Where Music Meets Medicine
For Marlon Kleinman, M.D., hematologist/oncologist at City of Hope® Cancer Center in the North Shore, Illinois location, the art of music and the science of medicine aren’t separate disciplines, but are intricately connected. “I find many musical elements are filtered in through a lot of oncology,” he says, explaining that listening with a stethoscope when a patient vocalizes may help reveal if he or she has a mass in their lungs. In this video, Dr. Kleinman explains how music and medicine meet.
Learning to Listen
Patients may not be aware of just how important sound is to the observations doctors make or their diagnosis. The connections are fascinating to Dr. Kleinman, who continues to sing as a cantor at his synagogue and enjoy family gatherings where music plays a central role.
“I was intrigued because there were so many connections between the body and sound,” Dr. Kleinman says, noting that this link first became apparent during his second year in medical school when students are taught how to do physical exams. This is when Dr. Kleinman learned about the concept of egophony — the changes in the sound of the human voice heard through a stethoscope.
By listening with a stethoscope when a patient says the ‘e’ sound, a doctor may determine if they have fluid or a solid mass in their lungs. Because of how sound waves travel, that ‘e’ sound will sound like ‘a’ if something is obstructing airflow in the lung.
Then there is tactile fremitus, a test in which the doctor feels for vibrations by placing their hands on a person’s thorax and having the patient say a phrase or the number 99.
“I’m feeling the vibrations,” Dr. Kleinman says, with the frequency of the vibration giving him information about the amount of air in the lungs and the density of the lung tissue. “Let’s say I have increased vibration, that means the tissue is solid. Decreased vibrations means there is liquid.
“I was like ‘wow.’ I’m using sound and physicality to make diagnoses, to understand what’s happening to a patient.”
Physicians use sound in numerous other tests, including tapping on a person’s belly.
“If there’s a gas-filled area, I should hear almost like a timpani drum. If there is inappropriate solid tissue as in the case of splenomegaly, the sound would be dull on the left side of their belly, along the left midclavicular line. I’m busy tapping down trying to understand how far down the spleen goes,” Dr. Kleinman says.
As a medical student, Dr. Kleinman says he was “inspired by the precious link between musicality and the body.
The Art of Medicine Meets the Science of Music
Just as music has science to it, medicine has art to it, especially when dealing with the emotional aspects of a cancer diagnosis, which is just as important as the science behind that diagnosis and treatment, Dr. Kleinman says.
He likes to use analogies with his patients to help them understand the complexities of their illness and treatment. One he often finds useful is the idea that sound, like a singing voice, is actually a wave.
“I tell patients this: Let’s say you’re looking at a body of water and it’s a calm body of water. Is the surface of the water a straight line all the way across? If you were to measure, precisely the depth of water every 3mm in this body of water, would it be the same? I’m getting them ultimately to say, ‘no.’ Straight lines aren’t the real world. There’s variance.”
For patients who may be obsessed with monitoring their lab results, this is a useful concept.
“Quite often when I was a resident, and certainly now as a hematology/oncology physician, I’ve got anxious patients who take very deep interest in their lab trends and they’re looking at every precise deviation from normal or deviation from their baseline and concluding for themselves that something must really be wrong,” Dr. Kleinman says. “One of the things we need to do as clinicians is distinguish between what is a simple natural wave going up and down in a calm body of water versus a tsunami — exposing a trend that is clinically significant.”
Just as music may soothe the soul, so does this idea help calm anxious patients, Dr. Kleinman says.
“We can get philosophical,” he says. “The up and down of the wave form is part of real life. There is nothing in life that is a straight line.”
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