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Why I work as medical adviser to the Hallé orchestra

Dr Bill Tamkin explains why working with a leading orchestra is clinically challenging, intellectually most stimulating – and fun

Dr Bill Tamkin explains why working with a leading orchestra is clinically challenging, intellectually most stimulating – and fun

Santiago: Chile's capital and largest city. A vibrant and exotic place – and one where fortunately the chemists stay open late.

And it was in one of these late-night chemists that I found myself, prior to the Hallé Orchestra's first concert, negotiating in Spanglish over a bottle of lactulose.

The 100-strong band of musicians and the back-up team had arrived the previous day for the start of a three-week tour of South America. I had accompanied them in my role as medical adviser, clutching my medical bag (on loan from the England Rugby League doctor).

The bag was full of carefully thought-through medicaments, including a suture kit that I was reluctantly persuaded to take, and enough electrolyte solution to float a battleship – but absolutely nothing for constipation. So my very first consultation was of course with a dyschezic patient – hence the trip to the pharmacist, who wouldn't sell me less than a litre, which I then lugged back to the concert hall.

This was a far cry from the comforts of the Free Trade Hall in Manchester where I'd been appointed to the post of medical adviser the year before the South American tour. The Hallé Orchestra is Britain's longest established symphony orchestra, founded in 1858, and has one of the busiest schedules in this season, its 150th anniversary.

My job was advertised by the Hallé Concert Society and The British Association for Performing Arts Medicine (BAPAM) in 1991. Medical advisers to orchestras across the UK were to be appointed, and the Hallé was the second such appointment after the City of Birmingham Symphony. I was attracted by the combination of two of my main interests – medicine and music – and by the need to have a role away from the coalface of primary care.

Privilege and variety

Some 17 years on, the Hallé has moved to Bridgewater Hall, where I now do a clinic twice a month. Doctors from the Association of Medical Advisers to British Orchestras (AMABO) provide free, confidential and independent advice to orchestral musicians. The post is honorary, but twice-yearly training meetings are held for clinicians and the orchestral management provides free concert tickets.

The job is one of privilege, great interest and variety. I've had to learn about the ergonomics of a player's desk position, temporary hearing problems from sitting in front of the brass section, through to upper limb problems, performance anxiety and rare neurological problems such as dystonias. Seemingly trivial problems such as herpes simplex labialis means that a wind player ‘loses their lip' and can't play.

A mild essential tremor can finish a string player's career.

Musicians' ailments tend to fall into two categories. The first are those that are very common but have a much bigger impact on a musician. For example, nickel-triggered dermatitis in most people would be managed by avoiding the metal and buying more expensive jewellery. But playing a brass instrument with a metal mouthpiece presents a major problem for the afflicted player, who simply won't be able to blow.

The second group of problems are those that are unique to the role and include both psychological and physical difficulties. Performance anxiety is common, especially if the player has a solo or the conductor is particularly demanding. Physical problems commonly affect the upper limb and are usually related to using particular muscle groups intensely for prolonged periods, holding an awkwardly shaped instrument in an unnatural contorted position.

Musicians as athletes

The most common problems I see tend to be musculoskeletal. Playing at this level is hard work. There are a lot of notes in a Mahler or Tchaikovsky symphony, so such works are physically demanding. Getting the players to think of themselves as athletes – to keep physically fit, to warm up and to warm down – is one of my roles.

Many music teachers today are much more aware of posture and fitness. Music schools and colleges, who incidentally also send me patients, now incorporate injury prevention in their curriculum. However, when prophylaxis shifts to therapeutics there is quite a lot clinicians can do to help. In Manchester, and throughout the UK generally, BAPAM has built up a list of physiotherapists, rheumatologists, orthopaedic surgeons, hand surgeons, neurologists and others who have an interest in those that suffer for their art.

Performing arts medicine sits somewhere between occupational medicine and sports medicine. However, my appointment is to the players under the aegis of BAPAM, and so I avoid being seen as a management stooge whose role is to maximise the work that can be got from musicians. On the other hand, the job does involve working closely with the orchestral management and they are very supportive of what I do and when it is necessary to organise therapy for their players.

Understanding and helping the difficult problems players face requires pooled experience and teamwork. For me, it provides new learning and interest outside the norm of everyday primary care.

On the surface, a musician's life is attractive but the reality is hard physical and mental work, regular practice and rehearsals, uncomfortable trips and keeping quiet about health problems that might signal the end of a career. BAPAM and AMABO try to constructively intervene with the last of these.

The three-week trip to South America took in four countries, six cities, 14 concerts, 13 rehearsals and 11 flights with only one day off. I didn't need the lactulose again – but I did use the suture kit.

Dr Bill Tamkin is a GP in Withington, Manchester

In a nutshell In a nutshell

The highs...
• Variety outside everyday general practice
• Stimulates new learning (medical and musical)
• Privilege of working with top musicians
• Meeting renowned conductors and soloists
• Free tickets to concerts

... and the lows
• Post is honorary – for love, not money
• Long tours can be more hard work than fun
• Absences from practice need supportive partners

Dr Bill Tamkin

Being the medical adviser to an orchestra is for love, not money Dr Bill Tamkin

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