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Jazz and the art of medicine

If being a student of medicine is akin to learning theory, scales, arpeggios and learning how to play a passable Für Elise, practicing medicine in the real world is more like playing jazz — it involves the ability to improvise.

In his article Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter, Dr Paul Haidet emphasises the role of improvisation in the patient encounter and in good medical communication. The reality is that no amount of training in the biomedical sciences adequately prepares us for the messiness of applying medical knowledge to human beings in the wild: “Although physicians often follow biomedical patterns of inquiry, a patient-centred care ideal calls for adjustments to, and departures from, these patterns in response to concerns and perspectives voiced by the patient.”

He suggests that learning to improvise in medicine has a number of important parallels with learning to improvise in jazz — and that we might even be able to learn something about the practice of medicine from listening to jazz.

Developing a voice

After learning the basics of Jazz — chords, scales, some jazz standards — and after serving an apprenticeship, jazz musicians begin to develop their own voice and unique style of playing. Haidet uses the example of jazz saxophonist John Coltrane to illustrate this.

Although the hallmark of Coltrane’s sound are solos featuring extraordinary ‘sheets of noise’ — explosive runs of blisteringly fast notes which seem to blend into one another — his unique voice took many years to develop. Coltrane’s earlier work and solos featured relatively unexciting interpretations of the jazz standards of the time. His mature voice developed after years of playing but also after a period of intense self-reflection of his life, goals, his music and his spirituality.

Basic communication skills for doctors, Haidet suggests, are like the scales a musician must master.

Common communicative scenarios, eg, ‘breaking bad news’, ‘counselling for behaviour change’ and ‘conversing about end-of-life issues’ are like the songs that a musician must learn. After a time mastering these, doctors will begin to infuse these communications with their own style — not always adhering to strict guidelines or to the music on the page — knowing when to add humour, when to take risks, when to push and when to yield, and knowing when to stop altogether.

Creating Space

For good improvisation, a space must be created in which improvisation can take place. To understand the importance of communicative space in medicine, Haidet uses the example of the playing of Miles Davis.

“To hear a solo by Miles is to hear space. Miles does not play a lot of notes, he just plays the right ones. He conserves notes, plays them at a relaxed pace, plays on the ‘back end’ of the beat, and drops musical hints that allow the listener to use their imagination to fill in the phrases.”

Basic communication skills for doctors, Haidet suggests, are like the scales a musician must master. 

In medicine, he suggests, we should strive to use communicative space, as Davis did. This might involve the use of silence, pauses, a change of pace and taking care in the application of redirections (interruptions, changes of subject). We should allow space to let our patients say what they want to say, using our communications to gently lead them through telling the narrative of their illness from their perspective, rather than force them to follow a biomedical perspective.

Quoting Miles Davis: “Man, you don’t have to play a whole lot of notes. You just have to play the pretty ones.”

Cultivating ensemble

Perhaps the most difficult thing to master, even after developing a unique voice, is learning how to play with others. Learning to have a musical conversation with others often means adapting one’s own voice — after making space for, and being attuned to and responding to, the musical perspectives of others. This happens through developing a particular kind of listening, picking up on key musical cues, and being very attuned to subtle changes in emotion and to non-verbal cues.

Good improvisation, it seems, has as much to do with observing than playing. Whereas some doctors need reminding about the identity of the most important voice in the medical encounter, improvisation even allows for the possibility of more than one soloist to be heard simultaneously. If done well, numerous voices can be heard in an ensemble, to the point where it might not even be clear who the soloist is.

‘The essence of ensemble,” according to Haidet, “either in jazz or in medicine, lies in looking beyond one’s own perspective to see, understand and respond to the perspectives of others.”

Medicine, it seems, has more in common with jazz than we might have thought. Improvisation allows us to bend the rules of tradition to make room for our own humanity and that of our patients. Although the perfect musical performance, like the perfect medical encounter, may be rare in practice, we know it when we hear it.

Further reading: Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter; Haidet, P. Annals of Family Medicine; Vol 5, No 2, March/April 2007. Further listening: www.ronankavanagh.ie/Jazzplaylist.

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