May/June  2004

The Zen of Science

Beautiful, healing music

By Marc Ringel, MD

      Have you listened to any of those albums that record the attempts by classical virtuosos, such as Jean-Pierre Rampal or Yehudi Menuhin, to play jazz? I say "attempts" because that's what they tend to be, attempts. You take these guys, who have devoted their careers to playing with the precision and clarity that the classical genre requires, ask them to express themselves in the sort of slurry, slidey, quarter-toney style that lies at the heart of the jazz idiom, and they just cannot do it. It's not that classical musicians lack feeling. Give a listen to Pablo Cassals playing works by Bach on his unaccompanied cello to convince yourself that a classical dude can play with heart and depth. But not with soul-not in the modern American sense of the word "soul," anyway.

      Have you checked out Oscar Peterson, one of the best jazz pianists ever? He was classically trained. Thanks to all those finger exercises his teacher made him do as a kid, Oscar can squeeze more notes into one bar, effortlessly, gracefully, and distinctly, than anybody. To the delight of his millions of fans, the "Maharaja of the Keyboard" can play all those notes while improvising with the best of them, slip-sliding his music among the fixed tones that a piano offers in a way that feels just as bluesy as anything Miles Davis could coax out of his muted, unstopped horn.

      (All right, I know you didn't turn to this column to read an essay on music written by a medical doctor. Please indulge me for another paragraph or so, and you'll come to see the medical point.)

      Recently, a friend loaned me a CD she sometimes uses to meditate. It features the voice of a talented local intuitive healer who guides listeners through a series of visualizations of their chakras, energy centers within and even above the body, and connects those chakras with the rest of the Universe.

      It is a lovely exercise. I've done it once, listening to the CD from start to finish. Thanks to the teacher's wise words and calm voice, I got centered and even a little high. So, I thought, wouldn't it be nice to be able to do this for my patients? I could even produce my own healing CD.

      Then I realized that my classical medical training would almost certainly get in the way of making a crossover hit in the alternative healing genre. Medical education emphasizes objective facts to be gathered and used in caring for a sick person. One could even say that, in the name of applying the scientific method to patient care, allopathic medicine over-emphasizes facts at the expense of story and spontaneity. We've all had the experience of being grilled by a doctor who fires at us a string of simple questions that require brief specific answers, never giving us a chance to tell our own story of the illness.

      An interview style that consists of grilling the patient, instead of querying and listening, is the logical result of the reductionist scientific worldview that is forever held up to doctors as our practice ideal. Those multiple questions are meant to elicit hard data, data that are pieced together to lead the doctor to a precise diagnosis and appropriate remedy. The average physician considers the information generated by the patient's answers to his directed questions to be much more important than what he might learn from the patient's leisurely recounting of an imprecise illness narrative.

      While lip service is constantly paid in medical training to the need to pose open-ended questions to patients, studies have shown that, on average, the doctor interrupts his client within six seconds of the patient's first attempt at dialog. The conversation is usually switched right over to that series of doctor-led, conversation-stopping yes/no questions that patients know all too well.

      Concrete questions yield concrete factoids to add to the "objective" facts (laboratory values, diagnostic images, etc.) of a case. These facts and factoids are like notes in a classical composition, to be struck precisely and related to each other in a very structured way. Doctors tend to leave the bluesy, slurry, imprecise stuff of the patient's subjective story to the nurse, the psychologist or the alternative medicine practitioner.

      I was trained, more by example than by intention, to elicit and attend to the facts of the case, not to the feeling of the story. Reliable facts are of supreme importance when applying the scientific method. Couple good data with scientific, quantitative reasoning and add the hard-won pictures that we doctors carry in our brains of the beautiful and subtle mechanisms that make the human body go, and you have a general medical toolset that can be used to fix lots of things, from diabetes to bursitis. Scientific medicine dictates that the more reliable the data, the more reliable the conclusions and, of supreme importance to the patient, the more reliable the outcome.

      When I care for actual patients, I don't believe I've done my job if I haven't listened closely to the diabetic's story of weight loss attempts or haven't bothered to find out the occupation of the guy with shoulder pain. Still, as a doctor, I need always to know, precisely, whether the first patient needs insulin and just the right way to inject an anti-inflammatory agent into the shoulder bursa of the second one.

      I've spent over 30 years acquiring and refining my intellectual and procedural knowledge of a zillion diseases, conditions, drugs, and treatments. This is my classical training. I've worked just as hard, especially in recent years, to hone my listening skills and to employ consciously the healing power of the words that I wield as a trusted health practitioner. I'd call this para-classical.

      Classical or para-classical, I still ain't no jazz man of medicine. Were I to try leading a patient on a 90-minute audio tour of his chakras, I'm afraid I'd sound like the medical equivalent of Yehudi Menuhin, the classical violinist, trying to keep up with jazz fiddler Stephane Grappelli, of the Hot Club of France fame. (These two fabulous musicians did collaborate in the 1960s and '70s to produce some very mediocre disks that made few fans of either virtuoso happy. For what it's worth, my personal musical taste lies more in the direction of Stephane than of Yehudi.)

      Here's where I stand medically. I have lots of classical training and experience, and a jazz ear and heart. I aspire to do with patients from the stool in my exam room what Oscar does with music from his piano bench: to hit all the right notes, precisely and with feeling. A fair number of those right notes will be improvised.

      There's nothing like melding classical technique with jazz expression. When my patients need more Menuhin I refer them to a medical specialist. When they require more Grappelli, I send them to an alternative practitioner like the narrator of that healing CD. Meanwhile, I have great fun meeting the endless challenge of playing everything in between.