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Extemporaneous Exchanges Play Well in Jazz and Medicine

Posted By Prucia Buscell, Monday, September 17, 2007
Updated: Tuesday, February 15, 2011
"Man you don’t have to play a whole lot of notes. You just have to play the pretty notes”.
Trumpeter Miles Davis

Paul Haidet, a physician, former disc jockey and amateur jazz historian who has studied doctor-patient communication, marvels at the parallels between jazz and medicine. Gary Onady, a physician and jazz trumpeter who composes and arranges music, uses musical metaphor to describe patient-clinician interactions.

In his article Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter, Dr. Haidet writes that good communication results in fewer medical errors and a variety of good social, psychological, and biological outcomes. Further, he suggests jazz improvisation is a guide to the kinds of moment-to-moment decisions a doctor must make—what to say next, how to structure a question, when to let the patient keep talking, when to move on—that bring about high quality communication. Dr. Haidet’s story is instructive because he cites the artists and musical selections with the sounds that open new ways of examining the subtle, contextual and subjective experiences that are woven together when people try to share knowledge and meaning.

Dr. Onady, who has an academic career in medicine and pediatrics, is a member of the Eddie Brookshire Quintet, which just released the CD Base Notes: The Heart Beat of Jazz. He has developed a workshop that includes an introductory lecture on Jazz Improvisation and Physician-Patient Communication. He uses the "minimal structure theory” of jazz along with jazz improvisational tools for solving patient problems in a turbulent medical environment.

Consider what Dr. Haidet calls the communicative act of creating space. "I have found the act of providing communicative space to the patient to be one of the one of the most powerful yet underused skills by physicians,” he writes. We have a cultural inclination to be uncomfortable with silence and pauses, he observes, so the ability to create space in our encounters takes discipline and practice. Dr. Haidet, an internist at the Michael DeBakey VA Medical Center who also teaches at Baylor College of Medicine in Houston, TX, says when he is with a patient, he often thinks of how Miles Davis used his intuitive sense of space and time in his music. Davis was also exquisitely attuned to his surroundings. "We play what the day recommends,” he once remarked.

"He conserves notes, plays at a relaxed pace, plays on the ‘back end’ of the beat, and drops musical hints that allow listeners to use their imaginations to fill in the phrases,” Dr. Haidet writes of Davis. The result, he continues, is that the listener hears not only the solo, but what the rest of the band is playing. If you listen to a piece like his All Blues, you will see what he means.

Dr. Onady, in a written response to Dr. Haidet’s article, recalls using the concept of musical space in his own medical practice to help evaluate a patient who had received several conflicting diagnoses. "Giving the patient space to provide her own descriptive phrases, accented by arm and hand gestures much as a conductor uses to conduct an orchestra, the cause of her illness became obvious…”he wrote.

Like jazz musicians, Dr. Haidet writes, doctors need to develop their own improvisational voice. He notes the evolution of saxophonist John Coltrane’s"sheets of sound”, the high speed arpeggios so wide ranging and densely packed that the notes run together. In similar fashion, physicians need to master the basics of patient-centered interviewing to develop a personal style that honors their own humanity as well as that of their patients. It’s the kind of skill, he says, that enables the physician to "show up” in encounters where bad news is delivered. For the kind of respect and sharing that is critical for physician understanding of a patient’s illness perspective and the patient’s understanding of the biomedical processes the illness involves, Dr.Haidet turns to ensemble improvisation. As an example, he suggests Waltz for Debbie, by pianist Bill Evans and bassist Scott LeFaro, an intricate flowing musical conversation. Just as musicians "talk to” each other with their instrumental skill and personal style, cultivating ensemble in medicine means doctors need to go far beyond collecting data when they encounter patients.

Dr. Haidet’s article appeared in the March/April 2007 issue of the Annals of Family Medicine. Click here for the supplemental appendix where you can hear the music Dr. Haidet suggests. The Eddie Brookshire Quintet’s new CD, soon available for purchase on CD Baby, contains song Surrendered Life, written by Eddie Brookshire with Dr. Onady on flugelhorn.

Tags:  buscell  complexity matters  medicine  music 

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