[Thoughts about patient education: the experience of diabetes]

Patient education is not simply information or teaching or coaching. It is learning that is both practical and specialized, intended to help patients acquire therapeutic skills and to support them in changing their self-care practices to attain personalized objectives. It is therapeutic. An effective strategy to overcome health problems requires that patients not avoid the problem by denying the disease. Health prevention behavior requires that the patient be simultaneously confident in the prescribed treatments and able to project into the future. It is more difficult for asymptomatic patients to have a mental representation of the disease and thus be able to modify their lifestyle. Self-measurement of blood glucose can create anxiety and make the risk of complications more tangible, but it is beneficial only if it induces action or reassurance. Changing behavior is possible only to the extent that it does not challenge the patient's own well-being. It may be unreasonable but it is also rational to refuse what the patient perceives as a threat to his or her own identity. Thus, physicians caring for patients with a chronic disease must be skilled in three different fields: biomedicine, pedagogy, and psychology.