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Real life stories

BAPAM’s Manchester GP David Fielding keeps on learning about musicians’ health problems

Dr David Fielding is a semi-retired GP based in the North West. He has been involved in the Manchester group clinic since its inception in 2000, and since April 2007 has provided the GP assessment clinics in Manchester. His BAPAM workload continues to increase as the word gets out about the availability of the service.

How did you become involved with BAPAM?

I had played the violin and piano since I was a child, but only found time to progress to more advanced playing as an adult. Because of the obstacles that adult learners experience in acquiring performance skills, I came to understand some of the problems that can impair physical and emotional freedom for music performance. Another key development was attending the BAPAM symposium organised by Dr Ian James at the Royal Free in 1990. A main priority then was to appoint medical advisers to orchestras – at this time GPs were more likely to do this than to help run clinics seeing performers. The clinics tended to be London based.

However in 2000 the idea of a multidisciplinary clinic in Manchester arose and I joined neurologist Jon Sussman and hand surgeon Gavin Miller when this was started. We did the clinics together and learned from each other. At a later date we were joined by Karenna Caun. I continue to see patients with my colleagues but now am also one of the BAPAM GPs seeing patients for initial assessment.

What do you consider to be the most important health issues affecting performers?

Over 70% of the cases we see are of musicians with work-related upper-limb disorders. Around half of the patients we see are music students, which does raise various concerns. These factors have determined much of my subsequent learning. By 2001 I had completed a course in orthopaedic medicine. For the last two years I have been working through the eight-module course offered by the British Institute of Musculoskeletal Medicine. During this course much emphasis is placed on the psychosocial factors which are associated with musculoskeletal problems (and which can predispose to, precipitate or perpetuate the problem). Alongside this, the development of manual examination and treatment skills is encouraged. This helps adopt a multidisciplinary approach to patients and helps with working alongside colleagues who might deliver physical therapies. The world of sport and exercise medicine has long recognised that there is no distinct boundary between the 'medical' and 'non-medical' requirements of performers.

It is precisely this interdisciplinary aspect that makes BAPAM ideally placed to help performers; hence the importance of sharing with colleagues and having access to a range of treatment options, including expert music teachers. I would very much welcome extra access to NHS-based resources, such as are now available via the Bath clinic.

What do you get out of volunteering for BAPAM?

The area of Performing Arts Medicine is fascinating. It’s great to have extra time with patients and see them with their instruments. They’re a highly motivated group and always keen to understand their problem. More often than not, they're young and fit – you feel like you can make a difference. In addition, working with colleagues from other disciplines is not only a valuable learning experience, it’s also great fun!

July 2008