Music in Medicine?

The holiday season is finally over. Not to be a complete Grinch, but I am more than happy to see all the tinsel and reindeer and artificial snow come down from the halls of our hospital. Whether all that holiday ornamentation actually belongs in a hospital is fodder for a difference essay, but the part that I’m most glad about is that the piped-in music has stopped.

Every morning, for two long months, when I slogged into the hospital to make rounds on my ill patients, I had to suffer the repeating loop of Christmas music on my way to the elevators. It’s not necessarily that I dislike holiday music—though these renditions were definitely not Grammy finalists—but that I didn’t want someone else’s music forced into my head.

Music is intensely personal. Unlike the art that adorns the hospital walls, which I am free to turn away from if I don’t like, the music was inescapable for the length of the hallway, which could feel interminable on the 57^th loop of “Jingle Bell Rock.”

Music has strong therapeutic qualities, as evinced by the growing number of music therapy programs in hospital settings. There’s even a scientific journal “Music and Medicine” devoted to scientific developments in musicology that affect patients.

But I wonder about the effects on the staff who are forced to listen to music that is not of their choice? I’m not sure about the rest of my colleagues, but I am horrifically susceptible to musical worms—the melodies that get stuck in your head and replay in perpetuity.

So, for the majority of the extended holiday season, I would round on my patients and review their medical conditions with “Deck the Halls with Boughs of Holly” as an underlying basso continuo. Some would say that this could be a good thing, but personally I felt hostage to these saccharine tunes.

When finally I turned in despair to my (Jewish) supervisor, he said confessed to me in a low voice: “Oh, this is my favorite time of year. The music in hall just makes me feel so happy.”

Maybe it is just personal taste, but to me music is too potent to squander with tinny Muzak forced on the unbidden masses. Here’s an essay I wrote on music and medicine that appeared in The Lancet, trying to reconcile my day-job as a physician and my after-hours gig as a struggling cello student. I’d appreciate your thoughts.

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Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Bryan Charnley

Bryan Charnley was an artist and schizophrenic patient, he started the 'Self Portraits Series' in 1991 and was encouraged by a friend to keep a diary that explained the imagery of the portraits. You could call it an experiment of sorts as the series openly describes the graded sufferings he was oppressed by, as he struggled with his medication (see the enclosed linked for more information). The portraits describe his paranoia, depression, and psychosis accurately.

Brian Charnley in March 1991 at the beginning of the series.

3 Months later


18th of May 1991


13th of June 1991

There was no commentary for the penultimate and final portraits which do not even have faces on them, but this 'map' shows very well the paranoia Charnley was facing as he feels surrounded by enemies, despite 'Hope' being at the centre.

This final portrait was left on the easel in his studio where he committed suicide shortly after painting it.

Writing About Patients: Is it Ethical?

There is a veritable epidemic of doctor-writers out there. What is going on?

Are doctors suddenly in the kiss-and-tell mode? What about confidentiality? Professionalism? HIPAA?

As one of the aforementioned doctor-writers, I look upon this trend with both awe and trepidation. I suspect that that this flourishing literary phenomenon relates to the public’s fascination and fear about all things medical. It also relates to the falling away of previous, pedestal-like images of doctors and doctoring. Lastly, it may have occurred to the medical profession—and this has taken a few centuries, it seems—that doctors have profound emotional reactions to the work we do, and that exploring these reactions may offer benefit to both patient and doctor.

Whatever the reason, this literary genre appears to be here to stay, and it is worth considering the ethical implications. Legally, there doesn’t appear to be much beyond protecting identity and avoiding libel.

But physicians clearly need to work with a higher bar. For starters, patients speak to doctors with an expectation of confidentiality. This is vastly different from an ordinary citizen speaking to a journalist. This confidentiality needs to be preserved. Unless a patient indicates otherwise, a doctor-writer must change the name and identifying characteristics. My rule of thumb is that the description must be different enough that it would be tough for anyone other than that person or a close associate to recognize them.

This, of course, brings up an issue of reliability. We’re trafficking in nonfiction, not fiction. When I write, I try to ensure that the aspects I change are not the crucial ones in the story. When talking about the intricacies of an illness, it probably doesn’t matter whether the hair is blond or brown, or the country of origin is Trinidad rather than Jamaica. If these minor things mask the patient’s identity without altering the key aspects of the story, then I think it is a reasonable trade-off.

But most importantly, there is the consideration that patients come to us for our help. They are in a particularly vulnerable situation and doctors have an ethical obligation to put that first. If, at some later time, this seems like a story that might edify the current discourse, the doctor might think about writing it up. It is helpful to let some time pass, so that the situation is no longer “active.” If it’s possible to obtain consent, we should do so.

If I can’t obtain consent, then I need to ask myself whether I feel the patient might be hurt by the publication of the story. If there’s any thought that this person would be uncomfortable or embarrassed or pained, then the story stays in the drawer, no matter how amazing it is. (I have one powerful story—about a patient lied to me, and the implications of that lie—but I suspect that my patient would be unhappy if he ever saw the story, so I’ve never pursued publication.)

Ultimately, I want to give a respectful rendering of my patient’s story, one that I hope would honor them and what they’ve endured. Of course this is necessarily a subjective decision, but it is the only internal ethic that I can live with. My patients have entrusted me with their stories, and I need to respect that. If a particular story can edify future doctors, or educate the public, there might be value in publishing it.

I choose these stories very carefully. I obtain consent when possible—patients almost always have a positive reaction. I let time pass. I try my best to write a story that honors them, and show a draft to them if circumstances permit.

Ultimately, doctor-writers have to treat patients’ stories as we treat our patients, realizing that we are in a privilege position, and taking care not to abuse that.

(Read more about the ethics of doctors writing in Danielle Ofri’s essay in The Lancet.)

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Portraits, Patients and Psychiatrists

Last week I attended a very interesting seminar at King's College London's new Centre for the Humanities and Health. Artist Gemma Anderson and psychiatrist Tim McInerny have collaborated on a project called 'Portraits: Patients and Psychiatrists'. Dr McInerny, a forensic psychiatrist working at Broadmoor, was inspired by seeing Gemma's etchings at the RCA's graduate show. He felt that they had parallels with psychiatry in that they gave an insight into the personalities of her sitters. They decided to collaborate on a series of portraits of psychiatrists and their patients, supported by a Wellcome Trust Arts Award.

The portraits are deliberately ambiguous -- doctor and patient are not immediately discernable. One of the strengths of the project is that it honours both sitters as individuals, rather than highlighting the differences in status between them.

Gemma works from life on a large wax tablet. She gets to know her sitters, finding out what interests them. She then incorporates imagery from their narraties into the portrait, often drawing from natural history museum collections. The portraits reminded me of frontispieces to 18th century books -- full of symbolism and 'emblems'.

Because anonymity needs to be respected, the line-drawing nature of the etchings is ideal. There is not too much facial detail, but each is still recognisable as a portrait. Gemma stressed that she was not trying to capture the entire life story of her subjects, although this informs her work. The portraits are her interpretations, rather than a transcription of her sitters' stories. She did not seek 'approval' from the sitters about what to include.

Dr McInerny explained that the patients and the doctors enjoyed having their portraits made. The natural imagery and the sense of calm that pervades the portraits serves as a counterbalance to the often very negative imagery that abounds about psychiatric patients in the press. Of course, it is tempting to focus on the patients' portraits because their life stories have had such a profound influence on their circumstances, but this is also true of the doctors who treat them. The portraits remind us that there is more to the personality than the sum of our personal or profession actions.

You can read more about the project and find out about the fascinating working methods employed in making the etchings on Gemma's blog.

Hippocrates poetry prize -- deadline extended

The deadline for the Hippocrates Prize for Poetry and Medicine has been extended to 15 February. The prize will be announced at the splendid sounding 2010 International Symposium on Poetry and Medicine being held in Warwick on 10 April.

8.45am Registration
9.25am Symposium start
5pm Close of Symposium followed by a reception for speakers, delegates and Hippocrates Prize winners.

Symposium speakers will include: Peter Goldsworthy Poet and medical practitioner, Australia Michael Hulse Editor, The Warwick Review

Symposium topics will include: poetry in medical settings (oncology, cardiovascular disorders, childhood illness ...); doctor poets (Gottfried Benn, William Carlos Williams); poetry in the consultation; creative health professionals; medical inspirations for poetry (anatomy; poisoning in Shakespeare's writings ...).

Call for papers
Submissions are welcome for the Symposium as posters for discussion or short oral communications. Email the Symposium Office to express interest in submitting a Symposium Abstract. Closing date for Symposium Abstract submission has been brought forward to 6pm Friday 19th February 2010.

Key themes will include:history of interactions between medicine, health and poetry; impact of health and disease on the writings of the professional poet; poetry as therapy; the nature of the body, and anatomy; the history, evolution, current and future state of medical science; the nature and experience of tests; the experience of doctors, nurses and other staff in hospitals and in the community; the experience of patients, families, friends and carers in these situations; the experiences of acute and long-term illness and dying, of birth, of cure and convalescence; the patient journey; the nature and experience of treatment with herbs, chemicals and devices used in medicine.

The Symposium is being held on the awards day for the 2010 International Hippocrates Prize for poetry and medicine.

2010 Hippocrates Prize - Closing deadline 12 midnight GMT Monday 15th February. The 2010 Hippocrates Prize awards will be announced at the Symposium. There is a £15,000 award fund for the prizes, which will be given in an ‘open’ category which anyone can enter and in an ‘NHS’ category open to National Health Service employees and health students. The first prize for the winning poem in each category is £5,000.

Broadcaster, journalist and writer James Naughtie are joining NHS Medical Director Professor Sir Bruce Keogh and poet and Doctor Dannie Abse as judges of this new pair of national and international medical poetry awards.

The 2010 Hippocrates Prize is being organised by a joint team from the University of Warwick’s Department of English and Comparative Literary Studies and the University’s Medical School.

The International Poetry and Medicine Symposium and the 2010 Hippocrates Prize are supported by the Institute of Advanced Study at the University of Warwick and by the national Fellowship of Postgraduate Medicine.

Nurse Jackie

What to make of the new hospital series Nurse Jackie? Having watched the first week of episodes (thank you iPlayer! It's screening on BBC2 at 10 pm every night), it's hard not to feel rather horrified. Nurse Jackie is, in so many ways, inspirational. She acts in the patient's best interests. She subverts hospital bureaucracy whenever necessary, stealing from the bad to give to the more deserving. Unless, of course, the patient is a misogynist with diplomatic immunity, in which case she has no compunction is flushing his ear (sliced off by a prostitute he attacked) down the toilet. So far, so entertaining. But Jackie has a serious drug problem. She scores pills from her pharmacist lover, and takes them in a variety of ways -- from sprinkling them in her coffee to snorting up the contents of capsules.

The idea of a 'conflicted' health professional is not new. House has a drug problem too, along with brilliant clinical judgement. Why then, in Nurse Jackie so much more disturbing? Jackie is smart and sassy, and it is so refreshing to see a nurse in the prime role rather than another stereotyped doctor. But the message that Jackie gives is that it is not possible to cope with the job unless you have a pharmaceutical crutch. What sort of a role model is she?

There are plenty of cop shows on TV that show corruption, and we don't worry that these are serving as poor role models for aspiring policemen and women. Also, there is no shortage of doctor dramas that highlight character flaws in health professionals. So why do I feel so anxious watching Nurse Jackie? I think it is because we are seeing something new by way of character development, hinted at in House but fully developed in Nurse Jackie. Usually in TV dramas, you have clearly identifiable 'goodies' and 'baddies'. Over the course of a series, one type might turn out to be another, but almost invariably, character flaws are explicable in terms of someone's circumstances. The evidence of the first week of Nurse Jackie, however, plays havoc with the usual conventions of TV drama. Jackie has a lovely family: gorgeous husband and two adorable daughters. She is good at her job. And she seems entirely unconflicted by her frequent unethical personal behaviour. This may, of course, all come unstuck over the course of the series, but it's too late. We already love Nurse Jackie for her sheer chutzpah and her apparent ability to be in total control of her complicated life. Most tellingly, one would really want her on your side if you were a patient.

Medical students often tell me that they are inspired by House. But they do realise that House is utterly unrealistic, and most admit that they would not like to be his patient. For all its good writing and well researched medical interventions, House still comes across as a bit of a soap opera. Personal relationships unfold within a clinic that looks like a hotel, with little evidence of the demands of 'real' medicine. Nurse Jackie sets up greater intimacy with the viewer, using the Gray's Anatomy voice-over technique to impart wisdom. The bureaucracy in the hospital makes it feel more realistic, albeit in a rather superficial way. She is a far more sympathetic character than the gruff and misanthropic House ever could be.

Nurse Jackie will undoubtedly inspire more people to enter the nursing profession -- and that's good. We need more nurses. But we have to trust that people can distinguish right from wrong. Drug taking has no place in the profession, but this doesn't mean we should condemn a well-written, well-acted TV drama.

Brian Fies at Comics and Medicine conference

Brian Fies, writer of the award-winning Mom's Cancer, will be speaking at the Comics and Medicine conference. Brian is a pioneer in the use of the graphic novel to communicate about illness, and his book has become a classic. I'm really looking forward to meeting him. The deadline for proposals for papers and posters is 29 January: more information here.