Arts medicine: an interdisciplinary paradigm.

Health hazards in the arts have been recognized at least since 1713 when Bernardino Ramazzini published Diseases of Tradesmen, (1) and there have been sporadic publications on various related subjects over the past three centuries. (2) However, the concepts of arts medicine have evolved into a medical specialty, primarily since the late 1970s and early 1980s. Many of the best-known advances in the field focus on the problems of performing artists, (3, 4) but equally important and dramatic advances also have occurred in the visual arts. Arts medicine has exerted an impact not only through medical improvements, but also through heightened awareness of health hazards among artists and improving artistic training and practice. Much important new information has been amassed. Medicine, the arts, and related disciplines are now faced with the challenge of disseminating information, educating practitioners in all fields, and creating an environment in which the arts can be practiced with the fewest possible adverse health consequences.

A great many musicians have health problems. Questionnaires were sent to 4,025 professional musicians with affiliate orchestras of the International Conference of Symphony and Opera Musicians (ICSOM), of which 2,212 questionnaires were returned. (5) Of the musicians responding, 82% reported medical problems and 76% had a medical problem that adversely affected performance. Many of these musicians had problems caused or aggravated by musical performance. Yet, until the past few years, this was not widely known, and musicians were afraid to admit their difficulties for fear of losing work. Moreover, those who did seek medical attention usually were disappointed with the evaluation and results.

When world-class pianist Gary Graffman developed difficulty controlling his right hand, he persevered until he found a physician who was willing to look at the possibility that his problem was caused by playing the piano. Together, they began to understand his overuse syndrome. When Graffman made his difficulties known to the general public and Leon Fleischer followed suit, thousands of musicians discovered they were not alone and began to seek help. Gradually, the medical profession has learned to provide the care musicians need. Moreover, farsighted music schools are beginning to incorporate scientifically based practice techniques in their curricula.

For physicians, arts medicine and sports medicine pose special interests, challenges, and problems. Traditional medical training has not provided the background necessary to address them well. Consequently, the development of these fields has required understanding and interaction among physicians, performers or athletes, and members of other disciplines. Such cooperation and interaction have taken so long to develop largely because of language barriers. For example, when a singer complains of a "thready midrange," most doctors do not know what he or she is talking about. To the traditional physician, if such a singer looks healthy and has vocal folds that appear normal on mirror examination, he or she is deemed normal by the physician.

Medicine, in general, enjoys a broad range of physical condition that is considered "normal." The biggest difference we encounter in arts and sports medicine is the performer's or athlete's sophisticated self-analysis and narrow definition of normal. In general, doctors are not trained to recognize and work with the last few percent of optimal physical performance. The arts medicine specialist is trained to discern subtle differences in the supranormal to near-perfect range in which the professional performer's body must operate.

To really understand performers, physicians must either be performers themselves or work closely with performers, teachers, coaches, trainers, and specific paramedical professionals. In voice, for example, this means a laryngologist works with a singing teacher, voice coach, voice trainer, voice scientist, speech-language pathologist, and often other professionals. In other fields, the specialists vary, but the principles remain the same.

Caring for patients who are performers, such as professional singers and actors, is not only fun but also extremely educational for otolaryngologists. By challenging us to refine our definition of "normal," they require us to observe more acutely, measure function and outcomes more accurately, and scrutinize our therapeutic responses more critically. These challenges, combined with what we learn through collaborating with professionals in other disciplines, make us better doctors, and this "outside the box" approach is continuing to improve the standard of care for all of our patients, not only the performing artists who have inspired us.

References

(1.) Goodman H, ed. Bernardino Ramazzini: Diseases of Tradesmen. New York: Medical Lay Press, 1933.

(2.) Harman SE. The evolution of performing arts medicine. In: Sataloff RT, Brandfonbrener AG, Lederman RJ, eds. Textbook of Performing Arts Medicine. New York: Raven Press, 1991:7-18.

(3.) Sataloff RT, Brandfonbrener AG, Lederman RJ, eds. Textbook of Performing Arts Medicine. New York: Raven Press, 1991: 1-432.

(4.) Sataloff RT, Brandfonbrener AG, Lederman RJ, eds. Performing Arts Medicine. 2nd ed. San Diego: Singular Publishing Group, 1998:1-436.

(5.) Fishbein M, Middlestadt SE, Ottati V, et al. Medical Problems Among ICSOM Musicians: Overview of a National Survey. Medical Problems in the Performing Arts 1988;3:1-8.