A few years ago, I had an experience while attending a music retreat that emphasized the importance of a comprehensive approach to teaching. I had been studying music theory on my own prior to the retreat. During the retreat, I attended group lessons on music theory which reinforced some of what I had been trying to learn on my own. My fellow learners were mostly more experienced in reading music and piano playing than I was, but I was surprised to note that some basic concepts in music theory that I was familiar with seemed new to them. It made me wonder why music theory and performance were so often taught separately.
My knowledge of music theory has helped my piano playing and I think about how much progress I could have made in the past if I had understood concepts such as chord progressions earlier on.
I observed a parallel in the evolution of medical education — how the basic medical sciences were traditionally taught in complete isolation from the clinical sciences — and to some extent, from each other. What now seems so logical — the integration of basic and clinical sciences — is a relatively new phenomenon in medical education. It makes sense to learn about the clinical manifestations of a torn meniscus of an athlete while learning about the anatomy of the knee or how to insert a speculum while studying the anatomy of the female pelvis. So why wasn’t this approach taken all along?
During the retreat mentioned earlier, our piano instructor gave us an assignment that involved identifying the chords in a piece of sheet music. I was working on the assignment with another student and we got stuck on one of the chords, thinking one of the notes was missing. Our instructor later told us that the “missing” note was actually in the bass clef, while we had been focusing on the treble clef! It now seems obvious that we should have been analyzing the notes in both clefs simultaneously, but we hadn’t done that. On the other hand, if I had learned about chords when I first learned how to read sheet music, I would have understood that chords are formed when notes are played simultaneously, regardless of which clef they appear on in the sheet music.
In medicine, concepts make more sense and are easier to remember when they are learned in the context of patient presentations — whether it is an actual patient with the condition or a discussion about how such a patient would present. However, even in case-based learning, because medical students learn about diseases according to systems, they can easily start thinking that patients present with isolated symptoms. Medical trainees need to realize that patients don’t present according to systems. While using the systems-based approach to teaching pathophysiology makes sense from a developmental perspective, medical trainees need to be prepared to think about the patient as a whole, just as with sheet music, the notes in both clefs need to be considered simultaneously.
The ability to make a diagnosis and formulate a treatment plan depends on the ability to put things together in a logical and coherent fashion., just as playing the appropriate notes in addition to a melody creates harmony in music. Neglecting to consider important factors such as ignoring the bass clef note in the above example, may be excusable in certain circumstances (such as a music lesson), but not when a person’s life may be hanging in the balance.
Another lesson from my musical retreat experience was the importance of learning to listen. We were given the opportunity to work on pieces and perform at a recital at the end of the retreat. I played a piano duet, which required a lot of effort and practice on my part. I discovered how important it was to listen to my duet partner — to play at the same speed, pay attention to the rests and play in harmony. The pieces sounded very nice when played together, but my part didn’t sound as interesting when played alone.
The same listening skills required of musicians are essential when it comes to patient care. As Osler once said, “Listen to your patient…he is telling you the diagnosis”. Listening to the patient’s story not only strengthens the doctor patient relationship, but in some instances, may also avoid unnecessary testing with the attendant expenses.
Music and medicine have been described as having a symbiotic relationship that improves listening and communication skills. (1) Effective communication is essential for patient care and can be enhanced through musical training. For example, the listening skills developed in musical training are invaluable when it comes to using a stethoscope to listen to heart sounds. A musically trained ear is more likely to recognize a subtle heart murmur than an untrained ear.
Music and medicine have a lot more in common, including the diligent practice that is required to excel in both. Diligence, perseverance and attention to detail are essential for musicians and physicians alike. It has been argued that music and medicine both involve being “in the moment” with others. Good doctors need to be “in tune” with their patients, just as good musicians have a connection with their listeners. (2)
It is no wonder then that there are so many medical professionals who have combined their passions for music and medicine and excelled in both, but that is a subject for another essay. People who are interested in both fields of endeavor should be encouraged to explore ways of combining both interests. The resulting synergy that can be expected is perhaps best captured in this quote from Steven Scheinman, MD, Dean of the Geisinger Commonwealth School of Medicine, “Medicine is a rewarding career, and I could not be nearly as good a doctor, or as open to my patients, if I didn’t have the arts in my life.” (3)
1. https://news.harvard.edu/gazette/story/2016/10/finding-harmony-in-music-and-medicine/. Accessed August 12, 2020.
2. https://www.mededpublish.org/manuscripts/1914. Accessed August 12, 2020.
3. https://www.nxtbook.com/hoffmann/NEPA_VitalSigns/NEPA_VitalSigns_SummerFall2019/index.php#/p/20. Accessed August 14, 2020.
by Olapeju Simoyan, MD, MPH
Olapeju Simoyan is the Executive Director of Research at Caron Treatment Centers and a full professor in the Department of Psychiatry at Drexel University College of Medicine.