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Humanities CMAJ

CMAJ • JANUARY 12, 2010 • 182(1)© 2010 Canadian Medical Association or its licensors

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Can Duke Ellington improveyour diagnoses? Will MilesDavis ease your exams? Dr.

Paul Haidet offers an emphatic Yes.Music, he says, can teach doctors tolisten deeply. Particularly Jazz.

Jazz is intrinsically tied to the ideaof improvisation. Players riff off a pre-vious idea, stylistically darting on adime before picking up on an unex-pected rhythmic course. It’s what givesthe genre its flavour and distinction.Such “beautiful music” can find its wayinto the examining room too, if doctorslearn to work in concert with theirpatients to develop an alert and empa-thetic communication style.

That’s the conclusion that Haidetcame to almost a decade ago. He’s nowthe director of medical educationresearch at Pennsylvania State Univer-sity in Hershey, Pennsylvania, wherehe teaches a course called Jazz and theArt of Medicine: Improvisation in theMedical Encounter.

A jazz DJ in college, Haidet initiallymade the connection between jazz andmedicine while he was at a communica-tions course. “The way that doctors andpatients talk in some ways is similar tothe way jazz musicians communicate onthe bandstand,” he says. In each case,both encounters are improvised, yetthere is some sort of structure imposedon the exchange. Haidet recently wrotethat “rather than take up all the space inthe conversation with strings of ‘yes/no’questions … I find that I am at my bestwhen I can give patients space to saywhat they want to say, gently leadingpatients through the telling of their ill-ness narrative from their perspective,rather than forcing their narrative to fol-low my biomedical perspective.”1

“It takes listening aligned towardunderstanding, not just the collection offactual data.”1

Taught previously at Baylor Collegeof Medicine, Houston, Texas, andMount Sinai Hospital, New York City,New York, his one-and-a-half-hourcourse involves watching two, seven-minute videos on doctor–patientencounters. One shows the doctor witha high-control style; the other has moreof a narrative exchange.

Jazz-listening exercises are inter-spersed. With the music as a guide,Haidet emphasizes the importance ofspace, latency (the time between talk-ing) and pace (Box 1). Discussionsfollow and it becomes obvious that inthe less-controlling video, the bio-medical diagnosis develops veryquickly (Box 2).

“It also provides a number ofmoments where there’s a deep connec-tion between the doctor and patient,”Haidet says. “You can really see that

the patient leaves feeling that the doctorreally understands her.”

While it’s both effective and emotion-ally satisfying, medical communicationsresearch often has a Pollyannaish tone.In real-life situations, is there time and aneed to develop a deep connection witheach patient? Haidet acknowledges thetime crunch, but says strong communica-tion skills can be time-efficient.

Research supports his theory. Whileit’s widely documented that doctors inter-rupt patients on average after 18 seconds,2

it’s not often mentioned that in the samestudy, researchers Frankel and Beckmanfound in the rare instances when doctorsdid not interrupt, the patient was finishedspeaking after about two minutes.

While this may seem like an eternitywhen there are less than 15 minutesallotted per patient, those two minutescan give doctors a chance to tune into

Essay

Jazz and the art of conversation

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CMAJ • JANUARY 12, 2010 • 182(1)© 2010 Canadian Medical Association or its licensors

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Humanities

nonverbal signals and fleeting glimpsesof emotion — telling clues that theycan then follow up on. “That expres-sion lets the patient know not only thatyou’ve understood what they’ve said,but you have understood on a deeperlevel,” Haidet says.

He notes that many doctors work-ing at inner-city public hospitals learnto achieve a level of connection andunderstanding in a short time.

“They’re very good at getting centredand being in the moment with thosepatients,” he says. “They listen deeplyand co-construct the narrative with thepatient.”

It’s not a one-way street. Haidet also

notes that patients need to be assertive— and studies support that theory. Inmany cases, “interventions were associ-ated with improved physician andpatient communication behaviors.”3

In reviews of Haidet’s course, doc-tors remarked that while most of whatthey learned wasn’t new to them, thematerial allowed them to enjoy theirpractice much more.

Fateema Sayani BJMusic criticOttawa, Ont.

REFERENCES1. Haidet P. Jazz and the ‘art’ of medicine: improvi-

sation in the medical encounter. Ann Fam Med2007;5:164-9.

2. Beckman HB, Frankel RM. The effect of physicianbehavior on the collection of data. Ann Intern Med1984;101:692-6.

3. Rao JK, Anderson LA, Inui TS, et al. Communica-tions interventions make a difference in conversa-tions between physicians and patients: a systematicreview of the evidence. Med Care 2007;45:340-9.

Box 2: Clinical exercises

1. “Mastering space”

For the next two weeks, pick onetime when the patient is finishing asentence. Wait for at least 10seconds before saying anything. Ifthe patient talks before 10 seconds,follow up on what they say. Watchfor the times when the patient sayssomething unexpected or profound.

2. “Cultivating ensemble”

For the next two weeks, say asentence that begins with: “So,what I’m hearing you say is… ” Dothis once with every patient. Aftertwo weeks, do it when it feels right.Experiment with different ways ofsaying the phrase.

Box 1: Suggested listening

• Now’s the Time, Sonny Stitt (altosaxophone) from Stitt Plays Bird(Atlantic/Warner)

• All Blues, Miles Davis (trumpet)from Kind of Blue (Sony/BMG)

• Giant Steps, John Coltrane (tenorsaxophone) from Giant Steps(Atlantic/Warner)

• Waltz For Debby, Bill Evans (piano),Scott LaFaro (bass) from The Bestof Bill Evans (Fantasy Inc.)

Books

A commentary on the truth

The orange wire problem and other talesfrom the doctor’s office

David WattsUniversity of Iowa Press; 2009.186 pp $25.00

Writing reflective essaysabout clinical experiencesis a complex endeavour

that can appear deceptively simple. It is not always easy to balance

fidelity to the facts with the imperativeto maintain patient confidentiality.There are the ethical questions of whatbenefits are accrued, and to whom, andwhat the risks might be. There is thematter of choosing your audience anddeciding how best to speak to them.

The number of physicians who writedespite these difficulties is quite strik-ing and while not everyone possesses

the same degree of skill, there is gener-ally an earnest quality to the writingthat suggests an effort to understand,and to share, truth.

San Francisco, California, physicianDavid Watts takes this task seriously.As well as authoring several books onmedicine, he is a poet, musician, andtelevision personality. In the preface toThe orange wire problem and othertales from the doctor’s office he writesthat he is striving “not so much to doc-ument as to approach a truth that goesbeyond nonfiction and dares to flirtwith the realm of mystery.” As such astatement would suggest, this is anambitious book.

In 26 short narratives, Watts pro-vides sparse sketches of encountersbetween doctor and patient. Most of theclinical scenarios will be familiar tophysicians, but Watts imbues them withimportance and significance. He bringshimself deeply into the encounters andD

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