INSIDE MUSIC IN MEDICINE

WRITER: RICHARD T. BOSSHARDT, M.D., FACS

In the 1991 movie The Doctor, actor William Hurt played the role of Dr. Jack MacKee, a surgeon who undergoes a transformative experience when he is diagnosed with cancer. In one early scene, he is shown in the operating room. Music is playing, and he grabs a nurse and starts dancing around with her. At the time, I had been in practice for two years. I viewed this scene and my first reaction was “this is too much.” It just didn’t come across as realistic. However, that reaction is a tad ironic in that I have loved having music in the operating room going back to my time in the Navy in the mid to late 1980s.

The therapeutic effects of music are undisputed. There is even an entire field of psychotherapy that has put music therapy on scientific grounds. Studies show music can benefit patients in lowering stress, relieving depression, stimulating intellectual function, treating learning disabilities, rehabilitating people with brain injury, and even benefiting those with dementia. One of the recommended ways to forestall intellectual deterioration with age and Alzheimer’s dementia is to take up a musical instrument. There is even an official Certification Board for Music Therapists that oversees training and licensure of music therapists and the American Music Therapy Association, which serves as a professional organization that supports people in the field. Clearly, music can benefit patients in innumerable ways. Can it benefit medical professionals? Yes, indeed.

I am a passionate advocate for music in surgery. I can’t speak for what happened in operating rooms before my time but it is my impression that music there really took off when the media for recording and playing music became more practical. I cannot imagine a turntable playing vinyl LPs in the corner of an operating room! X-rays are commonly taken in operating rooms for a number of reasons, so most operating rooms are lead-lined. This makes radio reception problematic.

My early music source was a small boom box that played cassette tapes. While simple, they had disadvantages of being limited to one tape at a time; there was no capability to shuffle songs, so you always heard them in the same order; and the acoustics were mediocre. When compact discs came out, playing multiple discs and shuffling songs became a reality, and the sound quality certainly went up.

The true paradigm shift occurred with MP3 players and the ultimate one was, of course, the iPod. Now you could carry your entire music library in the palm of your hand — the newer versions are the size of a pack of matches — and play songs in any order. Plug one into a good quality amplifier with decent speakers and voilà, concert quality sound.

Speaking for myself, I could not imagine operating without music. There are two sides to the issue, and both can cite studies and data to support their position. I find music to be soothing; it helps me focus, and it relieves much of the stress inherent in performing surgery. I do feel some factors must be considered. My taste in music is pretty eclectic and the crew in the operating room usually responds favorably to it. Some surgeons like rap or heavy metal and play it loud. I have heard complaints from some nursing staff that this is unpleasant. I believe the volume should allow for normal conversation. There are certainly times when music is inappropriate. I ask for the music to be turned down or shut off when I need to listen for blood circulation in the surgical field. I usually turn off any music when patients are going to sleep to provide a quiet, calm ambiance for them. This also allows the anesthesiologist to listen for breath sounds when they put their breathing tube into the windpipe. The same applies to waking up.

Some issues do arise when music is introduced into the operating room. One is who gets to decide what gets played? I have always felt the surgeon should decide since he or she has the central role in the whole undertaking and it is in the patient’s best interest for the surgeon to be relaxed, focused, and yes, happy. Of course, one could argue that I am biased, and I would have to allow that this is possible. A case can be made for the anesthesiologist to be the arbiter of music in the OR. One can even argue for the nurses. After all, it is in everyone’s interest to keep the nurses happy. A democratic solution might be to rotate who gets to decide. Fortunately, I have seen almost no conflicts in this area.

Although no two surgical procedures are identical, most procedures have intervals when what is being done is fairly routine and repetitive. I feel music allows the surgeon to relax and get through these parts of an operation so it goes more quickly, smoothly, and pleasantly. Properly chosen music relaxes the operating room staff, as well.

I have done a number of surgical mission trips overseas. Operating in a foreign operating room in a developing country can be surreal and stressful. Things that we take for granted, such as proper anesthesia delivery, electricity, suction, cautery, and more, are often absent or available erratically. Couple those with cultural differences, language barriers and jet lag, the stress levels sky rocket. Having familiar music can be crucial in relaxing and settling the surgical team.

What about the patient having surgery? How does music affect them? I have seen some studies out of Europe that have shown when patients are given their choice of music and fitted with headphones during surgery, they require less anesthesia for the same procedure. This is routinely done in some medical centers.

And dancing? Well, I have not grabbed a nurse to swing her (or him) around in the operating room. I do recall, however, that at the end of a successful mission trip to Venezuela, I was finishing my final case on the last day when someone down the hall turned up the music and an honest-togoodness conga line of doctors, nurses, and other staff snaked in one door of my room and out the other!