Physicians are a varied lot these days -- chiropractors, acupuncturists, homeopaths and other "alternative" therapists are all challenging the MD establishment -- but on one point there is wide agreement: Charge what the market will bear.

Enter Dr. Hunter D. (Patch) Adams, who commits the ultimate heresy: He does not believe in charging for medical care. Instead, he funds his work through donations and supports himself and his family from lectures and presentations such as his "wellness show," which he performs for universities, medical schools, corporations and community groups. When practicing, he refuses to carry malpractice insurance, which is not legally required of doctors in Virginia. He insists on becoming friends with his patients and has even let them move into his home as part of the health care process. "The best therapy is being happy," he says. "All the other things doctors can do are, at best, aids."

Adams, 42, is a theatrical character who has been known to don a Viking costume, walk a tightrope, even strap a rubber nose on a Soviet customs official. His place is cheerfully chaotic: a crystal ball, a replica dinosaur skeleton, string puppets, a rubber eyeball, more than 15,000 books and lots of friends and family, including his wife Lynda and sons Zag, 11, and Zig, 6 months.

For 17 years, Adams has been the director of the Gesundheit Institute. At its height, the institute was staffed by 20 medical workers, including two physicians in addition to Adams. Between 1971 and 1983, 15,000 patients flowed through Gesundheit's doors, and Adams has a tall stack of letters from them attesting that his clinic's mix of humor and compassion helped when others could not.

Five years ago, he was forced to stop seeing patients so he could concentrate on coordinating plans and raising $2.5 million needed for the institute's permanent and much-expanded home, a "health community" in Pocahontas County, West Virginia. It will include a 40-bed hospital, a theater, craft and exercise rooms, vegetable gardens and an orchard. Gesundheit has purchased 310 acres, and construction is under way. Adams' "optimistic estimate" is that it will open in four years.

I was an Army brat, the result of a weekend furlough in World War II. My mother met my father in New York City when he was coming back from fighting in Europe, they had a weekend fling, and nine months later I was born. I grew up all over: seven years in Germany, three years in Japan, Texas, Oklahoma, lots of places.

My life was basically happy until I was a mid-teen-ager. My dad was not around, but my mother was a completely loving person. I think most of all what is good in me came from my mom. I grew up without any guilt and thinking I was a great person, because that is how I was treated. I was an A student, everything was easy. I used to dissect hamsters and frogs and always thought I would be in the healing arts.

The conflicts came in my teen-age years. My father died when I was 16. The week before he died, he had cleared our problems with each other, as if he had a premonition. He apologized for not being a father. He told how the war had destroyed his spirit. We cried and we cried and then he died. Heart attack. He was 52. He was a war victim. Another kind of war victim.

Whammo. There I was. I had lived overseas most of my life, I had never really been around civilians. I came back to Northern Virginia, and the civil rights movement had not started yet -- this was 1961, and the big march was in '63. I went to Wakefield High in Arlington, a school with a lot of racial tension, and I could not cope with the hate. People would say derogatory things about black people, and I would stand up in class and correct them, and I would get into a lot of trouble. Physical harm, ostracism, stuff that is rough on a teen-ager. Twice in my senior year in high school I was hospitalized for ulcers. My guts were eating out.

Then I started school at an egghead university, Sewanee, University of the South, and my uncle, who was the man I had adopted kind of as my father because I really respected him, blew his brains out.

I tried to kill myself. I used to walk to the edge of a cliff and try to write epic poems. I remember trying to write one to my girlfriend who had left me. Fortunately, I was long-winded -- I never finished it, and I told myself I couldn't jump until I finished it. I didn't want to die, but I acted that way.

So I committed myself to a mental hospital and in that hospital really turned my life around. My roommate was so much worse off than I was -- older, had three wives, 15 jobs, hallucinating terribly, never had visitors. I could not believe the pain of this person. For the first time in my life, I really empathized with another human being. I stepped out of my problems and into this other person's problems, and I realized how bad it could be if I let myself continue that way. I spent the rest of the hospitalization talking with all the other patients. I saw how they had alienated their support system -- the love -- from their lives. There was a recurrent theme of being alone.

I had what now seemed like a revelation: that I was a weak person, that I needed friends. I have celebrated that need, and it has never failed me, so I have not been sick for 25 years. I am an extremely healthy, 42-year-old, happy guy. I grew to respect what matters in life: wonder and curiosity and love and faith and family and friends and nature.

I left that hospital on fire with this information that love is what mattered and that I could make a difference and that it was up to me. I got on the path.

I started work as a file clerk in Anacostia and there was another college dropout there, and he has since become my oldest friend. He liked to play. We started doing street theater. That was important, because my playfulness has been a major factor in giving me the strength to keep going in the face of whatever the hardships are in following a dream. We wore gorilla costumes to work, we dressed up as women and cheered on the office softball team, we wore these kids' space helmets to work with little buzzers in them going whirrrrr! We stayed up late watching Steve Allen, being inspired by what he did.

I went to George Washington as an undergraduate, then Medical College of Virginia, and graduated in 1971. I was smart, I was particularly smart in memorizing, so medical school wasn't hard for me. I spent a lot of time with patients; I even got complaints for spending so much time with patients. I felt excited to be a doctor. I felt that I had a role to fulfill.

So in my senior year, I wrote up the original paper for Gesundheit. My wife and I saw four major issues that needed to be addressed: the cost of care, the dehumanization of care, malpractice and third-party reimbursement. It was easy to address them: Don't charge money, see the ideal doctor-patient relationship as a friendship, don't carry malpractice insurance, and don't accept third-party insurance.

So Gesundheit never accepted money. All of the staff worked irregular part-time jobs, and we got donations of stuff -- one time someone dropped off 15 wheelchairs. A little old lady in Iowa sent us a box of used sheets. She said, "I know you are a hospital, you'll need sheets, they are all clean." Another person who worked in a sock factory sent us a box of socks. A doctor in Maine just gave us a used tractor and baler. And we don't need much to live. In a community like ours, there is a sense of security, so I don't have life insurance, I don't have savings, I literally own nothing, yet I feel that I have greater insurance and wealth than anybody I know. Yourself and your friends, that is your real insurance in life.

For eight years I worked eight nights a month at St. Elizabeths. I worked in the emergency room. I was the medical officer, doing medical histories. I probably admitted eight to ten thousand people before they were medicated. Imagine the experiences I have. Whoever goes gaga in Washington ends up in St. Elizabeths. I spent as much as 2 1/2 hours with them. Forty percent of those admissions were PCP induced, so they were not open to much of anything. But if they were open, I certainly told them how I felt they could achieve a mentally healthier life. There were some that I offered to come to our place. It was a great experience; I felt honored to do it.

At Gesundheit, we see deep, intimate friendship between patient and doctor as having great medicinal power. By being free of charge, we enhance the potential for forming that relationship. When a person comes to me, unless the problem is an arterial bleed, which has to be addressed that second, the first goal is to have a friendship happen out of that relationship. So we spend three to four hours in the first meeting. We might go for a walk. If you like to fish, maybe we will go fishing. If you like to run, we run together, and I'll interview you while we are running. By the end of that time, I hope we have a trust, a friendship starting to develop, and from there we can proceed.

We do not carry malpractice insurance. We will not carry malpractice insurance. If the laws said we had to carry malpractice, we would not carry it. We will not practice in fear and mistrust. I mean, a lot of people know because I have lectured and written about it, but it was never a part of the discussion. Because of the nature of the relationship, I did not take it to be an issue, and I did not make it an issue with patients. Malpractice insurance sets up an adversarial relationship with your patients. It eliminates intuition, it forces you to prescribe the cookbook treatment rather than something else, even if the doctor feels the accepted treatment is inadequate or damaging. Where is there room for creativity? And it dramatically boosts costs -- some doctors pay more than $100,000 a year for coverage. Many docs are retiring early because they despise this new horror.

It has never caused us a problem. We have not been sued. I can't imagine a lawyer taking the case -- we don't own anything, and our salaries are not very big. But I like to think the real reason we've had no trouble is that we're friends with our patients, and they accept the fact that we make mistakes.

This whole malpractice thing inadvertently reinforces the doctor-as-God concept. If we can't make mistakes, we must be perfect. It also implies that the doctor is responsible for the cure and the patient the passive recipient of it. The huge majority of illnesses have a life-style component -- ultimately, the health of each of us is our own responsibility. We'll have a sign in our hospital that says "Please live healthy -- medicine is an imperfect science." I suspect when we reopen, we will also have a booklet that we hand to patients, some kind of "How to Be Here and What It's About" kind of thing because it will be a complex, and they will need maps and everything. I would not be surprised if we mentioned malpractice insurance in there. Individual doctors at Gesundheit may carry malpractice if they wish. We will not prevent them.

Early on, we realized how ill-equipped allopathic medicine is, which is what an MD practices, to deal with all health needs. So within the first year, we started letting an acupuncturist come and work with us. Since then, we have been very open to naturopathy, homeopathy, acupuncture, chiropractic, lots of things. If the practitioners did not charge, and they would let us watch, then we would let them do those things. And we found miracles in every one of them. We avoid the arrogance of thinking that any particular system will help more than a fraction of the people who come for help.

I don't prescribe many symptomatic drugs, because they are not curative and a lot of them have side effects. So I have never given tranquilizers or mood elevators. It has been years and years and years since I have given decongestants. I prescribe as many drugs in a year as some doctors do in a day.

From the start, it was obvious to me that we had to have fun in what we were doing or the staff would have left in a week. Forget the patient, it had to be fun for us. Life has to be fun! What the hell good is any of it if it is not fun? I saw what it was like when I was serious. I had ulcers, and I wanted to kill myself. That was me as a serious person. That failed. So, I used to rent my gorilla costume, then I made one. My wife and son also have gorilla costumes. We were like a Monty Python medical facility.

Not only is fun a glue for our community, but it had overwhelming medicinal effects on the patients. So many fewer pain medications! With psychiatric patients, there was overwhelming progress in intimacy and in relieving symptoms.

After all, what is bedside manner? When you say "That doctor has a good bedside manner," what are you really talking about? The element of love that they bring into the room, and the elements of humor they bring into the room. I suggest that when you say "good bedside manner," you are really talking about love and laughter in some kind of mixture and projection.

Health is typically defined as the absence of disease. To me, health is a happy, vibrant exuberant life every single day of your life. Anything less is a certain amount of disease.

In the 12 years that we saw patients, 15,000 people came through our home. I do not presume to say who we helped. I can say we gave our time, and we cared, and we love to care. I can show you hundreds of letters that say they liked what we did. We will never think in terms of cure rates. It gives a false sense of security. People are always in process until they die. You don't cure an ulcer, you have remission. You don't cure depression, you help a person find happiness according to their own definition, and hopefully you help them perpetuate that.

We feel physicians should not be concerned only with individual patients, but with the health of society, so we have been involved with the movement to end the war in Vietnam, nuclear disarmament, dealing with ecology, spouse abuse, the problems of our society. It all ties in with the concept that community matters.

In 1983, we realized that we could not see patients any more until we had a facility, a hospital. That was a very difficult choice for me, because I had made the choice never to turn patients away. But I had tried for 12 years to see patients and raise money, and all I did is see patients. It's certainly not been our wish to have such a large hiatus because I love being a doctor. But the fact is, until we build a place with beds for our patients and the technology required of a modern medical facility, a model, we will have no impact on the health care delivery system in this country, and that's what we're about. I have to turn away patients every day, and I hate it.

Now, I'm pushing paper. I spend most of my time at home trying to process the organization. I started getting invitations from all over the country: from medical schools, churches, community centers and universities to lecture about our work. I have also created shows that convey what we do. I lecture about poetry in medicine, I have several hours of poetry memorized. I have a show on balance that I do with my wife. I walk a rope and ride a unicycle and talk about the balance of nature, the balance of our lives, how all kinds of things have to integrate.

I teach a class on how to be nutty. I have done it at Harvard and Yale at conferences. I bring costumes for the students: leotards, tights, angel wings. Deely Bobbers and rubber noses. At the one I gave at Harvard, we had 24 Harvard medical students get into these costumes, and we all ran around the medical school, different places, and were nutty. Everyone loved it. That's how we support ourselves right now.

When we open in West Virginia, we will have some doctors who don't do four-hour interviews. I am trying to hire a staff with broad points of view, so that whoever walks in there will be able to go to somebody that they can be touched by. You don't want meditation, fine; you don't want brown rice, great; you don't want goofiness, fine. You may come in and be a redneck woman-hater, black-hater; you hate everything except your three beer-drinking buddies. You may still be a hippie. We'll know who to send you to.

As for doctors, I just put together a booklet of 100 letters we have gotten, which is just 1 percent of the letters we have received, from doctors, nurses, medical students, in essence describing how much medical practice is painful to them, and how much they are behind us, how much they would want to work with us, how much we represent the little hope that they have in medicine and why they are not quitting medicine. All of them, doctors, nurses, just crying out for a meaningful context in which to practice medicine. We are not in it for the money. We are not in it for power. We want to serve. To me, it is as much a reason as any to build this place.

We bought the land in 1980, 310 acres. We have been building this dream for 17 years, but we physically began building three years ago. We have just about finished our first structure, an incredible 6,000-square-foot shop. It is an exquisite building. People look at it and say, "This is your shop -- what will the hospital look like?" Our feeling is that esthetics is healing.

In September we got our first $100,000 donation. To date, only one foundation has helped us, and we have over 1,000 foundation rejections. Most of our contribution checks are from $10 to $50. We get more money every year. For the last four to five years, we've gotten a little over $100,000 a year. This year we have gone up to almost $240,000. For our total project, we will probably end up needing 3 1/2 to 4 million dollars. That will include not just the hospital, but the grounds, the shop, the landscaping, everything. We are on the verge of getting the money we need.

It is called Gesundheit first and foremost because it is our home, and we are not about to live with West Virginia Holistic Health and Healing Center. And it makes people laugh. Once they are laughing, you've got their pants halfway down. Once people are laughing, they are open. Also, literally translated it means "good health."

It will happen, because there are a lot of people like me. {Sings} "To dream, the impossible dream, to right the unrightable wrong!" I get more excited every year. Last night, I spoke in a room with 35 doctors and medical students at the Association of American Medical Colleges, and they stayed an hour and a half longer than they were supposed to. They stayed because on their faces was hope.

I feel the world is on a very short fuse. We need social change, and we won't get it with philosophy. Talk is cheap. We need models. If love matters, you have to show love mattering. If community matters, you have to show community mattering. We estimate operating cost to be between $300,000 and $600,000 annually. We intend to provide a very high quality of care at a very small cost compared to other facilities. If Edward Kennedy or somebody who is trying to address health care delivery reads something about us and even a tiny little paragraph ever hits him and he says, "Let's suppose what he says is true, let's suppose he can operate this hospital at 1 percent of the annual cost to operate a facility of comparable size" -- then we are a revolution.

For my children, for the world's children, for incredible nature, for the incredible gift that life is, I am going to act as if the peace we are striving for is on Earth right now. I am going to act and believe that if we all work together and do our best, that something can happen. Not because I see it happening, except in small ways, but because I know it can. ::