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For Surgeons, Music Augments Relaxation, Improvisation, and Flow

M. Sophia Newman, MPH

February 7, 2024

The overlap between medicine and musicality is long-standing and well-known. Doctors of all types have excelled at playing musical instruments. For example, famed physician and Nobel Peace Prize winner Albert Schweitzer, MD (1875鈥1965), worked as a professional organist before attending medical school.1 Theodor Billroth, MD (1829鈥1894), known as the father of modern abdominal surgery, was an amateur pianist and among the first to research scientific aspects of musicality.2

But what does a pervasive love of music mean for surgeons鈥 work in the OR? What insights do surgeon-musicians have to offer those whose musical experience extends no farther than hitting play on a stereo? In this article, four surgeon-musicians鈥擟laudius Conrad, MD, PhD, F2023年澳门开奖结果记录, Jeffrey B. Matthews, MD, F2023年澳门开奖结果记录, Daniel Shoskes, MD, MSc, FRCS(C), and Joseph A. Dearani, MD, F2023年澳门开奖结果记录鈥攕hare their insights.

Relaxation from Cells to Fingertips

If anyone knows about music in the OR, it鈥檚 Dr. Conrad. After training as a pianist at a conservatory in his native Munich, Germany, he completed both a doctorate in the philosophy of music and a medical degree. He focuses clinically on minimally invasive liver and pancreas cancer surgery in Boston, Massachusetts.

Dr. Conrad also maintains a robust research portfolio on 鈥渕any domains related to music in clinical medicine,鈥 as he put it, briefly listing studies on the impact of music on patients undergoing surgery, the well-being of patients鈥 relatives, surgical performance of surgeons with varying experience levels, and team dynamics in the OR.

This comprehensive overview gives Dr. Conrad insight into what surgeons may gain through integrating music. In conversation, those findings flow together with observations from his many years of playing music.

His study3 examined the molecular means by which music may impact the human stress response: 鈥淲hat we found was an interesting inverse correlation between growth hormone and interleukin 6. Growth hormone at that time was considered to be a stress hormone, and it was later found that cells of inflammation have growth hormone receptors on the surface, so that when growth hormone binds with interleukin 6, it is less secreted. So, when you listen to music, your brain will secrete growth hormone that then binds with cells of inflammation, and interleukin 6 is less secreted. That鈥檚 the pathway.鈥

The same general finding鈥攎ore music, less stress鈥攈as consistently shown up in the results of his studies and in his own life and work. As a part of a team attempting challenging and sometimes wholly new surgeries, Dr. Conrad sometimes finds himself needing methods to cope with tremendous stress. 鈥淚 want to do the best for my patients. So, I not only employ some of the mental mechanisms that I learned to deal with the anxiety of being on stage, but I try to practice the piano more,鈥 he said. 鈥淭here鈥檚 no question that even at this stage of being a relatively senior surgeon, the more I practice the piano, the more relaxed I am. I will use the weekend to practice more to be ready on Monday for a big surgery.鈥

He also said that practicing sensitizes his fingers to feedback from the patient鈥檚 tissues during surgery, explaining the hyperawareness is simply about being relaxed enough to focus on this sensory input, 鈥淭he more relaxed you are, the entire body leading up to your fingers, the better you will be as a pianist and the better you will be as a surgeon.鈥

Improvising on Stage or in the OR

For Daniel Shoskes, MD, MSc, FRCS(C), the connection between music and surgery is less molecular and more metaphorical.

A kidney transplant surgeon by training, Dr. Shoskes transitioned to surgical practice in urology at the Cleveland Clinic in Ohio, and more recently took a position as vice-president of global medical affairs at Pacific Edge Diagnostics, a company focused on bladder cancer diagnostics.

Dr. Shoskes played music in his youth, set it aside while becoming established as a surgeon, and then returned to it. This involved a shift from the cello and guitar of his earlier years to the lute, a stringed instrument with a short neck and a rounded back that was once played worldwide. Since his early 40s, he has played 鈥渕usic from the Renaissance to the Baroque,鈥 a period from the 13th to the 18th centuries.

鈥淚鈥檝e been professional adjacent, in that I have performed with some professional orchestras,鈥 as well as creating four albums, consulting on films, and offering prodigious output via his YouTube channel, Dr. Shoskes said.

For him, improvisation is a key to both music and surgery. 鈥淚 would have to say that the musical event most similar to a complex surgery is playing continuo, which is primarily in Baroque music, when you鈥檙e accompanying a singer or an opera or in the orchestra,鈥 he said, further explaining that only a single bass line and some indications of harmony are planned, with all other elements improvised live by the musicians.

The result is total commitment. 鈥淵ou鈥檙e constantly listening. The singer may do a particular ornament, and then you might imitate that over the bass line that you鈥檙e playing, or the singer may jump to the third verse instead of the second verse, and you have to adjust to that. So, you鈥檙e simultaneously controlling both your hands and reading the music and listening to multiple other musicians and responding to them,鈥 an experience that occupies the mind and body so fully in the present that everything else simply falls away.

The same feeling arises during a complex surgery, particularly 鈥渨hen you know something does not go as planned,鈥 he said. 鈥淭hat鈥檚 when you slow your breathing and really become focused. I would say that those skills, when things go wrong in music, that鈥檚 like when things are tense in the operating room. That is probably the skill that is most complementary to surgery.鈥

Dr. Dearani, director of pediatric and adult congenital heart surgery at the Mayo Clinic in Rochester, Minnesota, is a saxophonist, trained in part at the New England Conservatory of Music. He currently plays in a jazz combo called TakeTwo & Friends4 and a charity-focused band of pediatric cardiology clinicians called the Baby Blue Sound Collective,5 as well as maintaining daily music practice that aids in work-life balance and stress management. 鈥淚 play 4:30 to 5:30 in the morning before I come to work. During the pandemic鈥 felt like music, to some degree, saved me a little bit.鈥

He discussed the relationship between musical improvisation and surgery in a 2021 article in The Journal of Thoracic and Cardiovascular Surgery.6 Dr. Dearani wrote that in jazz improvisation as with a Baroque continuo, elements such as harmony are nonnegotiable and the musician has autonomy to otherwise interpret and embellish the score. 鈥淭his requires intense acuity in communication,鈥 through each musician listening and responding to the notes the other musicians play.6

When players are skilled, excellence can result. 鈥淕reat jazz performances occur when whole-system thinking is embraced by everyone involved,鈥 including 鈥渃ross-functional relationships, real-time sharing of firsthand knowledge, highly attuned skills of listening, and in-the-moment design thinking.鈥6

He posited that the same elements may apply to cardiothoracic surgery. Some procedures (e.g., valve replacement) are highly predictable, with little need and few opportunities for modification. Others, such as corrections for Ebstein anomaly, are far more variable. For these operations to succeed, the surgical team must have skills similar to those required for jazz improvisations: the basic surgical plan鈥攁 factor analogous to the nonnegotiable harmony of a song鈥攑lus solid technical skills, good communication and teamwork, awareness of each patient鈥檚 unique anatomy and pathology, and readiness for all potential mid-procedure changes.

Finding Flow

While others revamp their musical skills for surgical purposes, Dr. Matthews, a Harvard-educated surgeon with a practice focused on the pancreas, uses music itself to aid his work in the OR. For 17 years, he has been the chair of surgery and Dallas B. Phemister Distinguished Service Professor of Surgery at The University of Chicago in Illinois.

Alongside his thriving career, Dr. Matthews is a self-described 鈥渄rooling fanatic鈥 for rock music. His background includes learning to play guitar as a teenager, becoming a punk rocker and radio disc jockey at Harvard in his undergraduate years, and transitioning into a blues and jazz fan later in life. As Dr. Shoskes did (and many other musically inclined surgeons do), he set music aside for years as his career advanced. 鈥淲hen I was in my 40s, I kind of decided, with the encouragement of my wife and kids, to get more seriously back into it again,鈥 he said.

Gradually, he moved from intensive practice to writing his own songs, finally landing at recording albums with a team he described as a Grammy-winning producer, a drummer formerly employed by Paul McCartney, a guitarist who toured with David Bowie and played on John Lennon鈥檚 Double Fantasy, and other rockers with similarly illustrious CVs. The songs they record together are available on Spotify and elsewhere. 鈥淚 don鈥檛 have any illusions about the talent level I bring to the table,鈥 Dr. Matthews humbly noted, 鈥渂ut it鈥檚 a lot of fun to do.鈥

While he is impressed with the resumes of his musician colleagues, he said, they are impressed with his surgical achievements. And the connections between music and surgery don鈥檛 stop at mutual respect. For Dr. Matthews, music is important in the OR鈥攚here the purpose involves targeting attention. 鈥淢usic helps with my flow,鈥 he said.

Flow in the psychological sense is a term first defined by psychologist Mihaly Csikszentmihalyi, PhD. It is an intense state of concentration in which a person becomes so fully devoted to the task at hand that self-consciousness, awareness of time, and even a focus on one鈥檚 own physical needs temporarily vanish. The original impulse to study the phenomenon arose, Dr. Csikszentmihalyi once said, when he realized that artists, including musicians, often had the experience of becoming totally lost in their work.7

A mental state not fully under personal control, flow occurs when the amount of information a person receives is at or near, but not over, their maximum capacity. Through his research, Dr. Csikszentmihalyi eventually pinpointed this at 110 bits of information per second (in comparison, understanding a conversation takes approximately 60 bits per second).7

The Yerkes-Dodson law,8 first defined in 1908 by Robert Yerkes and John Dodson, captures an empirical relationship between physiological or psychological arousal and performance. To wit, increased stimulation improves performance up to a point, after which excessive arousal causes performance to decline. The key to sustaining a state of flow鈥攁nd thereby maximizing performance鈥攊s to perfect the rate of input and the arousal it creates.

The goal of music in the OR, then, is to fine-tune arousal to the right level. In describing immersive operations as akin to an intensive experience of musical improvisation, Drs. Shoskes and Dearani are perhaps nodding to the concept of flow鈥攊n that case, flow achieved by maximal absorption in two different kinds of challenging situations.

For other, more routine operative experiences, Dr. Matthews described music itself as a topping-up of the information rate. He noted that it involved adding easily accommodated sound (鈥淚t鈥檚 sort of about filling in the spaces in the atmosphere鈥) and covering up extraneous noises (鈥淚 find it really distracting to hear people鈥檚 conversations around me. So, for me, having the music on allows that to go away鈥).

The Best Way to Play Music in the OR

Dr. Matthews鈥檚 approach is common; most surgeons, including Drs. Conrad and Shoskes, listen to music in the OR. Dr. Dearani noted that music can reduce tension in the surgical theater: 鈥淭his feeling that making the room completely silent translates into people being more focused鈥擨鈥檓 not sure that鈥檚 the case. That鈥檚 not the case for me, I know.鈥

But Dr. Matthews鈥檚 experience hints that the choice of songs playing in the surgical theater often needs to be precise. Getting it right is no small matter; all the interviewees, as well as the literature on music in surgery,9 agree that there is no guarantee music will aid an operation.

It is a finding that Dr. Conrad could verify through his own research. 鈥淚 would say you should think about the role of music in the operating room like a drug. There are positive effects, but there can be side effects, and you have to be very strategic in the dosing of your music,鈥 he said.

That includes the volume, which should be neither blasting loud nor whisper quiet; beat frequency, which should be slow to moderate; and shifts in tone and emotional intensity, which should be limited.

Dosage does not necessarily dictate genre, however. Here, tastes can vary. In the OR, Dr. Matthews tends to prefer the genre he plays himself, rock. Dr. Dearani said he has kept the same carefully curated mix of songs by James Taylor, Carole King, and Stan Getz for 25 years. Meanwhile, Dr. Conrad has examined the question of which genre of music is best and strongly favors classical music. As a result, he has created an entire album, Healing Hands, tailored for use in the OR and freely available online.

When referring to the lute music he plays, Dr. Shoskes noted, 鈥淢y music is good background music,鈥 but specified this was true for 鈥渙nly the people who have no connection with the music I perform,鈥 an audience that of course excludes himself. Knowing the nuances of Renaissance and Baroque music means he taps into the music鈥檚 emotional depths, an experience too complex to handle mid-surgery.

鈥淧op music doesn鈥檛 engage me emotionally and intellectually the way this other stuff does,鈥 he said, and this means the procedure itself can be his central focus. In the OR, where flow and the need to improvise can be essential, the only 鈥渂est鈥 music may be the kind that achieves this exact result.

A Long History

Whatever one鈥檚 involvement with music, it is clearly inextricable from the lives of many surgeons.

Indeed, surgeons鈥 inquiries into music in surgery go nearly as far back as surgery itself. In addition to the 19th-century inquiries of Dr. Billroth, a 1914 JAMA article, 鈥淧honograph in Operating-Room,鈥10 raised the option of playing music 鈥渇or calming and distracting patients.鈥

That early modern work added to a tradition already more than a millennium old. The medically trained Turco-Persian philosopher Al-Farabi (who, like Dr. Shoskes, played the lute), considered music a form of therapy in his treatise Meaning of the Intellect, written around AD 925, and compared learning music to learning medicine in his Kitab al-Musiqa al-Kabir (Grand Book on Music).1

The centrality of music to human lives is unlikely to abate, too. Dr. Matthews said his lifelong love of music has 鈥渄eep, deep psychological roots,鈥 a statement less particular to him than a description of nearly all of humanity.11

Music can be uniquely powerful for humans鈥攚hether surgeons or anyone else. Dr. Conrad mused, 鈥淧eople go to a concert and have this ecstatic or out-of-body experience that people rarely have from looking at a painting or listening to poetry. And what is it from? It鈥檚 nothing. It鈥檚 nothing we ingest. It鈥檚 just molecules in space that change their frequency. This is unbelievable, right?鈥

Where to Access the Music of Surgeon-Musicians

  • Lutenist Daniel Shoskes, MD, MSc, FRCS(C): on YouTube at his channel,
  • Claudius Conrad, MD, PhD, F2023年澳门开奖结果记录: his album 鈥溾 via Spotify; further information via
  • Jeffrey B. Matthews, MD, F2023年澳门开奖结果记录: 鈥溾 EP via Spotify
  • Joseph A. Dearani, MD, F2023年澳门开奖结果记录:
    • Baby Blue Sound Collective 鈥溾
    • Take Two and Friends:

  1. Wong L, Viagas R. Scales to Scalpels: Doctors Who Practice the Healing Arts of Music and Medicine. Pegasus Books, 2012.
  2. Kazi RA, Peter RE. Christian Albert Theodor Billroth: Master of Surgery. J Postgraduate Medicine. 2004; 50(1): 82-83.
  3. Conrad C, Niess H, Jauch K-W, Bruns CJ, Hartl W, Welker L. Overture for growth hormone: Requiem for interleukin-6? Crit Care Med. 2007;35(12):2709-13.
  4. Sievers J. Mayo Clinic surgeon practices both music and medicine. Published February 1, 2021. Accessed December 15, 2023. https://www.postbulletin.com/lifestyle/arts-and-entertainment/mayo-clinic-surgeon-practices-both-music-and-medicine.
  5. In the Loop. Songs of the Heart, For the Heart. Published February 2, 2017. Accessed December 21, 2023. https://intheloop.mayoclinic.org/2017/02/02/songs-of-the-heart-for-the-heart/
  6. Dearani JA, Gold M, Leibovich BC, et al. The role of imaging, deliberate practice, structure, and improvisation in approaching surgical perfection. J Thoracic and Cardiovascular Surgery. 2021; 154(4):1329-1336.
  7. Csikszentmihalyi M. Flow: The Psychology of Optimal Experience. First edition. HarperCollins, 1990.
  8. Sisterhen McAllister L. The Balanced Musician: Integrating Mind and Body for Peak Performance. Scarecrow Press, 2013.
  9. Oomens P, Fu VX, Kleinrensink G-J, Jeekel J. The effect of music on simulated surgical performance: a systematic review. Surgical Endoscopy. 2019;33:2774-2784.
  10. O鈥橬eill Kane E. Phonograph in Operating-Room. JAMA. 1914;LXII(23):1829. doi:10.1001/jama.1914.02560480063031.
  11. Conrad C. Music for healing: From magic to medicine. Lancet. 2010;376(9757): 1980-1

M. Sophia Newman is the Medical Writer and Speechwriter in the 2023年澳门开奖结果记录 Division of Integrated Communications in Chicago, IL.