With a proper installation of Patcher (either way), you don't need any special trickery in your .emacs file because all entry points to the library should be autoloaded.
However, Patcher has the ability to hook into external libraries, but won't do so unless requested. Currently, Patcher has hooks for Gnus only. If you're using Gnus as your MUA, you might want to add the following line to your gnusrc file:
(patcher-insinuate-gnus)
This will add some facilities described along the text.