Career Reflections Through the Lens of Rock and Roll Music

I recently had an epidural steroid injection to treat my sciatica. An anesthesiologist at a surgicenter performed the procedure while other medical personnel were in attendance.

“We’re missing something,” the anesthesiologist exclaimed prior to beginning the procedure. No one in the room had a clue what was missing until the doctor blurted out, “We need music!” “The Grateful Dead, please!” I requested while lying prone on the table. The anesthesiologist quickly dialed up “Casey Jones” on Spotify and started humming to the lyrics: “Casey Jones you better watch your speed . . .” The procedure was over before the train hit River Junction.

Important Role

There are numerous accounts detailing the importance of rock and roll music in the professional lives of physicians.(1-3) That rock music has found its way into hospital operating rooms, outpatient surgical centers, and other healthcare environments should come as no surprise given that 43% of all physicians in the United States are age 55 or older(4) and were likely immersed in rock and roll music in their formative years. For many, rock music offers comfort and soothes the psyche, providing the perfect vehicle for creative introspection while practicing medicine. More than a few physicians lead dual careers as weekday practitioners and weekend musicians.

Powerful Lyrics

Reflecting on my own career, I recall many rock and roll tunes that hold special meaning for me because of their combination of catchy melodies and powerful lyrics. I strongly identify with certain songs whose lyrics impart universal truths coincident with different stages of my career—a 40-year career divided equally between practicing psychiatry and working in industry. So, in no particular order, here are my “top 10” songs and their unique attributes to medical practice as viewed through my lens.

1. Song: “She’s Gone”

Artist: Hall & Oates

Lyric: “I need a drink and a quick decision. Now it’s up to me, ooh what will be.”

Hall & Oates are the best-selling music duo in history. Their platinum 1973 album Abandoned Luncheonette contained elements of R&B, rock and roll, and “Philly soul.” It produced the crossover hit “She’s Gone,” a song about the breakup of a relationship. When I was a resident, I treated many patients with relationship problems. However, the short time allotted for an initial evaluation (45 minutes) made it difficult to sort out all the issues. I often wished for a “drink and a quick decision,” but I forged ahead, scheduled additional therapy sessions, and hoped for an eventual good outcome. What I really needed was time to think. When the noted physician Dr. Danielle Ofri found herself in a similar position she wrote: “Extra time dedicated to thinking—with either longer patient visits or protected time for ‘panel management’—could actually be remarkably efficient. We would save money by reducing unnecessary tests and cop-out referrals. We’d make fewer diagnostic errors and avert harms from over-testing. And allowing doctors to practice medicine at the upper end of our professional standard would make a substantial dent in the demoralization of physicians today.”(5) To that, I say, “Amen!”

2. Song: “Subterranean Homesick Blues”

Artist: Bob Dylan

Lyric: “You don’t need a weather man to know which way the wind blows.”

The lyric “You don’t need a weather man to know which way the wind blows” lent its name to the radical 1960s group the Weathermen. “You don’t need a weather man . . .” has also been frequently cited by lawyers and judges in legal opinions and briefs.(6) British Prime Minister Harold Macmillan’s “Wind of Change” speech, which predated Dylan’s song, hinted at Britain’s intended exit as a colonial power in Africa and sparked the movement against apartheid. When generalized to clinical practice, “You don’t need a weather man to know which way the wind blows” serves as warning to physicians to be ever alert to the many forces of nature that may derail their careers—for example, mergers, acquisitions, downsizing, reengineering, and so on. Such events usually are beyond a physician’s control. Nevertheless, physicians may find themselves between a rock and a hard place when an ill wind blows, and there are some tough career choices they will have to make.

3. Song: “Won’t Get Fooled Again”

Artist: The Who

Lyric: “Meet the new boss; same as the old boss.”

In the closing verse of The Who’s anthem “Won’t Get Fooled Again,” lead singer Roger Daltrey belts out, “Meet the new boss; same as the old boss!” Persistent conflict with a boss, a board member, or a key stakeholder can certainly shorten the tenure of physicians working in organizations, now estimated to outnumber independent physicians.(7) Physicians who report to a new boss because their previous boss was fired or left the company also may face problems. New bosses may be overburdening. They sometimes bring unnecessary chaos and may be difficult to adjust to. New bosses may be intent on replacing their subordinates with friends and former colleagues in a proverbial housecleaning. Physicians who report directly to nonphysician administrators often experience personality clashes with them. A physician’s relationship with his or her boss affects job satisfaction and overall work environment. It also can be the basis for staying in a job or not. Be careful what you wish for—a change in leadership is not always for the better!

4. Song: “Back in the High Life Again”

Artist: Steve Winwood

Lyric: “I’ll be back in the high life again. All the doors I closed one time will open up again. I’ll be back in the high life again. All the eyes that watched me once will smile and take me in.”

Steve Winwood set the slick “High Life” melody to Will Jennings’ lyrics when the former was going through a divorce. There isn’t a physician whose personal life hasn’t been in turmoil at some point in time. My time of distress occurred around the turn of the century, when I uprooted my family and relocated for a job, only to see it evaporate in two years, followed by another job I accepted on the rebound, which required 50% travel. I was miserable, and my wife and children noticed my unhappiness. But like Winwood, good fortune came my way. I was hired by another organization, and my job offer came with a relocation package to my hometown. Whether through the actions of others or simply by the whims of life, we have all experienced the back-and-forth tendency of emotions between happiness and sadness. Take heart in this cyclical nature of life and know that tomorrow brings with it the possibility for change.

5. Song: “You Can Leave Your Hat On”

Artist: Randy Newman

Lyric: “You can leave your hat on.”

The controversial tunesmith Randy Newman wrote “You Can Leave Your Hat On” in 1969. It is a risqué song in which the singer invites his love object to turn on the lights—“all the lights”—and slowly remove her clothing, except her hat. The song was made famous by Joe Cocker and has been featured in striptease scenes in the movies 9½ Weeks and The Full Monty. My association with the song, however, is unrelated to lascivious behavior. For me, the “hat” symbolizes the doctor’s white coat. At one time, the white coat was considered a powerful symbol of the medical profession. Now it has been eschewed for a more casual appearance among doctors that attempts to put the doctor–patient relationship on an equal footing, not to mention a sanitary interaction (coats and ties carry germs!). I have attended two white coat ceremonies—my twin daughters are medical professionals—and both times I was reminded of the sacrosanct relationship between doctor and patient. The medical quality expert Dr. Donald Berwick delivered a stirring keynote address to the 2010 graduates of Yale Medical School—a graduating class that included his daughter. Dr. Berwick remarked, “When you put on your white coat, my dear friends, you become a doctor. But, now I will tell you a secret—a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off.”(8) To serve the suffering, it doesn’t matter whether you wear a white coat, dress casual, or wear nothing at all. You can leave your hat on.

6. Song: “Why Must I Always Explain”

Artist: Van Morrison

Lyric: “It’s just a job you know and it’s not sweet Lorraine.”

In Morrison’s classic rock song “Why Must I Always Explain,” he attempts to quell the press, critics, and fans when questioned about the demands on his life as a musician constantly on tour, as well as the need to make records for a living. Morrison sings, “It’s just a job you know and it’s not sweet Lorraine.” Very few people, however, are able to treat work solely as an impersonal activity. Physicians, more than most professionals, find it difficult to disengage from work and establish a normal work–life balance. Many have worked in unhealthy, even toxic environments, to the point where they have succumbed to burnout and depression rather than simply walk away or take some time off. Others have developed substance use disorders during their careers, which occurs among physicians at a rate similar to or exceeding that of the general population.(9) Indeed, physician wellness has increasingly been recognized as an important, although often overlooked, quality indicator.(10) A careful assessment of the “goodness of fit”(11) between physicians and organizations prior to starting a job may reduce the risk of burnout and keep physicians from having to explain to their family and friends what went wrong.

7. Song: “The Harder They Come”

Artist: Jimmy Cliff

Lyric: “I’d rather be a free man in my grave than living as a puppet or a slave.”

A survey of 620 physician executives conducted by the late Dr. Howard Kirz(12) found that 290 (47%) said that they had been involuntarily terminated from a medical management position during the past five years. I have been “let go” several times in my career through no fault of my own, and most recently it resulted in my “involuntary retirement.” I understand the dangers involved in taking a high-profile job, but it really riles me when layoffs are dictated by “bean-counters” who work their profit/loss ratios behind the scenes. Individuals in authority sanction the layoffs, and human resources personnel carry out the terminations, following a chain of command. Worse yet, my boss (a physician), acting as a “puppet on a string,” delivers the bad news to me on the telephone. The sad fact is that from 1975 to 2010, the number of healthcare administrators in the United States increased 3200%, while the number of physicians grew 150%, roughly in keeping with population growth.(13) There are now approximately 10 administrators for every doctor. This trend has to be reversed, and physicians need to stand up for their colleagues rather than kowtow to the “suits.” We need to increase our medical leadership activities and empower physicians working in healthcare organizations. Otherwise, we may as well be free men (and women) in our graves.

8. Song: “Wharf Rat”

Artist: Grateful Dead

Lyric: “Old man down, Way down, down, down by the docks of the city. Blind and dirty, asked me for a dime, a dime for a cup of coffee. I got no dime but I got some time to hear his story.”

“Wharf Rat” was one of the first in a series of great story songs penned by Jerry Garcia and Robert Hunter—songs set in an America populated by outlaws, the down-and-out, and a range of more or less unsavory characters. Wharf Rat is a homeless beggar named August West (imagine him as a patient) who tells his story to the song’s narrator (imagine him as a doctor down on his luck—he has no dime). However, the narrator takes the time to listen to West. Practicing medicine is all about offering patients the requisite time to listen to their stories and reflect on them. Doctors tell their patients’ stories because it liberates profound emotions kindled by the clinical experience.(14) Physicians have made great storytellers throughout time, from Anton Chekhov, considered the greatest writer of short fiction, to the late Oliver Sacks, best known for his collections of neurological case histories, not to mention countless other physician authors. Collectively, physicians’ stories illustrate the importance of humanity in medicine.(15)

9. Song: “Born to Run”

Artist: Bruce Springsteen

Lyric: “Tramps like us, baby we were born to run.”

Springsteen’s 1975 “Born to Run” song and album are world famous. The song proclaims love for a girl named Wendy, coaxing her to “run till we drop” on a “last chance power drive” out of town (via Highway 9 in Freehold, New Jersey). It’s not only the song, but also the story behind the making of the album Born to Run, that resonates with me. Springsteen had previously released two albums with little commercial success. He needed a hit song to continue his recording contract with Columbia Records. He had labored over Born to Run for more than a year, causing great distress among the record label executives. With his career on the line, Springsteen delivered the song and the album that became an unparalleled success, catapulting him into the limelight and resulting in overnight stardom with simultaneous cover stories in Time and Newsweek magazines. I envision the entire process akin to medical residency and the triumph of passing one’s certification boards. Hard work, creative thinking, and a “never give up” mentality are often rewarded by success.

10. Song: “Ghost on the Canvas”

Artist: Glen Campbell

Lyric: “We dream in color, others they color their dreams.”

Paul Westerberg of The Replacements wrote the surreal “Ghost on the Canvas” in 2009, a song with allusions to dreams, departure, and mortality. “Ghost” became the title track of Campbell’s 2011 album, released following the revelation he was in the early stages of Alzheimer’s disease (Campbell died in 2017). Despite the diagnosis, Campbell undertook a “Goodbye Tour” to promote the album and the many classic Jimmy Webb songs he had brought to life over the years. Campbell played 151 spectacular sold-out shows on tour for a year and a half, utilizing a teleprompter to help him remember the lyrics, until he could no longer perform. Dozens of rock songs have allusions to “dreams” —The Everly Brothers’ “All I Have to Do is Dream,” Roy Orbison’s “In Dreams,” and Crowded House’s “Don’t Dream It’s Over” immediately come to mind. Of all of them, “Ghost on the Canvas” is my favorite. The song enshrines Campbell’s legacy and inspires us to strive for our very best even under extraordinarily difficult circumstances. It dares us to dream in color and not let adverse conditions color our dreams.

Conclusion

Various dimensions of rock and roll music viewed through my medical optics raise associations with the doctor–patient relationship, storytelling, career changes, professionalism, physician wellness, death and dying, and other topics. These themes are only the tip of the iceberg represented by a select and admittedly biased handful of songs that hold significant meaning for me. Moreover, there are additional representations of doctors and clinical practice depicted in art, the literature, opera, television, and movies, which, like rock and roll music, may provide a window into the culture and practice of contemporary medicine.

Rock and roll artists have always been somewhat ambivalent about having their lyrics viewed as poetry, tools for social change, or anything other than a means of self-expression. Nonetheless, it seems natural to want to compare the lives of rock icons to doctors and interpret rock lyrics with the medical profession in mind, just as it is natural to want to write about the spectrum of human emotions and conditions provoked by patient encounters in the course of practice.

References

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2. Lazarus A. The doctor-patient relationship in rock and roll music. J Med Pract Manage. 2006;22:162-165.

3. Wolthers OD. Doctors in popular songs: the dark side of the moon? Br J Gen Pract. 2017;67:273.

4. Physician Supply Considerations: The Emerging Shortage of Medical Specialists. Merritt Hawkins White Paper Series, 2017. www.merritthawkins.com/uploadedFiles/mhawhitepaperspecialties2017.pdf .

5. Ofri D. Perchance to think. N Engl J Med. 2019;380:1197-1199.

6. Long AB. uses and misuses of popular music lyrics in legal writing. Washington and Lee Law Review. 2007;64:531. https://scholarlycommons.law.wlu.edu/wlulr/vol64/iss2/4 .

7. 2018 Survey of America’s Physicians: Practice Patterns & Perspective. The Physicians Foundation. https://physiciansfoundation.org/wp-content/uploads/2018/09/physicians-survey-results-final-2018.pdf .

8. Berwick DM. Yale Medical School Graduation Address. May 24, 2010. https://docplayer.net/16043223-Yale-medical-school-graduation-address-donald-m-berwick-md-mpp-new-haven-connecticut-may-24-2010.html .

9. Berge KH, Seppala MD, Schipper AM. Chemical dependency and the physician. Mayo Clin Proc. 2009;84:625-631.

10. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.

11. Lazarus A. Avoid burnout by finding your “fit” in the organization. Physician Leadership Journal. 2020;7(1):38-40.

12. Kirz H. Congratulations . . . you’re fired! Physician Executive Journal. 2000;26(4):20-25.

13. Cantlupe J. The rise (and rise) of the healthcare administrator. AthenaInsight. November 7, 2017. www.athenahealth.com/insight/expert-forum-rise-and-rise-healthcare-administrator .

14. Ofri D. The passion and the peril: storytelling in medicine. Acad Med. 2015;90:1005-1006.

15. Moniz T, Lingard L, Watling C. Stories doctors tell. JAMA. 2017;318:124-125.