The Specialists.

• Author: BARR, MARY

Patient demand and advancing medicine create narrowly focused doctors.

When a concert violinist needs W a repair on her instrument, she'd probably consult with fellow violinists for the name of a specialist. And when that concert violinist experiences muscle strain in her wrist, she'd probably do the same thing--and probably be pointed in the direction of the Performing Arts Medicine Clinic.

It started simply enough. Fifteen years ago, after seeing an increasing number of musicians with problems somewhat different than his conventional rheumatology patients, Dr. Kenneth Brandt received support from both the dean of the Indiana University School of Music and the dean of the IU School of Medicine to establish the Performing Arts Medicine Clinic at the IU Medical Center. What resulted was a clinic designed exclusively for the diagnosis and treatment of performance-related health problems experienced by professional, amateur and student performing artists.

"It is much more than a clinic. It is really a performing-arts medicine program that deals with performance-related problems of instrumentalists, vocalists and dancers." The clinic is staffed by a spectrum of health professionals, medical doctors and therapists--many of whom are amateur musicians themselves.

The Performing Arts Medicine Clinic joins the many highly specialized health-care facilities in Indiana that cater to a very particular patient need. According to the American Board of Medical Specialties, there are more than 8,000 board-certified medical specialists in Indiana whose practices range from sleep medicine to hand injuries to wounds that won't heal.

And like many of these Hoosier specialty-care centers, the Performing Arts Medicine Clinic has a global reach. "There is relatively a small number of specialty facilities that do this," says Brandt, a musician himself. "It gets picked up on the Internet, and we get calls from Europe and literally around the globe."

He says the clinic can often identify the problem over the phone in speaking with a prospective patient prior to the first visit because many of the problems are instrument-specific. On the initial visit, the patient brings his or her instrument and can meet simultaneously with a number of clinic's specialists.

"We have a rheumologist, a neurologist, a psychiatrist--kept busy particularly with problems with performance anxiety--a hand therapist, a joint specialist, a dental specialist to deal with the blowers, a pediatrician and a social worker for dealing with chronic problems when that is appropriate," says Brandt. "We see a large number of overuse syndromes, muscle strain, soft-tissue problems, rheumatism and carpal-tunnel syndrome. Patients are self-referred as word gets around about the existence of this facility but they are often referred by other musicians who use the...