Patient emancipation by health education: an impossible goal?

The development of patient education in hospitals received its first impetus in the U.S. For this reason, countries like the Netherlands where these developments tend to lag behind a bit, look to U.S. hospitals and literature for guidance on how to proceed in this matter. Although patient education in the U.S. has been steadily (and sometimes stealthily) creeping forward there are still many dilemmas and snags to be overcome. Some of these have gradually become clear, enabling patient educators in other countries to profit from American experience and using it whenever possible in their own situation. Given this context, the differences in social, political, and organizational climate between The Netherlands and the U.S., provide unique opportunities for clarifying some of the issues that characterize the development of patient education. In turn, such clarification may prove profitable for patient educators in the U.S. In view of the above, I propose in this paper to discuss some issues in patient education which may at first glance seem outdated, but are none the less unresolved. What are the general goals of patient education, and what means do educators have at their disposal to reach these goals? Is the practical day-to-day state of the art as expressed by these means in accordance with, or at least not contrary to, the lofty ideals that somehow seem to lie behind our efforts at implementation? Out of these general considerations emerges the dilemma which I will be dealing with in this article. After that I will outline a specific educational theory which might usefully be brought to bear on this dilemma: the theory of Paolo Freire. Having discussed its implications for patient education, I will draw some conclusions for the political issues involved as well as for the practical work of patient educators.