Medics & Maestros: Exploring the past and present relationship between music and the healing arts

#byMarybethConnaughton

When one thinks of a physician’s most essential instrument, it is more likely to be the stethoscope than the flute. And yet, without the influence of the latter, the former might never have been invented.

Made of wood and brass, this is one of the original stethoscopes designed by Rene Theophile Laennec (1781-1826) in 1816

In 1816, French physician and amateur flutist Rene Laennec (1781 - 1826) was looking for an alternative to direct auscultation — the method of placing one’s ear or hand directly on the patient’s chest to hear their heartbeat. Often, if a patient carried too much weight, this method would prove ineffective, and Laennec wanted to maintain a respectful distance from his patients, particularly the young women. In an attempt to find a solution, he rolled a sheet of paper into a cylinder shape and placed one end to his ear and the other to the chest of one patient, utilizing the acoustics to amplify the sound of the patient’s heart. After some experimenting, Laennec carved the first incarnation of the stethoscope out of wood, a hollow cylinder which collapsed into two parts that very much resembled his beloved flute.

Photo of Theodor Billroth in 1887

Though it might be surprising to learn, history abounds with examples of music and medicine overlapping. Perhaps the most archetypal example of the medical musician is 19th century Austrian surgeon Theodor Billroth (1829 - 1894) whose legacy bridges the perceived gap between the two worlds, since his influence remains so firmly planted in both.

Of the inordinate number of achievements and innovations throughout Billroth’s career in medicine, most notable is his designation as “the founder of abdominal surgery,” having performed the first successful gastrectomy, and having had two gastric surgical techniques named in his honor, Billroth I and Billroth II. He was also a very talented piano player and violinist, and though he had chosen a career in medicine out of a sense of obligation to his family, his first love remained music. This passion laid the foundation of a dear friendship between Billroth and German composer and piano virtuoso Johannes Brahms (1833 - 1897).

It was Billroth whom Brahms trusted most to critique his compositions before he debuted them in front of an audience. Brahms gave Billroth first look at his musical manuscripts, in hopes that the surgeon would be as exacting with his pen as he was with his scalpel — though he was enraged when at one point, Billroth physically cut out a line from one of the composition sheets. Billroth opened a room in his home to host trial performances of Brahms’ chamber pieces, often joining in himself on violin, and generally helped to promote Brahms’ as his star rose in Vienna’s musical setting. In recognition and gratitude for his friend’s contributions to his own career, Brahms dedicated his two Opus 51 string quartets, No. 1 in C minor and No. 2 in A minor, to his friend. These have come to be known, like his surgical procedures, as Billroth I and Billroth II. “It is one of the superficialities of our time to see in science and in art, two opposites,” Billroth once wrote. ”Imagination is the mother of both.”

In her book Scales to Scalpels: Doctors Who Practice the Healing Arts of Music and Medicine (2013), Dr. Lisa Wong, a Boston-based physician and violinist, estimates that about 80 percent of her fellow doctors studied a musical instrument during their developmental years. She believes this played an integral role in their ability to study medicine later on, as learning to play an instrument develops neurological connectivity, and makes room for the absorption of information. ”Playing music in childhood helps wire an information highway in the brain,” she says. “Once those highways are established, you can put science through that.”

John Dani, chair of Neuroscience at the University of Pennsylvania’s Perelman School of Medicine, calls playing music a total “work out” for the brain, and it’s easy to see where those strengthened brain functions support better performance in various medical practices. For example, he says, when playing an instrument, such as the violin, the left and right hands perform separate actions. This engages the peripheral nervous system, which is responsible for both gross and fine motor skills, which, in turn, are crucial to, say, performing successful surgery. While playing an instrument, one is taking in visual, auditory, and emotional input simultaneously, not unlike the kind any doctor would experience in a busy hospital. Musicians, when playing, must fully concentrate on the musical passage directly in front of them, while simultaneously anticipating the next one. This calls upon the “executive function of the brain” which is to plan and make decisions, crucial functions for any doctor, particularly those in an emergency setting.

In an article entitled “Medical Musicians” in Interlude magazine, Dr. Lily Vrtik, a plastic surgeon in Queensland, Australia, was asked why there is such an overrepresentation of doctors in music, more so than in any of the other arts. She replied: “The work ethic, the commitment and the tenacity which we learn from musical training (that) drives us in all aspects of life, and thus translates to our success in academia and drives us to higher professions.” In the same article, Dr. Myles Lee, former cardiac surgeon, offers simply that musicians and doctors, surgeons in particular, get satisfaction from “bringing order out of chaos.”

Orchestra Musical Instruments (1917)

These doctors speak from experience, as most of them are members of or associated with various doctors’ orchestras that an increasing number of today’s medical musicians are joining or forming in major cities throughout the world. Dr. Wong is the former president of the Boston’s Longwood Symphony Orchestra (LSO), Dr. Vrtik is a manager with the Queensland Medical Orchestra and Choir, and Dr. Lee is the president of The Los Angeles Doctors Symphony Orchestra. Other similar organizations include the Australian Doctors Orchestra, and the European Doctors Orchestra and the World Doctors Orchestra.

Comprised of physicians, health care professionals and medical students, these ensembles are voluntary and not for profit, and often put on performances that raise money and awareness for medically related causes, such as AIDS, diabetes, domestic violence, hunger, and homelessness. However, those who participate should not be mistaken for hobbyists. Many are semi-professionals, and take their musical pursuits as seriously as they do their medical careers, believing that each art (and many consider medicine to be an art) complements and improves the other in tandem.

To begin with, time spent in orchestra rehearsal replenishes a physician’s exhausted emotional and mental reserves, which in turn allows them to give themselves fully to the next patient. This lends new meaning to the phrase medice, cura te ipsum, which translates to physician, heal thyself. Dr. Susan Pauker, Chief of Medical Genetics at Harvard Vanguard Medical Associates tells Dr. Wong in “Scales to Scalpels” that playing with the Longwood Symphony Orchestra, “helps me do my job. It refills my tank in a way that allows me to give to my patients. I give all day long...to my patients, and this is a chance for me to receive healing.”

Sphygmomanometer

What’s more, the kind of stress doctors experience at the end of a shift is more than just the average rough day at the office. In a single day physicians can witness the worst in human suffering and grief. Dr. Heidi Kimberly, an emergency room doctor and violinist with the LSO, explains to Dr. Wong in her book: “When you’re a doctor, the intensity of it comes home to you, literally. I go home and lie in bed and think about my patients all night. And I wonder, ‘Did I do the right thing?’” Further compounding this undue stress is that outside of the medical setting, there aren’t many people who can relate to it. Orchestra rehearsals offer a sort of cloistered haven where doctors all understand what the other has been through without having to say a word. The sustained and intense focus required to play one’s instrument doesn’t allow for intrusive thoughts or distractions. “When you’re playing music,” Kimberly says, “you just can’t have other thoughts in your mind.”

The most essential skill required of musicianship is the ability to listen well, a skill many patients feel is lacking from their increasingly distracted and harried health care workers. Many express the desire for a more collaborative experience with their physician, where they can reach a common solution. Regular practice in actively listening to fellow players across several instrument sections expands doctors’ receptivity and perceptivity to patients and their concerns about their health. Physical therapist Denise Latufo explains: “When I’m playing cello in the LSO, I have to listen carefully all the time. You learn to listen whether you’re sharp or flat and when you’re playing a note in tune. That helps me listen for the right information from the patient.”

Modern Medicine

Even being unable to listen can bring a doctor closer to the patient sitting across from him, by gaining an understanding of how it feels to be overwhelmed, and unable to keep up with what one doesn’t understand. Dr. Tom Sheldon, a New Hampshire-based radiation oncologist recalls joining the LSO decades after putting down his oboe, and struggling to keep up with the group. “Here I am, a respected senior physician, and I start playing in a high-quality orchestra on a difficult instrument after a twenty-year hiatus,” he recalls. “There is a lot to listen to and follow in orchestra playing, and I just could not separate it out. So much of it was confusing noise.” Of everything music can teach a doctor, a sense of empathy might be the greatest one.

For all that music enhances a doctor’s practice, it’s a wonder that it’s not a mandatory part of a med student’s curriculum. They form such a harmonious union.

Note* All images are either Fair Use or in the Public Domain.