Patch Adams is an MD with a difference. Not only is he a clown and a diplomat but for more than 23 years he has been putting into practice the idea that "healing can be a loving human interchange, not a business transaction." He is the former director of the Gesundeit Institute, (877 Washington Blvd, Arlington, VA 22213. 703/525-8169) which has the modest goal of creating a model health facility that addresses all the major issues in health care delivery.

One of the most puzzling aspects of the discussion around the health care crisis is the paucity of description by health care professionals about their fantasy care facility. Has anyone or any study asked doctors and nurses to fully describe their ideal clinic or hospital? With the vast majority of staff and patients not liking hospitals, why is this context so tenaciously held on to? What role does powerlessness have in quieting a dreamer’s voice?

Let this article be a stimulant to all people interested in health care delivery. Dare to think up and create a healing context (home, hospital, clinic) that the staff would crave to work hard in and patient and family would delight in returning to, when sick or well.

The health care context has been the horror of so much of today’s medicine. One can still find the one-on-one intimacy so treasured in medicine and work with an endearing team, but these are special cases. Even as the doctor or nurse has these great moments, they still feel choked by the context of their practice. The administrative (billing, paperwork, regulations, etc.) and the hospital (serious, solemn, unfriendly, etc.) contexts are not conducive to a thrilling, thriving practice of medicine.

The modern medical context must change. Many new experiments are needed to explore this very complicated field. For 24 years, Gesundheit Institute has been one such experiment.

The institute’s first 12 years were devoted to a pilot experiment. For most of those years, 20 adults lived in a large home and used it as a crude hospital. Open 24 hours a day, seven days a week, we had three physicians who did what we could for whoever came.

We never charged money, accepted third party reimbursement, or carried malpractice insurance, believing these practices are at the core of the horror of a modern medical practice. The work was supported by the part-time jobs of the live-in staff. We found that the joy of practicing medicine unencumbered by the trappings of the modern practice is so great that it was even worth paying for ourselves!

To humanize medicine we formed friendships with our patients. We gave 3-4 hour initial interviews, invited patients into our homes as guests, and went to their homes for both social and medical visits. Whatever the patients’ reasons for their visit, we stressed the importance of living a wellness lifestyle and provided many ways to make that happen.

To stimulate a path towards a joyous life for both staff and patient, we integrated medicine with the performing arts, arts and crafts, agriculture, nature, recreation, and social service.

To celebrate diversity and act as peacemakers in the healing arts, we accepted all complementary healing arts as long as they charged nothing and could work interdependently.

To disseminate what we were learning, we invited medical students, nurses, etc., into our home to work with us and participate in the experiment. In these 12 years, 15,000 people came through our home/facility for everything from profound illness to simple curiosity and play. Since the heart of the practice of medicine is in the depth of relationship, all these visits were seen as part of primary care.

After 12 years of this experiment, we decided that it was more important to build a model hospital than to keep practicing in our style because there seemed to be no vision in the United States of real solutions to care delivery. We decided to give up the practice to devote ourselves full-time to fundraising and building.

The last 10 years have been devoted to this task, and we have raised $1.1 million. We bought 310 acres in Pocahontas County, West Virginia (the least medically served state in the US) and built one building and finished plans for a second. With the completion of this building we can reinitiate patient care.

I have spent this time networking with people and projects around the world and speaking at medical schools, chiropractic schools, and naturopathic colleges. Other members have lived on the West Virginia property giving birth to our master plan with the assistance of a legion of volunteers from around the world. Though slow, the process feels organic, the progress ever palpable and the quest constantly thrilling. We will not settle for less than our dream!

Our 40-bed rural community hospital will offer surgery, OB-GYN, pediatrics, internal medicine, family practice, psychiatry, optholmology, acupuncture, chiropractic, homeopathy, naturopathy, herbal medicine, body work, faith healing, etc. in an interdisciplinary atmosphere. We will also have an outpatient clinic.

Forty staff members and their children will live in the hospital along with part-time help, medical and healing arts students, and entertainers. We will be an education center, providing opportunities for people who want to learn about what we do and want to serve humanity.

We will have a school for our children, sick children, and children of sick patients. We will have a fully operating farm, ornamental and herb gardens managed by staff, guests, and patients.

Indoor facilities devoted to the arts will include a modern stage, and workshops for ceramics, metal work, photography, fine arts, and woodworking. There will be a large library. Since esthetic beauty is medicinal, we plan to make the hospital itself a work of art.

We will set aside 30 to 40 acres for a village for long-term staff and for chronic-care homes, and explore fun ways to care for elderly, disabled, or chronically ill people.

We are confident that we will be able to operate this facility on between $1 million and $1.5 million per year of donations. We have agreed not to borrow money to create the facility so we will not have the burden of an expensive loan. We plan to rely (as we have for 24 years) on a cornucopia of generosity of services and things from our network of supporters.

Our care facility is one approach to solving the health care crisis. The point is not to suggest that we are the answer. In a complex, diverse world, we cannot afford single solutions. Instead, we need to nurture health professionals to band together and dream big. Be vocal and demonstrative about how you would like your health practice to be so that others can help co-create it! If we can make our dream a reality, then you can boldly go after your own. You can lean on us for help. Please, see us as a stimulant.

We are also here as an irritant. We must refuse to accept things the way they are because they are hurting everyone. We have a breakdown of community, a loss of a sense of belonging. As a family doctor I see this in my practice as choking loneliness and insecurity. Everyone needs a health care system – why not use that as an impetus to bring people together as a community that co-creates a healing environment.

Our world is too troubled to think up puny solutions for gigantic problems. Do not settle for band-aids where radical surgery is needed. Help co-create with the medical profession and all the healing arts a context they love working in and you love being in. It is possible!

Towards Financially
Accessible Healing

by Don Menkin

In this time of rapid change and economic uncertainty, many healing arts professionals are becoming more interested in examining their ideas and policies concerning client financial accessibility.

Many are also attempting to apply their ideals of personal integrity, beliefs about social and economic justice, and their spiritual awareness to their professional practice. In an age dominated by materialistic values, this can often be a lonely and frustrating challenge.

After four years of having a fixed fee for my counseling and transformation-oriented massage services, I changed my financial policy in 1989. To publicize the change, I added this line to my promotional materials: "The session fee is determined by you."

When prospective clients called, they were sent a brochure explaining my practice, which included this financial information:

An amount in the range of $50-75 is suggested in most situations. However, if you have more limited finances and feel that this experience would be beneficial for you, whatever you offer will be joyfully accepted.

In analyzing my records over the past eight years, I found that the average fee for all client sessions has remained about the same, while my business volume has grown substantially, thereby increasing my total income. I have many more low-income clients paying in the $20-30 range, and enough in the $60-75 range to keep the overall session average at about $50. By operating this way, I avoid having to make the uncomfortable judgment about who qualifies for reduced fees.

This success, combined with the desire to help others nurture a growing link between their personal values and client work, prompted the creation of the Guild of (financially) Accessible Practitioners (the GAP). The guild provides an ongoing forum for grappling with emotion-laden questions concerning money, prosperity, personal and political values, respect, and financial accessibility. Through newsletters, local support groups, and other direct connections, we share the support, clarity, and courage to walk our talk. The guild espouses no particular "way," but instead offers a wide range of approaches used to address these issues and a means for sharing successes and difficulties.

Since the Guild’s inception last winter, more than 50 healing arts practitioners have joined – including counselors, chiropractors, yoga teachers, massage therapists, and MDs. The only requirements for guild membership are an interest in exploring financial accessibility, and helping to pay the costs of printing and postage. The guild is a support and information network for healing arts professionals and does not at this time offer referrals.

For more information on the Guild of Accessible Practitioners, write 3 Harvard St., Arlington, MA 02174-6017, or call 617/641-4469.

A New Era In Healing

by Larry Dossey

If you thought modern medicine would never veer from its near total reliance on drugs, surgery, and high-tech therapies, reconsider. Recent developments at the National Institute of Health (NIH), the most prestigious and powerful medical research body in the world, suggest that change may be on the way.

With some prodding from Congress, the NIH has created the Office of Alternative Medicine and is gearing up to begin research into alternative therapies. Panels are now assessing:

• mind/body interventions – meditation, biofeedback, psychotherapy, hypnosis, prayer, distant or psychic healing, art, music, dance
• nutritional approaches, traditional and ethnomedicine – acupuncture, ayurveda, herbal medicine, homeopathy, Native American approaches, natural products, oriental medicine
• structural and energetic therapies – acupressure, chiropractic, massage, reflexology, rolfing, therapeutic touch
• pharmacological and biological treatments – anti-oxidizing agents, cell treatments, chelation, metabolic therapy
• electromagnetic applications.

The NIH Office of Alternative Medicine is drafting a report describing the evidence for and against the effectiveness of these therapies and recommending further research directions.

Major hurdles await the new office. Even if validated, how can unorthodox therapies be integrated into mainstream medicine? How are they to be researched? Are controlled studies – the kind used to investigate a new drug, for example – suited to evaluate therapies like meditation, diet, and acupuncture? How can communication be fostered between alternative practitioners and orthodox physicians and surgeons?

Advocates of alternative therapies should hold on to their hats. Just because a therapy dubs itself "holistic" is no guarantee it works. Some will be shown to be worthless or actually harmful. But others will almost certainly be validated as effective, safe, and relatively inexpensive.

Larry Dossey is a doctor of internal medicine, co-chairman of the NIH Panel on Mind/Body Interventions, and the author of several books that deal with the role of consciousness in health and with the interface of science and spirituality.