Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry
Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry; Book Review by Paul…
When I was invited by the Physicians Organization Committee based in San Francisco to attend a lecture by Patch Adams at UCSF medical center, I was ignorant as are many people of the real man. Most of us think of the movie Patch Adams released in 1998 starring Robin Williams. Robin and Patch were good friends as were their families. The movie grossed 500 million dollars and Robin 20 million.
First a word about the P.O.C.: This is a non-profit started by Geoff Wilson after he graduated from UCSF medical school. He chose to make his career as an advocate for medicine of old—solo offices, small groups and hospitals. So, as the organization as grown over the last thirty five years they have become and advocate for the above and fight the corporatization of medicine. They go to bat for small and large hospitals bought out by larger corporate groups here in California such as Sutter, Kaiser, HCCA and Tenet.
In some cases, once acquired the staff of these hospitals are fired and locums are brought in to make bigger profits. They also have become a watch-dog group for proposition 63 the millionaires tax passed by California in 2005 that adds a 1% surcharge to all people making over a million dollars. For 2015 alone two billion dollars were collected. These monies are supposed to be used solely for all aspects of psychiatric care. They are not. Therefore there are many psychiatrist members of the POC.
I immediately “Googled” Patch and discovered many personal and public facts. He graduated from Wakefield High School in 1963. He was born in Washington D.C. as was I. I attended Wakefield until 1964 when my family moved to NYC where I graduated from a private school in 1966. Patch did pre-med courses at George Washington University but began medical school without a BS/BA and graduated from what is now the Medical College of Virginia in 1971. Patch, as I now call him, is also 71 years old. I am 68. Also, this lecture was held at UCSF where I did my medicine residency.
Soon after graduation with his MD he founded the Gesundheit Institute! with the concept of a free clinic therefore not requiring medical insurance for their patients in Pocahontas County, West Virginia. As of 1998 his small clinic has treated over 15,000 people for free. As of this lecture his organization is finishing a free full service clinic and teaching center with a 40 bed hospital. His approach is beyond holistic. It is a combination of environment, compassion, humor, hugs and play time for physical and mental health.
Hunter Doherty “Patch” Adams born May 28, 1945 was a military brat. After his father died when a teenager Patch and family moved back to the States. He was bullied because “he found institutional injustice” and became disillusioned, unhappy and suicidal. He was institutionalized three times in one year. He decided “you don’t kill yourself, stupid; you make revolution” Ever since he has traveled to every state in the US and 87 countries using humor to heal everywhere from children’s cancer wards to active war zones in Afghanistan and Iraq.
Patch states that the movie was one of the biggest mistakes of his life as it did not portray the real Patch Adams and monies made were spent in minuscule amounts toward his Foundation.
In his lecture he was dressed in his trademark clown outfit which hides over twenty “toys” that can be used depending on the occasion.
Everything from this point on is taken from his two books Patch Adams with Maureen Mylander : Gesundheit! Published in `1993 and House Calls written by Patch Adams, MD: How We can All Heal the World One Visit at a Time, published in 1998.
In the Foreword to the first book Matthew Budd, Assistant Professor of Medicine Harvard Medical School wrote “The Human essence of fundamental relationships is obscured by procedures, technology, and regulations. Eight-second sound bites drive political processes; our families become the focus of justice as the right of children to divorce their parents is affirmed; a Norwegian MIT student is “punched out” to death by a trio of high school students seeking excitement. We are out of touch with the historic roots that give our lives meaning.
So, too, in health care we are out of touch with what gives the meaning. At a time when the power of our technology makes possible undreamed-of interventions and the disease of mankind, the very relationship between doctor and patient has become a battleground. Distrust and disrespect prevail where alliance and intimacy are most needed. What we as physicians have lost in this process is almost too much to acknowledge: the dreams that guided us into a profession.”
Patch Adams is an unlikely wake-up call for us. Soon after meeting him, I realized that this Clown was deadly serious. His Clowning has the power of all good humor: to reveal to us what we have become and to do so in a mood of good humor that allows us to see.”
In a testimonial Rick Wade, Sr. Vice President, The American Hospital Association writes:”At last, Patch Adams has put on paper his vision of patient-centered health care—a vision that has inspired so many over the years. Patch’s “crazy dream” is, in reality, the root of what good health care should be all about and too often isn’t. Any health care professional who reads Gesundheit! Will come away with a renewed sense of mission and joy about what they do.”
In the Foreword to his second book (written entirely by Patch) Robin Williams states: “A man visits his doctor and says, “Doc, my elbow hurts. What can you do?” The doctor slams his foot down on the patient’s toes. “Owwww! Hey, what did you do that for?” The doctor asks, “Do you still feel the pain in your elbow? “No.” “Next.”
In the Introduction Patch writes: ‘Few things can enhance a hospital stay as much as a visit from a friend, who can bring love, empathy and even play to calm these anxieties. When I interview patients about their hospital stays, consistently they say the most powerful element in making their time more pleasant is the presence of a friend.”
In the lecture I attended he said his treatment for patients included hugs—one lasted twelve hours! In the picture above if you enlarge it you will see that he has a dentist’s mouth guard and false teeth. He wanted me to place hanging snot from deep inside his nose into my mouth. I deferred. He wanted me to put my pinky as far up my nose as I could while he did the same. I could barely get my third PIP joint while his entire finger disappeared then he licked my thumb.