Alice Brandfonbrener M.D.  

"Things Are Seldom What They Seem"

Alice Brandfonbrener M.D.
April 10, 2019

Editor's Abstract (Click to Hide)

Dr. Alice Brandfonbrener needs no introduction to many orchestra musicians - she is arguably "the" pre-eminent physician in the field of music medicine. She is on the faculty of Northwestern University Medical School and is the founder of the Medical Program for Performing Artists at the Rehabilitation Institute of Chicago, where she edits the journal, Medical Problems of Performing Artists.

Samantha George and I asked Dr. Alice to write an overview of some of the medical symptoms encountered by instrumental musicians, and how one goes about finding the good specialized care required by musicians. The good news is that a lot of our problems will go away by themselves, but Dr. Alice has a lot of excellent advice about self-diagnosing our problems.

She warns us about "diagnosis by stand partner" and the reliability (or lack thereof) of medical information you can find on the Internet, and discusses some alternative care approaches. In summary, she asserts that diagnosing musicians' medical problems requires "a unique combination of medical skill and musical knowledge" and offers suggestions of where to find such care.

This is a must-read article for all instrumentalists!

- Ann Drinan

Little Buttercup’s wisdom

Little Buttercup’s wisdom, "Things are seldom what they seem," quoted from Gilbert & Sullivan’s HMS Pinafore, can be liberally and usefully applied to many occasions. Here it serves as a segue to discuss how musicians can find quality medical care, and no, this is not an oxymoron. As I probably need not tell you, the general public’s perception (including that of many of my colleagues) of what you do for a living is indeed “playing,” a misnomer if ever there was one. However, I’m here to tell you that there are people dedicated to your well-being who understand the risks of orchestral musicians for occupationally-related injuries. Furthermore, they also understand that even non-musically-induced maladies, such as arthritis or physical trauma, can impact performance. In fact, the diagnosis of many problems common in musicians requires a unique combination of medical skill and musical knowledge.

How does one go about getting the specialized care required by musicians? In this article I will look briefly at what advice is available, and give you some of the pros and cons regarding selecting care, to help you arrive at better-informed decisions that can best serve your needs. Specifically, I will talk about self-diagnosis – what I refer to as diagnosis by stand partners or hearsay, medical information on the World Wide Web, non-traditional medical care, and traditional medical care. By necessity this discussion will be general, and inevitably cannot cover every conceivable situation or alternative. But I offer it as an attempt to provide some common sense guidelines for getting sound medical advice.

For starters, here are a couple of sweeping statements about medical symptoms and diagnoses typically confronted by instrumental musicians. The good news (as implied by Ms. Buttercup) is that the vast majority of problems are not the serious problems they at first may seem to be, but are self-limited and often will go away with quite non-specific care, even self care. Therefore the first job of a musician confronting a medical problem is to self-assess with discretion. This should include questions such as:

  • Has this ever happened before and, if so, what did I do about it?

  • How did it resolve, etc.?

  • Did I do anything different in the recent past, musically or otherwise, that might be responsible?

  • How and when does it bother me most?

  • Does not playing make a difference, etc.?

  • What happens if I back off from playing to a degree, or entirely if necessary, for 2-3 days?

  • If I use some ice, take some ibuprofen or similar drug, and wait?

  • How long should you wait?

No absolutes exist in most medical affairs but here, as always, use common sense. If the condition clearly is waning after a few days of simple measures, stay with what’s working. If it remains, gets worse, or if you are worried about it (never a helpful feeling when you’re ailing), get some professional help.

At the risk of sounding arbitrary and judgmental, let’s talk about some sources of health information about which I, a physician dedicated to the care of musicians since the 1970s, have serious reservations. That is, I readily admit to some bias that comes both from training, and from years of working with ailing, as well as healthy, musicians.

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