Abstract
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.
This is a preview of subscription content, access via your institution.
Notes
- 1.
Prosumer: a consumer who is involved in design and manufacture, so the product is made to individual specification. The term is introduced by Alvin Toffler.
- 2.
This means that it is not necessary to report the study to the Privacy Ombudsman (Norwegian Social Science Data Services).
- 3.
Endochrinologists are doctors who treat hormonal diseases, which means that they are the specialists with the most knowledge about Arne's illness.
References
Argyris, C. (1993) Knowledge for Action: A Guide to Overcoming Barriers to Organizational Change. San Francisco, CA: Jossey-Bass.
Bateson, G. (1972) Steps to an Ecology of Mind. New York: Ballantine Books.
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.
Bruner, J. (1987) Actual Minds, Possible Worlds (The Jerusalem-Harvard Lectures). Cambridge, MA: Harvard University Press.
Bruner, J. (2004) Life as narrative. Social Research 71 (3): 20.
Cole, M. (1996) Cultural Psychology: A Once and Future Discipline. Harvard, MA: The Belknap Press of Harvard University Press.
Coulter, A. (2002) The Autonomous Patient: Ending Paternalism in Medical Care. London: Stationary Office (for The Nuffield Trust).
Eidsvåg, B. (1983) Eg ser [Ballad]. Oslo, Norway: Kirkelig Kulturverksted.
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.
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.
Engeström, Y. (1987) Learning by Expanding – An Activity-Theoretical Approach to Developmental Research. Helsinki, Finland: Orienta-Konsultit Oy.
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.
Frank, A.W. (1995) The Wounded Storyteller Body, Illness, and Ethics. Chicago, IL: University of Chicago Press.
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.
Glaser, B.G. and Strauss, A.L. (1967) The Discovery of Grounded Theory Strategies for Qualitative Research. Chicago, IL: Aldine.
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.
Habermas, J. (1984) The Theory of Communicative Action. Boston, MA: Beacon Press.
Hatem, D. and Rider, E. (2004) Sharing stories: Narrative medicine in an evidence-based world. Patient Education and Counseling 54 (3): 251–253.
Heiene, G. and Thorbjørnsen, S.O. (1994) Fellesskap og ansvar: innføring i kristen etikk. Oslo, Norway: Universitetsforlaget.
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.
HMN. (2004a) Handlingsprogram for pasient- og pårørendeopplæring for Helse Midt-Norge. Stjørdal, Norway: Helse Midt-Norge.
HMN. (2004b) Overordna strategi. Stjørdal, Norway: Helse Midt-Noreg.
HOD. (2005) Fra stykkevis til helt – En sammenhengende helsetjeneste, http://www.regjeringen.no/Rpub/NOU/20052005/003/PDFS/NOU200520050003000DDDPDFS.pdf.
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.
Hutchins, E. (1995) Cognition in the Wild. Cambridge, MA: MIT Press.
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.
Jacobsen, B. (2000) Eksistensens psykologi – en introduksjon. Translated by T. Andersen. Oslo, Norway: Pax forlag AS.
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.
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.
Kvale, S. (1996) Interviews. An Introduction to Qualitative Research Interviewing. Thousand Oaks, CA: Sage.
Kvangarsnes, M. (2006) Nattkaffi som medisin – Samhandling og kommunikasjon mellom pasient og sjukepleiar ved kritisk sjukdom. Nordisk Tidsskrift for Helseforskning 3 (1): 3–14.
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.
Lave, J. and Wenger, E. (1991) Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press.
Lian, O.S. (2007) Rural doctors on a global stage: Do local communities make a difference? Social Theory & Health 5 (1): 88–102.
Locker, D. (1991) Social Causes of Disease. In: G. Scambler (ed.) Sociology as Applied to Medicine, 3rd edn. London: Baillière Tindall, pp. xiii, 303s.
Løgstrup, K.E. (1997) The Ethical Demand. Notre Dame, IN; London: University of Notre Dame Press.
Lorig, K. (2002) Partnerships between expert patients and physicians. Lancet 359 (9309): 814–815.
Lukes, S. (1974/2005) Power: A Radical View, 2nd edn. Basingstoke, UK: Palgrave Macmillan.
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.
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.
Malterud, K. (2001) Kvinners ubestemte helseplager. Oslo, Norway: Pax.
Morgan, M. (1991) The Doctor–Patient Relationship. In: G. Scambler (ed.) Sociology as Applied to Medicine, 3rd edn. London: Baillière Tindall, pp. xiii, 303s.
Nettleton, S. (2006) The Sociology of Health and Illness, 2nd edn. Cambridge, MA: Polity Press.
NKLMS. (2004) Ideologi og metode for Lærings- og mestringssentre. Oslo, Norway: Nasjonalt kompetansesenter for læring og mestring ved kronisk sjukdom.
Ong, W.J. (1982) Orality and Literacy. London and New York: Routledge.
Parsons, T. (1951) The Social System. New York: The Free Press of Glencoe.
Parsons, T. (1964) Social Structure and Personality. London: Free Press.
Pearlin, L.I. (1989) The sociological study of stress. Journal of Health and Social Behavior 30 (3): 241–256.
Scambler, G. (2001) Introduction: Unfolding Themes of an Incomplete Project. In: G. Scambler (ed.) Habermas, Critical Theory and Health. New York: Routledge.
Scambler, G. and Britten, N. (2001) System, Lifeworld and Doctor–Patient Interaction. In: G. Scambler (ed.) Habermas, Critical Theory and Health. New York: Routledge.
SHdep. (1997) Pasienten først!, http://odin.dep.no/hod/norsk/dok/andre_dok/nou/030005-020012/inn-bn.html.
SHdep. (1998) Høringsnotat – Lov om spesialisthelsetjenesten, http://odin.dep.no/hod/norsk/dok/andre_dok/hoeringsnotater/030005-990728/dok-bn.html.
Skjervheim, H. (1996) Participant and Spectator. In: G. Skirbakk (ed.) Selected Essays. Bergen, Norway: University of Bergen, The Department of Philosophy, pp. 127–141.
Solvang, P. (2002) Annerledes – Uten variasjon, ingen sivilisasjon. Oslo, Norway: H. Aschehoug Co.
Sørhaug, T. (2004) Managementalitet og autoritetenses forvandling – Ledelse i en kunnskapsøkonomi. Bergen, Norway: Fagbokforlaget AS.
Stevenson, F. and Scambler, G. (2005) The relationship between medicine and the public: The challenge of concordance. Health (London) 9 (1): 5–21.
Toulmin, S. (1981) The tyranny of principles. The Hastings Center Report 11 (6): 31–38.
Vifladt, E.H. and Hopen, L. (2004) Helsepedagogikk – Samhandling om læring og mestring. Oslo, Norway: Nasjonalt kompetansesenter for læring og mestring ved kronisk sykdom.
Vygotsky, L.S. (1978) Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press.
Weber, M. (1968) Economy and Society an Outline of Interpretive Sociology. New York: Bedminster Press.
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.
Acknowledgements
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…
Author information
Affiliations
Additional information
*Current address: Patient Education Resource Centre, Volda Hospital, Volda 6100, Norway.
Rights and permissions
About this article
Cite this article
Stokken, R. The patient educated patient: A health-care asset or problem?. Soc Theory Health 7, 81–99 (2009). https://doi.org/10.1057/sth.2008.22
Published:
Issue Date:
Keywords
- patient education
- empowerment
- Habermas
- power
- knowledge