4.3.3 1990-2000

In the nineties, patient education became more and more a natural part of primary care consultations. This development was supported by legislation on the one hand and media attention on the other. In the Netherlands but also in most other western countries patients' rights were firmly anchored in health laws [Nys 2001] and the media paid ample attention to health and the health care system. Numerous programs were broadcasted about health problems and the health care system, varying from educational programs about coping with illness, medical procedures and the work of physicians to entertainment programs about patients' experiences and physicians' misconduct. Thus, the general public became more aware of their rights and became more critical about the care they received, which forced physicians to be more transparent about their work and achievements. Medical specialists, especially in oncology, became also more aware of the importance of patient education for secondary prevention and quality of life improvement [Epstein 2007b]. Medico-technical innovations played a role too. Patients were confronted with more complex and specialized procedures, patients faced more health care choices that are consequential, and patients with chronic conditions had to adhere to complex drug and lifestyle recommendations in order to attain prolonged quality of life. Furthermore, patient education research became a grown-up discipline with national and international research platforms, journals and congresses [Hoving 2010].