April 2009 By Nat Hentoff
How Jazz Helps Doctors Listen
There is a growing momentum in medical education to make doctors aware that they not only take the patient’s history, but, much more meaningfully, must listen to his or her stories about why they came to a doctor. Too often a physician makes a diagnosis quickly, based on past experiences with that condition and certain stereotypes of the illness. A leading medical educator and practicing physician, Dr. Paul Haidet, is pioneering the use of jazz to teach medical students and doctors how jazz musicians, as they improvise, listen deeply to one another’s stories.
Haidet, a longtime jazz listener—he was a jazz disc jockey in college—quotes in his essay “Jazz and the ‘Art’ of Medicine: Improvisation in the Medical Encounter,” what McCoy Tyner said of Roy Haynes: “The thing that sets Roy apart from other musicians is that he listens so well. He teaches you to listen carefully and to respond accordingly—to put things in perspective, not simply go out for yourself.”
Haidet tells me that Miles Davis is another of his teachers in how to use space in communicating with a patient. As he has written in the Annals of Family Medicine (March 2007), “Rather than take up all the space in the conversation with strings of ‘yes/no’ questions or long psychological explanations, I find that I am at my best when I can give patients space to say what they want to say, gently leading patients through the telling of their illness narrative from their perspective, rather than forcing their narrative to follow my biomedical perspective.”
As of this writing, Dr. Haidet is a staff physician at the DeBakey VA Medical Center as well as an associate professor at Baylor College of Medicine, both in Houston. I was introduced to him and his work by my son-in-law, Dr. David Nierman, who directs a hospital in Queens, N.Y., and who is a swinging jazz saxophonist when he can find time for jazz gigs. Dr. Nierman is also involved with using music to teach medical students how to listen.
I wish Duke Ellington were here so that I could tell him about this advance in medical education. The Ellington Orchestra was like the Supreme Court in that vacancies were few. I once asked Duke what his criteria were in deciding to bring a new player into the band. “He has to show me,” Duke said, “that he knows how to listen.”
Dr. Haidet, who is designing a course for medical students and young doctors to teach them, through jazz, improvisation in medical settings, educated me with a quote from Dr. Stephen Nachmanovitch, a violinist and educator, on the vital importance of improvisation in doctor-patient settings. What he says is something that jazz educators should also tell their students about how to listen creatively during a gig: “In real medicine, you view the person [the patient] as unique. You use your training, but you don’t allow your training to blind you to the actual person sitting in front of you [or alongside you in a band]. In this way, you pass beyond competence to presence. To do anything artistically, you have to acquire technique, but you create through your technique, not with it.”
As Ralph Ellison puts it in Living With Music (Modern Library), “After the jazzman has learned the fundamentals of his instrument and the traditional techniques of jazz … he must then ‘find himself,’ must be reborn, must find, as it were, his soul. He must achieve his self-determined identity.” And simultaneously, must be able to listen to the “actual persons” playing with him.
How does this apply to the doctor-patient relationship? Says Dr. Haidet, “It takes recognition that all voices in the medical encounter have things to say that are as important as one’s own statements. … And it takes raising one’s awareness to clues: nonverbal signals, fleeting glimpses of emotion, and key words [such as ‘worried,’ ‘concerned’ and ‘afraid’] and following up on these clues when they present themselves.
“The essence of ensemble, whether in jazz or in medicine, lies in looking beyond one’s own perspective to see, understand and respond to the perspective of others.”
In July, Haidet will become Director of Medical Education Research at the Penn State University College of Medicine in Hershey, Pa. He will carry with him a lesson from a teacher he much admires, Bill Evans, on the challenge of group improvisation: “Aside from the weighty technical problem of collective coherent thinking, there is the very human, even social, need for sympathy from all members to bend for the common result.”
And, in medicine, Haidet adds, “Physicians and patients can achieve ensemble in their improvisation by accommodating, where possible, to each other’s statements and styles of communication.” As a patient, there are varied and uneven skills of communication, when you’re conscious of your mortality.
Dr. Haidet has already conducted several sessions with medical students and physicians in which they learn through “guided jazz listening” (specific jazz recordings) about how hearing this music can enhance their interrelationships with patients telling them their stories.
In my next column, I will give you a list of those recordings he chooses, through which you can test yourself—even if you’re not a doctor or medical student—in what jazz teaches you about the nature of improvisation; the creation of a singular personal sound; the importance of space in the act of communication; and the art of listening to one another in ensembles. Haidet told me that one of his references in teaching is a story in my book, Listen to the Stories, about how Charlie Parker shocked fellow musicians at a bar by choosing country music records on a jukebox. Bird explained his pleasure in that music: “Listen to the stories!”
Originally published in April 2009