New Speciality Focuses on Artists : Musicians Perform in Doctors’ Offices

When neurologist Michael Charness asks a patient to tuck a violin under his chin or sit at a piano and play Beethoven’s Fourth Concerto, he is not taking a break from the rigors of his work.

The San Francisco doctor is practicing a new twist in the art of modern medicine--that is, medicine for performing artists.

Until the past few years, there had been little recognition that something akin to sports medicine was needed for musicians, dancers and actors.

Now, a few cities--including Boston, New York, Denver, Chicago, Cleveland and Philadelphia--have clinics specializing in medicine for performers.

New Medical Journal

The latest opened at the University of California at San Francisco this spring, about the same time the first edition of a new medical journal, Medical Problems of Performing Artists, rolled off the presses in Philadelphia.

“Sometimes watching a performer playing his instrument is the most dramatic part of our encounter with him,” said Charness of his musician patients.

The neurologist, an amateur pianist who is married to a flutist, learned several years ago that he was suffering from a growing weakness in his hands and had to stop playing. When his problem was finally diagnosed, he underwent minor surgery and is again able to play the piano.

That experience, Charness said in an interview, sparked his interest in the field of medicine for performers.

He said standard medical examinations often failed to reveal the cause of a musician’s frequent complaints about such ailments as tendinitis, muscle spasms and fatigue. But a physician experienced in treating musicians may be able to spot the source of the problem while watching him perform.

Performances Videotaped

Some doctors record the performance on videotape which they then can review in slow motion in an attempt to reach a proper diagnosis.

Correcting the ailment may call for surgery, rest or therapy. In some cases, the problem may be solved simply by changing a shoulder rest on a viola or switching to a different type of guitar strap.

Actors who suffer undue stage fright may be referred to psychiatrists.

While the aches and pains caused by hours of daily practice may seem trivial to outsiders, they can be serious enough to cause cancellation of concerts or end careers.

Two of America’s most talented pianists, Leon Fleisher and Gary Graffman, discovered in mid-career that they were losing their ability to perform because of problems with their hands, which is not uncommon among pianists after years of striking keyboards.

“In three months I saw 18 doctors and received almost as many diagnoses,” Graffman wrote in the premiere issue of Medical Problems of Performing Artists.

Muscle Abnormality

Finally, in early 1980, Graffman found doctors at Massachusetts General Hospital in Boston who were able to diagnose a muscular abnormality stemming from a years-old finger injury. They prescribed a therapy.

In addition to Graffman’s testimonial, the journal printed scholarly articles on muscle, nerve and bone problems caused by overuse, and on a peculiar elbow problem found among woodwind players who spend hours scraping reeds with knives before they are suitable for making music.

The publication’s editor, Dr. Alice Brandfonbrener, an internist at Northwestern Memorial Hospital’s performing arts medical program in Chicago, says future issues will deal with psychoanalytic views of anxiety related to performances and the hazards of using artificial fog on stages.

Other articles are scheduled on eating disorders of dancers and on tonsil and adenoid problems of musicians.

She said the journal should help physicians swap ideas and create a stimulus for research.

“It’s a brand-new field, and anytime you start a new field, there’s real sparse information,” she said. “There’s a need to communicate that information among the few of us who are practicing this kind of medicine.”

Programs Differ

Brandfonbrener said each of the performing arts medical programs in the United States has its own characteristics. The one in New York City offers performers comprehensive medical care, whereas Boston’s specializes in problems of the hand and arm.

The Chicago and San Francisco doctors are associated with university hospitals and, in addition to offering medical care, are oriented toward research and teaching.

Brandfonbrener says the United States is clearly the leader in the field.

“I think Asia and Europe are back where we were 10 years ago when a performer tried very hard to cover up any problems,” she said.

Charness says performers are cautious about admitting medical problems associated with their art for fear of losing their livelihoods. They fear that conductors or concert organizers who suspect they are in less-than-perfect performing health will not offer them contracts.

“Musicians and performers of any sort are in a similar position to athletes because if people know they have a problem, they stand a chance of being excluded from their very competitive fields,” he said.

“They’re under a tremendous amount of pressure to continue playing when they are in pain.”