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His bedside manner spreads good weal Doctor: But is time running out for Patch Adams' brand of dispensing medicine?


Hunter D. "Patch" Adams, the doctor, was wearing his trademark red nose, striped outfit and big floppy shoes when a hospital-industry executive spotted him eating a steak-and-cheese sandwich in Denver airport's Terminal B three weeks ago.

Sneaking up from behind, the executive teased the clown: The sandwich was not exactly the kind of fare a certain doctor in Arlington, Va., might recommend.

But then, Patch Adams is not your ordinary doctor. "Wearing a rubber nose wherever I go has changed my life," he says.

The life story and mission of this maverick Arlingtonclown/physician has just hit the nation's theaters in the form of the Robin Williams movie "Patch Adams." It's about a doctor who challenges the stiff-shirted medical establishment with an unorthodox treatment plan.

On his real-life crusade, Adams lives by no rule but one: Be happy, or as he puts it, silly. "No other attribute has been more important," he wrote in his 1993 autobiographical book on health care, "Gesundheit," which inspired the movie.

Sparked an idea

Adams began his crusade decades ago. It was after his two-week stay in a Fairfax, Va., psychiatric hospital for a suicide attempt in the early 1960s that the brilliant but troubled student realized the cure for what ailed him and the rest of us: humor. He entered medical school at the height of the Vietnam War in 1967 with the idea of laughing people back to health. At the time, his idea to treat the whole patient was a revolutionary concept in medical schools obsessed with a tradition that insisted upon doctors keeping their distance from patients.

Since then, Adams has relied on humor to carve a unique role for himself on the medical landscape. First, he made it part of his treatment plan, and now, wearing his trademark clown suit, he preaches the value of humor at medical schools and symposiums around the country.

Adams, 53, father of two sons, probably has not done some of the outlandish things attributed to him in his namesake movie -- the Robin Williams character dressed up as an angel to help a dying patient accept death, and tap dances in the children's ward wearing bedpans for shoes.

But he was rebuked by a dean at the Medical College of Virginia of Virginia Commonwealth University in Richmond 30 years ago for being "excessively happy." His sin: transference, or getting too close to patients: When the other docs were away, he liked to visit patients, listen to them, massage their backs, even cry with them.

The patients and the nurses loved him, of course, but fellow students and professors responded predictably, by focusing on his long hair and handlebar moustache, he says in "Gesundheit." (Adams declined to be interviewed for this story. "AGGHHH. I don't have any time," he said.)

A few years after graduation, in 1974, Adams did indeed set up a free medical clinic that treated patients with a holistic approach. The Gesundheit Institute, a medical center in a house in the woods of West Virginia, was a sort of commune that served an estimated 15,000 people before its leaders ran out of money and will power in the late 1970s.

In 1981, Adams moved to Virginia to begin raising money for a full-fledged hospital to practice his brand of health care; that year, too, he bought a 310-acre farm in Pocahontas County, W.Va., where he expects to build it.

Sharing the message

He no longer treats patients -- his license in West Virginia is inactive. But for the past 15 years, Adams has made a career of selling his dream to doctors and philanthropists.

His one-man industry took off with a 1983 magazine article in the Washington Post that described his approach to healing. The publicity generated contributions, more publicity, lecture opportunities, a book and, finally, the movie. Adams started wearing his clown outfit on the lecture circuit, and audiences found him uproariously funny.

One of Adams' earliest speaking engagements in the mid-1980s was to Maryland hospital executives at their annual meeting in Ocean City.

vTC Rick Wade, then-president of the Maryland Hospital Association, asked Adams to speak after reading about him. The two have stayed in touch since.

"What Patch believes, and this is unwavering, is that medicine has become too commercial and too impersonal," Wade said. "Intellectually Patch understands why the dollar is important, and he doesn't denigrate medical care, medicine, surgery, all of that. But he believes there needs to be more humanity in that care."

Wade, now senior vice president of the American Hospital Association and the executive who ran into Adams in the Denver airport, notes that Adams' ideas are no longer unfamiliar or revolutionary. In the past decade, health professionals have introduced such patient-centered changes as the hospice movement, child birthing in home-like environments and child-care for patients and families in the emergency room.

Hospitals are different now, too. They are largely for patients too ill to appreciate humor.

And because of changes in the way medicine is delivered, the dream Adams has been stuck on for more than 20 years -- a hospital that offers a humanistic approach to caring for patients who are chronically ill or in long-term rehabilitation -- is more unlikely than ever.

A new hospital, even one that provides free care, isn't needed in Pocahontas County, W.Va., because it built its own in the early 1990s. The county is no longer desperately poor, either -- even U.S. Sen. Jay Rockefeller owns a house there now.

Finally, its health statistics show that education may be a more pressing need than laughter: The county where Adams owns a farm is No. 1 in fetal deaths in the state, infamous for people who suffer needlessly because they refuse to wear seat belts, and the subject of a state campaign against smokeless tobacco use by youth because of its high number of cancer deaths.

Plus, most physicians take a conservative approach to patients because that's what patients want. "I would wonder, as a physician at some point, [about using humor.] 'I'm glad I made you smile here, but let's talk about your diabetes,' " said Jim Messmer, associate dean for medical education at Adams' old alma matter, the Virginia College of Medicine.

One of Adams' goals on the lecture circuit is to get people to remember why they got into medicine -- and it often isn't for the money.

This message is never out of date, Wade and others say.

"I think his greatest value is exactly what he does -- going around the county to the front lines where it is increasingly tough to work," Wade said.

"His value is caring for people who care for patients."

Pub Date: 12/26/98

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