For performing a routine colorectal surgery, Dr. Claudius Conrad prefers the music of Bach, whose fugues and preludes mirror the methodical, structured steps of the procedure. But when operating on a patient with terrible burns, Conrad queues up techno or rap to set the right tone of tension and urgency.
Surgeons have long listened to music while they work – everything from classical to Celtic to rock. They say it helps them relax and concentrate.
But now Conrad, an accomplished pianist and a senior surgical resident at Massachusetts General Hospital, is scientifically testing how music affects surgeons, their patients, and even relatives in the waiting room.
The goal is to understand whether music can improve results of surgery, and whether it might be used as a medical treatment.
“We are already using music, but not in a standard protocol fashion,’’ Conrad said. “How can we make it a tool of everyday practice?’’
Despite the prevalence of music in the operating theater, the topic has not been intensively studied.
Fifteen years ago, a study in the Journal of the American Medical Association found that surgeons’ speed and accuracy in performing a stressful math task were improved when they selected their music instead of a piece – Pachelbel’s Canon – chosen by the experimenter. A 2006 survey of 171 doctors and nurses at three hospitals found that the majority of respondents listened to music on a regular basis in the operating room and 58 percent preferred classical music.
“It makes you more calm,’’ said Dr. Yehuda Ullmann, a surgeon at Rambam Health Care Campus in Israel, who reported results of the 2006 survey. “Maybe some patient will think if we are hearing the music, we are not so concentrated on the operation details. But it’s not in fact true.’’
The use of music in medicine is not new. As early as 4,000 BC, descriptions of music therapy appeared in cuneiform writings from Mesopotamia. Studies have shown music’s benefits in everything from dentistry to obstetrics.
What Conrad hopes to better understand is why, and how, music works. His interest in the soundtrack of operating rooms comes from his musical background. He attended a music school as a teenager, and during operations, listens to recordings of himself playing Mozart. His piano training helps him in the operating room, too.
In surgery, “you do something delicate that is comparable to a concert,’’ he said. “It’s a situation you want to do the most beautiful music possible, under the most stress.’’
Conrad’s research on music and medicine began when he investigated how music affects patients in the intensive care unit. In a study published in 2007, he tested the effects of music on a group of 10 critically ill patients. Half of them listened through headphones to the slow movements of Mozart piano sonatas for an hour, and half heard no music. Those who heard music needed less sedation, and had reduced stress hormone levels, and lower blood pressure and heart rate. That work motivated him to turn those same techniques on other parts of medicine.
“What he’s looking at is the subliminal effect that could produce a positive effect on performance. . . . If I’m in some difficult operation, maybe there is some positive effect on my physiology – not even on my conscious mood – that would translate into a better surgical performance,’’ said Dr. Andrew Warshaw, surgeon in chief at Mass. General.
To systematically test the effects of music in the operating room, Conrad created tasks for surgeons to complete on a computer simulator of laparoscopic procedures – surgeries that involve operating through a small incision. He tested the speed and accuracy of eight expert surgeons under different conditions: Surgeons performed the tasks in silence; while listening to Mozart; and accompanied by the chaotic, stressful noise produced by hearing a different stream of music in each ear – one, German folk music; the other, death metal.
He found that the folk and death metal mix increased the time it took expert surgeons to do the procedures, but did not affect their accuracy compared with silence. It also negatively affected their ability to learn a task: their accuracy did not improve when doing the task a second time while listening to the same music. While listening to Mozart, surgeons’ speed varied, but their accuracy improved compared with silence.
When Conrad tried the same test on 40 participants who had received no surgical training, he found that the Mozart music also had a beneficial effect when they repeated the procedure.
The studies are small and preliminary, but they suggest music may help with learning and indicate even the most proficient surgeons are not immune to stressful noises or distractions. Conrad hopes to conduct follow-up studies to understand how music affects people’s ability to learn a task.
Dr. David Rattner, a Mass. General surgeon who participated in the laparoscopy study, said music creates a comfortable and relaxing environment, but its effects seem to have nothing to do with any particular song playing on his iPod, which holds everything from classic rock to rap.
“I must say if I were operating and there was music going and you asked me what was on, I probably wouldn’t even remember what music was played,’’ Rattner said. “My own view is any sort of high-performance activity – you do better if you’re relaxed than if you’re tense.’’
Conrad is working with others at Mass. General to begin playing music in the emergency room waiting areas to see whether it has an effect on the relatives of patients, which will be measured by surveys.
“Music has been part of medicine since the beginning of cultural history,’’ Conrad said. “The music can be a unifying element that makes people work toward one goal: the optimal outcome for the patient.’’
Carolyn Y. Johnson | December 7, 2009