Alice Brandfonbrener M.D.  

"Things Are Seldom What They Seem"

Alice Brandfonbrener M.D.
April 10, 2019


A lot of people, musicians and others but especially musicians, are scared stiff of something “bad” happening to their health that might affect what is both their livelihood and their passion. Often they have an inborn distrust of people in my profession, some of it based on past negative personal experiences, on hear-say, on miscommunication, and on unrealistic expectations (“cure me!”), or simply because they are generally apprehensive.

Thus the natural instinct is to go for trust: authority figures such as parents, spouses, significant others, stand partners, teachers, or other musicians known to have had their own medical misfortunes. This is understandable, but not realistically the way to get informed and medically-credible advice. The seeming same symptoms in more than one individual may have entirely different underlying explanations. Only people trained to take an appropriate history, do physical evaluations, and perform what is referred to as a “differential diagnosis,” are qualified to give potentially reliable advice.

I like to say in this regard that more people walk into my office with a diagnosis of carpal tunnel syndrome, based on their stand partner’s diagnosis, than emerge from my office with that diagnosis. Differential diagnosis takes experience and can lead us into grey areas. It is frequently difficult to make accurate and specific diagnoses on any patient, musician or not. The unique feature of musicians as patients, and why the specialty of performing arts medicine has taken off to the extent that it has, is that the symptoms with which musicians present are often subtle.

Musicians’ symptoms are not the stuff on which most medical texts are based, so careful practitioners must know not only their medicine but also their music. More often than not, one needs to put together the risks under which the musician performs (instrument, repertoire, technique, hours, and especially intensity of playing), and one’s knowledge of anatomy, physiology, pathology, and psychology. Even this broad approach to evaluating a musician patient may not lead to a positive diagnosis, although it often helps us rule out some conditions and can give us a ballpark idea of the problem at hand, which is sufficient to give reasonable therapeutic advice.

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