hunter "patch" adams (robin williams) is suicidal and admits himself to a mental institution. once there, he finds that using humor, rather than doctor-centered psychotherapy, better helps his fellow patients and provides him with a new purpose in life. because of this, he wants to become a medical doctor, and two years later enrolls at the medical college of virginia (now known as vcu school of medicine) as the oldest first year student. he questions the school's soulless approach to medical care, as well as the methods of the school's dean walcott (bob gunton), who takes an instant dislike to patch and believes that doctors must treat patients his way and not befriend them. because of this and incidents such as setting up a giant pair of legs during an obstetric conference, he is expelled from the medical school, although he is later reinstated when it becomes apparent to the school that his unconventional methods often help cure his patients. adams encourages medical students to work closely with nurses, learn interviewing skills early, and argues that death should be treated with dignity and sometimes even humor.
patch begins a friendship with fellow student carin fisher (monica potter) and develops his idea for a medical clinic built around his philosophy of treating patients using humor and compassion. with the help of arthur mendelson (harold gould), a wealthy man who was a patient whom patch met while in the mental hospital, he purchases 105 acres (425,000 m²) in west virginia to construct the future gesundheit! institute. together with carin, medical student truman schiff (daniel london), and some old friends, he renovates an old cottage into a clinic. when they get the clinic running, they treat patients without medical insurance and perform comedy sketches for them.
patch's friendship with carin soon turns into romance. when she tells him that she had been molested as a child, patch comforts her and reassures her that she can overcome her pain by helping others. encouraged, carin wants to help a disturbed patient, lawrence "larry" silver (douglas roberts). however, larry murders carin, then commits suicide. patch is guilt-ridden by carin's death and begins to question the goodness in humanity. standing on a cliff, he contemplates suicide again and asks god for an explanation. he then sees a butterfly that reminds him that carin had always wished she was a caterpillar that could turn into a butterfly and fly away. the butterfly lands on his medical bag and shirt before flying away. with his spirits revived, patch decides to dedicate his work to her memory.
walcott eventually finds out that patch has been running a clinic and practicing medicine without a license and attempts to expel him again because of this, as well as complaints that he has made his patients uncomfortable (which is obviously not true). desperate to prove walcott wrong, patch files a grievance with the state medical board on the advice of his former medical school roommate, conservative mitch roman (philip seymour hoffman). patch succeeds in convincing the board that he must treat the spirit as well as the body. the board allows him to graduate and he receives a standing ovation from the packed hearing room.
at graduation, patch receives his diploma and, bowing to the professors and audience, reveals his naked bottom
