by Patch Adams, MD

Medical students and other health care students, join a revolution in loving.

Here is an invitation to medical students, nursing students, and all other health care students in the world to explore compassion (tender, loving, fun care) and its delivery from September, 2010 to September 2011. The plan is to gather data so that we can collectively then create an embedded course in all the years of medical school in order to graduate compassionate beloved physicians.

Can compassion (tender, loving, fun care) become a central interest and action in your life and at all times?

The practice of medicine is the practice of compassion in the deep engagement with people and their families. One can never promise to cure; one can promise to care 100%. The compassion is equally given to self and coworkers. Compassion is the love portion of the word care in the phrase “health care delivery system.: Compassion is a conscious way of being loving to create atmospheres in human groups and ways of being with people that make comfort and ease suffering.

No medical school in the world, to my knowledge, teaches compassion as a course thread running through all medical education. I’ve spoken at 90 of our medical schools and medical schools in 68 countries, and none have a compassion curriculum. Students everywhere feel this is a big, horrible problem in medical education. I would like to suggest that a lot of burnout in health care delivery is connected to the absence of a compassionate, fun, practice of medicine. The research data on the value of love, joy , humor, creativity, and companionship overwhelmingly support a context for the practice of medicine (or being a healthy human in general that is happy, funny, loving, cooperative, creative, and thoughtful. There is no data showing any value ever in any situation to being serious, grumpy, rude, hierarchical, etc.

Compassion is an intentional skill thoughtfully constructed and easily learned if given the opportunities and exploring exercises. To be compassionate, one constructs radar to read situations and quick willingness to act in care. First, one wants to be compassionate. Then, one says, “I will be compassionate!” The rest is exploration. For me, adding funny, silly, goofy, foolish and happy made it really easy to sustain compassion since the age of 18. A purpose in this course is to suggest that love and compassion can be thoughtfulness, with ideas that animate behavior. A medical student can create unfolding compassionate care.

We want all who care to move the medical profession to a radiant, joyful, ecstatic calling; to intensively keep journals to explore compassion within themselves and as a way of life. The primary investigators will be medical students and we hope those already in practice will do the same. The more in depth the better. Remember this has not been done, you are a pioneer. The results will be most valuable with as many thoughtful commitments to detail as possible. Imagine a medical system with no complaints of dehumanism from patients, families, and staff.

1. Keep a journal about you in relationship with love and compassion. What is it? Ask everyday – How are you giving it? (Pay close attention. Be present.) How are you receiving it? (From everything, from strangers, from trees, etc.)
2. Do things outrageous for love, like clowning.
3. Actually see if you can produce the vibration of compassion for prolonged periods. What sustains it? (friends, having meaning, fun) What hurts it? (arrogance, apathy, tight underwear.) Are there times you do not want to be compassionate?
4. Be observant of compassion in action around you, everywhere, give details of its languages.
5. Become aware of compassionate projects around the world and plan on a least one elective at a project. Post these projects on this website and ideally how to contact them.
6. Explore the language of love and compassion. Read psychologists and poets, write essays on things you love. Add books you love to our book list.
7. How do you recognize love/compassion? Are there measurements?
8. Do we invite professors in on our exploration? Whom?
9. How do you change performances of compassion in different situations?
10. At the small weekly meetings, find easy ways to present your findings to the group. Mention difficulties and ways they were overcome. Search for common languages to speak of these things. Keep notes. Bring questions for the group and preceptor. Find a preceptor from the staff at the medical school or hospital. Find someone who is really interested in the project maybe even will explore it themselves. Relax in the first 6 months on judgments. First collect data, experiences and develop a passion for the project. Once a month, have 4 groups of 4 to get together for a potluck – to have fun, be affectionate, and explore inter-group similar and different findings. It would be great to go clowning once or more times a week both to institutions like hospitals, orphanages, nursing homes and prisons; as well as streets, parks, shopping malls, buses, etc/ As you gain experience, try adding clowning (playfulness and engagement) to your personality. How do you find a preceptor? Think of who you know at school or hospital to suggest ones.
11. I recommend my son Lars to come for one year as a clown/love/teacher/advisor. This is a human love coach and playmate. Lars would also tie it in with Bola Roja. Lars and select members of Bola Roja could be enlisted at any time for visiting anyone anywhere for compassionate enagement even on an individual basis. Lars can be in constant contact with me and the U.S. team for consultation. Maybe there could be 1-2 weekend retreats with teams to explore loving. Work on volunteer projects to practice giving yourself for love.
12. Have conferences one each year in South America for medical students on the subject and its implementation. Send delegated in spring 2011 to national AMSA Convention to speak of this initiative.
13. Encourage staff(doctors, nurses, families of patients) to ask for compassion consult. Sign up for them – Lars could be part of these visits.
14. Have hug patrols, or better, a room in a hospital, the Affection Room, designed for anyone to go there as a giver or receiver. Operated by volunteers. (Grandparents, High School Students?)
15. Get Humberto Maturama from Chile to have him team to come 1-2 times a year. They have done an extensive study on love. I can help make this happen.
16. How do you relate to other people on issues of class consciousness, race, age, sexual preference. Pay close attention! Decide to connect with people you have no experience with.
17. I will send three kinds of letters: A) from Healthcare professionals hurting – wanting this change. Hear – listen for how people ask for something in healthcare delivery – probe, answer.
B) Healthcare students or providers who work for solutions – try to answer for them. Share answers with fellows.
C) Letters form patients – reaching – what would you say? Share answers with others – see differences, similarities.
18. A very important question to answer is: Should a medical student be evaluated as a compassionate doctor and not pass if they are not compassionate. How can they be evaluated? By patients, their families, their classmates, attending physicians, and all the other staff? IN your research, study staff and imagine how you can evaluate them. Should there be a way for student to give feedback to rude, or uncaring staff?
19. If you are not at Cayatano Heredia – then get at least 3 students to do this exploration together and find a preceptor. Groups at Cayatano Heredia can offer to be connected to sister groups in other schools.

Tools That Help Me Be Compassionate

• Twinkle in the eyes, smile on the face and an excitement to meet.
• Eye contact
• Be fun and tender
• Turn off TV
• Develop all your interests
• A tender love for people
• Engage with the arts and nature
• Do volunteer work
• Practice organizing and following through.

Reading List

Books By Our Team:

1. Patch Adams, MD
Gesundheit!
House Calls
2. Carl Hammerschlag, MD
The Dancing Healers
The Theft of the Spirit
3. Bowen White, MD
Why Normal Isn’t Healthy

Other books of relevance

1. The Nature of Suffering, Eric Cassell, MD
2. The Illness Narratives, Arthur Kleinman, MD
3. Love and Survival, Dean Ornish, MD
4. Loneliness, John Caccioppo
5. The Biology of Love, Humberto Maturama (in Spanish)
6. The Doctor Series, William Carlos Williams, MD
7. Love, Medicine, and Miracles, Bernie Siegel, MD
8. Caring, Nel Noddings,
9. Pathologies of Power, Paul Farmer, MD