Dr. Mc Millan (21:47)
But I try to make sure that someone knows that they're okay, whether it's putting my cell phone number on their discharge instructions, whether it's on a weekend replying back to a message, even when I'm not on call or you're not supposed to look at your epic on the weekend, you do. ⁓ Remembering little things about patients like their kids' names, something like that. I think all that's important ⁓ because unfortunately the way medicine is, if you don't take a second to be human, it's a mill.
And you know, nobody, nobody cares that you remember Johnny's, you know, last name. They remember, did you see 40 patients today? Right. I mean, that's, that's all there is. And I don't like that. So for me, it's, I'll never sacrifice, you know, who I am with, with patients, right? Like I don't wear a lab coat and that's just me. Um, half my patients call me Sean. You know what I mean? Like, um, but there's, it's a respect. Don't get me wrong. Um, I give my cell phone out to tons of patients because I know how hard it is to get through to offices, even in the best case.
Andrea Davis (22:20)
Love that.
Yeah.
Mm-hmm. Mm-hmm. Yeah.
Yes.
Dr. Mc Millan (22:47)
And I can tell you in 13 years, I've had maybe two patients abuse it, but I've probably had 30 patients to a hundred patients text me and say, sorry to bother you. My neighbor broke their ankle. Can you help them? Right? So I'm like, yeah. know, so I think there's that delicate balance of just being, you know, I won't give up. Yeah. I won't give up being who I am to a patient and vice versa. And I think that goes a long way because patients don't like to feel like they're just a number in a catalog.
Andrea Davis (22:58)
Yeah, yeah. Yeah.
Authentic.
It's difficult to do though, no? Like, do you find it difficult at times to maintain that?
Dr. Mc Millan (23:22)
yeah, mean, listen, when you're in Disney World and you're getting a message, I try to ignore it as long as I can until I have a break, it's that line, because I never want my kids to also think that work is more important, right? So it's that delicate line. But one of the things that I've done with my kids, they used to go to the hospital and round with me at Twins, they'd be in the stroller and they'd be there at a year old and they'd come around, they knew where the cookies were in the doctor's lounge, they liked to press the buttons. they're really good at surgery.
Andrea Davis (23:34)
Yeah.
Love that.
Yeah, yeah, yeah.
Dr. Mc Millan (23:50)
I do little things to include them in things, whether it's practice labs, I'll bring them to labs. We'll talk about surgery, I'll send them videos. They like that stuff. I think there's the balance also when you talk about your North Star, like don't lose sight of, anytime I feel like I'm going too heavy in one direction, I got to come back the other and stay in the middle.
Andrea Davis (23:51)
Ha ha.
Yeah, it is. I mean, I find it challenging just owning and running a business and two high school kids. And, you know, the mom part is always challenging, but just, think healthcare in general, when you give so much to other people, it does weigh at times on what you're able to bring home. I love, I do the same, try and get my kids involved in the practice. So it's a little bit less, ⁓ they're away from what I'm doing. They feel more involved. So I love that, man. So let's talk selfishly about a little bit of PT here.
Dr. Mc Millan (24:34)
Mm-hmm.
Andrea Davis (24:42)
Give me the things you like that you see in PT or that you like to see and then maybe some things that frustrate you a little bit. Because you've been around a while, so you've seen the game and I'm sure.
Dr. Mc Millan (24:54)
When you say that, you make me sound old. That ain't cool. Signing off Dr. McMillan. We'll see everyone next time. Yeah, I'm teasing. So listen, the things that I love, I love, I mentioned before, love innovation. So I like things in therapy that get patients back quicker and individualize approach, whether it's muscle stim, whether it's looking at ⁓ arc of motion and range of motion. We talked about scapular extension.
Andrea Davis (24:55)
No, no, you're much younger than I am. So there's that upside.
Dr. Mc Millan (25:21)
All those things I think are important. Finding a way to help someone get better quicker is better without worrying about necessarily the cost, even though you have to be smart, it's a business. What I hate is when a patient comes in, and this is awful, when a patient comes in and says, I don't want to go back to therapy because I feel like there's one therapist taking care of six of us at a time. And I'm just giving my exercises, going to a corner and they come back and they just check on me like I'm in preschool.
Andrea Davis (25:42)
Yeah.
Dr. Mc Millan (25:50)
there's lack of buy-in. feel like those patients struggle more. They're going to therapy and not that you need a one-on-one therapist, but they have to feel like they're getting attention, right? We all want attention, right? We all do better when we have that. it would be fair, healthcare companies are the ones that have made this situation real, but nevertheless, it's still nice to see when you get individualized attention. think that that's important. listen, I believe
Andrea Davis (26:01)
Yeah, of course.
Mm-hmm.
Dr. Mc Millan (26:19)
in rehab, there are some that don't. talked about my innovation before, so not that I'm a therapist and nor do I want to be a therapist, Andrea, but I've been part of writing the protocol team for the rotator cuff patches. there was 10 of us surgeons got together, pulled all of our data from our outcomes, and we wrote the rehab protocol that's used across the entire country for that. And then the Bayer updated protocol, I was part of that group as well, again, another eight or 10 surgeons.
Andrea Davis (26:21)
Mm.
Yeah. Yeah, nobody does.
Yeah.
Wow.
Dr. Mc Millan (26:48)
got together with all of our outcomes and we adjusted and rewrote the rehab protocol for the the bear implant. So seeing those protocols, which are touching hundreds of thousands of lives every day and knowing we were a part of it, not because we're therapists, but because we took our outcomes of our patients from the therapist like you and then translated into a tangible thing, I think is is huge. And that's where I think we got to keep doing it.
Andrea Davis (26:54)
That's awesome.
Yeah.
Yeah.
Yeah, I mean, we need the guidance too. That's the thing. You guys are in there doing the surgery and you know if you moved something or did something a little bit different through another stitch in or whatever, which sometimes does carry over into expectations for a functional return, what they looked like before and what the expectations are after. So the protocols do provide really great guardrails around that, but it does not excuse us as professionals from not knowing the processes.
and understanding the science underneath it, that just because it's on, you you go from step one to step two, but if you can't do the things in step one, why are we in step two kind of thing? that's the, you know, the upside downside, I guess, of, you know, the protocol world on our side anyway.
Dr. Mc Millan (27:49)
Sure.
It's
incumbent upon us. mean, I give tons of talks to therapy groups. Just if I'm doing something new, like I'll try to make an effort to give a talk in an area to be like, here's what we're doing. Here's why, right? If I say why once, you get it. And then you can tell your patients, right? Because listen, as a surgeon, I see a patient maybe four or five times postoperatively over the course of six months and they're done, which means you've seen them more than I have, right? You've seen them anywhere from one to three times a week for God knows how many months.
Andrea Davis (28:07)
Yeah.
Right. Yeah.
Dr. Mc Millan (28:26)
⁓ before surgery and after. So if I'm doing something new and you or your team understand what I'm doing and why, you could then help reassure the patient, talk them off the ledge, maybe get them to me if they're concerned about going to surgery because they're scared and you're like, no, no, it's okay. Like go listen to this guy. He's not a cutter. He's, you know, I think therapists have always been the biggest referral source for us as physicians because if you do a good job, therapists talk, patients talk.
Andrea Davis (28:42)
Yeah, yeah.
Dr. Mc Millan (28:53)
And that helps reassure someone who's scared to maybe take the first step.
Andrea Davis (28:57)
Well, and people let, they wear it as a badge of honor as well. Like, you my surgeon, you should see my surgeon because I felt like this and he talked to me like that and now I can do this kind of thing. So there's definitely, you know, taking care of the whole person and you know, everything kind of flows around that. ⁓ the innovations, they just seem to keep coming progressively and AI is a big part of.
like, you know, the next frontier, so to speak. Do you have any thoughts you'd like to share on AI ⁓ in your world?
Dr. Mc Millan (29:27)
Listen, we
love AI. I can tell when a patient has used AI before they come into the room to ask about their rotator cuff repair. It's better than Dr. Google, but AI is there. And listen, we use AI. have a paper coming out on AI when it comes to taking your orthopedic board examination. How does AI do on it? So it's there. And like everything else, you can be afraid of innovation. You can abuse innovation, or you can understand it or try to.
Andrea Davis (29:32)
That's awesome.
wow.
Dr. Mc Millan (29:53)
and use it to your advantage. And I think that's what we're all trying to wrap our brains around right now.
Andrea Davis (29:57)
Yeah, no, I agree. Love AI, don't hate it. Think it's gonna, just like you said, I think you said it perfectly right down the middle. It can't be your absolute and you can't ignore it because it's not going anywhere, but you should learn how to leverage it, I think, in all areas, make your life work smarter, not harder, not anymore. Vans, great conversation. I appreciate it.
Dr. Mc Millan (30:18)
So listen, I will leave you with this, right? Dr. Davis, if you were coming into my operating room, and I usually give patients, they're still awake, I give them the chance to pick their radio station, all right? So you get to pick a Pandora station. Any artist, what are we listening to if you're coming into the OR? You're getting an ACL surgery done, what do you wanna hear going to sleep? Lithium. Okay, all right, nothing wrong with it. Listen, we've been on a creed kick, all right? So we've got...
Andrea Davis (30:20)
Yeah, yeah. Yes.
Okay.
⁓ Lithium, Series XM, lithium, yeah, like 90s grunge. Grunge, grunge all.
Ooh,
that's oldie buddy goodie.
Dr. Mc Millan (30:48)
Yeah, we somehow stumbled
upon the greatest 90 station. was a Creed Nickelback three doors down station the other day. I was back in college in my head. I don't know what happened, but it was great. ⁓
Andrea Davis (30:56)
All the same. They're all the same people. my God, that's
awesome. Listen, if people want to get in touch with you or your office and learn more about what you do, how can they find you?
Dr. Mc Millan (31:07)
So I got a website drschanmcmillan.com ⁓ or our office number which is the easiest way. It's going to be 856-470-9029.
Andrea Davis (31:21)
You're the best man. Nobody better right now. So thank you. I appreciate it. All right, guys. Yeah, you too. Thank you guys until next time. We'll see you keep working hard and keep expecting more.
Dr. Mc Millan (31:23)
Thanks, Andrea. Thank you. Have a great night.
Hello and welcome back to Expect More with Dr. Andrea. I am so excited to introduce my guest this episode, Dr. Sean McMillan, Chief of Orthopedic Surgery, amazing innovator, excellent surgeon. I've had the good fortune of doing some or sharing in some of his work in rehabbing for many, many years now and the outcomes are always so, so good and the conversations are even better. So Dr. McMillan, thank you for coming.
Dr. Mc Millan (00:07)
Thank you.
Andrea, thanks for having me.
Dr. Andrea Davis (00:29)
Yeah, man, so please, let's tell everybody your prestigious history. I feel so lucky to have you on and pick your brain a little bit. So lay it out there.
Dr. Mc Millan (00:38)
I appreciate that. Yeah. So
listen, I'm a central Jersey kid. If you believe in central Jersey that ended up in South Jersey, been down here with a lords and then virtual for the last 13 years. And it's been really cool sort of cultivating orthopedic sports medicine practice in the region. You you and I see a lot of the same patients take care of five schools in the area.
Andrea Davis (00:45)
you
Dr. Mc Millan (01:01)
⁓ Really just good kids, good families. And it's fun, know, everything from sideline coverage to getting them back on the field through the operating room. we talk about the different people that walk into your clinic and my office. It's people like me and you that try to feel like we're still young. ⁓ And it is that 16 year old kid who tears her ACL and starts to wonder if they're ever going to play again. And then you and I, you know, and others work together to get them back there and get their head out of the.
out of the sand and back on the field. And that's a lot of fun, you know?
Andrea Davis (01:32)
No, it's what's kept me in the game 25 years and still keeps bringing me back for more. And the fact that there's medical professional surgeons like yourself that continue to pour into their patients, what I like to refer to old school medicine where you listen, you pay attention, your head's not in the computer all day, we're not treating and treating, you're really trying to find a way to help them. that's been, and I've had the pleasure of watching
You've gone from small practice to large practice to larger practice. So you've kind of run the gamut in the healthcare field, I think at this point and watched that landscape shift a whole lot, especially over the last maybe six years or so. Do you feel that as much? I mean, we feel it like crazy on the PT side, but do you feel that as much in your world?
Dr. Mc Millan (02:22)
Yeah, it's, you know, listen, from a 30,000 foot view, I've been in the same spot, but you know, organizations get acquired and change hands. And you know, the biggest thing that never changes is the patients, right? So every time, you know, something changes with administration or you get a new partner, or in my case, you know, 30 new partners as we grow, when you see a familiar face, a patient who's been with you eight, nine, 10 years, or they come back with their kid.
Andrea Davis (02:33)
Yeah.
Dr. Mc Millan (02:47)
That is the sort of grounding point to life, right? At the end of the day, when the exam door shuts and it's just you and the patient in the room, when you get to the operating room and you get the green light to sort of make incision, that's when nothing else changes. And that's really the perspective I think we all try to keep because we know this medicine changes for good, bad or indifferent. It's changing. You can't fight it. You got to embrace it. But the one constant is, patients will seek out.
they want to be treated by, whether it's for therapy, whether it's for surgery. And that is the biggest thing that's changed in 13 years is the informed consumer that really wants what they want. They will wait six weeks to see one of us. They will, by all means, refer everyone they know from their church, from their work, if they do good work. But they will take the social media and also give their thoughts if they're not happy, right? So it is really a different age that we live in right now, but I love it.
Andrea Davis (03:17)
Yes.
I love it too and I think the intelligently informed patients are really awesome to work with. I feel on our side of things too, on the rehab side, it's just more challenging to filter through some of where did you hear that, where is that coming from? ⁓ But the ability to collaborate with surgeons like yourself make our job so much easier. So it's always easier when the work is clean, like post-surgical work is clean and good and.
you know, minimal worries about infection or all the things, but when the recovery starts going faster with some of these newer techniques that are available in our world, I've been doing this 25 years, you have to adapt, really adapt and change because the timelines are changing and protocols, expectations shift a little bit and nobody ever really tells you in PT. Hey, by the way, we're doing a robotic, you know, la la la.
and you're gonna see this, this and this. So it's something that's definitely, I find exciting and keeps it fresh on my side of things.
Dr. Mc Millan (04:42)
Yeah. And it's our job too. So you and I know this. I have a website and I put my rehab protocols on there, but they're, um, they're meant to be able to run the gamut of very fast recovering patients and very slow recovering patients. if anyone in the world were to pick up that protocol, they could rehab someone. But how many times have you or one of your colleagues texted me? Um, and that's the other thing I think everyone, everyone in South Jersey has my cell phone number. So, but it's good, right? You can text me and say, Hey, John Smith is.
Andrea Davis (05:03)
Lots.
Shoot.
Dr. Mc Millan (05:11)
doing great, can we do XYZ in their rehab? I'm like, yeah, do it. Or I'll be like, well, we'll pump the brakes even though they're doing great because of this. But I think that communication that, you you're not afraid to reach out to me and I'm not afraid to, you know, adjust on the fly if a patient's doing well because of the feedback you and your team give. I mean, that's awesome. And patients eat that up. I mean, they love when there's communication between a therapist and the surgeon. There's no, you know, he's on a pedestal or she's on a pedestal. It's like, we're here and we're just trying to get you better.
Andrea Davis (05:39)
No, man. I mean, that's one of my favorite things about you. Like ⁓ as medicines progress and as the landscape, as we're saying, has shifted, like you've stayed pretty, like pretty true to things, like never, you know, too busy to answer a text. Like you'll always, you know, shoot back like, Hey, you know, my, my favorites are, Hey, speaking at a conference in 10 minutes, can I hit you later? And I'm like, yes, sorry to bother you, but ⁓ yeah, no, never goes ignored. And I do agree with you. I think that's a big part of, ⁓
Dr. Mc Millan (06:00)
Yes. All good.
Andrea Davis (06:08)
why patients keep coming back because you allow that accessibility and are super open really and can adjust. The only way you can adjust is if you know your medically sound in your training and the background and you know what to expect. So somebody throws you a curve ball, like you're very quick to respond on your feet and not ⁓ making us feel stupid really. And not once have you yelled at us and I've been yelled at in my 20s, I was yelled at a whole lot by a few. ⁓
Dr. Mc Millan (06:37)
Yeah,
no, no, no yelling here. I'll tell you a good yelling story. So in my first year or two of practice, ⁓ let's be fair, we're all, you jittery, we're all nervous. We're, you know, we're scared. I was doing a surgery and it was taking me a long time and I had an instrument that was broken and ⁓ I went to do something and it made my case more difficult. Right? So like a little two year old, I took the device and I threw it on the ground. was like, never get this to me again. First time I ever yelled, kind of yelled.
Andrea Davis (06:38)
much appreciated for that.
Dr. Mc Millan (07:07)
last time I ever yelled because I talked to my mom every night and I'm driving home and I'm telling her, you know, I had a rough day and yell our mom, everything came out okay, but you know, I threw this instrument and I'm thinking she's gonna give me the, you know, it's okay, honey, I love you thing. And she's like, you're gonna go in tomorrow and you're gonna apologize to everyone. She's like, and if I ever find out you yelled at someone, I was like, never again. But yeah, so yeah, here I am. I think I'm a big shot surgeon and you know, my mom still gets to yell at me, you know, in my 40s, you know, so.
Andrea Davis (07:27)
I love that!
Hahaha!
Dr. Mc Millan (07:36)
But it's proof that we don't stray far. And I still respect my mom, my dad, so I'll do what they tell me.
Andrea Davis (07:43)
Yeah, no, my mom's my billing manager. So try that one when you're trying to get something passed on the books. I want to buy, nope. Hey, I want to buy this piece of equipment. No, you don't. I'm like, oh, okay. So talk to me about the like innovate, like what are your favorite innovations you've seen maybe in the last five years? Like, I feel like there's been a lot, like I know the bear is one for sure. Is there anything else that comes to top of mind that you've seen that's really significantly shifting things?
Dr. Mc Millan (07:50)
Yeah, so again, you know, just speaking selfishly in the sports medicine world, love biologic advancements, meaning like, how can we take what we're good at and biology? Because look, at the end of the day, the body wants to heal itself and how can we accelerate it? And I did masters research back in med school on biology, trying to make ligaments in rabbits actually heal quicker. And you fast forward a decade later, that same research was then
Andrea Davis (08:15)
Yeah.
favorite.
Dr. Mc Millan (08:39)
really the foundation of where we started putting these patch augmentations on rotator cuffs to make them heal and regenerate. for me, anything I can do biologically to make rotator cuffs heal quicker, to make ACLs heal quicker, that's where I'm at. And we've published a lot. And one of the things, Andrew, that whenever a surgeon does something new, we all know the adoption curve, right? You're either you're behind, you're way in the front, or you're somewhere in the middle, kind of never want to be on either spectrum.
Andrea Davis (08:43)
Mm-hmm.
Dr. Mc Millan (09:06)
But whenever you do something new, everyone looks at you kind of like screwy-eyed, like, you know, what are you doing? That makes no sense. So I've always put my research where my mouth is. So if I want to do something new, I'm researching it. I'm taking a road trip to go find the surgeon who started it. I'm doing my own bench research. We're publishing papers. You know, we're well over, you know, 60, 70 peer publications in the last couple of years. We've done, we were part of the Bayer III clinical trial where we looked at how to restore the ACL rather than.
Andrea Davis (09:11)
awesome.
Dr. Mc Millan (09:36)
reconstruct it, can sew it back together and add biology to it to make it heal. It's amazing. It's great. We're publishing all over the place on that right now. So I think the innovation in using the body to heal itself and we're just doing a good job of pushing it along. ⁓ It is huge. I remember God, yeah, I had to be maybe in fellowship. We're talking about, you know, how, how good we are as surgeons and someone says, you know, it doesn't matter if you're a good surgeon or a bad surgeon, you just got to give the body a chance. And I was like, kind of like whatever.
He's like, no, seriously. He's like in the 1600s, someone fell out of a tree and broke their leg or broke their arm. They weren't putting rods inside their arm. was basically survival of the fittest, right? Either the body healed or it didn't and they died and got dysentery, right? So, you our job is to avoid dysentery on our patients, but give them a, give them a running start with a good surgery and let the body do the rest and get out of the way. And I think that's, that's it. You know, we're not God. We just happened to do a good job of getting God to do the job.
Andrea Davis (10:16)
Right.
Right, right.
Yes, please.
I mean, I think part of it too ⁓ is that once you know something, right? Once you experience it in medicine and you think you can truly affect that change, once you know, it's very difficult to unknow. And once you start seeing it and applying it, and I agree with you, innovation, you don't wanna be behind, you don't wanna be ahead, but you kinda wanna be open to being ahead. Because we had a lot, when we started doing wireless sensors was the first foray into rehab tech application, and nobody...
Like, are doing that? You don't get paid more for that. you doing that? How can you not do that? When you start looking at ACLs and the retail rates and the contralateral side being injured and at risk, all the things it's like, once you know, you just have to help people ⁓ accelerate and educate. And you do that amazingly well. I mean, you were out there.
Dr. Mc Millan (11:22)
Yeah, no, listen,
we talk about this all the time. There are patients that will say, if you tore something, who would you go see for this, right? Forgetting insurance, forgetting everything else, forget driving, where would you go, right? And then why? And how many patients end up at your doorstep because of that? Because look, at the end of the day, you and your team have been dedicated to advancing in science, not just doing the same thing that CMS or Horizon or Aetna says you should do, right?
Andrea Davis (11:30)
Mm-hmm. Sure.
Dr. Mc Millan (11:51)
And I think that's the difference. And also it's really about customizing the recovery to the patient, right? You so one of the things that I pride myself on is I don't just do the same surgery for every patient. I sort of look at their needs, right? Like if John Smith comes in and says, I need to go back to work in six weeks because I got to provide for my family. I can't take six months off or whatever it is. We devise a surgery with an understanding of what everything is for them. And you guys are the same way, right? It's like, all right,
Maybe you only get 10 PT visits, right? We're gonna make those 10 PT visits count. Or, you know, I need to get back quicker. What can we do early on to get things going? And we'll put some of the other stuff on the back burner for now. I think asking the patient, what are your goals rather than you setting the goals for them, I think is really huge. you know, bravo to you guys for doing it.
Andrea Davis (12:39)
Well, I mean, back at you, because I love hearing that perspective from a medicine side for sure. And what you're, ⁓ you know, trying to achieve for the patient. And that's the feedback we get and why people are always, you know, so complimentary of you that you're just a regular kind of guy that's got a big brain. That's usually, well, super long time, but you've done some interesting work with overhead athletes. spend some time. Do you still go back and work with some of the professional teams like you did?
Dr. Mc Millan (12:56)
We just went to school for a long time, that's all, you know, so.
Yeah, so
we trained at University of Massachusetts with Brian Busconi and he's been great. He lets us all come back every year for spring training, get to do some physicals, see some of the players. And then the really cool part is, and we were just talking about an athlete offline, you and I, from doing that, we see a lot of pro athletes in the off season or locally when they come home, they got an injury, want another opinion. So it's great. And that doesn't have to be a pro. How many college and high school athletes do we see that get them to the pros?
So yeah, we do a lot with overhead athletes.
Andrea Davis (13:38)
Yeah, and you take that approach like, ⁓ you know, for professional athletes, higher level athletes, and you apply it, you're like basically applying it to the masses as well. I mean, modifying expectations and whatnot, but the treatment strategy and thought process doesn't really change, right? From ⁓ the elite pro athletes to like regular person coming in from work with a rotator cuff, other than expectations. Like you're not lowering what you provide because they're not.
you know, playing in the MLB.
Dr. Mc Millan (14:07)
No, it's,
listen, everybody's got something they want, right? Like obviously nobody wants to hurt, right? But you know, how many, this is a time of year where everybody's like, I want to play golf this summer, right? Well, how am going to do that? Right? So we even talk about, you know, return to play protocols for golfers, right? Like my 60 year old guy is like, look, I just need to be able to go out there with my buddies every other Tuesday and play. And we'll talk, right, listen, everything you're gonna do for six months and I'll even give them a cheesy note for their friends.
Andrea Davis (14:17)
Yeah.
Dr. Mc Millan (14:33)
you're going to tee everything up in the fairway. I don't want you taking any chunks out of the ground. You do that, I'll let you play. And we're going to use nine irons, pitching wedges, seven irons, no drivers. So we're changing what they're doing, but we're meeting in the middle. And we set that expectation at a time. And I'll talk about that stuff. I always like to ask a patient, what are your hobbies and what do you want to do before we do surgery? Because it gives me an idea of what they want to get back to you. Because how many times are patients
Andrea Davis (14:40)
Mm-hmm.
Mm-hmm. Yeah.
Dr. Mc Millan (15:02)
afraid of a surgery because they're thinking in their head like, my daughter's getting married in six months. I can't be down or I'm getting a grandbaby or I want to golf. If you ask what life events are coming up, just take two seconds and you know what it is. You can then shape their recovery, surgical or non-surgical, around that. And that'll make them feel like, all right, I'm going to be able to do what I want because otherwise patients leave your office and they go home and you never get that feedback. You just can't understand why they didn't come back. It's like,
Andrea Davis (15:09)
Yeah.
Dr. Mc Millan (15:30)
They did not like you. It's just they were afraid they wouldn't be able to do what they have to in six months. And life is always busy. No one ever has that clear horizon where like after this, you know, January, I can do whatever I want for the next year. There's always the next hurdle. So I think, you know, getting them on track with what they want is important.
Andrea Davis (15:42)
Right, right, Right.
No, I mean, it's usually important because otherwise what happens, right? They go and make their own rules. They'll go and make their own rules and then figure out that, ⁓ you know, wait, that's not working. So it's much easier to meet them where they are. I know when I had kids, I was adamant coming from a sports background myself, coached at a division one level, played in college, adamant that my kids were not gonna play all year round. Not gonna do it, no way.
I've got a daughter who's a freshman in high school. She plays softball and guess what we're doing, doc? We're playing all year round right now. So instead of like the narrative in my naive mind was I'm gonna change the, you know, change the culture or whatever. On my side of things, rehab side, I'm trying to meet people where they are and understanding that they are doing this all year round. We know in the research, we know in the literature. I mean, everybody talks about it.
Dr. Mc Millan (16:19)
Will you? Let's go. All right, go for it.
Andrea Davis (16:42)
Overuse, overuse, overuse, but nobody's adapting to it. We're just identifying that there's a problem, but what are we going to do to address this problem? You know, have you shifted like anything with that mentality? Like not the mentality, but you know what I mean? You know, January through December, you know, they're coming in pictures, especially with overuse stuff. They're not, they're not appropriately shutting down. Like have you had to change your approach with that at all?
Dr. Mc Millan (16:58)
Yeah.
No, I think it's an honest conversation. That's really all it is. Cause look, there are kids that go year round and they're fine, right? And there are kids that go year round and aren't. So if my, you know, five foot two, 106 pounds soaking wet kid comes in and he's pitching six days a week and his elbow hurts, you know, I kind of have the conversation like maybe your body's not meant for that, right? ⁓ I talk about alternatives, but look, the reality of it is, and it's kind of a sad state of things. Generally when someone comes in like that,
Andrea Davis (17:30)
Love that, yeah.
Dr. Mc Millan (17:38)
They've seen three or four other doctors beforehand just looking for someone to give them the answer they want. So I'm just pretty honest with things. And I tell them, look, if I were to tell you, you're going to be better for it if you did something else, maybe they'll do it. Maybe they won't. It's rare that dethrowing athlete needs surgery. hear about Tommy John all the time. We hear about laboral tears and rotator. It's rare that the throwing athlete needs surgery. It's less than 3%, less than 5%.
Andrea Davis (17:52)
Mm-hmm.
Dr. Mc Millan (18:07)
So those that come in thinking they need surgery usually don't they just need good rehab Not even sometimes over overuse stuff. It's it's disuse the bad external rotation bad shoulder girdle muscles awful trunk rotation at their core you know if I got a picture that comes in and you know, he's got a little bit of a you know, we'll call it soft midsection I can tell you right now when I start doing their trunk rotation stuff. That's where they're dragging their arm through the zone because
Andrea Davis (18:31)
Mm-hmm.
Dr. Mc Millan (18:36)
So just getting them on a core program will help their shoulder velocity a ton, right? So it's identifying it in being honest, but being nice about it. You don't have be rude about it and saying, look, if you do this, we can change that. And that's where, and again, I keep tooting your horn. feel like I should be on your payroll. But again, ⁓ some of this stuff that you do in other places near you do with ⁓ pitching examinations and throwing motions and looking at trunk and arm rotation, I think is huge because
Andrea Davis (18:52)
I love it! Keep going!
Dr. Mc Millan (19:06)
Patients, much like anyone, can relate to numbers. If you can see that someone's supposed to have a certain amount of arm angle or arm strength and you're 20 % less than what it should be, that explains a lot, right? It's not just me telling you, this is what's going on. They need to see a tangible number. And then with the rehab, they need to see that number change, whether it's motion, whether it's strength, whether it's rotation. Those changes fuel someone to continue on a plan that ultimately lead to the right answer. And I think that's important.
Andrea Davis (19:36)
No, it's massively important. Another big thing, thoracic extension, like lacking that rotational component and then thoracic extension when you're talking about scapular dyskinesia, which nine times out of 10 is like the first identifiable thing when they have a pictures have shoulder elbow pain. It's like, how's rest of you moving? True or false? Your legs have ⁓ anything to do with the fact of the strain on your shoulder. that be true, right?
Dr. Mc Millan (20:02)
Right, exactly. Right, you're right. Yeah. Right, true. Yeah, of course.
Yeah.
Andrea Davis (20:06)
Yeah,
but yeah, but you should see like the eyes like, what do do for legs? What do mean? It's my shoulder. I'm like, come on.
Dr. Mc Millan (20:14)
Right. But again,
it's, listen, if I bring my card to a mechanic, I don't know anything, right? but at end of the day, like, so it's more about, to your point, explaining anything in a way that, I always ask a patient, if you were to walk out of here, could you explain this to someone at home, right? And if they can't, I'll try to re-explain it differently, whether it's drawings or whatever it might be, but understanding equals buy-in equals good results. If you talk at a level,
Andrea Davis (20:20)
True, yeah!
Mm-hmm.
Dr. Mc Millan (20:44)
that is either so high that no one can understand it or condescending that no one wants to hear it, it doesn't get through. So I think it's very much just about like, here's what's wrong, here's how we're going to fix it. You got to trust me because this is what I'm good at. And whatever you're good at, I'll trust you on later on, right? Teach me how to bake a cake, teach me how to change a tire. I don't care. I think that sort of buy-in works really well with people.
Andrea Davis (20:51)
Mm-hmm.
Yeah.
Talk to me about ⁓ non-negotiables for you, for yourself. Like when we talk about medicine and, you know, I have a few non-negotiables for myself, is just like, you know, consistency, how I talk to patients, making sure you put them first. Is there anything that like comes to mind for you that you ⁓ like kind of said early on or even later on in your career that I'm like, this is kind of like my North Star, this is what kind of keeps me coming back and keeps me on the right path, so to speak?
Dr. Mc Millan (21:34)
Yeah, I mean, honestly, it's touch with the patients, right? So we are so busy. You know this, right? And I try.
Andrea Davis (21:40)
Yeah, yeah. Well, you
guys are way busier than we are. Like we have time, you do not.
Dr. Mc Millan (21:47)
But I try to make sure that someone knows that they're okay, whether it's putting my cell phone number on their discharge instructions, whether it's on a weekend replying back to a message, even when I'm not on call or you're not supposed to look at your epic on the weekend, you do. ⁓ Remembering little things about patients like their kids' names, something like that. I think all that's important ⁓ because unfortunately the way medicine is, if you don't take a second to be human, it's a mill.
And you know, nobody, nobody cares that you remember Johnny's, you know, last name. They remember, did you see 40 patients today? Right. I mean, that's, that's all there is. And I don't like that. So for me, it's, I'll never sacrifice, you know, who I am with, with patients, right? Like I don't wear a lab coat and that's just me. Um, half my patients call me Sean. You know what I mean? Like, um, but there's, it's a respect. Don't get me wrong. Um, I give my cell phone out to tons of patients because I know how hard it is to get through to offices, even in the best case.
Andrea Davis (22:20)
Love that.
Yeah.
Mm-hmm. Mm-hmm. Yeah.
Yes.
Dr. Mc Millan (22:47)
And I can tell you in 13 years, I've had maybe two patients abuse it, but I've probably had 30 patients to a hundred patients text me and say, sorry to bother you. My neighbor broke their ankle. Can you help them? Right? So I'm like, yeah. know, so I think there's that delicate balance of just being, you know, I won't give up. Yeah. I won't give up being who I am to a patient and vice versa. And I think that goes a long way because patients don't like to feel like they're just a number in a catalog.
Andrea Davis (22:58)
Yeah, yeah. Yeah.
Authentic.
It's difficult to do though, no? Like, do you find it difficult at times to maintain that?
Dr. Mc Millan (23:22)
yeah, mean, listen, when you're in Disney World and you're getting a message, I try to ignore it as long as I can until I have a break, it's that line, because I never want my kids to also think that work is more important, right? So it's that delicate line. But one of the things that I've done with my kids, they used to go to the hospital and round with me at Twins, they'd be in the stroller and they'd be there at a year old and they'd come around, they knew where the cookies were in the doctor's lounge, they liked to press the buttons. they're really good at surgery.
Andrea Davis (23:34)
Yeah.
Love that.
Yeah, yeah, yeah.
Dr. Mc Millan (23:50)
I do little things to include them in things, whether it's practice labs, I'll bring them to labs. We'll talk about surgery, I'll send them videos. They like that stuff. I think there's the balance also when you talk about your North Star, like don't lose sight of, anytime I feel like I'm going too heavy in one direction, I got to come back the other and stay in the middle.
Andrea Davis (23:51)
Ha ha.
Yeah, it is. I mean, I find it challenging just owning and running a business and two high school kids. And, you know, the mom part is always challenging, but just, think healthcare in general, when you give so much to other people, it does weigh at times on what you're able to bring home. I love, I do the same, try and get my kids involved in the practice. So it's a little bit less, ⁓ they're away from what I'm doing. They feel more involved. So I love that, man. So let's talk selfishly about a little bit of PT here.
Dr. Mc Millan (24:34)
Mm-hmm.
Andrea Davis (24:42)
Give me the things you like that you see in PT or that you like to see and then maybe some things that frustrate you a little bit. Because you've been around a while, so you've seen the game and I'm sure.
Dr. Mc Millan (24:54)
When you say that, you make me sound old. That ain't cool. Signing off Dr. McMillan. We'll see everyone next time. Yeah, I'm teasing. So listen, the things that I love, I love, I mentioned before, love innovation. So I like things in therapy that get patients back quicker and individualize approach, whether it's muscle stim, whether it's looking at ⁓ arc of motion and range of motion. We talked about scapular extension.
Andrea Davis (24:55)
No, no, you're much younger than I am. So there's that upside.
Dr. Mc Millan (25:21)
All those things I think are important. Finding a way to help someone get better quicker is better without worrying about necessarily the cost, even though you have to be smart, it's a business. What I hate is when a patient comes in, and this is awful, when a patient comes in and says, I don't want to go back to therapy because I feel like there's one therapist taking care of six of us at a time. And I'm just giving my exercises, going to a corner and they come back and they just check on me like I'm in preschool.
Andrea Davis (25:42)
Yeah.
Dr. Mc Millan (25:50)
there's lack of buy-in. feel like those patients struggle more. They're going to therapy and not that you need a one-on-one therapist, but they have to feel like they're getting attention, right? We all want attention, right? We all do better when we have that. it would be fair, healthcare companies are the ones that have made this situation real, but nevertheless, it's still nice to see when you get individualized attention. think that that's important. listen, I believe
Andrea Davis (26:01)
Yeah, of course.
Mm-hmm.
Dr. Mc Millan (26:19)
in rehab, there are some that don't. talked about my innovation before, so not that I'm a therapist and nor do I want to be a therapist, Andrea, but I've been part of writing the protocol team for the rotator cuff patches. there was 10 of us surgeons got together, pulled all of our data from our outcomes, and we wrote the rehab protocol that's used across the entire country for that. And then the Bayer updated protocol, I was part of that group as well, again, another eight or 10 surgeons.
Andrea Davis (26:21)
Mm.
Yeah. Yeah, nobody does.
Yeah.
Wow.
Dr. Mc Millan (26:48)
got together with all of our outcomes and we adjusted and rewrote the rehab protocol for the the bear implant. So seeing those protocols, which are touching hundreds of thousands of lives every day and knowing we were a part of it, not because we're therapists, but because we took our outcomes of our patients from the therapist like you and then translated into a tangible thing, I think is is huge. And that's where I think we got to keep doing it.
Andrea Davis (26:54)
That's awesome.
Yeah.
Yeah.
Yeah, I mean, we need the guidance too. That's the thing. You guys are in there doing the surgery and you know if you moved something or did something a little bit different through another stitch in or whatever, which sometimes does carry over into expectations for a functional return, what they looked like before and what the expectations are after. So the protocols do provide really great guardrails around that, but it does not excuse us as professionals from not knowing the processes.
and understanding the science underneath it, that just because it's on, you you go from step one to step two, but if you can't do the things in step one, why are we in step two kind of thing? that's the, you know, the upside downside, I guess, of, you know, the protocol world on our side anyway.
Dr. Mc Millan (27:49)
Sure.
It's
incumbent upon us. mean, I give tons of talks to therapy groups. Just if I'm doing something new, like I'll try to make an effort to give a talk in an area to be like, here's what we're doing. Here's why, right? If I say why once, you get it. And then you can tell your patients, right? Because listen, as a surgeon, I see a patient maybe four or five times postoperatively over the course of six months and they're done, which means you've seen them more than I have, right? You've seen them anywhere from one to three times a week for God knows how many months.
Andrea Davis (28:07)
Yeah.
Right. Yeah.
Dr. Mc Millan (28:26)
⁓ before surgery and after. So if I'm doing something new and you or your team understand what I'm doing and why, you could then help reassure the patient, talk them off the ledge, maybe get them to me if they're concerned about going to surgery because they're scared and you're like, no, no, it's okay. Like go listen to this guy. He's not a cutter. He's, you know, I think therapists have always been the biggest referral source for us as physicians because if you do a good job, therapists talk, patients talk.
Andrea Davis (28:42)
Yeah, yeah.
Dr. Mc Millan (28:53)
And that helps reassure someone who's scared to maybe take the first step.
Andrea Davis (28:57)
Well, and people let, they wear it as a badge of honor as well. Like, you my surgeon, you should see my surgeon because I felt like this and he talked to me like that and now I can do this kind of thing. So there's definitely, you know, taking care of the whole person and you know, everything kind of flows around that. ⁓ the innovations, they just seem to keep coming progressively and AI is a big part of.
like, you know, the next frontier, so to speak. Do you have any thoughts you'd like to share on AI ⁓ in your world?
Dr. Mc Millan (29:27)
Listen, we
love AI. I can tell when a patient has used AI before they come into the room to ask about their rotator cuff repair. It's better than Dr. Google, but AI is there. And listen, we use AI. have a paper coming out on AI when it comes to taking your orthopedic board examination. How does AI do on it? So it's there. And like everything else, you can be afraid of innovation. You can abuse innovation, or you can understand it or try to.
Andrea Davis (29:32)
That's awesome.
wow.
Dr. Mc Millan (29:53)
and use it to your advantage. And I think that's what we're all trying to wrap our brains around right now.
Andrea Davis (29:57)
Yeah, no, I agree. Love AI, don't hate it. Think it's gonna, just like you said, I think you said it perfectly right down the middle. It can't be your absolute and you can't ignore it because it's not going anywhere, but you should learn how to leverage it, I think, in all areas, make your life work smarter, not harder, not anymore. Vans, great conversation. I appreciate it.
Dr. Mc Millan (30:18)
So listen, I will leave you with this, right? Dr. Davis, if you were coming into my operating room, and I usually give patients, they're still awake, I give them the chance to pick their radio station, all right? So you get to pick a Pandora station. Any artist, what are we listening to if you're coming into the OR? You're getting an ACL surgery done, what do you wanna hear going to sleep? Lithium. Okay, all right, nothing wrong with it. Listen, we've been on a creed kick, all right? So we've got...
Andrea Davis (30:20)
Yeah, yeah. Yes.
Okay.
⁓ Lithium, Series XM, lithium, yeah, like 90s grunge. Grunge, grunge all.
Ooh,
that's oldie buddy goodie.
Dr. Mc Millan (30:48)
Yeah, we somehow stumbled
upon the greatest 90 station. was a Creed Nickelback three doors down station the other day. I was back in college in my head. I don't know what happened, but it was great. ⁓
Andrea Davis (30:56)
All the same. They're all the same people. my God, that's
awesome. Listen, if people want to get in touch with you or your office and learn more about what you do, how can they find you?
Dr. Mc Millan (31:07)
So I got a website drschanmcmillan.com ⁓ or our office number which is the easiest way. It's going to be 856-470-9029.
Andrea Davis (31:21)
You're the best man. Nobody better right now. So thank you. I appreciate it. All right, guys. Yeah, you too. Thank you guys until next time. We'll see you keep working hard and keep expecting more.
Dr. Mc Millan (31:23)
Thanks, Andrea. Thank you. Have a great night.
