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My son graduated from college last year and is now in Nepal, visiting schools and writing about rural education under the Maoist regime. He was excited to tell me, when I visited him recently in India, about how a classic book on education, Pedagogy of the Oppressed by Brazilian Paulo Freire, radically influenced and inspired him to readjust his career goals.

The book postulates that real revolution can occur only when the playing field is leveled between teacher and student, whereby critical thinking is infused in education and where ‘teachers become students’ and ‘students become teachers.’ Communication amongst students (i.e., social networking) is equally important in this equation. While in India I read this short book, substituting doctor for ‘teacher’ and patient for ‘student’ and indeed, feel better equipped for the PM agenda.

Freire expands upon the theories of Rousseau and Dewey, postulating that active learning, or problem solving using real-life situations, is necessary for the individual to translate theory into action or practice (this is the definition of praxis, invoking the company I co-founded in 1998, Praxis.MD). He describes and refutes traditional education as ‘banking,’ where the student is an empty account awaiting deposits or “prescriptions” from the teacher.

Sound bites abound in this little volume! See the quotes below, where I’ve italicized words that are PM substitutions or additions to Freire’s language:

  • To alienate patients from their own decision making is to change them into objects.
  • Education either functions as an instrument that is used to facilitate the integration of the younger generation into the logic of the present system (e.g., failures in health care), OR it becomes the practice of freedom, the means by which men and women discover how to transform their world.
  • Patients, having adopted guidelines of their health care providers and internalized his images, are fearful of freedom. Freedom would require them to eject this image and replace it with autonomy and responsibility.
  • Patients suffer from duality; the conflict lies in choice between…following prescriptions or having choices; between being spectators or actors.
  • Patients must see examples of the vulnerability of the health care system so that a contrary conviction can grow within them.
  • To achieve praxis, it is necessary to believe in e-patients and their ability to reason. Whoever lacks this trust will fail to initiate dialog, reflection, communication, and will fall into using slogans, monologues, and instructions.
  • Problem-posing education rejects communiques and embodies communication. Liberating health care consists of acts of cognition, not transferrals of information. Arguments of ‘authority’ are no longer valid.
  • The health care system is suffering from narration sickness, where the provider ‘fills’ the patient with his narration of words, and they have lost their transforming power, become sonorous. In the banking concept of education, knowledge is bestowed by those who consider themselves knowledgeable, upon those they consider to know nothing. However, in the libertarian view of eduction, the drive is toward reconciliation of the poles of patient and doctor, so that both are simultaneously playing the roles of each other and themselves.
  • Health care providers who lack humility cannot communicate with their patients, cannot be their partners in naming and understanding the world. At the point of care, there are neither perfect sages nor ignoramuses; there are only people, who are attempting together, to learn more than they now know.
  • It is only as patients rethink their assumptions in action that they can change. Understanding and acting upon their own health concerns—not consuming ideas of others—must constitute that process.
  • Why do newspapers present different interpretations of the same fact? It is indispensable to analyze the content of newspapers following an event. This practice helps develop a sense of criticism, so people will react to what they read not as passive objects but as consciousnesses seeking to be free.
  • Participatory medicine cannot tolerate an absurd dichotomy in which patients are merely following their doctors’ decisions—a dichotomy reflecting the prescriptions of the dominant elite. Revolution is a unity, and doctors cannot treat patients as their possessions.
  • The dialog which is radically necessary for the participatory medicine revolution corresponds to another radical need: that of women and men as beings who cannot be truly human apart from communication, for they are essentially communicative creatures. To impede communication is to reduce men to the status of things.

As a publisher, content developer, scientist, and occasional patient, this book set me on a new path, brainstorming how critical thinking can be more forcefully injected into patient education materials. I expect the forthcoming Journal of Participatory Medicine (watch this space) will gather and present some revolutionary ideas in this vein –with your help and ideas? Let’s communicate.


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