Music and surgery: Focus or distraction?
Christmas Day is fast approaching. As we approach this holiday season, many still have to work in hospitals because of the call of duty. Maybe, for the surgeons out there, you could try a little music in the OR, if you don’t already?
Which begets the questions: As a surgeon, do you play any music during surgery? As a patient, would you like your surgeons to be listening to any music during your life-saving procedure? Will it help them focus? Or is it a form of distraction?
Why don’t you be the judge and listen to the following as you read the following article: (its an .mp3 file, so a fast broadband will ensure no intermission)
Susan Schwartz, a Montreal Gazette reporter , and Dr. Alan I. Benvenisty, M.D., a general/vascular surgeon at St. Luke’s Roosevelt Hospital Center join us to explain in “The Many Soundtracks of Surgery“. Susan also reports in the following articles “Surgery’s many soundtracks” and “What’s on surgeons’ playlist?” Interesting reads. Highly recommended. Below i list some take-away points:Having music on whilst the operation is going on happens in operating theaters run by younger surgeons. Dr Alan mentions that these “younger surgeons recognise they are part of a team, and they are the captain, and are conscious of the fact that they want the team to be happy and relaxed, and comfortable in the OR/OT.”
(i wonder what the senior surgeons think about this. i have no idea how young Aggravated DocSurg is, but his sheer knowledge of music in this post swept me away.)
In addition, according to Dr Alan, the volume must be low such that the music is only in the background. There are many distracting sounds in the OR, which are more distracting than the background music. Some kinds of music encourage organised thought, he claims. (photo credit)
However, it wouldn’t take much of a genius to know that music tastes differ. Also, differing levels of musical backgrounds may affect performance levels of an operating team. A concert pianist operating might find music distracting, for example. I guess it boils down to personal preference; a surgeon who used to study with the music on probably might enjoy having music on in the OR/OT as well. Music to my ears may not be music to yours., as Aggravated DocSurg shares with us. (photo credit)
Patients’ (and personal) perspectives
Dr Alan mentions that his patients like it with music playing, especially those on local or regional anaesthesia. It is a diversion for their thoughts and might allay fears. There is even a blog called “Surgery with Music“. It is:
“devoted to informing people about the documented benefits of music for the patient during surgery. Many surgeons now use music in the OR, but few people are aware of the benefits for them of having their own music through headphones.”
I had a personal experience with a mole excision some time back. The music in the background was some local radio channel. Being a medical student, i actually wanted to hear what went on at each step, but was too afraid to ask the plastic surgeon to describe what he was doing each step of the way. I strained myself to listen to his conversations with the other staff. He noticed soon after making the 1st incision and asked me to “just relax and listen to the music…!” (in a c’mon tone) This I did and found myself “enjoy” the surgery much more.
“Do doctors take requests from patients?” was another question asked in the interview and the candid reply came “yea why not?”
Benefits for patients
A pilot study (Patients’ perceptions of music during surgery) conducted at an acute hospital involved interviewing 25 patients who, through an attitudinal scale and their interview responses, revealed positive support for the music that they listened to during their operation. Their remarks focused on the ability of the music, as a familiar personal and cultural medium, to ease their anxiety, to act as a distractor and to increase their threshold of pain.
A search on PubMed reviews other research, like “Music and the surgical patient. The effect of music on anxiety”.
Also, for patients under spinal anaesthesia, it seems that it is possible to decrease sedative requirements during surgery under spinal anesthesia by allowing patients to listen to music to reduce their anxiety, well at least according to this 2001 study by Lepage et al. The results of this study indicate that music is an effective anxiolitic adjunct to flexible sigmoidoscopy.
Well so far it seems that patients under GA would have no benefit from ‘listening’ to the music played, as an investigation into “the effect of music on the neurohormonal stress response to surgery under GA” revealed, contrary to what some might claim.
Benefits for surgical team
This is something i am actually more interested in, and hope that readers who are surgeons can comment. It seems that music has a positive effect as this JAMA article concludes,
“Surgeon-selected music was associated with reduced autonomic reactivity and improved performance of a stressful nonsurgical laboratory task in study participants.”
Audio Slide Show: Soundtrack for Surgery
Dr. Brian Jacob, a general surgeon at Mount Sinai Hospital in New York who specializes in laparoscopic and stomach stapling surgery, said music helped everyone in the operating room.
“You’re basically sending a message to the people around you that it’s a cool place to be,” he said. “I found I get a lot done when I have U2 in the background,” he said.
Downsides – “I hate the Attending for his/her choice of music!”
In a survey of 200 anesthesiologists published in 1997 in the British journal Anaesthesia, 72 percent of respondents said music was played regularly in their operating rooms. About 26 percent felt that music “reduced their vigilance” and interfered with communication. Half felt that music was distracting when they encountered a problem.
Imagine getting stuck in the OR with a surgeon who constantly plays the same song over and over again. Now, that wouldn’t be nice. But perhaps, i overheard a voice (medical student fearful of getting pimped) saying “as long as it keeps him or her happy?”
What not to play!
Nope, no “killing me softly”.
Choosing which song to play
This video is hilarious. “Nurse! Erasure!” i like this song, btw, and when i’m an attending in the far far away future, i’ll make sure my OR has this song to start the day! (do turn off the christmas song above first, i highly recommend watching this)
References:
As an anesthesia provider, I love listening to good music and toons in the OR. But as a patient, I would rather that no one was paying attention to anything but me. Good article!
Congrats on making the WordPress front page, Jeff. I like music in the OR, usually. It does seem to make people happier and more relaxed. I don’t like most modern music, though (country/rock/etc), so I look forward to being an attending so I can put classical music on. I am concerned that my favorite kind of music, masses or cantatas by Haydn/Bach/Mozart might be too distracting, since I like to pay attention and follow the Latin words.
Very nice article; thanks for all the links.
In my OR, it’s “no music, no operating!” And, please, no radio — too many morning talking heads and commercials. I will sometimes ask patients what music they want to listen to on the way in, but generally we keep it quiet until the patient is asleep. And we listen to (almost) everything — the only absolute “nevers” are rap and opera.
In my case Music was a must in the OR. Kept me focused and relaxed than stressed out and embarrased while doing my internship rotation in Surgery back home in Africa. The team also relaxes and the chitchat suddenly dies down all attention is on the patient. You can be suprised without music the theatre can be like a market place, the team cracking jokes which can be very inappropriate at times.
I recently had my third knee surgery and, for the first time, heard music playing as I was wheeled into the OR. I wouldn’t have minded except that it was rather indie-ish music and I almost felt like I’d been wheeled onto the set of “Grey’s Anatomy.” (My parents asked if the surgeons discussed their sex lives during the operation, but, thankfully, I was completely out and have no idea what they discussed during the procedure.)
Wonderful article! As a general surgeon who has a specific passion for music (see my website), I would say the following.
Surgery is very much about concentration, and at the same time a team effort. Therefore, it depends on who is on your team, and how they react to certain types of music, whether it should be turned on or off. Since the instruments are being handled by the surgeon (the ‘pilot’ on this ‘flight’), he/she should have the final say in whether or not music is being played, and which type of music. However, he/she should take into consideration what the other team members think of his choice, since this will influence the mood in the OR greatly, and therefore may influence the fluency of the team effort.
If the patient is able to hear the music, then it should be entirely according to the patient’s wishes. It should be avoided with the utmost effort for the patient to hear any music by accident or involuntarily. The team should never turn on the music without asking the surgeon’s permission. This way it is always clear who is in charge of this issue, and responsible for it. Every surgeon knows that part of his/her work during an operation, is to be in control of his team and his/her environment.
The patient is always at the very centre of the whole team’s attention – so to sum it up, anything that helps us all work better and is in the patient’s interest should be done, including music if it applies to these rules.
So thrilled to find this article and comments! I am a Ph.D. clinical musicologist and my passion is teaching patients about the benefits of music during surgery. I have a blog on the topic http://www.music-with-surgery.blogspot.com, and am getting a patent right now on a device that will deliver slow, steady, purely instrumental music to the patient during surgery through wireless headphones.
Research suggests that the patients biorhythms entrain with the tempo and mood of the music even though they’re “asleep” enabling the patient to require up to 50% less anesthesia! A huge benefits. It’s great for the surgeon and staff to listen to their own music but they need upbeat music that will encourage focus and concentration. The patient needs slow, steady purely instrumental music so that their left-brain is not engaged! Make sense? I need your feedback and support! Thank you!
wireless headphones are a great idea. but when the patient is under, its entirely theoretical that they can hear things. i think the anaesthesia arena is still trying to do much research on this. some quacks even say hypnosis can be used instead of the classic drugs used in anaesthesia.
i’d rather have great music for the surgical team to do their best for me!