The Art of Patient Education

  • Yasser El Miedany


In modern healthcare, patient education has been considered as part of the continuum of the service provided and is an essential additive intervention in the care of people with rheumatic diseases. Patient education goes beyond just providing information: targeting behaviour, beliefs and attitudes. It may be provided both formally and informally. In either case it should be planned and goal oriented, based on an assessment and agreement with the patient. Interventions should adopt psycho-educational approach, applying theoretical models rather than educational and counselling methods. The goal of patient education is self-management, i.e. the patient is empowered and able to take responsibility for the day-to-day management of the illness. Patients are considered as partners in the whole education process. This chapter will discuss the differences between patient and health education, and then it will expand to discuss the art and science in patient education and techniques of delivering patient education with examples of patient education programmes. The chapter will conclude by discussing the potential role of patients as teacher in the medical education setting and the use of technology to enhance patient education.


Patient education Patient teachers Patient education programmes Techniques of patient education Rheumote 


  1. 1.
    Dorr Goold S, Lipkin M. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med. 1999;14(Suppl (1)):S26–33.CrossRefGoogle Scholar
  2. 2.
    Nikiphorou E, Alunno A, Carmona L, Kouloumas M, Bijlsma J, Cutolo M. Patient–physician collaboration in rheumatology: a necessity. RMD Open. 2017;3:e000499. Scholar
  3. 3.
    Strehl C, Bijlsma JW, de Wit M, et al. Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis. 2016;75:952–7. Scholar
  4. 4.
    Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2017;0:1–18.Google Scholar
  5. 5.
    Riemsma R, Taal E, Kirwan J, Rasker J. Systematic review of rheumatoid arthritis patient education. Arthritis Care Res. 2004;51(6):1045–59.CrossRefGoogle Scholar
  6. 6.
    Basic concepts of patient education. Jones and Bartlett (Pub). Accessed 28 February 2018.
  7. 7.
    El Miedany Y, El Gaafary M, Youssef S, Palmer D. Towards a multidimensional patient reported outcome measures assessment: development and validation of a questionnaire for patients with ankylosing spondylitis/spondyloarthritis. Joint Bone Spine. 2010;77(6):575–81.CrossRefGoogle Scholar
  8. 8.
    El Miedany Y, El Gaafary M, Youssef SS, Palmer D. Incorporating patient reported outcome measures in clinical practice: development and validation of a questionnaire for inflammatory arthritis. Clin Exp Rheumatol. 2010;28(5):734–44.Google Scholar
  9. 9.
    El Miedany Y1, El Gaafary M, Palmer D. Assessment of the utility of visual feedback in the treatment of early rheumatoid arthritis patients: a pilot study. Rheumatol Int. 2012;32(10):3061–8. Epub 2011 Sep 11CrossRefGoogle Scholar
  10. 10.
    Yasser EM, Gaafary ME, Sayed S, Palmer D, Ahmed I. Implementing shared decision making in clinical practice: outcomes of a new shared decision making aid for chronic inflammatory arthritis patients. J Patol Care. 2016;2:117. Scholar
  11. 11.
    Fraenkel L, Nowell WB, Michel G, Wiedmeyer C. Preference phenotypes to facilitate shared decision-making in rheumatoid arthritis. Published online ahead of print December 15, 2017. Ann Rheum Dis. Scholar
  12. 12.
    Palmer D, El Miedany Y. Shared decision making for patients living with inflammatory arthritis. Br J Nurs. 2016;25(1):31–5.CrossRefGoogle Scholar
  13. 13.
    Li L, Adam P, Townsend A, Lacaille D. Usability testing of ANSWER: a web-based methotrexate decision aid for patients with rheumatoid arthritis. BMC Med Inform Decis Mak. 2013;13:131.CrossRefPubMedGoogle Scholar
  14. 14.
    NICE Clinical Guidelines, No. 138. Patient experience in adult NHS services: improving the experience of care for people using adult NHS services: patient experience in generic terms.
  15. 15.
    El Miedany Y, El Gaafary M, El Arousy N, Ahmed I, Youssef S, Palmer D. Arthritis education: the integration of patient-reported outcome measures and patient self-management. Clin Exp Rheumatol. 2012;30(6):899–904.Google Scholar
  16. 16.
    Towle A, Bainbridge L, Godolphin W, Katz A, Kline C, Lown B, Madularu I, Solomon P, Thistlethwaite J. Active patient involvement in the education of health professionals. Med Educ. 2010;44(1):64–74.CrossRefGoogle Scholar
  17. 17.
    De Silva D. What works to support self-management. Chapter 3 in helping people helping themselves. The Health Foundation (pub). 2011.
  18. 18.
    El Miedany Y. Telehealth and telemedicine: how the digital era is changing standard health care. Dove Medical Press. 2017;4:43–5.CrossRefGoogle Scholar
  19. 19.
    El Miedany Y, El Aroussy N, Youssef S, Almedany S, Palmer D. Teaching the millennials: using youtube for teaching rheumatology in the standard educational settings. Ann Rheum Dis. 2018; (in press).Google Scholar
  20. 20.
    Knowles MS, Holton EF III, Swanson RA. The adult learner: the definitive classic in adult education and human resource development. 6th ed. St. Louis: Elsevier; 2005.CrossRefGoogle Scholar
  21. 21.
    Lorenzen B, Melby CE, Earles B. Using principles of health literacy to enhance the informed consent process. AORN J. 2008;88:23–9.CrossRefGoogle Scholar
  22. 22.
    Iversen MD, Hammond A, Betteridge N. Self-management of rheumatic diseases state of the art and future perspectives. Ann Rheum Dis. 2010;69:955–63.CrossRefGoogle Scholar
  23. 23.
    Iversen MD, Sharby N. Arthritis patient education health promotion and team approach to management. Principles of management. Chapter 46. 396–5.Google Scholar
  24. 24.
    Fox S. Online Health search 2006. Pew Research Center 2006.
  25. 25.
  26. 26.
    Jack BW, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178–87.CrossRefPubMedGoogle Scholar
  27. 27.
    Patient Education Management. “Don’t get left behind: iPads making strong inroads with patient education” 2011.Google Scholar
  28. 28.
  29. 29.
    Pulman A, Hill J, Masding MG. The development of an innovative mobile phone app for type 1 diabetes alcohol education. In: Diabetes UK professional conference, 13–15 March 2013, Manchester; 2013.Google Scholar
  30. 30.
    The Beryl Institute. Enhancing the patient experience through the use of interactive technology. 2011.Google Scholar
  31. 31.
    Acosta-Lobos A, Riley JP, Cowie MR. Current and future technologies for remote monitoring in cardiology and evidence from trial data. Futur Cardiol. 2012;8(3):425–43.CrossRefGoogle Scholar
  32. 32.
    El Miedany Y, El Gaafary M, El Aroussy N, Bahlas S, Hegazi M, Palmer D, Youssef S. Toward electronic health recording: evaluation of electronic patient reported outcome measures (e-PROMs) system for remote monitoring of early systemic lupus patients. Clin Rheumatol. 2017;6(11):2461–9.CrossRefGoogle Scholar
  33. 33.
    El Miedany Y, El Gaafary M, Youssef S, Bahlas S, Almedany S, Ahmed I, Palmer D. Toward electronic health recording: evaluation of electronic patient-reported outcome measures system for remote monitoring of early rheumatoid arthritis. J Rheumatol. 2016;43(12):2106–12.CrossRefGoogle Scholar
  34. 34.
    Moe R, Haavardsholm E, Grotle M, Steen E, Kjeken I, Hagen K, Uhlig T. Development of a brief multidisciplinary education programme for patients with osteoarthritis. BMC Musculoskelet Disord. 2011;12:257.CrossRefPubMedGoogle Scholar
  35. 35.
    Coleman S, Briffa NK, Carroll G, Inderjeeth C, Cook N, McQuade J. Effects of self-management, education and specific exercises, delivered by health professionals, in patients with osteoarthritis of the knee. BMC Musculoskelet Disord. 2008;9:133. Scholar
  36. 36.
    Superio-Cabuslay E, Ward MM, Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis: a meta-analytic comparison with nonsteroidal antiinflammatory drug treatment. Arthritis Care Res. 1996;9(4):292–301. 10.1002/1529-0131(199608)9:4<292::AID-ANR1790090414>3.0.CO;2-4CrossRefGoogle Scholar
  37. 37.
    Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4(6):256–62.Google Scholar
  38. 38.
    Ofman JJ, Badamgarav E, Henning JM, Knight K, Gano AD, Levan RK, Gur-Arie S, Richards MS, Hasselblad V, Weingarten SR. Does disease management improve clinical and economic outcomes in patients with chronic diseases? A systematic review. Am J Med. 2004;117(3):182–92. Scholar
  39. 39.
    Devos-Comby L, Cronan T, Roesch SC. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. J Rheumatol. 2006;33(4):744–56.Google Scholar
  40. 40.
    Chodosh J, Morton SC, Mojica W, Maglione M, Suttorp MJ, Hilton L, Rhodes S, Shekelle P. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med. 2005;143(6):427–38.CrossRefGoogle Scholar
  41. 41.
    Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil. 2010;18(4):476–99. Scholar
  42. 42.
    Jamtvedt G, Dahm KT, Christie A, Moe RH, Haavardsholm E, Holm I, Hagen KB. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys Ther. 2008;88(1):123–36. Scholar
  43. 43.
    Solomon DH, Warsi A, Brown-Stevenson T, Farrell M, Gauthier S, Mikels D, Lee TH. Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. J Rheumatol. 2002;29(2):362–8.Google Scholar
  44. 44.
    Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164(15):1641–9. Scholar
  45. 45.
    Hopman-Rock M, Westhoff MH. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. J Rheumatol. 2000;27(8):1947–54.Google Scholar
  46. 46.
    Keefe FJ, Caldwell DS, Baucom D, Salley A, Robinson E, Timmons K, Beaupre P, Weisberg J, Helms M. Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. Arthritis Care Res. 1999;12(2):101–11. 10.1002/1529-0131(199904)12:2<101::AID-ART5>3.0.CO;2-9CrossRefGoogle Scholar
  47. 47.
    Fries JF, Carey C, McShane DJ. Patient education in arthritis: randomized controlled trial of a mail-delivered program. J Rheumatol. 1997;24(7):1378–83.Google Scholar
  48. 48.
    Allen KD, Oddone EZ, Coffman CJ, Datta SK, Juntilla KA, Lindquist JH, Walker TA, Weinberger M, Bosworth HB. Telephone-based self-management of osteoarthritis: a randomized trial. Ann Intern Med. 2010;153(9):570–9.CrossRefGoogle Scholar
  49. 49.
    Osborne RH, Spinks JM, Wicks IP. Patient education and self-management programs in arthritis. Med J Aust. 2004;180(5 Suppl):S23–6.Google Scholar
  50. 50.
    Osborne RH, Buchbinder R, Ackerman IN. Can a disease-specific education program augment self-management skills and improve health-related quality of life in people with hip or knee osteoarthritis? BMC Musculoskelet Disord. 2006;7:90. Scholar
  51. 51.
    Hewlett SA. Patients and clinicians have different perspectives on outcomes in arthritis. J Rheumatol. 2003;30(4):877–9.Google Scholar
  52. 52.
    Brady T, Kruger J, Helmick C, Callahan L, Boutaugh M. Intervention programs for arthritis and other rheumatic diseases. Health Educ Behav. 2003;30(1):44–63.CrossRefGoogle Scholar
  53. 53.
    Palmer D, El Miedany Y. PROMs: a novel approach to arthritis self-management. Br J Nurs. 2012;21(10):601–7.CrossRefGoogle Scholar
  54. 54.
    British Medical Association, Medical Education Subcommittee. Role of the patient in medical education. 2008. tcm27–175953.pdf. Accessed 28 Feb 2018.
  55. 55.
    Barrows HS, Abrahamson S. The programmed patient: a technique for appraising student performance in clinical neurology. J Med Educ. 1964;39:802–5.Google Scholar
  56. 56.
    Stillman PL, Ruggill JS, Rutala PJ, Sabers DL. Patient instructors as teachers and evaluators. J Med Educ. 1980;55:186–93.Google Scholar
  57. 57.
    Towle A, Bainbridge L, Godolphin W, Katz A, Kline C, Lown B, Madularu I, Solomon P, Thistlethwaite J. Active patient involvement in the education of health professionals. Med Educ. 2010;44:64–74. Available from. Scholar
  58. 58.
    Vail R, Mahon-Salazar C, Morrison A, Kalet A. Patients as teachers: an integrated approach to teaching medical students about the ambulatory care of HIV infected patients. Patient Educ Couns. 1996;27:95–101.CrossRefGoogle Scholar
  59. 59.
    Solomon P, Guenter D, Stinson D. People with HIV as educators of health professionals. AIDS Patient Care STDs. 2005;19:840–7.CrossRefGoogle Scholar
  60. 60.
    Plymale MA, Witzke DB, Sloan PA, Blue AV, Sloan DA. Cancer survivors as standardized patients: an innovative program integrating cancer survivors into structured clinical teaching. J Cancer Educ. 1999;14:67–71.Google Scholar
  61. 61.
    Skog M, Grafstrom M, Negussie B, Winblad B. The patient as “teacher”: learning in the care of elderly persons with dementia. Nurse Educ Today. 2000;20:288–97.CrossRefGoogle Scholar
  62. 62.
    Coodin S, Chisholm F. Teaching in a new key: effects of a cotaught seminar on medical students’ attitudes toward schizophrenia. Psychiatr Rehabil J. 2001;24:299–302.CrossRefGoogle Scholar
  63. 63.
    Hall IS, Hollins S. The Strathcona theatre company: changing medical students’ attitudes to learning disability (mental handicap). Psychiatr Bull. 1996;20:429–30.CrossRefGoogle Scholar
  64. 64.
    Hanson JL, Randall VF. Patients as advisors: enhancing medical education curricula. Bethesda: Uniformed Services University of the Health Sciences; 2007. p. 156.Google Scholar
  65. 65.
    Langton H, Barnes M, Haslehurst S, Rimmer J, Turton P. Collaboration, user involvement and education: a systematic review of the literature and report of an educational initiative. Eur J Oncol Nurs. 2003;7:242–52.CrossRefGoogle Scholar
  66. 66.
    Spencer J, Godolphin W, Karpenko N, Towle A. Can patients be teachers? The Health Foundation (pub). 2011. Accessed on 28 Feb 2018.
  67. 67.
    Tew J, Gell C, Foster S. Learning from experience. Involving service users and carers in mental health education and training. Nottingham: Higher Education Academy/National Institute for Mental Health in England/ Trent Workforce Development Confederation; 2004.Google Scholar
  68. 68.
    Jha V, Quinton ND, Bekker HL, Roberts TE. Strategies and interventions for the involvement of real patients in medical education: a systematic review. Med Educ. 2009;43(1):10–20.CrossRefGoogle Scholar
  69. 69.
    Masters H, Forrest S, Harley A, Hunter M, Brown N, Risk I. Involving mental health service users and carers in curriculum development: moving beyond ‘classroom’ involvement. J Psychiatr Ment Health Nurs. 2002;9:309–16.CrossRefGoogle Scholar
  70. 70.
    Ingham M. How patients can contribute to nurses’ education. Nurs Times. 2001;97:42–3.Google Scholar
  71. 71.
    Flanagan J. Public participation in the design of educational programmes for cancer nurses: a case report. Eur J Cancer Care. 1999;8:107–12.CrossRefGoogle Scholar
  72. 72.
    Seden J, Reynolds J, Henderson J, Kubiak C. Managing care and joined up thinking in the curriculum. Soc Work Educ. 2005;24:841–56.CrossRefGoogle Scholar
  73. 73.
    Raj N, Badcock LJ, Brown GA, Deighton CM, O’Reilly SC. Student and patient educators’ (PE) attitudes to PE led undergraduate musculoskeletal examination training. Rheumatology Oxford 2007; i115.Google Scholar
  74. 74.
    BEME: Best Evidence in Medical Education. Guidelines and coding sheets. www. Accessed 28 Feb 2018.
  75. 75.
    Côté L, Turgeon J. Appraising qualitative research articles in medicine and medical education. Med Teach. 2005;27(1):71–5.CrossRefGoogle Scholar
  76. 76.
    Buijink AW, Visser BJ, Marshall L. Medical apps for smartphones: lack of evidence undermines quality and safety. Evid Based Med. 2013;18(3):90–2.CrossRefGoogle Scholar
  77. 77.
    Bartlett E. Cost-benefit anaylysis of patient education. Patient Educ Couns. 1995;26(1–3):87–91.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yasser El Miedany
    • 1
    • 2
  1. 1.King’s College London, Darent Valley HospitalDartfordUK
  2. 2.Rheumatology and RehabilitationAin Shams UniversityCairoEgypt

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