Taylor Swift on the psych ward  

“If you had to pick a song to describe this patient which one would it be?”  

Without hesitation, the medical student answered “Blank Space. I’m a big Swiftie, but the farther I’ve gotten into medical school, the more her songs sound like a description of personality disorders.”  

“Which one does Blank Space describe?”  

“You can tell from the promises she makes. To show heaven, sin, and nothing in between. It’s rumors, sudden travel, and perfect storms.”  

For the first time in my 13 years supervising students on the psych ward, the fourth-year med student began to sing about oscillations between nightmares and daydreams. Then she matched the lyrics to the diagnostic criteria—frantic attempts to avoid abandonment, unstable and intense relationships, identity disturbance, self-damaging impulsivity, self-harming behavior, affective instability, empty feelings, displays of anger, and dissociative symptoms—and declared her diagnosis.  

“The patient we just saw does not have depression like the ER thought. She has borderline personality disorder.”  

I nodded.  

I was a music nerd before I became a doctor. In all my early memories, my mother was singing to me. She sang with a beautiful tone and was always on key. One of my favorite childhood memories is me playing an instrument while she sang, but my tone has always been off. I can never stay on key. My mother gets asked to sing louder; I get asked to quiet down.  

I channelled my musical interests in other directions. I taped songs off the radio, paid a penny to get nine free CDs from the Columbia Record House Music Club, and made mixtapes with friends from their older siblings’ collections. In college, I was a midnight DJ on the campus radio station long before I went pre-med, and all those experiences taught me to make the kind of fine distinctions only music nerds care for.  

In a way, deciding which Townes Van Zandt record was on the right side of road-worn, whether Sam Cooke was better solo or with the Soul Stirrers, and why the Silver Jews were better than Pavement, was the best preparation for being a physician. Listening to music taught me to follow subtle clues to make critical decisions.  

As a physician, I make those decisions for patients with students and residents. For years, I’ve taught the psychiatric diagnosis to learners, then built those curricula into textbooks. I like to share a quotation from Dr. Henry Cohen’s 1943 paper on diagnosis: “All diagnoses are provisional formulae designed for action.” Diagnoses are provisional because they change when additional information requires a different diagnosis; formulae because the diagnoses follow rules that we can share; action because we diagnose not to label, but to drive clinical changes.  

Curricula and textbooks have their place, but sometimes I find that I need playlists.  

Music has long been a great way to induce the kinds of emotions which reinforce learning. You learn the alphabet with a song, so why not a diagnosis?  

Over the years, I have posted playlists for clinical services like obstetrics, clinical spaces like callrooms, and clinical moments like quarantine.

My med student’s association between “Blank Space” and borderline personality disorder got me thinking about how music can teach trainees about clinical diagnoses. Now, I share playlists with students before classes and specific songs while on rounds. Music helps students remember the criteria, but also how it feels to be ill. There’s often an unexamined divide between the sick and those who care for them, an unspoken sense that illness happens to patients, not doctors. Sharing a song with a trainee is a way to remind them what it might feel like to be a patient and, as the student sings along, what it would mean for them to someday suffer the same condition.  

After all, we all have our blank spaces to sing about.  

Abraham M. Nussbaum is a physician and writer. His next book, “Progress Notes: One Year In The Future of Medicine,” will be published by Johns Hopkins in June. Listen along to his work at www.abrahamnussbaum.com 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.