Social Theory & Health

, Volume 7, Issue 2, pp 81–99 | Cite as

The patient educated patient: A health-care asset or problem?

  • Roar Stokken
Original Article


Patient education is one of the four main hospital tasks in Norway. The intention is to reduce the impact of chronic diseases, and the rationality is obvious: knowledge of one's own disease should lead to a positive health outcome. But patient knowledge can challenge the health worker, for when it comes to taking care of own disease, interaction with health workers is important. This paper investigates the role and value of knowledge in the interaction. The investigation is done through analysis of stories in an inductive process informed by the connection between knowledge and power and systemization of the lifeworld. Five different relationships are identified: the classic relationship, the team relationship, the battle relationship, the inverted relationship and the powerless relationship. All five relationships are considered as double meetings: one meeting in the system between a patient and a health worker, and one meeting in the lifeworld between two human beings. The professional meeting is found to be subordinate to the human one.


patient education empowerment Habermas power knowledge 



First of all, a debt of gratitude goes to all the informants who have generously shared their lifeworld and stories with me. Thanks are also owed to those who have read the text and passed on their comments – most of all as a lifeworldly gift. Finally, I would like to thank the Central Norway Regional Health Authority that has financed the project. Because, it is the lifeworld that comes first, and the system afterwards…


  1. Argyris, C. (1993) Knowledge for Action: A Guide to Overcoming Barriers to Organizational Change. San Francisco, CA: Jossey-Bass.Google Scholar
  2. Bateson, G. (1972) Steps to an Ecology of Mind. New York: Ballantine Books.Google Scholar
  3. Bloor, M.J. and Horobin, G.W. (1975) Conflict and Conflict Resolution in Doctor/Patient Interactions. In: C. Cox and A. Mead (eds.) A Sociology of Medical Practice. London: Collier-Macmillan, pp. 271–285.Google Scholar
  4. Bruner, J. (1987) Actual Minds, Possible Worlds (The Jerusalem-Harvard Lectures). Cambridge, MA: Harvard University Press.Google Scholar
  5. Bruner, J. (2004) Life as narrative. Social Research 71 (3): 20.Google Scholar
  6. Cole, M. (1996) Cultural Psychology: A Once and Future Discipline. Harvard, MA: The Belknap Press of Harvard University Press.Google Scholar
  7. Coulter, A. (2002) The Autonomous Patient: Ending Paternalism in Medical Care. London: Stationary Office (for The Nuffield Trust).Google Scholar
  8. Eidsvåg, B. (1983) Eg ser [Ballad]. Oslo, Norway: Kirkelig Kulturverksted.Google Scholar
  9. Emanuel, E.J. and Emanuel, L.L. (1992) Four models of the physician–patient relationship. Journal of the American Medical Association 267 (16): 2221–2226.CrossRefGoogle Scholar
  10. Emerson, R.M. (2007) Working with ‘Key Incidents’. In: C. Seale, G. Gobo, J. F. Gubrium and D. Silverman (eds.) Qualitative Research Practice, Concise paperback edn. London: Sage.Google Scholar
  11. Engeström, Y. (1987) Learning by Expanding – An Activity-Theoretical Approach to Developmental Research. Helsinki, Finland: Orienta-Konsultit Oy.Google Scholar
  12. Foucault, M. (2002) Regjering. In: I.B. Neumann (ed. and trans.) Forelesninger om regjering og styringskunst. Oslo, Norway: J.W. Cappelens Forlag a.s, pp. 7–38.Google Scholar
  13. Frank, A.W. (1995) The Wounded Storyteller Body, Illness, and Ethics. Chicago, IL: University of Chicago Press.CrossRefGoogle Scholar
  14. Friedson, E. (1975) Dilemmas in the Doctor/Patient Relationship. In: C. Cox and A. Mead (eds.) A Sociology of Medical Practice. London: Collier-Macmillan, pp. 271–285.Google Scholar
  15. Glaser, B.G. and Strauss, A.L. (1967) The Discovery of Grounded Theory Strategies for Qualitative Research. Chicago, IL: Aldine.Google Scholar
  16. Greeno, J.G., Collins, A.M. and Resnick, L.B. (1996) Cognition and Learning. In: D. Berliner and R. Calfee (eds.) Handbook of Educational Psychology. New York: Macmillan, pp. 15–46.Google Scholar
  17. Habermas, J. (1984) The Theory of Communicative Action. Boston, MA: Beacon Press.Google Scholar
  18. Hatem, D. and Rider, E. (2004) Sharing stories: Narrative medicine in an evidence-based world. Patient Education and Counseling 54 (3): 251–253.CrossRefGoogle Scholar
  19. Heiene, G. and Thorbjørnsen, S.O. (1994) Fellesskap og ansvar: innføring i kristen etikk. Oslo, Norway: Universitetsforlaget.Google Scholar
  20. Hellesnes, J. (2002) Den galne grisen hans Lars Liabø og dei tre verdene hans Jürgen Habermas, eller om formalpragmatikkens grunnlag, Grunnane :Aschehoug, pp. 93–115.Google Scholar
  21. HMN. (2004a) Handlingsprogram for pasient- og pårørendeopplæring for Helse Midt-Norge. Stjørdal, Norway: Helse Midt-Norge.Google Scholar
  22. HMN. (2004b) Overordna strategi. Stjørdal, Norway: Helse Midt-Noreg.Google Scholar
  23. HOD. (2005) Fra stykkevis til helt – En sammenhengende helsetjeneste,
  24. Hodge, S. and Perkins, E. (2007) Communicative rationality in the clinic? Exploring the parental role in the management of gastro-oesophageal reflux in children. Social Theory & Health 5 (2): 107–125.CrossRefGoogle Scholar
  25. Hutchins, E. (1995) Cognition in the Wild. Cambridge, MA: MIT Press.Google Scholar
  26. Illeris, K. (2004) The Three Dimensions of Learning: Contemporary Learning Theory in the Tension Field between the Cognitive, the Emotional and the Social. Frederiksberg, Denmark: Roskilde University Press; Leicester, UK: Niace.Google Scholar
  27. Jacobsen, B. (2000) Eksistensens psykologi – en introduksjon. Translated by T. Andersen. Oslo, Norway: Pax forlag AS.Google Scholar
  28. Kierkegaard, S. (1978) Hjælpekunst. In: A.B. Drachmann, J.L. Heiberg and H.O. Lange (eds.), Søren Kierkegaard Samlede Værker, Vol. 18. Gyldendal: København, pp. 96–99.Google Scholar
  29. Kristiansen, A. (2005) Tillit og tillitsrelasjoner i en undervisningssammenheng: med utgangspunkt i tekster av Martin Buber, Knud E. Løgstrup og Anthony Giddens. Oslo, Norway: Unipub.Google Scholar
  30. Kvale, S. (1996) Interviews. An Introduction to Qualitative Research Interviewing. Thousand Oaks, CA: Sage.Google Scholar
  31. Kvangarsnes, M. (2006) Nattkaffi som medisin – Samhandling og kommunikasjon mellom pasient og sjukepleiar ved kritisk sjukdom. Nordisk Tidsskrift for Helseforskning 3 (1): 3–14.Google Scholar
  32. Latour, B. (1992) Where are the Missing Masses? The Sociology of a Few Mundane Artifacts. In: W.E. Bijker and J. Law (eds.) Shaping Technology Building Society: Studies in Sociotechnical Change. Cambridge, MA: MIT Press.Google Scholar
  33. Lave, J. and Wenger, E. (1991) Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  34. Lian, O.S. (2007) Rural doctors on a global stage: Do local communities make a difference? Social Theory & Health 5 (1): 88–102.CrossRefGoogle Scholar
  35. Locker, D. (1991) Social Causes of Disease. In: G. Scambler (ed.) Sociology as Applied to Medicine, 3rd edn. London: Baillière Tindall, pp. xiii, 303s.Google Scholar
  36. Løgstrup, K.E. (1997) The Ethical Demand. Notre Dame, IN; London: University of Notre Dame Press.Google Scholar
  37. Lorig, K. (2002) Partnerships between expert patients and physicians. Lancet 359 (9309): 814–815.CrossRefGoogle Scholar
  38. Lukes, S. (1974/2005) Power: A Radical View, 2nd edn. Basingstoke, UK: Palgrave Macmillan.CrossRefGoogle Scholar
  39. Lupton, D. (1997) Foucault and the Medicalisation Critique. In: R. Bunton and A.R. Petersen (eds.) Foucault, Health and Medicine Elektronisk Ressurs. London, New York: Routledge, pp. xxi, 256s.Google Scholar
  40. Luria, A.R. (1976) Cognitive Development – Its Cultural and Social Foundations. Translated by M. Lopez-Morillas and L. Solotaroff. Cambridge, MA; London, UK: Harvard University Press.Google Scholar
  41. Malterud, K. (2001) Kvinners ubestemte helseplager. Oslo, Norway: Pax.Google Scholar
  42. Morgan, M. (1991) The Doctor–Patient Relationship. In: G. Scambler (ed.) Sociology as Applied to Medicine, 3rd edn. London: Baillière Tindall, pp. xiii, 303s.Google Scholar
  43. Nettleton, S. (2006) The Sociology of Health and Illness, 2nd edn. Cambridge, MA: Polity Press.Google Scholar
  44. NKLMS. (2004) Ideologi og metode for Lærings- og mestringssentre. Oslo, Norway: Nasjonalt kompetansesenter for læring og mestring ved kronisk sjukdom.Google Scholar
  45. Ong, W.J. (1982) Orality and Literacy. London and New York: Routledge.CrossRefGoogle Scholar
  46. Parsons, T. (1951) The Social System. New York: The Free Press of Glencoe.Google Scholar
  47. Parsons, T. (1964) Social Structure and Personality. London: Free Press.Google Scholar
  48. Pearlin, L.I. (1989) The sociological study of stress. Journal of Health and Social Behavior 30 (3): 241–256.CrossRefGoogle Scholar
  49. Scambler, G. (2001) Introduction: Unfolding Themes of an Incomplete Project. In: G. Scambler (ed.) Habermas, Critical Theory and Health. New York: Routledge.Google Scholar
  50. Scambler, G. and Britten, N. (2001) System, Lifeworld and Doctor–Patient Interaction. In: G. Scambler (ed.) Habermas, Critical Theory and Health. New York: Routledge.Google Scholar
  51. SHdep. (1998) Høringsnotat – Lov om spesialisthelsetjenesten,
  52. Skjervheim, H. (1996) Participant and Spectator. In: G. Skirbakk (ed.) Selected Essays. Bergen, Norway: University of Bergen, The Department of Philosophy, pp. 127–141.Google Scholar
  53. Solvang, P. (2002) Annerledes – Uten variasjon, ingen sivilisasjon. Oslo, Norway: H. Aschehoug Co.Google Scholar
  54. Sørhaug, T. (2004) Managementalitet og autoritetenses forvandling – Ledelse i en kunnskapsøkonomi. Bergen, Norway: Fagbokforlaget AS.Google Scholar
  55. Stevenson, F. and Scambler, G. (2005) The relationship between medicine and the public: The challenge of concordance. Health (London) 9 (1): 5–21.CrossRefGoogle Scholar
  56. Toulmin, S. (1981) The tyranny of principles. The Hastings Center Report 11 (6): 31–38.CrossRefGoogle Scholar
  57. Vifladt, E.H. and Hopen, L. (2004) Helsepedagogikk – Samhandling om læring og mestring. Oslo, Norway: Nasjonalt kompetansesenter for læring og mestring ved kronisk sykdom.Google Scholar
  58. Vygotsky, L.S. (1978) Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press.Google Scholar
  59. Weber, M. (1968) Economy and Society an Outline of Interpretive Sociology. New York: Bedminster Press.Google Scholar
  60. Williams, G. and Popay, J. (2001) Lay Health Knowledge and the Concept of the Lifeworld. In: G. Scambler (ed.) Habermas, Critical Theory and Health. New York: Routledge.Google Scholar

Copyright information

© Palgrave Macmillan 2009

Authors and Affiliations

  • Roar Stokken
    • 1
    • 2
  1. 1.Patient Education Resource Centre, Norwegian University of Science and Technology (NTNU)TrondheimNorway
  2. 2.Faculty of Social Sciences and Technology Management, Sunnmøre Hospital TrustVoldaNorway

Personalised recommendations