Wednesday, 30 January 2013

Clinical Practice, Melody and Harmony

Clinical Practice, Melody and Harmony

Music is an art that is given form by its characteristics including melody, harmony, rhythm, texture, dynamics and pitch coming together.

There is evidence both the 7-note diatonic scale (melody) as well as harmony existed 3400 years ago as seen in the Syrian city Ugarit tablets. Though in earlier times there was probably no formatted succession as musical melody of any sort. In musical development, a sense for "melody" would not have occurred overnight as music often was the playing of single notes, assigned to various rituals, such as one gong for moon, another for sun, another for death, birth, etc.

Every piece of music has its own DNA, made up of three elements: melody, harmony and rhythm; present in every popular song from every genre. Melody is defined as the soul of music can stand alone; the addition of harmony gives music its beauty and adds detail thus catching the listeners' attention.

One of the music explorers of the 20th century, Alan Hovhaness, once said that the compose  joins Heaven and Earth with threads of sound which  combine the melodic lines and harmony. They are the two necessary elements to music.


Melody is defined as the primary sequence of notes or successive line of single tones or pitches perceived as a unity forming passages or phrases in various patterns leading to a song with the characteristics such as range, shape, pitch and movement. Movement of a melody or melody line is the direction or shape or the geometric line made when notes are joined together. When the melody moves stepwise and is connected, the movement is termed conjunct. Melody that leaps from pitch to pitch with no natural connection or flow is said to be disjunct.
In melodic music, normally there are one or two 'leads' who sing or play the melody. Music forms such as country, rock, Hindustani and Carnatic are examples of melodic forms of music. Hip-hop, rap, reciting verses, reciting slokas can also be considered a version of melodic music.
In melodic system of music there is a greater freedom to improvise and almost no two artistes are likely to perform the same song/music in a similar manner neither would they wish to do so.


Harmony is defined as the secondary series of a particular sequence of notes or chords (a group of 3 notes played together or in a separate manner one after another) which occur simultaneously with the melody. Harmony is the relation of notes to notes and chords to chords as they are played simultaneously.

The harmony of a song always has a different series of notes from the melody, although sometimes when the harmony is played simultaneously with the harmony the notes in both may be the same briefly.

In harmonic musical systems very frequently there are 'lead' instruments which play melodies but are at the same time accompanied often by a large group of other instrumental musicians playing something different from the 'lead' at the same time. The relationship between different notes played at the same time is what is called harmony. When two singers or instrumentalists are playing the same notes instead of harmonizing notes, they are no longer harmonizing but instead said to be playing "in unison" or together.

Western classical music is from the same script whenever and where ever it is played. Of course there is improvisation and indeed there are differences between various orchestras and it results in great music but one that matches the script/notes.

Melody and Harmony

Melody and harmony are considered as the body and soul of music. We do not forget the importance of  rhythm and tone that are built into the writing thus making music.

Melody is the linear aspect of music, in contrast to harmony, the chordal aspect, which results from the simultaneous sounding of tones. Harmony's function has evolved mostly to make the notes of melodies "connect" or to make their connection to each other melodically more apparent to the ear. It is a result of the joint contribution of melody and harmony in which the listener is “directed to a single melodic line, but this is conceived in relation to harmony”

While the melodic constraint is nearly universal, the harmonic constraint is more particularly Western.  Many non-Western styles either reject chords altogether, using only one note at a time or build entire pieces around a single unchanging harmony.

Doctors  in melodic form

It will be apparent by now that most doctors who are trained as 'individuals' with high knowledge to be able to deliver 'independent' care supported by a few other individuals in small teams (units, firms, etc) are probably in the melodic form. The 'attending' or the 'consultant' is the 'lead' and will deliver care 'tailored' to the patient (improvisation) and often no two individual clinicians would ever do or want to provide the exact same care even when faced with similar situations. They do deliver great care.

This has recognition with rock stars and rock bands. There is usually a lead singer and a lead guitarist often both are the same person, supported by a very small team of rhythm, base, keyboard and drums. They make great music. Those who are familiar with the Indian systems of Carnatic or Hindustani music will easily recognise the similarity with one (rarely two) lead expert singer/musician supported often by just two other musicians (an instrumentalist and a rhythm player). They make great music.

Healthcare delivery systems are harmonic

Most of us will also recognise that the days of individual clinical experts practising independently in their own premises is over in many countries such as UK when the NHS was created and on the way out in many countries such as USA (with HMOs and other attempts) and India (with corporate sector multi-specialty large hospitals). The practise of medicine has become too complex and sadly too costly for the continuation of the purely 'melodic' practice of individuals however brilliant they may be due to the need to avoid disjuncts.

What might be happening now is that we have put 'melodic' practitioners all together on a harmonic platform and expect harmony. What we get is occasional 'unison' and not harmony. The 'unison' can sound good too as when top musicians perform on the same stage as a tribute to someone or on some occasion. South Indians will recognise the Thyagaraja Aradhana where individual melodic monarchs sing in unison but that should not be mistaken or harmony. Similarly, we have individuals with the training and ability to practice independently all under one roof, occasionally there is unison, often there is cacophony. Hopefully this will be a transitional phenomenon.

This is where leadership comes in. Healthcare employers should be explicit in defining that healthcare delivery is now in overall harmonic mode with the melodic element as a vital element. Conductors (Chief Execs, Medical Directors, Nursing Directors, Clinical Directors, et al) should ensure that doctors and other clinicians work in an harmony mode where every individual within the team/orchestra follows a script (evidence, especially operational evidence that has prior local agreement) that is specific for that song/music and though it does not match with other musicians in an exact manner and though there is some degree of improvisation to cater to the situation (variation as a result of patient based differences). The resulting output will be greater care than we are able to offer today.  Hence our belief is that doctors and clinicians may be better working in a harmony mode.

Melody by itself (monophonic music) was the principal form of composition in western cultures before the year 1000. Together these constraints ensure a two-dimensional coherence in Western music analogous to that of a woven cloth. The classical western music has now moved on to harmony. It is time for healthcare to move from the melody of individual brilliance to the harmony of collective success.

Geetha Upadhyaya & M Hemadri
Follow me on twitter @HemadriTweets

Geetha Upadhyaya is CEO and Artistic Director at Kala Sangam. She was a Consultant Pathologist, with a particulat interest in the health benefits of practising arts. Having a postgraduate degree in classical Indian dance and music, her main interests are cross art collaborations, choreography and music. Geetha's aim is to establish Kala Sangam at St Peter's House as a national centre for South Asian arts, heritage and culture.

Geetha's thoughts expressed in this blog post are her own personal views and does not represent any organisation.


Melody with Clapton on vocal and lead guitar with improvisation et al; obviously it is wonderful tonight

Melodic Carnatic music with Unnikrishnan singing Ramadas' Palukae Bangaramayena  and note how Balamuralikrishna renders the same song so very differently

Singing in unison (individual singing in the melodic form but all together) from the famous annual Thyagaraja Aradahana

A classic harmony based music (where the melody is part of the harmony) Holst Planets Suite Mars

Melody leads & harmony blends to create the James Bond theme



Sriram said...

Brilliant comparison of music with medicine! Very different and yet meaningful thoughts on medical practices. I enjoyed the read thoroughly and many thanks for the post.


M HEMADRI said...

Dr C Nanda Kumar wrote to me and I post here with his permission:

your blog caught my attention since it used music terms 'harmony' and 'melody'. I have great interest and some little knowledge of music and even in our melodic system (Carnatic), when male and female singers sing in the same 'shruthi', they are actually singing at different octaves, so in effect, it's a melodic harmony! This applies for most duets and the mass singing during the Thyagaraja aradhana festival in Thiruvaiyaru. The mridangam and Tabla (amazing percussion instruments which are tuned to the shruthi,)are not always tuned to 'shadjam', so this also constitutes harmony. So the music is the same, it's the prayogam which is different. The Tanpura which can have sa, pa, sa or sa, ma, sa is also a harmonic instrument though the notes are played one by one (the effect is orchestral). It's quite common in Violin to play two strings at the same time which is almost like a chord (Kunnakkudi's playing often has this effect)