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At the heart of general practice since 1960

I enjoy keeping top musicians in tune

Dr Elizabeth Nodder on her role with a leading orchestra helping players with their health problems

Musical GPs 'join the band' ran the picture caption way back in October 1989. Dr Ian James from the Royal Free Hospital was looking for GPs

to join the Association of Medical Advisers to British Orchestras (AMABO), for attachments with all the major British orchestras. As a part-time GP near Bournemouth who had played double bass earlier in life, I jumped at the chance. I was given the job almost a year later after an interview. Doctors are appointed by the British Performing Arts Medicine Trust (BPAMT), in conjunction with the orchestra's players and management.

When I joined the Bournemouth Symphony Orchestra I surveyed all the players and was surprised to find more than half admitted to performance-related anxiety and a third of string players had musculoskeletal problems that affected their playing at some time. Three-quarters said they suffered from back pain at times made worse by travelling in coaches, carrying heavy instruments or poor seating in peripheral venues.

More than a third admitted to drinking more than recommended levels and few took adequate exercise. Repetitive strain injury was a phrase bandied around a few years ago but this has largely been replaced by 'work-related upper limb disorder' ­ a better explanation.

I always ask players to bring their instruments. This allows me to enjoy snatches of wonderful playing and observe their posture and playing position. Performance-related anxiety can be helped by trying to teach coping strategies, occasional ?-blockers or in more serious cases referral to a psychologist.

The work is not onerous. I have about six to eight contacts a year. My role is not GP to the musicians, but to provide the time and contacts to deal with their playing-related problems and then liaise with their registered GPs.

In the early days before my second child I was lucky enough to be able to attend rehearsals once a fortnight and saw players either at work or at my home. Work was unpaid but tickets for concerts were readily available.

The British Association for Performing Arts Medicine provides the AMABO scheme and runs clinics for performers in London and Manchester. The association provides health awareness and injury prevention training. I have been a member since its inception more than a decade ago and have built a network of people who accept referral.

The network includes alternative therapists and a local rheumatologist who runs a dedicated musicians' clinic to speed up the service.

Each major orchestra has one or two doctors attached. AMABO doctors meet twice a year for training and to compare notes. We are currently planning a training programme to help educate budding musicians about their health and the importance of seeking help early before problems become too chronic.

We are also trying to extend the scheme to less well-known orchestras. Posts are honorary but we can ask for tickets to concerts at any time.

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