Music Lessons: What Musicians Can Teach Doctors (and Other Health Professionals)

Content Provider	Semantic Scholar
Author	Davidoff, Frank
Copyright Year	2011
Abstract	Music has a lot to offer medicine. Listening to music can clearly put us in touch with our own feelings; hearing the Brahms Alto Rhapsody pulled the author William Styron back from the edge of suicide (1). But whether it can sensitize us to what other people are feeling and make us more empathic or compassionate as caregivers remains an unanswered question. After all, Adolf Hitler was a passionate opera lover, but hearing opera (or at least Wagner's librettos) seems to have only fed his destructive fantasies. It is famously risky to generalize from extreme examples, but these reflections suggest it might be fruitful to explore other, more pragmatic approaches to what music and, particularly, musicians have to teach us. Exposition Understanding how professional musicians are trained may help us think more clearly about better ways for physicians, as well as many other health professionals, to become and remain expert practitionersinterviewers, diagnosticians, proceduralists, therapists, managers, or innovatorsand ways for our teachers and mentors to help us achieve high levels of performance. Examining the structure of music and musical careers may also reveal important insights into the structure of clinical practice. Development At least 10 aspects of the professionalization of musicians offer lessons on how health care practice might be learned, taught, and accomplished more effectively. Performance Although musicians must master at least some of the cognitive aspects of music (history, theory, harmony, and elements of style), at its core all music is a pure distillate of real-time performance. The word performance sometimes implies that what is being seen or heard is somehow not to be believed, not real, but great performances in music are above all authentic. Picasso probably captured this seeming paradox best in his comment that Art is the lie that tells the truth. The lesson: Although medicine is inarguably a learned profession, clinical practice is above all a matter of performance, in the best and deepest sense of the word. However, the performance aspect of medicine has been overshadowed in the past 150 years by the irresistible pressure to master an enormous, complex, and ever-changing scientific knowledge base (2, 3). Recognition of music's laser-like focus on performance could help us regain a more appropriate balance in medicine between knowledge and performance (between knowing and knowing how). Coaching Musicians learn to play music by playing it, by moving repeatedly through cycles of experiential learning. But experiential learning is only successful when it includes all parts of the cycle: live, hands-on experience (real or simulated); reflective observation (what happened? what went right? what could have gone better?); abstract conceptualization (finding explanations for why things happened the way they did and proposing ideas for how they might be done differently); and further active experience (4). Endless performance without feedback drifts into stagnation, whereas endless reflecting and conceptualizing without performance wanders off into pedantry (5). The lesson: Great teachers in music are coaches, not lecturers. Coaches watch, listen, and provide the feedback that closes the experiential learning cycle; that helps learners acquire the advanced professional skills of reflection-in-action and reflection-on-action that they need to become expert performers (6). It is not coincidence that Donald Schn observed teaching sessions in both medicine and music in his now-classic field studies of how practitioners in applied disciplines acquire their expertise (6). Although knowledge transfer will always be a basic element of medical education, lectures, readings, and discussions are enabling elements of experiential learningmeans, rather than endsand coaching at the highest level is the appropriate model for clinical teaching. Unfortunately, mastery of coaching in medicine is still not seriously taught, rewarded, or studied (7). It must be. Stardom Outstanding musical performers, the stars and superstars, provide budding musicians with goals, models, and inspiration, but even the greatest orchestras and bands are made up of strong rank-and-file performers, not stars and superstars. Moreover, great musical performers are rarely great teachers, and great teachers in music are rarely great performers (8). Performance and coaching require vastly different personalities, goals, skills, and experience. The lesson: Few health professionals become international experts, which is just as well, because neither health care delivery nor medical education could function if they depended mostly on superstars. The small number of master clinicians who become exceptional teachers apparently do so by learning to step away partially from their performance role even while they are performing, which lets them help their students move back and forth between being actor and observer (9). We do not know how those teachers acquire that particular multitasking ability. We need to find out. Talent Although many professional musicians have perfect pitch (the ability to know the exact pitch of a note when hearing it), it is not essential, and many wonderful musicians lack it (10). And although biological gifts undoubtedly factor in, it is increasingly clear that the most important factors in becoming an accomplished musician are training, practice, and experience, rather than some vaguely defined quality of talent. The lesson: Just as a person with a tin ear would be ill-advised to choose a career in music, a person who faints at the sight of blood or is uncomfortable when talking with people should probably steer clear of a medical career. But it is equally reasonable to expect that almost anyone with certain basic abilities (for example, a stable personality, lively curiosity, good problem-solving skills, a moderately hypertrophied work ethic, and a deep satisfaction in relieving other persons' distress) can become a terrific physician without also needing the medical equivalent of perfect pitch or other similar gifts. Time Achieving a high performance level in any musical style or tradition requires time, and a lot of it (and classical musicians may need even more time than others). Elapsed time is not the issue; in music, as in all professions, the real essentials are the extended, focused involvement with every aspect of the discipline and the hours of practice (11). The lesson: Medical school and residency together already involve at least the estimated 7 to 10 years of focused involvement and 10000 hours of practice needed to go beyond deliberative rationality to the level of true professional expertise (11, 12); surgeons may need substantially more time to master both the cognitive and technical aspects of their specialty (13). Because current medical training is riddled with inefficiencies and has become almost intolerably expensive, medical educators are now exploring accelerated systems for training to competence (7). Although such programs seem both rational and promising, they need to be approached with caution, lest we end up creating cohorts of prodigies rather than wise decision makers and mature healers. Growing up takes time. Art Musical performance can be technically brilliant but cold and mechanical; the flip side is that it can instead be artistically exquisite but technically sloppy and out of control. Masterful performance requires musicians to attain prodigious levels of technical skill, while at the same time going beyond technique into the domain of true musicalityfinding a way to put themselves into the sounds they make, the way Glenn Gould entered into Bach and Louis Armstrong into Dixieland. The legendary pianist Vladimir Horowitz is reputed to have said to a woman who told him she loved watching his hands as he played, Thank you, madam, but what makes you think I play with my hands? The lesson: Medicine is not just science, but a professional, science-using, inter-level interpretive activity taken for the care of a sick person (14); it is, as is often said, both science and art. Unfortunately, the lesson from music is unclear here, because we know musical technique is teachable but do not understand the sources of musicality (15) any more than we understand the sources of the personal strengths, limitations, or styles of health professionals. Exploring the nontechnical aspects of performance should be a serious research endeavor in both disciplines. (Neuroscience might even help.) Practice Musicians know that performance skill degrades rapidly over time and therefore spend much more time practicing and rehearsing than performing in public, both during training and throughout their careers. (Many professional musicians continue to take lessons for years.) A widely known saying among musicians, attributed to various musical giants, is, If I don't practice for a day, I know it; if I don't practice for two days, the critics know it; if I don't practice for a week, everyone knows it. The key here is the nature and quality of the practicing, not just the hours spent; its essential element is mindfulness, being really present while practicing, rather than mechanically repeating motions. The single most important piece of advice on practicing is listen (made easier these days by easy access to high-quality recording equipment), but slow it down and break it into parts are close runners-up. At its best, practicing includes learning how to practice; it involves both reinforcing what is already known and pushing the envelope into what has not yet been mastered. The lesson: If dedicated practice is an essential element in clinical teaching, the current clinical training system seems to come up short, although the increasing use of feedback from audio and videotapes, role-playing, and simulations are steps in the right direction (7). Extensive time in real-world clinical practice teaches many unique and
Starting Page	426
Ending Page	429
Page Count	4
File Format	PDF HTM / HTML
DOI	10.7326/0003-4819-154-6-201103150-00009
PubMed reference number	21403078
Journal	Medline
Volume Number	154
Alternate Webpage(s)	https://cell2soul.typepad.com/files/davidoff---music
Alternate Webpage(s)	http://www.etsu.edu/com/cme/documents/apolloWhatMusiciansCanTeachDoctors.pdf
Alternate Webpage(s)	https://doi.org/10.7326/0003-4819-154-6-201103150-00009
Journal	Annals of Internal Medicine
Language	English
Access Restriction	Open
Content Type	Text
Resource Type	Article