Search Talks | TEDx Brian Goldman: Doctors make mistakes. Can we talk about that?

Click on any phrase to play the video from that point. I think we have to do something about a piece of the culture of medicine that has to change. And I think it starts with one physician, and that's me. And maybe I've been around long enough that I can afford to give away some of my false prestige to be able to do that. Before I actually begin the meat of my talk, let's begin with a bit of baseball. Hey, why not? We're near the end, we're getting close to the World Series. We all love baseball, don't we? (Laughter) Baseball is filled with some amazing statistics. And there's hundreds of them. "Moneyball" is about to come out, and it's all about statistics and using statistics to build a great baseball team. I'm going to focus on one stat that I hope a lot of you have heard of. It's called batting average. So we talk about a 300, a batter who bats 300. That means that ballplayer batted safely, hit safely three times out of 10 at bats. That means hit the ball into the outfield, it dropped, it didn't get caught, and whoever tried to throw it to first base didn't get there in time and the runner was safe. Three times out of 10. Do you know what they call a 300 hitter in Major League Baseball? Good, really good, maybe an all-star. Do you know what they call a 400 baseball hitter? That's somebody who hit, by the way, four times safely out of every 10. Legendary -- as in Ted Williams legendary -- the last Major League Baseball player to hit over 400 during a regular season. Now let's take this back into my world of medicine where I'm a lot more comfortable, or perhaps a bit less comfortable after what I'm going to talk to you about. Suppose you have appendicitis and you're referred to a surgeon who's batting 400 on appendectomies. (Laughter) Somehow this isn't working out, is it? Now suppose you live in a certain part of a certain remote place and you have a loved one who has blockages in two coronary arteries and your family doctor refers that loved one to a cardiologist who's batting 200 on angioplasties. But, but, you know what? She's doing a lot better this year. She's on the comeback trail. And she's hitting a 257. Somehow this isn't working. But I'm going to ask you a question. What do you think a batting average for a cardiac surgeon or a nurse practitioner or an orthopedic surgeon, an OBGYN, a paramedic is supposed to be? 1,000, very good. Now truth of the matter is, nobody knows in all of medicine what a good surgeon or physician or paramedic is supposed to bat. What we do though is we send each one of them, including myself, out into the world with the admonition, be perfect. Never ever, ever make a mistake, but you worry about the details, about how that's going to happen. And that was the message that I absorbed when I was in med school. I was an obsessive compulsive student. In high school, a classmate once said that Brian Goldman would study for a blood test. (Laughter) And so I did. And I studied in my little garret at the nurses' residence at Toronto General Hospital, not far from here. And I memorized everything. I memorized in my anatomy class the origins and exertions of every muscle, every branch of every artery that came off the aorta, differential diagnoses obscure and common. I even knew the differential diagnosis

in how to classify renal tubular acidosis. And all the while, I was amassing more and more knowledge. And I did well, I graduated with honors, cum laude. And I came out of medical school with the impression that if I memorized everything and knew everything, or as much as possible, as close to everything as possible, that it would immunize me against making mistakes. And it worked for a while, until I met Mrs. Drucker. I was a resident at a teaching hospital here in Toronto when Mrs. Drucker was brought to the emergency department of the hospital where I was working. At the time I was assigned to the cardiology service on a cardiology rotation. And it was my job, when the emergency staff called for a cardiology consult, to see that patient in emerg. and to report back to my attending. And I saw Mrs. Drucker, and she was breathless. And when I listened to her, she was making a wheezy sound. And when I listened to her chest with a stethoscope, I could hear crackly sounds on both sides that told me that she was in congestive heart failure. This is a condition in which the heart fails, and instead of being able to pump all the blood forward, some of the blood backs up into the lung, the lungs fill up with blood, and that's why you have shortness of breath. And that wasn't a difficult diagnosis to make. I made it and I set to work treating her. I gave her aspirin. I gave her medications to relieve the strain on her heart. I gave her medications that we call diuretics, water pills, to get her to pee out the access fluid. And over the course of the next hour and a half or two, she started to feel better. And I felt really good. And that's when I made my first mistake; I sent her home. Actually, I made two more mistakes. I sent her home without speaking to my attending. I didn't pick up the phone and do what I was supposed to do, which was call my attending and run the story by him so he would have a chance to see her for himself. And he knew her, he would have been able to furnish additional information about her. Maybe I did it for a good reason. Maybe I didn't want to be a high-maintenance resident. Maybe I wanted to be so successful and so able to take responsibility that I would do so and I would be able to take care of my attending's patients without even having to contact him. The second mistake that I made was worse. In sending her home, I disregarded a little voice deep down inside that was trying to tell me, "Goldman, not a good idea. Don't do this." In fact, so lacking in confidence was I that I actually asked the nurse who was looking after Mrs. Drucker, "Do you think it's okay if she goes home?" And the nurse thought about it and said very matter-of-factly, "Yeah, I think she'll do okay." I can remember that like it was yesterday. So I signed the discharge papers, and an ambulance came, paramedics came to take her home. And I went back to my work on the wards. All the rest of that day, that afternoon, I had this kind of gnawing feeling inside my stomach. But I carried on with my work. And at the end of the day, I packed up to leave the hospital and walked to the parking lot to take my car and drive home when I did something that I don't usually do. I walked through the emergency department on my way home. And it was there that another nurse, not the nurse who was looking after Mrs. Drucker before, but another nurse, said three words to me that are the three words that most emergency physicians I know dread. Others in medicine dread them as well, but there's something particular about emergency medicine because

we see patients so fleetingly. The three words are: Do you remember? "Do you remember that patient you sent home?" the other nurse asked matter-of-factly. "Well she's back," in just that tone of voice. Well she was back all right. She was back and near death. About an hour after she had arrived home, after I'd sent her home, she collapsed and her family called 911 and the paramedics brought her back to the emergency department where she had a blood pressure of 50, which is in severe shock. And she was barely breathing and she was blue. And the emerg. staff pulled out all the stops. They gave her medications to raise her blood pressure. They put her on a ventilator. And I was shocked and shaken to the core. And I went through this roller coaster, because after they stabilized her, she went to the intensive care unit, and I hoped against hope that she would recover. And over the next two or three days, it was clear that she was never going to wake up. She had irreversible brain damage. And the family gathered. And over the course of the next eight or nine days, they resigned themselves to what was happening. And at about the nine day mark, they let her go -- Mrs. Drucker, a wife, a mother and a grandmother. They say you never forget the names of those who die. And that was my first time to be acquainted with that. Over the next few weeks, I beat myself up and I experienced for the first time the unhealthy shame that exists in our culture of medicine -- where I felt alone, isolated, not feeling the healthy kind of shame that you feel, because you can't talk about it with your colleagues. You know that healthy kind, when you betray a secret that a best friend made you promise never to reveal and then you get busted and then your best friend confronts you and you have terrible discussions, but at the end of it all that sick feeling guides you and you say, I'll never make that mistake again. And you make amends and you never make that mistake again. That's the kind of shame that is a teacher. The unhealthy shame I'm talking about is the one that makes you so sick inside. It's the one that says, not that what you did was bad, but that you are bad. And it was what I was feeling. And it wasn't because of my attending; he was a doll. He talked to the family, and I'm quite sure that he smoothed things over and made sure that I didn't get sued. And I kept asking myself these questions. Why didn't I ask my attending? Why did I send her home? And then at my worst moments: Why did I make such a stupid mistake? Why did I go into medicine? Slowly but surely, it lifted. I began to feel a bit better. And on a cloudy day, there was a crack in the clouds and the sun started to come out and I wondered, maybe I could feel better again. And I made myself a bargain that if only I redouble my efforts to be perfect and never make another mistake again, please make the voices stop. And they did. And I went back to work. And then it happened again. Two years later I was an attending in the emergency department at a community hospital just north of Toronto, and I saw a 25 year-old man with a sore throat. It was busy, I was in a bit of a hurry. He kept pointing here. I looked at his throat, it was a little bit pink. And I gave him a prescription for penicillin and sent him on his way. And even as he was walking out the door, he was still sort of pointing to his throat. And two days later I came to do my next emergency shift, and that's when my chief asked to speak to me quietly in her office. And she said the three words: Do you remember? "Do you remember that patient you saw with the sore throat?"

Well it turns out, he didn't have a strep throat. He had a potentially life-threatening condition called epiglottitis. You can Google it, but it's an infection, not of the throat, but of the upper airway, and it can actually cause the airway to close. And fortunately he didn't die. He was placed on intravenous antibiotics and he recovered after a few days. And I went through the same period of shame and recriminations and felt cleansed and went back to work, until it happened again and again and again. Twice in one emergency shift, I missed appendicitis. Now that takes some doing, especially when you work in a hospital that at the time saw but 14 people a night. Now in both cases, I didn't send them home and I don't think there was any gap in their care. One I thought had a kidney stone. I ordered a kidney X-ray. When it turned out to be normal, my colleague who was doing a reassessment of the patient noticed some tenderness in the right lower quadrant and called the surgeons. The other one had a lot of diarrhea. I ordered some fluids to rehydrate him and asked my colleague to reassess him. And he did and when he noticed some tenderness in the right lower quadrant, called the surgeons. In both cases, they had their operations and they did okay. But each time, they were gnawing at me, eating at me. And I'd like to be able to say to you that my worst mistakes only happened in the first five years of practice as many of my colleagues say, which is total B.S. (Laughter) Some of my doozies have been in the last five years. Alone, ashamed and unsupported. Here's the problem: If I can't come clean and talk about my mistakes, if I can't find the still-small voice that tells me what really happened, how can I share it with my colleagues? How can I teach them about what I did so that they don't do the same thing? If I were to walk into a room -- like right now, I have no idea what you think of me. When was the last time you heard somebody talk about failure after failure after failure? Oh yeah, you go to a cocktail party and you might hear about some other doctor, but you're not going to hear somebody talking about their own mistakes. If I were to walk into a room filled with my colleages and ask for their support right now and start to tell what I've just told you right now, I probably wouldn't get through two of those stories before they would start to get really uncomfortable, somebody would crack a joke, they'd change the subject and we would move on. And in fact, if I knew and my colleagues knew that one of my orthopedic colleagues took off the wrong leg in my hospital, believe me, I'd have trouble making eye contact with that person. That's the system that we have. It's a complete denial of mistakes. It's a system in which there are two kinds of positions -- those who make mistakes and those who don't, those who can't handle sleep deprivation and those who can, those who have lousy outcomes and those who have great outcomes. And it's almost like an ideological reaction, like the antibodies begin to attack that person. And we have this idea that if we drive the people who make mistakes out of medicine, what will we be left with, but a safe system. But there are two problems with that. In my 20 years or so of medical broadcasting and journalism, I've made a personal study of medical malpractice and medical errors to learn everything I can, from one of the first articles I wrote for the Toronto Star to my show "White Coat, Black Art." And what I've learned is that errors are absolutely ubiquitous. We work in a system where errors happen every day, where one in 10 medications are either the wrong medication given in

hospital or at the wrong dosage, where hospital-acquired infections are getting more and more numerous, causing havoc and death. In this country, as many as 24,000 Canadians die of preventable medical errors. In the United States, the Institute of Medicine pegged it at 100,000. In both cases, these are gross underestimates, because we really aren't ferreting out the problem as we should. And here's the thing. In a hospital system where medical knowledge is doubling every two or three years, we can't keep up with it. Sleep deprivation is absolutely pervasive. We can't get rid of it. We have our cognitive biases, so that I can take a perfect history on a patient with chest pain. Now take the same patient with chest pain, make them moist and garrulous and put a little bit of alcohol on their breath, and suddenly my history is laced with contempt. I don't take the same history. I'm not a robot; I don't do things the same way each time. And my patients aren't cars; they don't tell me their symptoms in the same way each time. Given all of that, mistakes are inevitable. So if you take the system, as I was taught, and weed out all the error-prone health professionals, well there won't be anybody left. And you know that business about people not wanting to talk about their worst cases? On my show, on "White Coat, Black Art," I made it a habit of saying, "Here's my worst mistake," I would say to everybody from paramedics to the chief of cardiac surgery, "Here's my worst mistake," blah, blah, blah, blah, blah, "What about yours?" and I would point the microphone towards them. And their pupils would dilate, they would recoil, then they would look down and swallow hard and start to tell me their stories. They want to tell their stories. They want to share their stories. They want to be able to say, "Look, don't make the same mistake I did." What they need is an environment to be able to do that. What they need is a redefined medical culture. And it starts with one physician at a time. The redefined physician is human, knows she's human, accepts it, isn't proud of making mistakes, but strives to learn one thing from what happened that she can teach to somebody else. She shares her experience with others. She's supportive when other people talk about their mistakes. And she points out other people's mistakes, not in a gotcha way, but in a loving, supportive way so that everybody can benefit. And she works in a culture of medicine that acknowledges that human beings run the system, and when human beings run the system, they will make mistakes from time to time. So the system is evolving to create backups that make it easier to detect those mistakes that humans inevitably make and also fosters in a loving, supportive way places where everybody who is observing in the health care system can actually point out things that could be potential mistakes and is rewarded for doing so, and especially people like me, when we do make mistakes, we're rewarded for coming clean. My name is Brian Goldman. I am a redefined physician. I'm human. I make mistakes. I'm sorry about that, but I strive to learn one thing that I can pass on to other people. I still don't know what you think of me, but I can live with that. And let me close with three words of my own: I do remember. (Applause) Tweet this talk! (we'll add the headline and the URL) Post to: Share on Twitter Email This Favorite Download inShare Share on StumbleUpon Share on Reddit Share on Facebook

TED Conversations Talks Jill Bolte Taylor's stroke of insight Click on any phrase to play the video from that point. I grew up to study the brain because I have a brother who has been diagnosed with a brain disorder: schizophrenia. And as a sister and later, as a scientist, I wanted to understand, why is it that I can take my dreams, I can connect them to my reality, and I can make my dreams come true? What is it about my brother's brain and his schizophrenia that he cannot connect his dreams to a common and shared reality, so they instead become delusion? So I dedicated my career to research into the severe mental illnesses. And I moved from my home state of Indiana to Boston, where I was working in the lab of Dr. Francine Benes, in the Harvard Department of Psychiatry. And in the lab, we were asking the question, "What are the biological differences between the brains of individuals who would be diagnosed as normal control, as compared with the brains of individuals diagnosed with schizophrenia, schizoaffective or bipolar disorder?" So we were essentially mapping the microcircuitry of the brain: which cells are communicating with which cells, with which chemicals, and then in what quantities of those chemicals? So there was a lot of meaning in my life because I was performing this type of research during the day. But then in the evenings and on the weekends, I traveled as an advocate for NAMI, the National Alliance on Mental Illness. But on the morning of December 10, 1996, I woke up to discover that I had a brain disorder of my own. A blood vessel exploded in the left half of my brain. And in the course of four hours, I watched my brain completely deteriorate in its ability to process all information. On the morning of the hemorrhage, I could not walk, talk, read, write or recall any of my life. I essentially became an infant in a woman's body. If you've ever seen a human brain, it's obvious that the two hemispheres are completely separate from one another. And I have brought for you a real human brain. So this is a real human brain. This is the front of the brain, the back of brain with the spinal cord hanging down, and this is how it would be positioned inside of my head. And when you look at the brain, it's obvious that the two cerebral cortices are completely separate from one another. For those of you who understand computers, our right hemisphere functions like a parallel processor, while our left hemisphere functions like a serial processor. The two hemispheres do communicate with one another through the corpus collosum, which is made up of some 300 million axonal fibers. But other than that, the two hemispheres are completely separate. Because they process information differently, each of our hemispheres think about different things, they care about different things, and, dare I say, they have very different personalities. Excuse me. Thank you. It's been a joy. Assistant: It has been. Our right human hemisphere is all about this present moment. It's all about "right here, right now." Our right hemisphere, it thinks in pictures and it learns kinesthetically through the movement of our bodies. Information, in the form of

energy, streams in simultaneously through all of our sensory systems and then it explodes into this enormous collage of what this present moment looks like, what this present moment smells like and tastes like, what it feels like and what it sounds like. I am an energy-being connected to the energy all around me through the consciousness of my right hemisphere. We are energy-beings connected to one another through the consciousness of our right hemispheres as one human family. And right here, right now, we are brothers and sisters on this planet, here to make the world a better place. And in this moment we are perfect, we are whole and we are beautiful. My left hemisphere -- our left hemisphere -- is a very different place. Our left hemisphere thinks linearly and methodically. Our left hemisphere is all about the past and it's all about the future. Our left hemisphere is designed to take that enormous collage of the present moment and start picking out details, details and more details about those details. It then categorizes and organizes all that information, associates it with everything in the past we've ever learned, and projects into the future all of our possibilities. And our left hemisphere thinks in language. It's that ongoing brain chatter that connects me and my internal world to my external world. It's that little voice that says to me, "Hey, you gotta remember to pick up bananas on your way home. I need them in the morning." It's that calculating intelligence that reminds me when I have to do my laundry. But perhaps most important, it's that little voice that says to me, "I am. I am." And as soon as my left hemisphere says to me "I am," I become separate. I become a single solid individual, separate from the energy flow around me and separate from you. And this was the portion of my brain that I lost on the morning of my stroke. On the morning of the stroke, I woke up to a pounding pain behind my left eye. And it was the kind of pain -- caustic pain -- that you get when you bite into ice cream. And it just gripped me -- and then it released me. And then it just gripped me -- and then it released me. And it was very unusual for me to ever experience any kind of pain, so I thought, "OK, I'll just start my normal routine." So I got up and I jumped onto my cardio glider, which is a full-body, full-exercise machine. And I'm jamming away on this thing, and I'm realizing that my hands look like primitive claws grasping onto the bar. And I thought, "That's very peculiar." And I looked down at my body and I thought, "Whoa, I'm a weird-looking thing." And it was as though my consciousness had shifted away from my normal perception of reality, where I'm the person on the machine having the experience, to some esoteric space where I'm witnessing myself having this experience. And it was all very peculiar, and my headache was just getting worse. So I get off the machine, and I'm walking across my living room floor, and I realize that everything inside of my body has slowed way down. And every step is very rigid and very deliberate. There's no fluidity to my pace, and there's this constriction in my area of perceptions, so I'm just focused on internal systems. And I'm standing in my bathroom getting ready to step into the shower, and I could actually hear the dialogue inside of my body. I heard a little voice saying, "OK. You muscles, you gotta contract. You muscles, you relax." And then I lost my balance, and I'm propped up against the wall. And I look down at my arm and I realize that I can no longer define the boundaries of my body. I can't define where I begin and where I end, because the atoms and the molecules

of my arm blended with the atoms and molecules of the wall. And all I could detect was this energy -- energy. And I'm asking myself, "What is wrong with me? What is going on?" And in that moment, my brain chatter -- my left hemisphere brain chatter -- went totally silent. Just like someone took a remote control and pushed the mute button. Total silence. And at first I was shocked to find myself inside of a silent mind. But then I was immediately captivated by the magnificence of the energy around me. And because I could no longer identify the boundaries of my body, I felt enormous and expansive. I felt at one with all the energy that was, and it was beautiful there. Then all of a sudden my left hemisphere comes back online, and it says to me, "Hey! We got a problem! We got a problem! We gotta get some help." And I'm going, "Ahh! I got a problem. I got a problem." So it's like, "OK. OK. I got a problem." But then I immediately drifted right back out into the consciousness -- and I affectionately refer to this space as La La Land. But it was beautiful there. Imagine what it would be like to be totally disconnected from your brain chatter that connects you to the external world. So here I am in this space, and my job -- and any stress related to my job -- it was gone. And I felt lighter in my body. And imagine all of the relationships in the external world and any stressors related to any of those -- they were gone. And I felt this sense of peacefulness. And imagine what it would feel like to lose 37 years of emotional baggage! (Laughter) Oh! I felt euphoria -- euphoria. It was beautiful. And then, again, my left hemisphere comes online and it says, "Hey! You've got to pay attention. We've got to get help." And I'm thinking, "I got to get help. I gotta focus." So I get out of the shower and I mechanically dress and I'm walking around my apartment, and I'm thinking, "I gotta get to work. I gotta get to work. Can I drive? Can I drive?" And in that moment my right arm went totally paralyzed by my side. Then I realized, "Oh my gosh! I'm having a stroke! I'm having a stroke!" And the next thing my brain says to me is, "Wow! This is so cool." (Laughter) "This is so cool! How many brain scientists have the opportunity to study their own brain from the inside out?" (Laughter) And then it crosses my mind, "But I'm a very busy woman!" (Laughter) "I don't have time for a stroke!" So I'm like, "OK, I can't stop the stroke from happening, so I'll do this for a week or two, and then I'll get back to my routine. OK. So I gotta call help. I gotta call work." I couldn't remember the number at work, so I remembered, in my office I had a business card with my number on it. So I go into my business room, I pull out a three-inch stack of business cards. And I'm looking at the card on top and even though I could see clearly in my mind's eye what my business card looked like, I couldn't tell if this was my card or not, because all I could see were pixels. And the pixels of the words blended with the pixels of the background and the pixels of the symbols, and I just couldn't tell. And then I would wait for what I call a wave of clarity. And in that moment, I would be able to reattach to normal reality and I could tell that's not the card ... that's not the card ... that's not the card. It took me

45 minutes to get one inch down inside of that stack of cards. In the meantime, for 45 minutes, the hemorrhage is getting bigger in my left hemisphere. I do not understand numbers, I do not understand the telephone, but it's the only plan I have. So I take the phone pad and I put it right here. I take the business card, I put it right here, and I'm matching the shape of the squiggles on the card to the shape of the squiggles on the phone pad. But then I would drift back out into La La Land, and not remember when I came back if I'd already dialed those numbers. So I had to wield my paralyzed arm like a stump and cover the numbers as I went along and pushed them, so that as I would come back to normal reality, I'd be able to tell, "Yes, I've already dialed that number." Eventually, the whole number gets dialed and I'm listening to the phone, and my colleague picks up the phone and he says to me, "Woo woo woo woo." (Laughter) And I think to myself, "Oh my gosh, he sounds like a Golden Retriever!" And so I say to him -- clear in my mind, I say to him: "This is Jill! I need help!" And what comes out of my voice is, "Woo woo woo woo woo." I'm thinking, "Oh my gosh, I sound like a Golden Retriever." So I couldn't know -- I didn't know that I couldn't speak or understand language until I tried. So he recognizes that I need help and he gets me help. And a little while later, I am riding in an ambulance from one hospital across Boston to [Massachusetts] General Hospital. And I curl up into a little fetal ball. And just like a balloon with the last bit of air, just, just right out of the balloon, I just felt my energy lift and just -- I felt my spirit surrender. And in that moment, I knew that I was no longer the choreographer of my life. And either the doctors rescue my body and give me a second chance at life, or this was perhaps my moment of transition. When I woke later that afternoon, I was shocked to discover that I was still alive. When I felt my spirit surrender, I said goodbye to my life. And my mind was now suspended between two very opposite planes of reality. Stimulation coming in through my sensory systems felt like pure pain. Light burned my brain like wildfire, and sounds were so loud and chaotic that I could not pick a voice out from the background noise, and I just wanted to escape. Because I could not identify the position of my body in space, I felt enormous and expansive, like a genie just liberated from her bottle. And my spirit soared free, like a great whale gliding through the sea of silent euphoria. Nirvana. I found Nirvana. And I remember thinking, there's no way I would ever be able to squeeze the enormousness of myself back inside this tiny little body. But then I realized, "But I'm still alive! I'm still alive, and I have found Nirvana. And if I have found Nirvana and I'm still alive, then everyone who is alive can find Nirvana." And I pictured a world filled with beautiful, peaceful, compassionate, loving people who knew that they could come to this space at any time. And that they could purposely choose to step to the right of their left hemispheres and find this peace. And then I realized what a tremendous gift this experience could be, what a stroke of insight this could be to how we live our lives. And it motivated me to recover. Two and a half weeks after the hemorrhage, the surgeons went in and they removed a blood clot the size of a golf ball that was pushing on my language

centers. Here I am with my mama, who is a true angel in my life. It took me eight years to completely recover. So who are we? We are the life-force power of the universe, with manual dexterity and two cognitive minds. And we have the power to choose, moment by moment, who and how we want to be in the world. Right here, right now, I can step into the consciousness of my right hemisphere, where we are. I am the life-force power of the universe. I am the life-force power of the 50 trillion beautiful molecular geniuses that make up my form, at one with all that is. Or, I can choose to step into the consciousness of my left hemisphere, where I become a single individual, a solid. Separate from the flow, separate from you. I am Dr. Jill Bolte Taylor: intellectual, neuroanatomist. These are the "we" inside of me. Which would you choose? Which do you choose? And when? I believe that the more time we spend choosing to run the deep inner-peace circuitry of our right hemispheres, the more peace we will project into the world, and the more peaceful our planet will be. And I thought that was an idea worth spreading. Tweet this talk! (we'll add the headline and the URL) Post to: Share on Twitter Email This Favorite Download Order DVD inShare Share on StumbleUpon Share on Reddit Share on Facebook TED Conversations

DR. PATCH ADAMS The Gesundheit! Institute Patch Adams, M.D. I entered medical school in 1967 to use medicine as a vehicle for social change. I used my free time to study the history of health care delivery around the world and to look at contemporary models with the idea of creating a medical model that would address all the problems of the way care is delivered. I didn't intend to create a model that would be the answer to the problems; but to model creative problem solving, and to spark each medical facility to design their own ideal rather than succumb to the garbage of managed care, or a resignation to the impossibility of humanistic care. Beginning in the climate of the political "war on poverty," I felt confident that a free hospital to serve the poorest state, West Virginia, would find easy funding and that we would be built in four years. I smile writing this as we enter our 33rd year without having broken ground on the hospital. However, we have asked our architect to go to finished drawings so that we can begin building as soon as we have funding in hand. None of the journey has gone as I imagined and the vision is so much deeper, more comprehensive and far-reaching as a consequence of such deliberate progress. The original vision had all the principles we have maintained all these years. There would be no charge for the care. Barter was also not an option. In fact, we wanted to eliminate the idea of debt in the medical interaction as a way to begin recreating human community. We didn't want people to think they owed something; we wanted them to think they belonged to something. We could not conceive of a community that did not care for its people. This also meant a refusal to accept third party reimbursement, both to refuse payment and to sever the stranglehold that insurance companies had on how medicine was practiced. We would have nothing to do with malpractice insurance, which forces fear and mistrust into every medical interaction. We espouse the politics of vulnerability and are clearly aware that we can only offer caring and never promise curing. In such a flagrantly imperfect science, we need the right to make mistakes. The loudest cry of patients was for compassion and attention, which was a call for time. So initial interviews with patients were three to four hours long, so that we could fall in love with each other. Intimacy was the greatest gift we could give them, especially at a death bed, with intractable pain or chronic, unsolved medical problems. It was natural to insist on a house call to sweeten this intimacy. When I made a house call, I opened every drawer and snooped in every closet. I wanted to know the patients in all of their complexities. An apparent secret in the practice of medicine (so easily erased when business is the context) is how care is bidirectional. This intimacy is as important for the care giver as it is the patient. The bidirectionality of healing is at the core of preventing burnout. The business of medicine has connected the word care with the concept "burden," to describe all who need care, who are not wealthy. But we found the unencumbered practice of medicine is an ecstatic experience. In spending this amount of time with patients, we found that the vast majority of our adult population does not have a day to day vitality for life (which we would define as good health). The idea that a person was healthy because of normal lab values and clear x-rays had no relationship to who the person was. Good health was much more deeply related to close friendships, meaningful work, a lived spirituality of any kind, an opportunity for loving service and an engaging

relationship to nature, the arts, wonder, curiosity, passion and hope. All of these are time-consuming, impractical needs. When we don't meet these needs, the business of high-tech medicine diagnoses mental illness and treats with pills. What the majority need is an engagement with life. This is why we fully integrated medicine with performing arts, arts and crafts, agriculture, nature, education, recreation and social service, as essential parts of health care delivery. We knew that the best medical thing we could do for the patients was to help them have grand friendship skills and find meaning in their lives. This is a major reason that the staff's home was the hospital. We insisted on friendships with our patients (made easy by not charging, and giving them our lives). A patient ideally would bring their whole family while they were healthy, and stay a few days as friends, becoming familiar with the hospital (home, sanctuary), so that just being there was relaxing, even healing. We wanted patients to bring all their interests and skills to essentially become temporary staff as well as patients during their stay. For example, if a car mechanic came as a patient, we could notify the poor in our greater community who might need their car fixed, and have it happen while the mechanic was getting care. The mechanic may also give classes on basic mechanics. All these features help build community, creating a sense of interdependence. Those receiving care can not feel indebted because they become both the help and the helped. To help promote diversity and truly to be full service in our planned facility, we insist on integrating all the healing arts. Allopathic medicine, including surgery, ob/gyn, pediatrics, internal medicine, family practice and psychiatry, will work hand in hand with complementary medicine, including acupuncture, homeopathy, naturopathy, chiropractic, ayurvedic, anthroposophic, herbal, body work and faith healing. It will be an exciting opportunity to study how they can all work together under close observation. The entire environment will be an example of preventive medicine exploring how to help a patient and their family grow healthy (or at least healthier!) From the beginning, social, environmental and global health were felt to be essential as part of our medical practice. There, violence and injustice became medical issues. Unemployment, the discrepancies between rich and poor, poverty, pollution, corrupt governments and economic systems all become concerns of a medical practice. There was always an invitation and encouragement to become involved in social change, even if the individual did not feel it affected their life. We want to build a fine community of people whose ethic is caring for all. Now, we have added to our vision a school to teach social change with the whole community as its laboratory. Agriculture will not just be about feeding people, but an exploration into sustainable agriculture. We'll use designing the community as an experiment in appropriate technology. One of the most radical parts of the vision was that we wanted all of the activity to be infused with fun. I wanted to build the first silly hospital in history. Foolishness was embraced, often to extreme, in even the most profound of situations. We had fun deaths and bizarre, outlandish behaviors with the mentally ill. In our normal, serious world with somber medical environments (even though no research supports being serious and thousands of research papers encourage joy and humor as healing), we saw no contradiction in feeling that a hospital could also be an amusement park, even implying it is important for staff and patient.

The ideal staff people we looked for were, by intention, happy, funny, loving, cooperative and creative. I knew the key to the creation of this beautiful model was in the people deciding and choosing to live there; because it is people that really make a model. Ideas can only be as real as the people living them. Politically, our most potent wedge for change would be living happily together, in constant, joyful service, fully expressing our creative selves at extremely low salaries. The point was not to try to teach a staff this, but to find people for whom this was their way of life. In our first 12 years (1971-1983) we did all this as a pilot project. Twenty adults and our children moved into a large, six-bedroom house and called ourselves a hospital. We were open twenty-four hours a day, seven days a week, for all manner of medical problems from birth to death. Three of the adults were physicians. We saw 500-1000 people each month, with five to fifty overnight guests a night; totaling 15,000 people over those 12 years. We were never sued. At least three thousand of the patients had mental illness and we did not give psychiatric medicines. We referred out what we could not handle. It was truly ecstatic, fascinating, and stimulating. No one gave us a donation and we were 0:1400 for foundation grants, so our staff had to work part-time jobs to pay to practice medicine. After nine years of nobody leaving, most staff said they felt we would never be funded, and wanted to stop. It was the saddest moment for me, for I loved all of them and knew that I had to persevere. I tried to recreate the work for three more years and realized that in order to continue, I need a facility to support this model of care. Now the job was to raise the funds to build it. It appeared that our ideas were too radical to get conventional funding, and so I realized that we had to go to the people of the world to get the needed funds. The model for that in modern society is through publicity and fame. So I broke a basic tenet of our philosophyno publicityand became public. For the last 20 years we have climbed that fame and fortune ladder in hopes that we would attract funds to build our ideal rather than compromise the vision. This went to monstrous extremes in 1998 when a feature film, "Patch Adams," was released with Robin Williams playing me. These efforts have brought us a three hundred seventeen acre farm in Pocahontas County, West Virginia. The land has three waterfalls, with caves behind one. We built a four acre pond, there is a mountain of hardwood trees and twenty-eight acres of rich bottom land that has had no chemicals on it for 22 years. We have built two beautiful buildings in anticipation of someday building the hospital. Two years ago, with a little sadness that the hospital was still not built, and a hunger to begin seeing patients again, I agreed to consider reopening with a first phase that would include an outpatient clinic and a school for social change, with residence facilities for the staff. We have asked our architect of 21 years to give us finished drawings for it. We owe no money and have a good start for Phase I. I could feel frustrated, even sad, that the hospital is still unbuilt. However, in the long run it may prove to have been a very positive time line. After 33 years, we have built a much larger, more diverse, more intelligent, more globally influential model than we ever dreamed of in those first 12 incubating years. Our global impact has affected far more patients' lives and inspired more social change than if we had gotten our funding early on. My failure at fund raising has forced me and our evolutionary staff and friends to expand in every direction and meet a quality and quantity of people that make our greater team of friends and contacts number

in the thousands in almost every area of endeavor; especially healing, the arts, and social change. Gesundheit! has indeed become a global mover and shaker active in forty or more countries, expanding beautifully all the time. When we build the model with people serving it, full and part time, its example will be breathtaking with a process already in place to have an important impact because a variation of that is happening already. The patients of our first 12 years were individuals and families looking closely at their organ systems. The patients of our last 20 years have been communities and societies looking at their organ systems: environmental, social, political, economic. All of these "patients" will dance through the hospital when it is built. I have had to earn the funds to support these last 20 years' activities, with every month being a creative journey of survival. Since the film's release, we're not on such a survival edge, but we have still not raised funds for major construction. The beauty of the journey makes patience easy, especially since every day is wildly exciting and globally influential, regardless of the building progress. This is not to say that the building of the hospital is any less important. On the contrary: it is more important than ever since it has remained, these 31 years, the only model in the U.S. (and one of few in the world) to comprehensively address health care delivery problems. Our example of joyful persistence alone is an important, inspiring model for the changes needed in the world. We stopped seeing patients in 1983 to devote ourselves to fund raising full time for the hospital, by expanding out into the world. I began lecturing and performing on a wide variety of subjects (fifty lectures, shows and workshops) with every imaginable kind of audience and with as many as eleven lectures in a day. All levels of education from elementary schools to medical schools (most of the ones in the United States and in thirty to forty countries), churches, community centers, conferences and corporations. For most of the time it was for 150-200 days a year and 300 days a year since the film, always all over the world. A constant flow of publicity and my two books translated into ten languages and the film have made our project part of the medical dialogue all over the world when referring to humanized health care. During these 20 years our clown healing work has expanded all over the world, so that clowns are now a regular part of hospitals on every continent and this is expanding as people hear the message that it is really about spreading joy in every public space as gestures toward peace, justice and care. I started taking clowns to prisons, foreign countries, even to refugee camps and war zones. For 18 years I've taken thirty clowns from all over the world to Russia for two weeks of clowning in hospitals, orphanages, prisons and nursing homes, as well as airports, subways, streets and hotels. Ten years ago this led to our getting involved in the care of orphans in Russia in work that is now recognized all over. We have taken clowns into the war in Bosnia, the Kosovo refugee camps in Macedonia, the Rumanian AIDS orphanages, African refugee camps, Cuba, China, El Salvador, Korea and Haiti. As I write this, we took twenty-two clowns from all six continents and ten tons of aid for three and a half weeks into the war in Afghanistan. Because this work has connected us with many aid and relief organizations (like Airline Ambassadors), it is now easy to organize huge quantities of people and aid quickly and effectively. These experiences have also gotten us involved in the global conversations on conflict resolution. All of our gestures of love and fun have been a magnet for beautiful people who want to devote their lives to loving service. Every year thousands of doctors and

nurses tell me they would be willing to live and work full time 40 to 60 hour weeks in our hospital for $3,000/year. Many more want to come part time. Students of medicine from all over the world constantly entreat us to let them come study what we are doing. This may be the most important reason to get the hospital built. Nine years ago a special group of old and new friends began to come together in a real group commitment toward the dream; our second major staff change. No longer did I have to carry the vision alone because the individuals of this group though quite diverse in thought and personalityeach felt they found a place and readiness in themselves to want to be and work for the now-collective vision. For any project created by one person this is a grand step so that the vision can continue if something happens to the visionary. Another important bonus is that each of them brings their special interests and talents to the project to vastly broaden how the multiple tasks I used to do now get done, and each adds their blessed creativity again enhancing every part of the vision. What it feels like to me is that now everything is in place to make the hospital a reality. We plan to build a forty-bed rural community hospital. There will be sixty beds for staff and beds for their families in a creative, comfortable communal hospital. There will also be forty beds for guests who would be healing arts students on electives, ophthal-mology teams every three months, plumbers, string quartets, and anyone wanting a service-oriented vacation. There will be 30,000 square feet devoted to the arts in a fully arts-centered hospital. There will be a school for social change and in-depth agricultural programs. It will be funny looking, full of surprises and magic. We'll be exploring how far below the national average our effective operating budget can runI believe we'll be shockingly inexpensive. Our ideal is that an endowment would cover the annual costs and realize without this we'll find creative ways to pay for its operation. There will be a forty-acre village to house our children's school (also for sick children and children of sick parents) and other important community experiments, like how to integrate all ages in a fun, healthy way. Staff persons who've served for four years and want a little distance from the intensity of the hospital can create their fantasy living space in our village. I want to tell all readers that the journey has been heavenly all along the way. Simply being in an idealist quest is its own reward. I've never felt I've sacrificed anything or thought it was a hard journey. Hard would have been having to work in corporate medicine and lie to patients and myself every day. My concern for humanity's future drives me to want to put whatever efforts I can to changing everything that hurts people and nature. The Gesundheit! Institute is that for me, and so many others. SCIENCE HERO: DR. PATCH ADAMS by Kelly Stephenson from Fredericksburg The dictionary defines a hero as any man renowned for his courage or feats of valor, or any man admired for his character, ideals, or accomplishments. But a hero is much more than just those things. A hero must have heart, he must be able to stand up for something he believes in, he must be caring and brave. It is not fair to call just anyone a hero. A hero must be someone special to you and

someone you admire. A hero is a champion, a conqueror, an idol, and your Superman. A hero is not just anyone. A hero is special. Hunter 'Patch' Adams was born into a strict military-like family. His father ran the household like a military institute and they were constantly moving. Due to his family's frequent moves to diverse places, he learned to accept differences in people and to quickly make friends. Although he was never close to his father, he was very close to his mother. She instilled in him a sense of humor and made him want to learn. She gave him love and attention. She was very special to him. As Hunter started school, he became known as the class clown. He goofed off all the time because he got so bored with learning things that were too easy and simplistic for him. Eventually, he became interested in the diverse world of science and math. He won many small science fairs and entered, and won, the All-Europe science fair. Soon after winning one of his last science fairs, he went to spend a week with his father, who had been constantly drunk or too busy for him and his brother before. During this time, his father told him of the wars he had fought in and of his best friend who had died while saving his life, subjects which he never even talked about before. He and his father became very close during this week. A few days after, his father died suddenly of a heart attack. Soon after, Adams and his family moved to Northern Virginia to live with his uncle and aunt for a few months before moving to West Virginia a little later. Adams became very close to his uncle and his uncle became a second father to him. He went to school and because he was in a racist town, he stood out as a person who loved everyone no matter what their skin color. Things got better for him. He started to date his first girlfriend, Donna. He dated her for quite some time. Right before he graduated, he developed ulcers in his stomach and he began to take medicine that made him sleepy most of the time. His girlfriend inevitably broke up with him in his freshman year in college, and then, right around the same time, his uncle committed suicide. He dropped out of college and became dreadfully depressed. He was convinced he was still in love with Donna, and he wanted her back. He became obsessed with suicide. He would go and sit on the edge of a cliff almost everyday, and he would write to or about her. He was convinced that he would jump as soon as he finished, but luckily he was too wordy. He went to his mother right after a terrible visit with Donna, and he told her that he had been trying to commit suicide and that he needed to be checked into a mental hospital. While in the hospital, Adams made many different friends. The patients in the hospital changed him, especially one of them. One of the patients, who was suffering from loneliness, made Adams realize that he was loved and he was not lonely; he had friends. It is said that this patient was the one who gave him the nickname Patch. (There is another story that says that Patch gave himself the name, Patch, because he wanted to forgo any evidence of his southern ancestry.) Also in the hospital, he realized his passion; healing people with laughter. When he got out of the hospital, he knew that he wanted to help other people. He applied to med school and they advised him that before he enrolled that he should get his life back together. He eventually decided to try to enroll again after getting a job for awhile. He finally entered pre-med school in '64 and then, three years later, he entered med school at Medical College of Virginia. He loved to go and visit the hospital patients. He would make them laugh and do the funniest antics

around them. His professors did not like his behavior, probably because of its uniqueness and non-seriousness. Patch went on to start making his one dream into a reality. He believed that the medical system was twisted and that it cheated poor people. So, he decided that he wanted to build a hospital. But his dream was for a hospital back home in West Virginia, where he would prove his methods in day-to-day practice. At the Gesundheit Institute, as he calls it, doctors would work for peanuts, and patients would never be billed. After much fund-raising, his dream started to become a reality. His Gesundheit Institute is not completely perfected, but it is up and running. One person said of the Institute: "There, amongst beautiful mountains, hardwood forests and waterfalls, Gesundheit advocates are constructing a wholistic rural hospital and healthcare community based on the vision of what healthcare should be like. That means patient care where laughter, joy and creativity will be an integral part of the healing process. Healthcare will be provided without cost and doctors will carry no malpractice insurance. Doctors and patients will relate to each other on the basis of mutual trust, and patients will receive plenty of time from their doctors. Allopathic doctors and practitioners of alternative medicine will work side by side." Although he does not run it anymore, he still talks about it and tries to raise money for it. Patch's theory on healing is definitely different. He believes that laughter is the best cure. He loves to go from hospital to hospital making people laugh and teaching regular doctors how to be funny for their patients. He "thinks every doctor should be a heart specialist -- a merry heart, that is." Patch could be considered the most useful clown of the century. He uses his clownlike attitude for good. He has helped people feel and/or get better, he has stopped fights in the streets by just walking around acting and looking like a clown, and he has made an unforgettable impression on many. He is so compassionate and has never once had to give one of his patients a tranquilizer or psychiatric medication. Silliness is one of his virtues and he thinks that every doctor should possess it. Hunter "Patch" Adams has been a physician for nearly 30 years, but he has been a clown for almost 40. He lives to make people laugh and feel good. He says that he is looking for a world where love will no longer be extraordinary, and he thinks that the role of a clown and a physician are the same: "to elevate the possible and to relieve suffering." Patch has been to many different countries with his clowns, trying to work his charms on the many different patients and underprivileged people of all shapes and sizes. He says that living in clown clothes is his gift to a world that he thinks is depressed, lonely, and lacking compassion. Since he started his expedition to raise money for the Gesundheit Institute, he has written two books, Gesundheit: Good Health is a Laughing Matter and House Calls. In 1994, he won the Institute of Noetic Sciences Award for Creative Altruism. He has come a long way in his dream of the Gesundheit Institute and he has become well-known through his movie, "Patch Adams." Patch Adams is an incredible man, and one that I truly admire. He is definitely NOT perfect, but he has accomplished so much and has more than just a good heart. He is special and everybody should know about him!

We've never carried malpractice insurance because we know we are imperfect we can always promise care we can never promise cure, we need the right to make a mistake. As a family doctor i knew i wanted to know my patients so my first interview with an adult patient is four hours long. I ask every question sensitive to life. I visited their home, and what i found out was that less than 3% of the adult population i saw did not have self esteem, less than 5% had any idea what a day-to-day vitality for life was about, what we just heard about health. Practically actually no-one was pro-active for their health. And thats why from our very beginning we integrated medicine with performing arts, arts and craft, agriculture, nature, education, recreation and social service. In a way we used their disease as a gimmick to get them into a university of human culture. We were teaching love, joy, humour, passion, hope, wonder, curiousity, creativity, intimacy, shared efforts with people. we realised that this country never rewards intelligence it rewards fame. .. we worked outside jobs to pay to practice medicine... rather the unencumbered practice of care is an ecstatic experience worth paying to do. ..the practice of medicine is the practice of compassion, with whatever humble tools and knowledge that you have to help another person.

no medical school teaches compassion as an embedded course (except unimelb! :D) we found that most people are lonely.. in fact the most typical american we saw didnt like themselves let alone their marriage, and their job and none of those were reasons they came to us. Nothing has been hard about this journey. It has been a thrill to practice medicine :|