Hipocondrie á 7 ConcertantiBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7672 (Published 30 November 2011) Cite this as: BMJ 2011;343:d7672
- Desmond O’Neill, consultant physician in geriatric and stroke medicine, Dublin
Fans of the US detective series Columbo (and of its recently deceased star, Peter Falk) will recognise the scenario immediately. The interview seems to be over without a satisfactory resolution, when, with his hand on the door handle, he turns and says, “Just one more thing . . .” As in medicine, it is this last question that is the key to the story, and astute doctors have learnt to temper natural impatience at late running consultations and to pay particular attention to the “doorknob question” (see Int J Clin Pract 2005;59:869, doi:10.1111/j.1368-5031.2005.0599a.x).
What is going through the mind of the patient is less easy to track: a window into these conflicts and concerns would advance our understanding of the art and science of the consultation. Inspiration springs from an unlikely source, a short piece of baroque music by a distinctly unconventional Bohemian composer, Jan Dismas Zelenka (1679-1745).
Born near Prague, Zelenka spent the latter half of his life as a court composer in Dresden. Eschewing court social circles, he composed a highly individual and attractive body of music that confounds popular conceptions of baroque music as formal and somehow impersonal. His music is eclectic, with vivid and unexpected rhythmic twists, and often surprising suspensions and discontinuities, winning the admiration of Bach and contemporaries.
His Hipocondrie á 7 Concertanti, lasting not much longer than Enid Balint’s famous six minute consultation, is scored for two oboes, bassoon, two violins, viola, and continuo. Resembling a French overture with three sections, it has a striking, rhythmic opening that progresses to a fast fugal section and a final broader chordal section.
The genius of the piece lies in several elements: several short expressive motifs suggest sighs during the consultation, and the piece alternates strikingly between major and minor keys in the opening section, intimating a wavering lack of confidence. The quicker section suggests some strengthening of resolve, but the final section has a remarkable false finale—like the customary end of a consultation—and then a timorous and minor hued final section analogous to that final hesitant question.
One of the dangers of narrative medicine is the procrustean urge to fit the facts to the theory. However, contemporary sources suggest that “hipocondrie” is similar to the modern meaning of hypochondria, and Zelenka thereby gives us at least two gifts. The first is the ability to travel on an elliptical journey with our patients for whom the direct assault on their main concern is ever delayed to the last, critical, moments of the encounter. The second is a reassurance that this is not an artefact of modern life but has been a shared space between patients and doctors over many centuries.
Cite this as: BMJ 2011;343:d7672
Hipocondrie á 7 Concertanti
A piece of music by Jan Dismas Zelenka
Composed in 1723
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.
Listen at www.youtube.com/watch?v=qa78V3uEA3U.