Sweet Sounds of the “SKINphony”: Incorporating Music into Daily Dermatologic Practice

By David A. Wetter, MD, FAAD
Nov. 29, 2023
Vol. 5, No. 47

It is amazing how music instantaneously transports us back in time. For me, Kool & The Gang’s catchy tune “Celebration” (“Celebrate good times, come on!”) hearkens back to the 1980s when my dad and I would attend St. Louis Steamers’ soccer games. We had season tickets to the Steamers (who were one of the teams in the now defunct Major Indoor Soccer League) and sat in the first row along the sideline plexiglass. After each home victory, the Steamers’ players jogged along the sideline and clapped the hands of excited fans as the “Celebration” lyrics blasted from the arena’s speakers. From the perspective of a school-age kid, it was pure joy. And decades later, hearing the song still conjures up joyful memories.

Similarly, I imagine that music has the potential to stir up intense emotions in everyone reading this commentary. It may be the soundtrack to your favorite movie. Or it could be a song played at an important family event (e.g., your spouse walking down the wedding aisle to the melody of Pachelbel’s Canon in D). Perhaps it is an energizing music snippet from a sporting event you attended (e.g., Europe’s “The Final Countdown” as the players re-entered the court in the waning seconds as the outcome of a pivotal game hung in the balance).

Can music enhance our daily experience in dermatology (particularly amid our busy clinical schedules)? For many of us, it already does in ways both obvious and subtle. When describing the tender occasion of singing an opera song to a frail patient, Joshua Wales, MD, remarked: “Connections forged with other people over shared experiences of the arts — movies, visual art, books, pop music, opera, theater, magazines — transcend these personal details and tap into something universal.” (1) Herein, I will briefly share a few (non-exhaustive) findings from the literature in bulleted form, admixed with some personal anecdotes, that suggest music may benefit our relationships with patients, colleagues, students, and ourselves.

Our patients

• Cynthia Peng, MD, recounted a patient for whom end-of-life discussions regarding complications from her ovarian cancer were facilitated through the effects of flute music. (2)

• Stella Fitzgibbons, MD, expressed stories of appreciation from patients, families, and workers who enjoyed her weekly piano sessions at a local hospital (including a patient who said, “I don’t have many good days, and hearing that music made me forget my troubles for a while”). (3)

• For surgeons who appreciated working with background music, performance scores were higher when performing a microsurgical arterial anastomosis procedure while listening to their favorite music through earphones. (4)

Although opportunities for musical interventions during our fast-paced outpatient medical dermatology visits may be limited, exploring ways to intercalate music within the overall patient experience (e.g., waiting room, clinic entrance) could potentially improve patient satisfaction.

Several questions regarding the incorporation of music within the medical dermatology setting should be further considered, including:

• What type of music (if any) do patients prefer to hear in the waiting room?

• Can music that does not align with an individual patient’s preferences cause anxiety?

• Is it helpful for patients to listen to music while undergoing minor office procedures such as shave or punch biopsies?

• Can music be a distraction (in some instances) that could hinder the patient-physician encounter?

Our colleagues and working together as a team

• Participants on a palliative medicine consult service felt that a “Thought for the Day” (a short reading of a poem, music, or spiritual piece) prior to their daily interdisciplinary team meeting provided benefit and enhanced the perception of teamwork. (5)

• A systematic review concluded that both self-facilitated and externally facilitated music engagement helped to reduce burnout in nurses. (6)

• Listening to music was one of several self-care behaviors identified among health care workers in the emergency department that helped reduce workplace stress. (7)

Recently, near the end of a Friday afternoon general dermatology clinic, the topic of music arose amongst our care team (faculty, residents, and nursing). One of the nurses then shared a playful song he composed in the style of “Closing Time” (a late 1990s pop song by Semisonic). We all laughed heartily as the nurse sang his creative song, which described multiple situations that may develop near the end of a busy clinic day and cause consternation for the nursing staff.

Similarly, I recently attended a dermatology conference which featured an off-site Friday evening social gathering. The lovely dinner was followed by dancing to music played by a disc jockey. After the music ended, the attendees boarded the bus heading back to the hotel. To our pleasant surprise, the bus featured an iPad with myriad karaoke songs and accompanying speakers. The 45-minute bus ride seemed like 15 minutes as we sang (mostly in unison) the entire way. The return trip culminated with an impassioned rendition of Celine Dion’s classic, “My Heart Will Go On.” A plethora of smiles and hoarse voices permeated the scene as we exited the bus and exchanged goodbyes!

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Our students

• An online survey study of medical students found that their self-reports of exposure to humanities (music, literature, theater, visual arts) significantly correlated with positive personal qualities (such as empathy) and inversely correlated with some components of burnout. (8)

• In a prospective, blinded, randomized trial of 19 general surgery interns, their performance of an in-vitro surgical anastomosis model was neither improved nor worsened while listening to standardized instrumental music. Most participants (89%) reported that they enjoy listening to music while performing tasks. (9)

I frequently look for opportunities to incorporate music into my workday. As I wrote in a “clinical tip” that I submitted for The Dermatologist: I enjoy listening to music, and often will play a “song of the day” before starting my outpatient clinic or hospital rounds. Not only does this put me in a good mood, but it also creates a feeling of camaraderie with the residents, medical students, and nurses working with me that day. Listening to music together creates a shared experience that boosts our team morale and puts all of us in a good frame of mind for caring for our patients. (10)

Fortunately, our dermatology residents enjoy the “song of the day” tradition, too. During an end-of-the-year faculty evaluation several years ago, one resident wrote, “I love starting with a song of the day.” Another resident remarked, “Even just being able to talk about music or sports is a huge morale booster for us.” Although the COVID-19 pandemic impacted the frequency of this practice in recent times, I look forward to consistently re-initiating the “song of the day” in my outpatient and inpatient practice in a fun and deliberate way.

Ourselves

• A systematic review found that music interventions decreased stress parameters (anxiety, mental workload, burnout risk, psychosomatic symptoms) in health care workers. (11)

• A cohort study of adults from the general population in Europe examining data on self-reported music listening during the COVID-19 lockdown period found that music listening was associated with improved perceptions of momentary stress and mood, prompting the authors to conclude that “music listening may be a means to modulate stress and mood during psychologically demanding periods.” (12)

My personal experience in dermatology clinic echoes these findings. During my 11-minute drive to work each morning, I eagerly anticipate 3-4 songs that I will listen to on Sirius XM radio (usually pop music from any decade from the 1980s to present, or sometimes electronic dance music, depending on my mood that day!). When I can sneak back to my office for a quick and quiet lunch, I also try to play a few upbeat songs from my Sirius XM app. Such moments, although not prolonged, help to put me at ease and unclutter my mind as I prepare for the patient session ahead, allowing me to be more mindfully present for my patients and to mitigate against becoming overwhelmed by their diseases and expectations.

Point to Remember: Incorporating music into our dermatologic practice can be fun and invigorating, potentially improving our relationships with our patients, our colleagues, and our students; and in turn, our own well-being.

Our editors’ viewpoints

Warren R. Heymann, MD, FAAD

Bravo! Dr. Wetter’s opus was pitch-perfect. The tenor of his overture to us to pick up our tempo and implement music to a grander scale could help us waltz through our days in triple time. His leitmotif is that when life is “mezzo-mezzo” for our patients, colleagues, or ourselves, the proper symphony can bring harmony to our lives. Do not let his fortissimo message fall flat. When incorporating music into your professional realm, do it andante; there is no need to go for Baroque. One of my favorite patient encounters was with two elderly twins — when I told one sister that she had a basal cell carcinoma, her response was “goody-goody”. I responded, “So you met someone who set you back on your heels” — instantly we formed a trio, singing Frankie Lymon’s classical tune together, laughing ourselves to tears. The ideal coda to the encounter.

Danielle DeHoratius, MD, FAAD

I must chime into this wonderfully written commentary and editor’s viewpoint for how in sync they both are! One of the best things about music is that in transcends generations and can bring all different types of people together on common ground. Since the sequel of the Top Gun (original 1986) movie, Maverick (2022), different decades of people now recognize the instrumental anthem at the start of each movie showing the jets in the early morning. There are no words to that piece, but it is inspiring and causes exhilaration. Any viewpoint about music written by someone from Philly must mention Rocky. Who hasn’t played that song during a workout?! I hope these could just be a few examples for a “song of the day.” Let’s face it, if you log on Instagram, so many of the reels are people dancing to music and it just makes you smile! So as James Taylor sings about your smiling face, whether you consider yourself a Swiftie or a Dead Head it is almost impossible not to have music put you in a good mood. Hopefully, if you play it in your office, it can have the same effect on your patients, even in you may be running behind, but not running on empty (Jackson Browne)!

1. Wales J. Last song – sharing humanity while maintaining boundaries. N Engl J Med. 2019;381:1894-1895.

2. Peng CS. Our shared humanity – music as a means of facilitating conversations on end-of-life care. JAMA Oncol. 2018;4:771-772.

3. Fitzgibbons S. Music and medicine: something important. JAMA Intern Med. 2017;177:1721.

4. Froschauer SM, Holzbauer M, Kwasny O, et al. Effect of music on the efficiency of performing a microsurgical arterial anastomosis: a prospective randomized study. J Hand Microsurg. 2020;15:13-17.

5. O’Neil T, Lyndale P, Szakatis K, Fitzgerald T. The value of a brief thought for the day reflection on an academic consult service. Am J Hosp Palliat Care. 2017;34:869-873.

6. Finnerty R, Zhang K, Tabuchi RA, Zhang K. The use of music to manage burnout in nurses: a systematic review. Am J Health Promot. 2022;36:1386-1398.

7. Bosch SJ, Valipoor S, Alakshendra A, et al. Coping and caregiving: leveraging environmental design to moderate stress among healthcare workers in the emergency department setting. HERD. 2023 Feb 1;19375867231151243. Online ahead of print.

8. Mangione S, Chakraborti C, Staltari G, et al. Medical students’ exposure to the humanities correlates with positive personal qualities and reduced burnout: a multi-institutional U.S. survey. J Gen Intern Med. 2018;33:628-634.

9. Shover A, Holloway J, Dauphine C, et al. A randomized prospective blinded study evaluating the effect of music on novice surgical trainees’ ability to perform a simulated surgical task. J Surg Educ. 2021;78:638-648.

10. Wetter DA. Incorporate music into your workday. The Dermatologist. (Clinical Tips section). 2018 Oct (submitted).

11. Colin C, Prince V, Bensoussan JL, Picot MC. Music therapy for health workers to reduce stress, mental workload and anxiety: a systematic review. J Public Health (Oxf). 2023 May 5;fdad059. Online ahead of print.

12. Feneberg AC, Stijovic A, Forbes PAG, et al. Perceptions of stress and mood associated with listening to music in daily life during the COVID-19 lockdown. JAMA Netw Open. 2023;6:e2250382.

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