Movie Critique: Patch Adams

            Loosely based upon the true story of Virginia doctor Hunter “Patch” Adams MD, the 1998 film Patch Adams undoubtedly delivers well in terms of emotional and audience appeal. Actor Robin Williams is perfectly cast as the off-beat and idealistic Dr. Patch Adams who is a firm believer in a working partnership between doctor and patient as well as the use of humor and personalized approaches in the treatment of patients.

On the other end, supporting characters Mitch (played by actor Philip Seymour Hoffman) and Dean Walcot (Bob Gunton) effectively represent the staid and traditional medical doctors who define medicine by academics and hard nosed objectivity.

Commercially, the film is effective as a “feel good” drama comedy with the right balance struck between the tragedies of death and illness and the zany antics of Williams as clown doctor Patch Adams.

The character Patch Adams was a non-conformist who lived by his own rules. Some night even say that his non-conforming attitude as well as his blatant disregard for protocol and tradition ruling the medical school might be symptoms of an anti-social personality disorder as mentioned in the library scene of the film.

Some may however argue that one can call it anti-social only from the medical school’s point of view. In general and real society however, the character Patch Adams is more of a “pro-social” person. Pro-social people exhibit actions that are always more for the good of others rather than one’s self. The traits that distinguish them are their drive to help, care, comfort, share with and co-operate with others for the common good. (Clarke 2)

In other words, it is the complete anti-thesis of anti-social personality disorders especially since the only possible (but insufficient) symptom that Patch exhibits that may qualify for anti-social disorder is his refusal to adhere to the medical school’s traditions.

Plot wise the film is good in the presentation of humor as a valid contribution in the improvement of a patient’s quality of life.  The positive physiological and psychological responses to humor as evidenced by the rise of electrical activity in the brain, increased heart rate without muscular strain, and reductions in stress anxiety levels have been well-documented by medical observations and studies (Szabo).

            The claim that humor in addition to a more friendly and trusting relationship between health care provider and patient may do more than pain killers and medication for the patient’s well-being is also well-founded. Studies show that patients who are unhappy tend to have difficulty in cooperating with their treating physicians as well as unconsciously inhibit their personal recovery (“The American Psychotherapy Association the American Association of Integrative Medicine & the American College of Wellness Present the Evolution of Health Care: Unifying Mind, Body & Spirit”).

            Such is also the premise of holistic medicine that claims more than medical diagnosis and medication, the relationship formed between treating physician and patient is a vital contributor to “making the patient whole, and curing or eradicating the disease.” (Whorton 250)

            The idea of shifting end of life care for geriatrics and terminally ill patients from clinical isolation to a more humanistic and informal approach also has its merits especially as more elderly American citizens are living out their last days at hospitals and nursing homes (Lynn, and Adamson 1).

            In his article for the Daily Herald that appeared in June 4, 2007, Dr. Patrick Massey admits, “quality of life at the end of life, historically, has not been a high priority for traditional medicine.” (Massey 6) While pain which is a fairly usual occurrence in geriatric care may be controlled by pain medication, there are concerns that the side effects that come with such medications may be more detrimental to the patient’s comfort in the long run (6).

The film addresses this issue with scenes of the balloon safari and spaghetti pool organized by Patch for two of the geriatric patients, as well as his attempts and eventual success in befriending the grouchy and terminally ill pancreatic cancer patient Bill (played by actor Peter Coyote).

There was also the use of humor employed in drawing out the character of Caryn (played by Monica Potter) who developed a distant and hard personality following a childhood of sexual abuse as implied in the scene where she opens up to Patch about her long hatred for men.

Humor is both an indicator and treatment of trauma and emotional disturbances involving unwillingness to communicate and avoidance. A person’s “humor ability” is linked to interpersonal stress, loneliness and security. Laughter and play are activities that develop interpersonal and social skills (Miczo). This is evidenced by the initial coldness exhibited by the character Caryn who eventually opened up and learned to appreciate humor in the course of her work and relationship with Williams’ character Adams

There are also references to issues facing today’s health care industry, its bureaucracy and red tape. Patch Adams’ motivation in establishing a free community hospital for those who have no health care or insurance stemmed from his observation of how people were prevented from enjoying proper health care, attention and assistance with the many protocols associated with hospitals and insurance.

Murray and Jennings report that despite the awareness of a need for reform in health care, people are still suffering in pain and dying not because of unavailability of physicians or pain medication but rather through untrained physicians “unnecessary regulatory red tape, and financial barriers to hospice and palliative care service.” (Murray and Jennings)

While the film made some pretty good points on healthcare and the integration of humanity into doctor-patient relationships, there are also some points that were made more for dramatic effect than accuracy and realism. Viewers will be well guided to practice introspection and evaluation.

For instance is the concept of “transference.” In the earlier part of the movie where Patch is seen to enter medical school, the objectivity and distance practiced by doctors with their patience is explained as a precaution against “transference.” In psychology, transference is defined as a “transfer” of experiences within a relationship. Often, transference is spoken of in a romantic and erotic context wherein the patient “transfers” romantic feelings to a treating physician, nurse of therapist. Transference and its subsequent effect of “counter transference” may cause conflict and problems in the way a professional relationship is carried out. (Jones)

In the film, the character Adams is seen dodging the rules set by the medical school and persisting in seeing and interacting with patients, even those who are terminally ill and would like nothing to do with him. While the story of Adams’ friendship with Bill and his success in “treating” patients in the film makes for good movie viewing, in real life, completely ignoring the system set in place by the medical school as well as the theft of medical supplies from the hospital supply room are not exactly commendable examples to set for would be medical practitioners. (Butts 146)

Neither is the setting up of an unlicensed and uninsured medical facility where the doctors have not even completed their medical degrees. Granted that the medical students/volunteers at Adams’ facility had their hearts in the right place, there are malpractice laws and statutes that prohibit unlicensed medical professionals from practicing medicine.

To the film’s credit there is an implication albeit very slight of Adams’ guilt and knowledge that the death of the character Caryn was due to the unstructured “medicine” that he was propounding.

According to the late Dr. Avedis Donabedian, one of America’s leading evaluators of health care quality, quality care is the combined result of a physician’s technical proficiency and rapport with the patient (Das, Schwartz, and Derenzo). Of the part regarding rapport, there is no question that the character Adams has it in spades. The question comes in the technical proficiency as neither he nor the other volunteers shown in the film have received their medical degrees.

The threat of malpractice suits is not an idle one. Observers within the medical profession themselves have stated that some physicians have actually implemented measures that protected them from possible suits but alienated their patients (1).

For example, in the scene at the diner where one of the friends Patch has made complained of paying for tests that ran up to about $200 that he considered unnecessary in the treatment of his sprained ankle. Such practice in the medical field has come to be known as “defensive medicine” where doctors order tests and procedures with the objective of avoiding any possible malpractice suits (1).

There is also the portrayal of self-mutilator “Larry” who sank into depression following his father’s death and became a frequent visitor to the emergency room to have his self-inflicted wounds treated. Larry is also the character who would figure in the shooting of Caryn in a murder/suicide.

Dealing with and treating people who suffer from depression and exhibit self-injurious/mutilation acts require special skills and training in counseling. Even the American Counseling Association’s (ACA) Code of Ethics and Standards of Practice state that counselors must work only “within the boundaries of their competence” as dictated by their experience, education, and training. (White, Mccormick, and Kelly)

 The way the character Caryn responded to a call from a known depressive self-mutilator may appear heroic and dedicated in the film but thoroughly irresponsible for a medical practitioner especially a yet unlicensed one. This particular part of the film works great for drama but gives viewers the wrong idea on how to handle mentally disturbed patients. The frequency of Larry’s visits to the ER with self-inflicted cuts coupled with depression and apparent disorientation are also warning signs of a possible suicide (Kress).

 In real life, while involuntary checking a suicide-risk patient in may be considered unethical, it is the medical practitioner/counselor’s duty to protect human life first and foremost (White, Mccormick, and Kelly). People such as Larry would not be left to go home to an apparently empty house.

Overall, the movie is good for entertainment and even inspiration. While it presents some salient points with regard to the humanization of the science of medicine as well as reforms in the healthcare and doctor-patient relationships, it would be best to treat the film as purely entertainment and regard some of the issues presented as possible subjects of debate and study.

Works Cited

“The American Psychotherapy Association the American Association of Integrative Medicine & the American College of Wellness Present the Evolution of Health Care: Unifying Mind, Body & Spirit.” Annals of the American Psychotherapy Association 6.2 (2003): 18+.

Butts, Heather. “Movie Review: Patch Adams.” Journal of the National Medical Association

 98(2006): 146.

Clarke, David. Pro-Social and Anti-Social Behaviour. New York: Routledge, 2003.

Das, Anand, Jack Schwartz, and Evan G. Derenzo. “True Risk Management: Physicians’ Liability Risk and the Practice of Patient-Centered Medicine.” Journal of Law and Health 18.1 (2003): 57+.

Jones, Alun C. “Transference and Countertransference.” Perspectives in Psychiatric Care 40.1 (2004): 13+.

Kress, Victoria E. White. “Self-Injurious Behaviors: Assessment and Diagnosis.” Journal of Counseling and Development 81.4 (2003): 490+.

Lynn, Joanne, and David M. Adamson. Living Well at the End of Life : Adapting Health Care to Serious Chronic Illness in Old Age /. Santa Monica, CA: Rand, 2003.

Massey, Patrick B. “Taking a Closer Look at End-of-Life Care.” Daily Herald (Arlington Heights, IL) 4 June 2007: 6.

Miczo, Nathan. “Humor Ability, Unwillingness to Communicate, Loneliness, and Perceived Stress: Testing a Security Theory.” Communication Studies 55.2 (2004): 209+.

Murray, Thomas H., and Bruce Jennings. “The Quest to Reform End of Life Care: Rethinking Assumptions and Setting New Directions.” The Hastings Center Report 35.6 (2005): 52+.

Patch Adams. Dir. Tom Shadyac. Perf. Robin Williams, Monica Potter, Daniel London, Philip

 Seymour Hoffman, Bob Gunton, Peter Coyote. VCD. Universal Studios, 1999.

Szabo, Attila. “The Acute Effects of Humor and Exercise on Mood and Anxiety.” Journal of Leisure Research 35.2 (2003): 152+.

White, Victoria E., Laura J. Mccormick, and Brandy L. Kelly. “Counseling Clients Who Self-Injure: Ethical Considerations.” Counseling and Values 47.3 (2003): 220+.

Whorton, James C. Nature Cures: The History of Alternative Medicine in America. New York: Oxford University Press, 2004.