For better or worse, everyone seems to listen to music at work—even surgeons. And now they’re taking a stand for the importance of a surgical soundtrack. In an editorial published today in the British Medical Journal’s annual Christmas issue, three surgeons at the University Hospital of Wales argue that a little operating room music can have benefits for doctors and patients. “We … embrace music in the operating theatre whenever the situation allows it,” they write.
The BMJ’s Christmas issue is often a source of amusing, intriguing and even downright odd perspectives on medical science—see our recap of this year’s entertaining papers. But in all seriousness, music and medicine have a long and surprisingly well-documented history. Ancient musical rituals have been linked to medical treatments as early as 4000 B.C. Frescos from that era depict priests and musicians playing harps as part of healing rituals, and patients of the day could offer a Codex haburami ("hallelujah to the healer") as reimbursement for medical services.
Over the centuries, some physicians have looked to their musical hobbies to find inspiration for medical innovations. In 1754, Leopold Joseph Auenbrugger developed a diagnostic technique called chest percussion, rhythmically tapping a patient’s chest to detect fluid in the lungs. Music itself developed into a legitimate therapy in the 1800s and 1900s based on perceived psychological benefits. For instance, because of the foreign, sterile nature of the operating room, many surgeons see music as a way to make patients feel more comfortable when they go under local anesthesia.
That’s exactly what Pennsylvania surgeon Evan Kane thought in 1914, when he got the idea to play music on a phonograph during procedures. Kane described his technique in a letter to the Journal of the American Medical Association:
“The phonograph talks, sings or plays on, no matter how anxious, busy or abstracted the surgeon, anesthetist and assistants may be, and fills the ear of the perturbed patient with agreeable sounds and his mind with other thoughts than that of his present danger … It is not uncommon for nervous patients to beg to have the phonograph continue, should it run down, and many of them converse animatedly with the anesthetist on the subject of the pieces being played throughout the entire operation.”
Since then, brain scans have shown that euphoric responses to music correspond to activity in areas of the brain associated with reward and pleasure. Today some surgeons view music as a practical pre-anesthetic, something to be administered to patients even before giving them drugs to help reduce anxiety and stress triggered by the bizarre noises, sights and smells of an operating room. It’s even been tested clinically. A trial of 372 patients found that playing harmonious melodies that are close to the rhythm of a relaxed heartbeat had a more calming effect than the pre-anesthesia medication midazolam. Musical treatment proved effective before, during and after surgery.
“It’s essentially free. You can immediately start and stop it. You can give a patient preference. It’s almost like a wonder drug,” says Dave Bosanquet at the University Hospital of Wales, one of the BMJ paper co-authors. Another study found that listening to music after open-heart surgery significantly reduced patients’ stress levels. And yet more studies have shown that music is more effective for calming patients than simply wearing noise-canceling headphones. The calming effects apply to the surgeons, too. Music has been associated with a lower heart rate and blood pressure and less muscle fatigue in surgeons. So long as the music isn’t too loud and doesn’t have angry lyrics, music can have a positive effect.
Just how often do surgeons play music while operating? About 62 to 72 percent of the time—and typically the lead surgeon picks the songs. Every playlist has its critics, though. While one survey says that 80 percent of members of the surgical team feel that music generally calms things down, a separate survey found that 51 percent of anesthetists thought it was distracting. “Going from a lovely piece of music to a distracting noise, I mean it’s very subjective. It’s what the surgeon and the anesthetist choose and like,” says Bosanquet. He also notes that for high stress or emergency operations, music is pretty much a universal no-no.
As with any music listener, surgeons vary in their tastes. Many prefer classical music and find it encourages mental focus. “The fact that there are no lyrics I think helps, and the fact that you can tune in and tune out very easily with classical music,” says Bosanquet. “Generally, you want something that’s easy going and nice to listen to.”
For long surgeries, rather than playing the same artist for several hours, Bosanquet recommends the random selection of the radio. He and his colleagues also provide some humorous recommendations out of the realm of pop music. “Fix You” by Coldplay is "suitable for those wishing to harness the full healing power of Chris Martin. Expect miracles," they write. They also recommend “Comfortably Numb” by Pink Floyd, but caution that one should "avoid repeated exposure as lyrics may cause dangerous introspection." (Somehow the Weird Al Yankovic classic "Like a Surgeon" didn't make it on the BMJ list.) Some songs best left out of the operating room include "Everybody Hurts" by REM. "No patient appreciates receiving such a repetitive reminder," they point out.
Bosanquet also says not to worry about musical mishaps—your surgeon won't be getting a groove on while performing an appendectomy. “The top priority is the patient,” he says. “If anybody is concerned that music is hampering anything, the music goes off. That’s standard practice.”