Monday, July 13, 2009

What is the Best Background Music for Dictating ICU Chest Films?

I was on call this weekend, where I dictated reports on about two hundred ICU chest films. This turned out to be a fine time to test an iPhone app called White Noise, which was a software pick of the week on last week's MacBreak Weekly podcast by Scott Bourne and Alex Lindsay.

White Noise generates random background sounds to replace the background sounds you already have, but don't want. Besides playing actual white noise, this app also plays brown, pink, blue and violet noise as well as other sounds, including 6 different intensities of rainstorm.

Even in my relatively quiet reading room, there was a surprising variety of annoying background noises this weekend, and White Noise did a fine job of covering them all. This got me to thinking about another topic from the same podcast, where Scott and Alex debated whether there were optimal background sounds for different activities. What would be the best background for dictating ICU chest films?

I listen to a lot of audiobooks and podcasts when performing mindless tasks like laundry, dishwashing or commuting. However, I find these way too distracting for cognitive work like film interpretation. So, I designed a quick and dirty controlled study on myself (n = 1), pitting White Noise against three different styles of music: Cajun/swing (Red Stick Ramblers), heavy metal (Metallica), and baroque (Glenn Gould playing Bach's Goldberg Variations).

My results are summarized in the bar chart above, where the vertical axis shows the number of minutes it took me to read 10 ICU chest cases while listening to a particular background. Despite my dubious experimental design, the results are intriguing: I seem to be about twice as efficient while listening to Bach as I am while listening to Cajun/swing. Just in case the first run of Bach was a fluke, I did an additional run of 10 films on a few more of the Goldberg variations. This second run was pretty similar to the first Bach run. However, before I could replicate runs on other styles of music, I ran out of films to interpret.

Taking this at face value, maybe these results are not so surprising. Maybe Lewis Thomas was right when he said:
Music is the effort we make to explain to ourselves how our brains work. We listen to Bach transfixed because this is listening to a human mind.
A quick googling of this topic shows that I am not the first to tread this ground. I quickly found a paper by Cassidy and MacDonald, titled "The effect of background music and background noise on the task performance", published in 2007 in the journal Psychology of Music (vol. 35; pp 517-537). One of their conclusions:
In conclusion, the current study has highlighted the detrimental effect of sound (noise and music) on task performance, in comparison to silence...
(Oops -- forgot to collect data for silence alone...)

They also found that introverts (e.g. radiology nerds) find music and noise more distracting than extroverts (e.g. orthopedic surgeons). Hmmm...

I also ran across a recent article on the work of Warren Brodsky of Ben-Gurion University, who has studied the effects of music on high-risk driving behavior. In a nutshell: fast music makes you drive faster -- and less safely.
For example, while listening to a piece of music, drivers are immersed in much cognitive work including aural analysis and processing of the music components at various levels related to understanding, operations of short- and long-term memory, emotions, and of course extra-musical associations which continually surface from music stimuli.
In other words, music may not relax your brain -- it may make it work even harder.

Nevertheless, I'm not quite ready to give up on music just yet. So, to add some rationality to my rationale, I'll collect some more data the next time I'm on call. Just in case silence is actually golden, I will add an arm to the study in which I dictate to silence alone. However, despite the growing evidence that background music is distracting, I secretly hope that Bach wins again.


Mog said...

Interesting post. I am now profoundely deaf but when I was just HOH(!) and working as an x-ray tech I used to hate it when surgeons and/or interventional rads would have music playing. I found it distracting as well as impairing my ability to hear. Of couse mood is affected by the music you are listening to and so one person's exhilarating Ride of the Valkyries turned my adrenalin into fear.

I know choosing music for all doesn't apply when you are working alone, but surely intricate calm music would be better for concentration than Wagner?

Incidentally, 200 ICU films in one weekend? How big is that ICU?

The Samurai Radiologist said...

@ Mog: That would be a big ICU. :) However, this is 200 films over 2 days. Some patients may have multiple films per day, especially if they have multiple line placements. We also have multiple ICU's in our large trauma hospital: a medical ICU, a surgical ICU, a trauma ICU and finally a burn unit. It all adds up.

Mog said...

Ah thanks, it all makes sense now. I'm glad to have found your blog BTW.

Dave Goldman said...

Surely your study remains incomplete until a second radiologist grades your reading accuracy under each aural regime!

Not that I'm questioning what I know are your high levels of accuracy...

The Samurai Radiologist said...

@ DG: My study design definitely has all sorts of holes in it. Also, there are many other metrics one could measure besides reading efficiency and interobserver variation. The most valuable metric for me in this study was the decrease in tedium while reading the last 50 exams in my worklist. :)