Kamal Chemali, MD, is director of the neuromuscular and autonomic neurology center at Sentara Healthcare. He is also a conservatory-trained pianist, and at times his performances include an audience of his patients.
That latter point links to Chemali’s work as a national advocate of clinical music therapy. And in 2010, he founded Sentara’s music and medicine center to focus on the integration of music as a supplement treatment for neurological conditions.
So, what came first—Chemali’s love of music, or his career in medicine? The answer, he says, is easy.
“Music came first, because your passion for music comes very early in life,” he explains. “My parents tell me that it started at age 3, when I was listening to Beethoven’s symphonies and singing them from memory. But in the beginning, the 2 (music and medicine) were not really connected.”
That would soon change.
Connecting the notes
Chemali likely began blending music and medicine when, as a medical student, he and his musician friends would perform in hospitals, particularly during holidays. To his surprise, the patients displayed a dramatic response to the music.
“Their eyes would start to twinkle, their faces started to shine, and they would smile when they were feeling upset,” Chemali recalls. “Even their pain would start to ease away. But I didn’t think much of it at the time.”
That stemmed from the difficult decision he made at age 18 between music and medicine. Chemali knew that if he pursued a career in medicine he would have to give up, albeit temporarily, his love for music. He opted for medicine, but recalls making a promise in a journal that he would one day return to his first love, music. It didn’t take long for him to make good on that promise.
“When I finished my neurology fellowship, literally, on the day I graduated, I was living in Cleveland, OH, and I went next door to the Cleveland Institute of Music and I registered as a student in piano,” Chemali says. “I studied 3 years at the Cleveland Institute of Music. And it allowed me to go back and organize concerts at the hospital.”
The feedback he received from patients who attended the concerts was overwhelming. Not only did the music make them feel good during the concert, but there was a lasting effect afterward as well.
“That’s when I started to take [the connection between music and medicine] more seriously.”
No simple answer
Studies have proven that music helps improve mood, manage pain, reduce anxiety, and bring about medical benefits. Music can improve functionality and reduce certain symptoms of neurological disorders, and it can increase patient satisfaction and shorten length of stay in the hospital, which translates into reduced operating costs.
But when pressed on that infamous ‘why’ question, Chemali says there’s no simple explanation, but rather a combination of factors that start with the autonomic nervous system.
“This system controls things in our physiology that are not under our direct control, such as heart beat, blood pressure, or how we digest food,” he explains. “Music has a very powerful effect on this system.”
For example, in order to ease anxiety, it’s essential to reduce blood pressure and slow a patient’s heart rate. By combining the proper parameters—such as harmony, melody, and timing—music can be used to reduce blood pressure and slow the heart rate, which will not only ease anxiety but also reduce pain.
“We secrete a natural morphine, which is a natural endorphin, to the body to ease pain,” Chemali says. “And we now know what components of music do in terms of generating a particular neurological response.”
The music prescription
Doctors often feel most rewarded when they see a patient respond to a therapeutic regimen they prescribe. It’s much the same for Chemali when he sees patients respond not just to music, but to his music. However, despite his training, he says he doesn’t consider himself a professional concert pianist.
“I’m not touring, and I’m not playing concert halls, but I do work with people who do that,” he says. “One of my missions is to convince professional musicians that they are, in a way, doctors.”
Benoit and ChemaliThrough the Sentara Music and Medicine Center, Chemali has partnered with Prisca Benoit (pictured at left), a concert pianist and assistant professor at the Paris Superior Conservatory of Music. Benoit visits 4 times a year to perform.
“Why does she do that?” Chemali asks, rhetorically. “Because it’s rewarding. It’s the realization that playing these concerts is fundamentally changing the physiology of the people listening to the music. It’s very rewarding for the artists to know the kind of medicine they are creating for the audience.”
Chemali and his colleagues at the Sentara Music and Medicine Center hope that the knowledge they are gaining, and the results they are seeing, will one day be used to convince legislators and the insurance industry to cover music therapy in the same way as physical therapy.
“I realize this is a very big goal, and we need even more research to be done, more convincing arguments,” he says. “But I think the body of information we have so far is largely sufficient to make the argument that we have here in our hands a tool that is very effective and relatively inexpensive.”
So, what’s the problem? Chemali says the problem is lack of awareness.
“People don’t know about [the effectiveness of music therapy],” he says. “This is where we need to work. And progress will be made as more people starting talking about it.”
Article written by Ed Rabinowitz, Posted in HPC Live, Friday, January 09, 2015.