Opinion: You may have been there, waiting your turn, wearing an ill-fitting hospital gown, surrounded by a flurry of staff, the smell of disinfectant in the air. If you’ve ever undergone surgery, you probably know the nervous, stress-laden pre-op feeling.
What may come as a surprise is that surgeons can also experience high levels of stress, while they are operating on you. Should they listen to music to settle their nerves, and if so, will it? As a vascular surgeon in training, this is a question I’m investigating in my PhD research.
Surgery requires the expert execution of technical and non-technical skills, dealing with the unexpected, assessing risk, performing fine motor tasks, and leading the operative team. Doing this well puts a considerable cognitive load on the surgeon especially as they are often dealing with on-call work, time pressures, complex cases or unexpected events, and interpersonal or personal stressors.
High levels of stress could impair the performance for the surgeon and/or the team and can lead to chronic stress. Finding ways to reduce the stress will likely promote consistent, excellent surgical performance and workforce sustainability. One way that surgical teams influence the mood of the operating environment is by playing background music.
This makes sense to me. Throughout school and university, listening and playing music had been a big part of my life. I was fortunate to have some extremely valuable and informative musical experiences in New Zealand and in India which fuelled my passion for performance. My penultimate year of medical school turned out to be a tough one, where I was heavily affected by mental wellbeing challenges, personal and amongst close friends.
This, alongside the strain of trying to keep up at medical school, put a huge amount of stress on me, so much so that I wasn’t sure if I would be able to finish medical school if I didn’t find some new perspective, so I left medical school, and went to the New Zealand School of Music in Wellington to study jazz performance.
After 12 months of jazz workshops, concert recitals and many hours of busking, I returned to the Dunedin School of Medicine with a different outlook. In the operating theatres, I discovered that music was often played. Staff were using it to improve the mood or calm the surgical team. But no one knew for sure if playing music was helpful or harmful.
The elements of stress and the human factors in surgery and the use of music fascinated me, and over time prompted me to start a research journey to try to find out what effect music really has in the surgical setting.
It would make sense that it would. Music is used to alter moods, create senses of divinity, used in ritual and trance, to build identities for communities. It often makes us want to dance and helps us relax, it can help those who are hurting, who are disadvantaged and anxious. Patients undergoing surgery too benefit from music, with studies showing it can reduce anxiety, increase feelings of patient post-operative satisfaction, and even act with similar efficacy to anaesthetic medications. But what effect does it have on surgeons in the theatre, the people who we are often trusting with our lives?
Looking at the research literature, I found that many surgeons liked having music in the operating theatre and most felt it reduced their mental workload and improved their mood. There were some who felt otherwise, that it could be distracting or impair communication among the surgical team. There are some small interventional studies suggesting that music could improve the accuracy and speed of an operating surgeon. However, there were a lack of studies directly investigating the effect that music had on a surgeon’s stress experience using the gold standard study methodology – the randomised controlled trial. And none had conducted a randomised controlled trial in the operating theatre itself.
So that’s what we did. We wired general and vascular surgeons with heart rate monitors and had them complete the barrage of psychological tests during and after performing their usual operations – mostly surgeries treating cancer and peripheral vascular disease. We found that there were high levels of cognitive load and a significant rise in heart rate when the surgeons started operating, but comparing surgeon-selected background music to silence, we found no difference in the surgeons subjective or objective experience of stress.
After analysis, we felt this was at least in part due to the number of uncontrollable factors, such as case difficulty, other members of the team and other operations on the list for the day. Currently we are wrapping up recruitment and analysis of a follow-up study involving comparing music and ambient noise during simulated complex surgical tasks in the laboratory. This new setting allows us to attach more detailed and intricate physiological measurement tools and account for many variables such as case complexity, time pressure and how much coffee they’d had.
Many questions remain about the relationship between music and surgery. Does the type of music matter? Why isn’t jazz played more often? Who chooses the music? If there’s a disagreement, how should consensus be reached? Musical preference is as varied as there are people on this earth. What may be an essential soundtrack for one may be grating and a distracting noise to another.
The jury is still out on whether we can find the perfect soundtrack for the operating theatre. But along the way we have been creating and testing tools which can be used by others who are also trying to find out what the optimum operating environment sounds like. The ultimate aim is to enhance the performance and the wellbeing of the clinicians who are asked to take the lives of our loved ones into their hands.
