Second Opinion: a musical narrative to accompany patients’ history

Despite the many benefits of new technologies, a surprising aspect of medicine for lay people is that 80 per cent of diagnoses arise from the history given by the patient. Underpinned by a sophisticated technique that improves with experience, this deceptively simple aspect of the consultation is the cornerstone of diagnosis. All diagnostic tests and scans should follow on from the history (and, to a lesser extent, the examination) rather than setting the pace; servants rather than masters of diagnosis.

However, as junior trainees may not fully trust in the potency of the patient narrative, a constant task of consultants on post-take ward rounds is to retake the history. At this stage, having been asked about the evolution of their symptoms several times, and guided by an experienced clinician, the story takes a more coherent and often different direction.

As Dr Muiris Houston noted in these pages recently, the narratives are always fascinating; a complex mix of background, body language, the imprecision of language, interactions and often a crust of received ideas. For example, Irish people often talk of "vertigo" when what they mean is dizziness, which is different from the medical sense of vertigo.

A broader sense of patient narrative has attracted attention in other ways in medicine. As educators, we are keen that the medical students develop an interest in the personal journey that patients take, including the imperfections of the medical system. Students are encouraged to explore narratives in cinema including The Diving Bell and the Butterfly and The Doctor, and in literature, works such as Simon Fitzmaurice's It's Not Yet Dark.

Concise and connecting

An emerging field is that of illness and personal narratives through music. Music is one of the most powerful art forms: appealing, concise and connecting with almost every system in the body.

I was reminded of this by the key work at the opening concert of the RTÉ National Symphony Orchestra season. Richard Strauss's Ein Heldenleben (A Hero's Life) is almost an hour long and scored for a huge orchestra. It is simultaneously music of great beauty and attractiveness as well as a concise autobiography.

Ironic and affecting by turns, the wonder of the musical narrative is how much ground it covers, from his compositions to lampooning his critics. A particular marvel is how the music allows him to enmesh quarrelling and nagging into a supremely loving portrait of his wife.

Medical narratives through music have a long pedigree. The French baroque composer Marin Marais portrayed an operation to remove a bladder stone, and both he and Rossini composed music describing asthma attacks. The Czech composer Zelenka has a striking piece describing a medical consultation, Hipocondrie á 7 Concertanti. In rock music, The Drugs Don't Work by The Verve and Cancer by My Chemical Romance continue this tradition.

Musical works

Next week, the public will have an opportunity to sample a remarkable triptych of musical works,

Synaptic Serenades

, that explore illness and ageing. One of Ireland’s foremost composers,

Ian Wilson

, spent three periods as composer in residence with patients and staff at the department of geriatric and stroke medicine in Tallaght hospital. Partners in the project included the National Centre for Arts and Health, and the

Irish Chamber Orchestra

.

The resulting works are quite extraordinary and will be performed together for the first time next week at the Royal College of Physicians in Ireland, in collaboration with the Royal Irish Academy of Music, as part of St Luke’s Week.

The first, Bewitched, is a song cycle for soprano and string orchestra, masterfully linking patient and professional perspectives of stroke with affecting music and songs popularised by Doris Day. This is followed by . . . and therefore I am for saxophone and strings, exploring the experience of Alzheimer's disease through the artwork of those so affected.

Life with Parkinson’s

In the last part of the triptych, Ian Wilson worked with poet Leontia Flynn to reflect the experience of life with Parkinson’s disease. The work,

Matter

, was premiered earlier this year in the atrium of Tallaght hospital, and will be the subject of a forthcoming documentary on TV3.

My abiding impression of these works is a strong sense of vitality, life and colour mingled with trauma and challenges, allowing us to see the fuller picture of the person and lightening the often gloomy discourse around neurological diseases of later life.

The power of this music to reassert our intrinsic humanity is a tribute to Wilson, and the concert promises to be a very special event.

Synaptic Serenades is on next Tuesday, October 14th, at 6.30pm in the Royal College of Physicians in Ireland, 6 Kildare Street, Dublin 2. Admission is free but tickets must be booked by emailing stlukes@rcpi.ie. Prof Des O'Neill is a consultant in geriatric and stroke medicine