Parulekar SV

Historically Apollo was identified as the father of healing as well as music by the ancient Greeks. But there is no mention of his combining healing and music. Perhaps he devoted separate times to the two jobs. ‘Hallelujah to the healer’ was played as part payment for medical services around 4000 BC. Dr Evan O'Neil Kane from Pennsylvania first played music on a gramophone in the operation theater (OT) in 1914. He believed that soft and soothing music helped surgical patients relax. This practice was soon taken up by many surgeons. No scientific studies were done to prove merits and demerits of playing music in the OT. Thus one can say that the widespread use of the trend was not evidence based. Just as the surgeon was considered the master of the OT for the surgical treatment of the patient, the music part of the treatment was also at his discretion, and the others in the OT heard what the surgeon wanted to listen to. One anesthesiologist was bold enough to voice his disgust saying “same songs, same order, every single time, every Thursday!” Of course the surgeons do it not for self, but for the patients. When an operation is done on an awake patient, music of the patient’s choice is supposed to relax the patient, reduce the amount of sedation required and reduce not only anxiety but also pain. The music is supposed to help the OT personnel relax, improve their cognitive function, and elevate their mood. The logic is that the patient benefits when the healthcare providers are feeling good. There are claims that specific types of music help surgeons perform specific types of operations best. Slow and melodic music is supposed to help perform critical steps, while fast music is supposed to help perform wound closures faster and better. Improvement is surgical efficiency is also claimed to lower healthcare costs. Now we understand that the surgeon is not the only person who matters in OT. Each member of the team does a specific job and proper performance of that job is critical for the outcome of the operation. Since there are attendants, nurses, anesthesiologists and surgeons involved in that chronological order, perhaps the music needs to be changed to suit the person and task at a given time. It must be noted that the task of a person does not end when that of another one begins, and all persons continue to be involved throughout the surgery. Hence music for one may not be suitable for the other, and if ten persons are involved at one time, one might require ten different tracks to be played simultaneously, but in such a way that each one hears what he or she prefers or there would be white noise. Added to that is the cacophony of the monitoring equipment signals and alarms, the electrocautery noise and error signals, and people talking professionally or otherwise. The talkers do not respect the music being played and keep quiet. They actually speak louder so as to be heard. If the surgeon is hard of hearing, as he is likely to be with age or after having listened to music while operating over a period of many years, he will keep the volume of the music high. It becomes rather difficult to manage. A study done in a 2007 study showed that noise levels in OTs are often more than 120 decibels, which is louder than on a highway at peak hours. I wonder if anyone has considered the auditory trauma to persons who work in OT all day, six days a week, and not just when they have a slot for operating like the surgeons do. Perhaps a study to find out the time of onset and degree of deafness in such personnel is due.

The surgical team members have to be in constant communication with one another. The surgeon has to tell his assistants, the nurse and the anesthesiologist what he needs. The assistants have to tell him of any difficulties they are facing, or any errors that might not be noticed by the surgeon. The anesthesiologist may need some input from the surgeon and the nurse. The nurse may have to ask another nurse or an attendant for things. The music may make this communication difficult. Either the person may be so engrossed with the music that he does not realize that he is being told to do something, or the music may be so loud that he may not hear what is said. One may be irritated by the music so much that he cannot concentrate on his work. There are concerns expressed that music may make one’s attitude casual, It may make one lose focus and make the results of the operative work less than optimum.

Operative work is not just physical work. Scrubbing and preparing the operation site are mechanical jobs that do not require application of the mind. Some operations are mechanical and can be performed without much thinking. The surgeon may be so experienced that he does not require any thinking while operating. However most people would not fall in that category. For those, and for a surgeon who has to perform difficult and critical operations, concentration and thinking while operating are very important. No matter what management gurus might claim, multitasking produces inferior results for the tasks performed. If the mind is busy with one thing, it cannot be engaged effectively with another thing. Whenever I am operating, I cannot listen to any music because it does not register. If there is any music, I cannot recall which tracks were played in the time between the beginning and the end of the operation. They claim the subconscious registers the music and that achieves the wonderful results which are claimed. This is another statement that is not evidence based. So the music is probably wasted on me when I operate. It could be true for a lot of other people.

The debate on whether to play music in OT will continue, because many persons are involved and their ideas differ widely. We do not want to do something that will be harmful to the patient. But we also do not want to avoid doing something that will improve results. We must satisfy all parties involved as far as possible. So the best solution seems to be to let each person decide whether he wants to listen to music or not while working in the OT. If he does, he can play tracks of his own choice on a personal music player, like a phone or mp3 player, and listen to it using an earphone. He may use a single bud, leaving the other ear open to listen to instructions, answers, signals, alarms and patient’s complaints if awake. If it is found that he cannot concentrate, loses focus and does not perform well while working, his listening to music can be stopped. This personal music playing will also do away with the problem of the institute having to pay for the music which is not royalty free, as each individual becomes liable for possession and playing of his own music.