This issue of The Hong Kong Practitioner discusses about three very different health issues – medically unexplained physical symptoms, low back pain and dialysis therapy for end-stage renal failure. Nevertheless, this reflects the diversity of the job nature of family physicians.

Health care has become more complex as various stakeholders with various perspectives are involved in the industry and multiple factors attribute to patients' health and health experiences.¹ Family physicians not only have to deal with patients' health problems but also the patient as a whole. As Osler once emphasized: 'It is much more important to know what sort of patient has a disease than to know what kind of a disease a patient has'.² This is particularly important when treating patients with chronic illnesses.³ As the prevalence of various chronic diseases such as diabetes and hypertension is rising⁴ and Hong Kong people are having longer life expectancy,⁵ family physicians have to work in closer partnership with their patients in order to maximize their quality of life. Patient empowerment has been advocated since the 1970s to improve patients' ability to manage their own health and illnesses.

Patient empowerment is a concept that is based on the assumption that people require psychosocial skills to bring about changes in their personal behavior, their social situations, and the institutions that influence their lives.⁶ It encourages patient participation and collaboration in health care management^6,7,8 particularly in chronic disease management, by making them recognize their responsibility for their own health. It provides them with the ability to understand their health and illnesses and as a result, feel more able to cope with them.^9,10 Patient empowerment helps people to develop psychosocial skills so that they can gain greater control over decisions and actions that affect their health¹¹ and through which psychological well-being can also be improved.¹²

In living with a chronic condition, patients need to have the ability to manage their symptoms, the treatment, the physical and psychosocial consequences, and make appropriate life style changes. Thus the major element in patient empowerment is the development of self-management skills to cope with health and illnesses in daily living. It encompasses problem solving, decision making, resource utilization, forming partnership with healthcare providers and taking step-wise actions in health management.¹³ There are three key areas involved in patient empowerment. The first area is the medical management of chronic conditions. This includes adherence to medical treatment, self-monitoring of the condition, following life style advice. The second area is role management, which is maintaining, changing or creating new meaningful life roles regarding jobs, family and friends. The third area is the management of various emotional responses towards a chronic condition for example fear, anger, frustration and sadness.¹⁴Therefore, a dynamic and continuous process of self-regulation has to be established to maintain a satisfactory quality of life. 

Much research has been done to explore the effectiveness of various patient empowerment programmes. One typical example is in the management of diabetes as it is a growing health concern worldwide and is a leading cause of mortality and morbidity.¹⁵ Stringent behavioral strategies are required in both controlling diabetes and in preventing its complications. However, self-management is a demanding task that requires long-term life style changes and considerable perseverance. Several literature reviews have shown that empowerment in diabetes care were promising however further research is much needed to prove the long-term effectiveness^16,17,18 as diabetes is yet a complex disease in which satisfactory control is affected by multiple factors.

Patient empowerment should not be limited to the management of patients with chronic illnesses but should be incorporated in daily clinical practice. Pendleton has long identified the seven tasks of consultation which aim to achieve this.¹⁹ The first task is to define the reasons of the patient’s attendance and these include the nature and history of the problems, their aetiology, the patient's ideas, concerns and expectations, and the impact of the problems. The second task is to consider other problems such as continuing problems and at-risk factors. The third task is to choose an appropriate action for each problem with the patient. The fourth task is to achieve a shared understanding of each problem with the patient. The fifth task is to involve the patient in the management and encourage the patient to accept and take up appropriate responsibility. The sixth task is to use time and resources appropriately in both the consultation and in the long-term management. The final task is to establish and maintain a relationship with the patient as this helps to achieve the other tasks. If the reader considers these tasks, he will pick out that the fourth and fifth tasks are identifiable as patient empowerment. The patient is given information about his illness; his understanding is checked so that he and the doctor are on the same page; helped with the information available to him, the patient makes informed choices regarding his treatment, carries out tasks and assumes responsibilities to improve his health, and in the process will often gain satisfaction from the thought that he has control over his body and his health. This is the essence of patient empowerment. 

In conclusion, patient empowerment is to help patients understand disease specific knowledge, acquire self-monitoring skills, risk factors control, the importance of drug adherence and life style modification, and to prepare for behavioral change, cope with negative emotions and stress, and be motivated. It is to provide patients a combination of knowledge, skills and heightened self-awareness regarding their own health and illnesses so that they can act in their own self-interest and maximize their potential for health and wellness.