Covid-19 knocked communal hobbies on their head. My weekly community wind band rehearsals were banned and concerts cancelled. But learning from our hobbies can inform our clinical work. If you would prefer a sporting analogy, then instead of clarinets and saxophones, think about cricket and baseball, or cycling and motorbikes.
On the face of it there are many similarities between clarinets and saxophones, and indeed many clarinet players can play the saxophone and vice versa. (There are also important differences too technical for this piece—if you are interested ask a clarinettist about the speaker key, overblowing a twelfth, the break, and altissimo register). Clarinets and saxophones have similar mouthpieces and are both single reed instruments. In order to make a sound you arrange your lower lip over your lower incisors, place the reed over your lip and apply pressure with your upper incisors, using orbicularis oris and buccinator muscles. This is called your embouchure, and requires stamina when playing for long stretches. The type of reed and mouthpiece, muscle tension, breath control and application of tongue control tone is similar for both instruments. Despite these similarities, playing a clarinet or saxophone to the full requires different approaches. I play both the clarinet and saxophone, but one of my band mates tells me that I play the saxophone like a clarinet; I need to relax more, both in embouchure, attitude, and posture.
Just as with medicine, there is an art and science to playing a musical instrument, whether by yourself or in a band. You need to listen to your own playing and that of others, swap techniques with other players, watch the conductor at all times, read ahead and plan your finger placement. You also need to gauge your audience. Music connects us back to the composer, reading their instructions (notes, tempo, dynamic) but also making our own interpretations. Musicians need to practise in their own time, but also with others, until the twists and turns of the music are committed to muscle memory.
As with music, medicine requires a combination of technique, attitude, knowledge, connections, and stamina. This is immediately obvious in situations such as a cardiorespiratory arrest, with the team coming together with their different skills, some in muscle memory from repetition, and others adapted for the specific situation. Technique may need to change with a new endotracheal tube or central line. The resuscitation team leader’s attitude can bring calm to the initial chaos and panic.
In the process of moving between specialties, from hospital medicine to general practice training, I have thought frequently about my bandmate’s comment about playing the saxophone like a clarinet. GP training posts in obstetrics and gynaecology, medicine of the elderly and paediatrics, bookended by GP posts in different GP practices, have highlighted the differences between clinical specialties. On qualifying, my predominantly hospital-based perspective persisted through years of medical training. Working as medical registrar brings a particular structure to your practice—the history, examination, raft of bloods, perhaps an ECG and/or chest x-ray; the decision on whether to wait for more specialist examinations or request them urgently; the safety and security of admission to hospital with ongoing observation, monitoring and treatment. Step outside that structure and you receive strange looks when presenting the patient on the admitting unit ward round or at handover.
When I started in GP training after 17 years in public health I still had the hospital worldview, reinforced by months of refresher experience in medicine of the elderly. I was attempting to squeeze my med reg approach into a 10-minute consultation. Not only is this impossible, it misses the purpose of GP consulting (see Claire Denness and Damian Kenny for more detail). Many of the basics of GP consulting—the exploration of impact of symptoms on everyday life, and ideas, concerns, and expectations early in the patient encounter—could be just as important in hospital practice. If the emergency department doctor does not understand that a patient with a cough is concerned about lung cancer and is expecting further investigations then there will be a mismatch when the doctor focusses discussions on whether to start antibiotics. Achieving this juggling act in the short consultations of general practice and the emergency department takes a lifetime of practice and makes “medical generalism” a specialist skill.
Switching between roles we need to remember that expertise and attitude are important. Just as a clarinettist needs to change their stance, embouchure, and mindset when swapping to saxophone for a big band piece, we need to think which consulting approach to use as we arrive at work or meet our next patient. Think what we can learn from our hobbies and each other as lockdown loosens and our clinical work shifts into a different gear.
Graham Mackenzie has been a doctor for 25 years, and is currently retraining as a GP. He has also worked in hospital medicine and was a consultant in public health medicine in NHS Lothian for 11 years, during which time his remit included women and children’s health and quality improvement. Twitter @gmacscotland
Competing interests: none declared.