August/September 2009 By Nat Hentoff
Final Chorus: Listening Guides for M.D.s and Us
When I was a kid, doctors made house calls and learned more about a patient’s living and emotional conditions than they did taking a medical history in an office. These days, many increasingly overburdened doctors can usually give a patient little more than a short listening period. Recently I got all of 12 minutes from a physician I went to. As a result, and as I previously wrote in the April issue, there’s growing concern among medical educators to teach doctors how to let the patient set the tempo for revealing his or her symptoms and worries.
In showing how Dr. Paul Haidet has become an expert in using jazz to instruct doctors in the advanced art of creative listening, I promised a second column on how he presents—in lectures and at medical conferences around the country—illustrations of “guided jazz listening” through specific recordings.
Although most JazzTimes readers are not doctors, I thought you might be interested in expanding and deepening what you hear in the music through his commentary. And maybe some of the teachers of jazz courses in schools around the country can choose other recordings to show how much there actually is to hear.
For instance, last December at New York’s Mt. Sinai School of Medicine, Dr. Haidet—during a seminar entitled “Where Medicine Meets Jazz: The Improvisational Aspects of Talking With Patients”—played the Bill Evans Trio’s “Waltz for Debby” (Take 2), from the Riverside CD of the same name.
In introducing the audience to the concept of ensemble playing, he said, “The early ’60s Bill Evans Trio was one of the most empathic units in the history of jazz. Bill Evans and bassist Scott LaFaro, in particular, had a kind of mental telepathy going on. It was said that Bill could start a phrase and Scott would finish it, and vice versa. When you listen to ‘Waltz for Debby,’ listen to how the piano and bass weave in and around each other. Both players are improvising simultaneously in a way that they are making up a collective new melody to the song. This takes advanced listening to each other.”
How does this happen in a doctor’s office? In an article, “Building a History Rather Than Taking One” (Archives of Internal Medicine, May 24, 2003), Haidet tells doctors how to improvise collectively, to develop “the ability of the physician not only to observe the patient during the medical interview, but himself/herself as well. This ability to observe one’s words and actions applies directly to questions asked during the development of the patient’s narrative,” a contrast to doctors’ “narrowly constructed yes/no questions.”
I’d call that spontaneous empathy a way of describing the advanced listening of musicians in a jazz ensemble.
Referring to “Waltz for Debby,” Dr. Haidet told the doctors and medical students at Mt. Sinai, “Listen to the first 30 seconds of this track. … [E]ven on something as straightforward as the statement of the melody, Evans and LaFaro compress and stretch time—in perfect unison! How did they do that?”
By being able to hear inside one another.
“Also,” Haidet continued during his seminar, “listen to what Paul Motian is doing on drums. LaFaro is not playing the usual thunk, thunk, thunk that you might expect from the bass player. Instead, he is running up into the high registers of the bass to ‘play’ with Evans. Then, when Motian goes off to rejoice with Evans, the drummer ever so subtly picks up the timekeeping function and accents his playing with the brushes in such a way that the song never loses its pulse, its ‘spark.’”
Dr. Haidet concluded: “These three define what it means to listen and play, simultaneously, harmoniously.”
And, as I can testify, being very much a lay listener, you don’t have to be able to identify the passing chords and what Basie guitarist Freddie Green called “the rhythm waves” in order to appreciate and learn from the music. At the core of the spontaneous interaction among jazz players, and listeners, is feeling.
Art Blakey said it for all times: “You don’t have to be a musician to understand jazz. All you have to do is be able to feel.”
So, too, in the doctor-patient relationship, the doctor has to give the patient the space and impetus to express not only his symptoms but also his range of feelings. And the doctor’s openness to his own feelings, as he takes real time to listen, will add to the spontaneity of his questions as he gets to know more of the whole patient.
If you feel regularly rushed by your doctor, and he or she doesn’t intimidate you, you might want to show them these two columns on how medical educator Paul Haidet is trying to enable doctors and patients to improvise.
This skill is all the more vital in our world of instantaneous communication and new media, where there is less and less true understanding of one another. (Take, for example, the Internet, where most people go only to sites they already agree with.) Another dividend of Dr. Haidet’s pioneering, I expect, will be more doctors starting collections of jazz recordings and being drawn into jazz clubs.
Originally published in August/September 2009