FLORENCE — Patch Adams, a doctor-clown made famous by a 1998 movie starring Robin Williams, once said that the "role of a clown and a physician is the same: to elevate the possible and to relieve suffering."

But there's much more to the field of "clown care" than just trying to put a smile on patients' faces, and pure improvisation would never cut it. There's of course the basic medical knowledge required, as well as artistic competency, plus the necessary skills to handle the difficult social environments that a hospital can present.

The Meyer Pediatric Hospital in Florence, one of the worldwide pioneers in this field, recently hosted an international conference on clown therapy. The two-day event brought together physicians, psychologists, nurses and clowns from all over the world. Also present was Michael Christensen, founder of the Big Apple Circus Clown Care Unit in New York — the first program of its kind — and founder of the method practiced in the Florence hospital.

Since 1986, the Big Apple Circus has participated with hospitals in the U.S. where a group of professional clowns trained extensively in hospital procedures, circus skills, and improvisation make rounds as "clown doctors." Back in Florence, Meyer works with a clown group called Soccorso Clown (Clown Rescue).

"For the past 20 years, the professionals at Soccorso Clown have helped us make our departments more child-friendly and are an integral part of the institutional care programs," says Andrea Messeri, head of the Pain Therapy and Palliative Care Department at Meyer. "With the knowledge that laughter is a great ally for recovery, bodies are better able to respond to the disease and treatment." In other words, a good belly-aching laugh triggers the production of endorphins, which are the body's natural painkiller.

Messeri says the clowns in the wards are now considered valuable support to non-pharmacological pain management, especially in children. "When a child knows they will have a painful experience, for example from an injection or other procedure, the clown's presence can lessen the tension and, in some cases, can be more powerful than some sedative drugs," he explained.

Clown Doctors have been at Meyer since a pilot program began in 1995 and "health professionals have increasingly noticed their effectiveness," says psychologist Laura Vagnoli. From Monday to Friday, they stroll from ward to ward in pairs to ease anxiety, fear and boredom, wearing skewed hats and colored tassels. Their stethoscopes aren't for listening to heartbeats — they're for blowing bubbles.

"Although the objective is to make a child laugh," explains Vagnoli, "they must not interfere with doctors and, of course, must respect the child, their needs and their wishes." So they ask permission and don't suddenly burst into rooms with their skits and gags. Training, in such a context, is essential.

Messeri says, if applied with care, laughter is "one of the best weapons we have available for pain treatment." And so, serious research into clown therapy continues.