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Dr Mike Shipley

Dr Mike Shipley. Consultant Rheumatologist University College Hospital, London Trustee BAPAM. Introduction to BAPAM services. Information about BAPAM How can performers get the most out of BAPAM? What can you do for BAPAM? BAPAM staff. BAPAM. Mission:

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Dr Mike Shipley

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  1. Dr Mike Shipley Consultant Rheumatologist University College Hospital, London Trustee BAPAM

  2. Introduction to BAPAM services • Information about BAPAM • How can performers get the most out of BAPAM? • What can you do for BAPAM? • BAPAM staff

  3. BAPAM Mission: ‘To develop an independent nationwide occupational health provision for professional, semi-professional and student performing artists, including clinical advice for performance-related health problems, health promotion and education.’

  4. BAPAM • Objectives: • Profile – to give information about our and other services to performers and their teachers and representatives • Access to independent health support through telephone advice and seeing clinicians • Education of students, teachers & performers • Research • Income generation

  5. BAPAM PAID STAFF • Naomi Wayne - Chief Executive • Sanchita Farruque - Health Promotion in Music Development Officer • Dan Hayhurst - Clinics and Administrative Officer • Clare Hicks - Office and Clinics Manager

  6. BAPAM • Clinical governance: • Medical Committee • Risk assessment • For the benefit of the patients • To protect the Directory members

  7. What does BAPAM offer for Performers? • Free assessment clinics • Referrals to the most appropriate specialist or practitioner (most of whom provide their services free) • Directory of interested practitioners • Advice on getting & staying healthy • AMABO: special service for orchestral players • Training in performing arts medicine

  8. BAPAM Assessment Clinics • We run free health-assessment clinics for full or part time professional and student performing artists and production crews in • London • Bath & Bristol • Birmingham • Cambridge • Cardiff • Dublin • Glasgow • Leeds • Manchester • Newcastle • Portsmouth

  9. BAPAM Assessment Clinics • Usually delivered by a GP (occasionally a specialist physiotherapist or rheumatologist) • Route to further specialist help (advice or treatment, again usually free of charge) • Information and advice normally sent to the performer’s NHS GP

  10. BAPAM Assessment Clinics • The clinicians are often musicians or performers themselves • Awareness of the pressures and demands placed on performers and teachers • Understanding of problems with technique and access to advice • Major role of reassurance and helping people to cope

  11. BAPAM Assessment Clinics • Whom do we see? • 1200 visits (750 new) per year • 70% instrumentalists • 15% singers • 8% actors • 5% dancers

  12. BAPAM Assessment Clinics • What do we see? • 75% Musculoskeletal • 9% Voice • 3% Hearing • 5% Psychosocial

  13. BAPAM Assessment Clinics • Pressure points • Over-practicing and not taking breaks • Lack of general fitness • Going from top of class to middle of conservatoire • Change of instrument • Learning new techniques • Unwilling to accept there is a problem

  14. BAPAM Assessment Clinics • Effects of pain • A slight increase can have a major impact when under pressure • Wind-up is a common feature – a vicious circle of pain, muscle tension and poor posture • Fear of the dreaded ‘RSI’ or ‘teno’ and ending a career - catastrophising • Pain acts as a block between brain and performance

  15. BAPAM Specialist Referrals • Performer-friendly clinical specialists or healthcare practitioners • Specialists usually NHS and provide their services free • Practitioners are mostly private but offer care free or at a reduced price to BAPAM patients • Advice on sources of funding for treatment is given

  16. BAPAM Directory • Comprises around 250 practitioners • Doctors (33%) • Physiotherapists (10%) • Counsellors & psychotherapists (10%) • Complementary therapies (40%) • Requirements for listing – qualifications, insurance, attendance at twice yearly BAPAM updates

  17. BAPAM Directory • Performers can access directory via the web www.bapam.org.uk/ • Searchable by area of expertise & locality • Additional information is available by phone from BAPAM • Practitioners’ website address is published if appropriate

  18. BAPAM Health Promotion • Prevention is the key but difficult to do • Health Promotion Officer gives talks to students and teachers • Resources area on the website www.bapam.org.uk/ • Covers: musculoskeletal, voice, ENT and psycho-social and lifestyle issues • Hard-copy resources (concertina cards and posters are available)

  19. Association of Medical Advisors to British Orchestras (AMABO) • Free confidential medical advice to orchestra players • Long-term relationships with players, independent of orchestra management • Clinics, telephone access for advice plus ‘on call’ by some

  20. AMABO doctors BBC Concert Orchestra - Dr Frances Carter Bournemouth Symphony Orchestra - Dr Elizabeth Nodder City of Birmingham Symphony Orchestra - Dr Jonathan White Chair English Chamber Orchestra - Dr Jennifer R Lisle English National Opera - Dr Michael Shipley Hallé Orchestra - Dr Margaret Garner & Dr Bill Tamkin London Philharmonic Orchestra - Dr Louise Miller Philharmonia Orchestra - Dr E Chonon Lewis Royal Liverpool Philharmonic Orchestra - Dr Christopher Mimnagh Royal Philharmonic Orchestra - Dr Frances Carter & Dr Peter Warren Ulster Orchestra - Dr Christine Hunter

  21. BAPAM Training in Performing Arts Medicine for Practitioners • Induction days (2 annually) • Training days (following a syllabus) • Attendance is required to remain in the Directory • Diploma in Performing Arts Medicine jointly with University College London from September 2011.

  22. MSc & Diploma in Performing Arts Medicine • Being run jointly with • University College London • The Ear Institute, UCL (Vocalists) • The Royal College of Music (Musicians) • Trinity Laban Conservatoire of Music and Dance (Dancers) • BAPAM • Generous start up funding from PPL

  23. MSc & Diploma in Performing Arts Medicine • The diploma will run over one year (two days per week) or two years (one day per week) with an optional research module leading to an MSc. • Costs will be of the order of £6500 for a full timer, £3300 per year for part timers and £15,000 pro rata for overseas students.

  24. MSc & Diploma in Performing Arts Medicine • Aimed at • Physiotherapists • Doctors • Osteopaths • Alexander technique teachers • Counsellors • ?Performers

  25. DIPLOMA AND MSc in Performing Arts Medicine - Syllabus • Musculoskeletal & Neuromuscular Injury in Performing Arts Medicine • Performance Psychology • Research Methods – shared with Sports Medicine • Drugs and Disability in the Performing Arts Medicine world

  26. DIPLOMA AND MSc in Performing Arts Medicine - Syllabus • Environmental Issues, Travelling & Touring, Governance & the Law • Practical assessment & wellness of Performance Artist • Rehabilitation of Performance Related Injury’s - shared module with Sports Medicine

  27. DIPLOMA AND MSc in Performing Arts Medicine - Syllabus • One of the following: • Clinical Voice Management (Voice Institute UCL) • Medical Problems in Dancers (Trinity Laban) • Medical Problems of Instrumentalist (RCM) • Research Module for MSc

  28. www.bapam.org.uk

  29. BAPAM • A charity generously supported by • The Musicians Benevolent Fund • Musicians Union • Equity • Incorporated Society of Musicians • PPL (MSc & Diploma start up funding) • Fund raising and private donations

  30. How you can help us • Spread the word to performers & teachers • Encourage people to join the Directory • Write fact sheets • Help us to collect stories • Donations! or fundraise for us

  31. A Typical Problem • A second year violin student • Had done well at school and in the first year but was under pressure • Responded by working and practicing over 12 hours a day • She was sleeping badly and had developed neck pain.

  32. A Typical Problem • She had been advised to take time off and not play at all • She feared for her career • Neck pain was muscular & related to poor posture • Sleep disturbance is well recognized to worsen chronic pain

  33. A Typical Problem • Advised to play a little intermittently & gradually increase – she immediately looked less anxious • Take regular paracetamol for a while to break the cycle of pain – not wait until at ‘screaming pitch’ • See a physio about posture & relaxation • Get advice about violin technique

  34. A Typical Problem • She took up exercise & yoga and got fitter • Sleep improved • Pain levels reduced & she no longer needed paracetamol • Felt happier with her technique • Came to terms that she would never be a superstar • Graduated and now plays in a professional orchestra

  35. KEY POINTS • Educate the teachers and the performers • Prevention is better than cure • Early recognition can often reduce long term disability • We need to reduce the stigma – intolerance from colleagues not yet affected

  36. Thank You mike.shipley@uclh.nhs.uk

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