Paper short abstract:

This paper questions the way therapeutic education (TE) is currently provided in general practice. The educational sciences point of view allows a critical reflection on predominant approaches in this field and presents as results an analysis of how knowledge circulates between patients and doctors.

Paper long abstract:

This contribution stresses the importance of tackling crucial subjects such as autonomy and self-management in an original way. We need to define ‟education" (within ‟therapeutic education") in a much broader scale, as a transformation of one's relationship with the world more than as the result of a behavioural equation. This requires a shift in theoretical and methodological approaches of chronic disease.

This communication exemplifies this shift by presenting the results of a qualitative study on non-therapeutic adherence of cardiovascular patients. Those diseases are very specific, as they remain silent until they strike; therefore, the patient does not even necessarily see himself as sick. They ask for lifestyle transformations rather than technical competences, which makes TE very difficult to perform and assess, because it is way harder to make a patient change his way of life than to teach him to take his blood pressure.

This work shows how knowledge is built and circulates from General Practitioners (GPs) to patients but also the other way around and how this circulation improves or damages therapeutic relationship. The diversity of Backgrounds (Searle, 1982) between patients and GPs leads to the conclusion that the consultation may be a physical encounter but it is not an educative moment (or only under fragile conditions). Patients then relate to whatever they can hold to: epistemic trust in the GP (and not actual educative relationship), family's help, common sense, etc. Hopefully new approaches can help to prevent patients and educators' efforts to get lost because of these phenomena.