Surgeon Preference and Music in the Operating Room: a Randomized, Controlled Trial

by Marie Crandall, MD, MPH, FACS

Background: Music in the operating room has been studied fairly extensively, mostly in the context of ambient music used to decrease anesthetic requirements during surgery. However, very little has been written about musical preferences of the operating surgeon, which is arguably very important, as “ambient” music often translates into that irritating New Age music which meanders aimlessly, relying heavily on woodwinds and bird tweets, and defies all rhythm or syncopation. Still, apparently it’s very helpful to patients who are not actively driven to poke their eyes out with stray syringes of propofol having to listen to that nonsense.

Methods: The authors (A.K.A. me) decided to conduct a randomized, controlled trial of surgeon-directed music in the operating room (OR). Except that randomization is sort of painful, in that there has to be blinding, measurement of covariates, and I really only had a week. So, instead, I performed a population-based survey, by sending out an email and posting a Facebook notice querying surgeons about their OR musical preferences. I guess one could quibble about the “population-based” aspects, as I mostly just emailed the cool women surgeons whose email addresses were in my Outlook contacts, and well, I suppose my Facebook friends are not exactly a random sample of American surgeons. Oh, yeah, and I only asked women. Just because. But I digress. Four questions were asked, “1. Do you listen to music in the OR?, 2. Is it your music?, 3. Do you let residents pick the music?, and 4. What do you listen to?” (yes, I know I ended the question with a preposition, but remember this is a population-based survey, and EVERYONE does it, ok I’ll change it. See Table 1 below).

Results: Seventeen attending women surgeons responded to the survey (100% response). Nearly all respondents listen to music in the OR. Most bring their own music, but some attendings allow the residents, nurses, and anesthesiologists to choose music. A theme emerged that many surgeons will turn off the music when a patient is unstable. Those who always listen to their own music were fairly vehement about it. Otherwise, musical preferences are all over the map and completely contradictory to each other, defying any kind of theme analysis. And some people listen to really terrible music, as you can see for yourself in Table 1 below.

Table 1: Survey of badass* attending surgeon musical preferences

Question	N (%)	Comments
1.     Music in OR? Yes No	16 (94%) 1  (6%)	“If it’s an unstable patient, I turn the music off,”  “Occasionally it’s distracting when I have to make sure anesthesia is not slipping some pressors in the IV,”  “Will turn tunes on when out of the danger zone,”  “No music allowed. Focused concentration mandatory”
2.     Your music? Yes No	10 (59%) 7  (41%)	“Really?  That’s the absolute best thing about being an attending, choosing the OR music.  That and wearing pajamas every day to work.”
3.     Let residents pick music? Yes No	12  (71%) 5  (29%)	“NEVER,” “Yes, unless it sucks”
4.     Musical choices? Neurosurgery resident playlist; Pandora, dance music  (all decades); “Mostly alt country/Americana with a little Southern rock thrown in; Drive-By Truckers for nec fasc”, “Washed Out, Wye Oak, Beach House, Sharon Van Etten, Wild Nothing, Iron & Wine, Silent Years, Alela Diane, Army Navy”; ‘80s, upbeat dance music, “My Sharona”; “Top 40 radio, classic rock, top 40, jazz, classical”; “Electronica is my office default, but it’s not appropriate in the OR”; contemporary pop; “OR specific playlists with Pink, Indigo Girls, Patrice Pike, Bonnie Raitt, Tim McGraw, Lady Antebellum, Shawn Colvin, The Rescues, just to name a few”;  Indian and American club music; “I use Pandora; liver transplants get 80s pop or Vanilla Ice mix, liver resections get Abba or Pink”, “my iPod (all decades)”; “A mix on Pandora, what it is depends a bit on the case and time of day,  one of our night scrub techs is a huge Disney fan so we tend to play Disney Pandora and have a name that tune session” ; “My music is the best.  I have everything from Metallica to Otis Taylor to Agent Orange to Santana.  If you hate the current song, wait til the next one.” Pertinent negatives:  no country (x2), no musicals, no rap, no metal, no Britney Spears, no Taylor Swift, no Justin Bieber, no smooth jazz

*badass (adj). Used to describe all study participants; indicates clarity of mind, a humorous disposition, and excellence in the field of surgery

Conclusions: My first conclusion is that most of us are united in turning off the music to enhance concentration, consistent with previously published research. Second, in this non-randomized, uncontrolled, not remotely population-based survey of experts in the field of surgery, there is a wide variety of music played in the OR. And, finally, the near-unanimous agreement that the best music to be heard in any OR anywhere is that of Marie Crandall, MD, MPH, FACS.

What music do you like to play in the OR? Let us know in the comments below.

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Marie Crandall, MD, MPH, FACS is an Associate Professor of Surgery and Preventive Medicine in the Division of Trauma and Critical Care at Northwestern University Feinberg School of Medicine. She is originally from Detroit, MI, a product of Head Start and local public schools. Dr. Crandall obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley in 1991, and completed her M.D. in 1996 at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001, and in 2003, completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA. During her fellowship, she obtained a Masters in Public Health from the University of Washington. Dr. Crandall performs emergency general and trauma surgery, staffs the SICU, and is an active health services researcher. Dr. Crandall loves travel, triathlons, hiking, and is a passionate animal rights activist; you can follow her on Twitter @vegansurgeon.

Solidarity

by Minerva Romero Arenas, MD, MPH

Since medical school, I had an interest in oncology. Our professors frequently invited patients and families to come and share with our class how they were personally affected by disease. I remember meeting a survivor of glioblastoma multiforme despite having been initially given a poor prognosis. Another family shared the heartache after losing a child to neuroblastoma and their efforts in raising his siblings. I was inspired to do something to show support for patients like the ones who shared their stories with us - the patients whom I one day hoped to treat. Being on a limited student budget, I had to think outside the box since I could not afford to make "significant" monetary donations. One day I decided I would donate my hair so someone else could have a wig.

Having had long tresses for decades, I must admit I was hesitant to go for a short bob. The fear quickly faded, as the stylist transformed my ponytails into "locks of love." The selflessness I felt, as I placed those long ponytails in the mail, let me know that it was one of the best ways I could contribute outside of my dedication to the medical field. I first donated to Locks of Love, though I have since switched to the Beautiful Lengths program.

Since that time, I have donated my thick, brown locks again. However, the next time became a lot more personal. During my first week of surgery residency, one of my surgery attendings made me burst out in tears after a teaching conference. Now, there is an unspoken rule that there's no crying in surgery! (just like in baseball). But my tears were not the result of a terrible pimping session or getting chewed out for making any mistake-- I had just learned that this surgeon, my professor, had terminal cancer. Having been given less than six months, she already had beat the odds a few years from initial diagnosis. Over the next year and half, she became a mentor and had a great influence on my early development as a young surgeon. I did not think twice about donating my hair again when she faced a debulking surgery for a recurrence. During our last conversation, she smiled when I told her about the donation.

My hair grew long again; it had been more than two years since the last donation. What a perfect metaphor for my progression in residency, and the adage that a tincture of time is sometimes the best medicine. Then I found out a colleague was facing a cancer recurrence. I prepared to visit my favorite hairdresser. He gets the most length by separating the hair into at least two ponytails. That day I mailed two ponytails, 12 inches each, of solidarity. Priceless.

~~~

Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of Baltimore and is completing a research fellowship at The University of Texas MD Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The University of Arizona, and studied Cellular Biology & French at Arizona State University. She is also involved in mentoring and public policy. On her personal time she enjoys spending time with friends and family, especially when it involves good food.

Shoes to Wear in the Hospital

by Mary L. Brandt, M.D.

I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet…. which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.

What kind of shoes should you wear in the hospital?
 
There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide the right kind of support for standing, which means your feet will suffer if that’s what you wear.

It goes without saying that you should not wear open toed shoes in the hospital. It’s not only against the rules, but it’s going to gross you out one day.

Basic concepts to choose good shoes for work in the hospital

• Look for good support. The classic “nursing” or “operating room” shoe exists for a reason – they are designed to provide the support your feet need during long days of standing and walking.

• If you are not in scrubs, you’ll still need OSHA compliant, comfortable shoes. They can be stylish, but make sure they fit the overall professional image you are trying to achieve. Check out San Antonio Shoes (SAS), Clarks, Rockport and Ecco.

• If you will be standing for long periods on rounds or in procedures, think about getting shoes that slip on and off. When you are standing for a long time, being able to slide out of your shoes becomes important. If you’ve been standing for hours it really helps to stretch your calves and change the pressure points. It’s also easier to step out of your shoes all together and stand barefoot for a little while. When you are sitting, you can slip them off and let your feet breathe. Dansko Professional clogs are expensive but are probably the best in this class. Sanita clogs are supposedly now made in the original Dansko factory. Birkenstock, Keen or Clarks clogs are good alternatives. Crocs are tempting but have poor support, minimal ventilation and have been banned in some hospitals.

• Try to get shoes that breathe. You can find shoes that are like clogs in their design, but are made of materials that breathe. Examples include Merrell’s Encore Breeze (my current personal preference). They are not only comfortable, but they can be put in the washing machine (minus the insoles) if they get really dirty at work.

• Once you’ve met those criteria, lighter is better.

• Cheaper is good, too. One lead from studentdoctor.net is footprints.com.

Long days standing at work also make for stinky feet. Just like long-distance runners, you have to learn some tricks to deal with this.

1. Have more than one pair of good shoes and alternate them.
2. Don’t buy cheap socks. Wicking socks like Balega socks are worth the price.
3. Take an extra pair of socks with you for long days and change them in the middle of the day.

Foot massage, pedicures, and other foot care

After work, in terms of “bang for the buck” there is nothing that will make you feel better than a little attention to your tired feet.

Use a good foot scrub in the bath or shower like Bath and Body Toe the Line of The Body Shop’s peppermint scrub .

Take 10 minutes and try some methods to soothe tired feet. If you are lucky enough to have a significant other who will rub your feet … congratulations! (and, by the way, it really is “true love”…)

Even if you are a guy – don’t blow off pedicures. If you’ve had one… you know. If you haven’t… try it before you decide.

Cross-posted on August 14, 2011 at wellnessrounds.org

What shoes do you wear around the hospital? How do you take care of yourself after being on your feet all day? We would love to know. Share with us in the comments below!

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Mary L. Brandt, M.D. is a professor of Surgery, Pediatrics, and Medical Ethics at Baylor College of Medicine and a practicing pediatric surgeon at Texas Children’s Hospital. She is involved in education on a day-to-day basis in her clinical work. She also thinks about medical education on a bigger scale through her work as Vice Chair of Education of the Michael E. DeBakey Department of Surgery and Associate Dean of Student Affairs at Baylor College of Medicine. She is an active participant in the blog-o-sphere and on Twitter.