TY - JOUR T1 - Further observations on enablement JF - British Journal of General Practice JO - Br J Gen Pract SP - 499 LP - 500 DO - 10.3399/bjgp08X319477 VL - 58 IS - 552 AU - John GR Howie AU - David J Heaney AU - Margaret Maxwell AU - George K Freeman AU - Stewart W Mercer Y1 - 2008/07/01 UR - http://bjgp.org/content/58/552/499.abstract N2 - We welcome the excellent paper by Mead and colleagues on the characteristics and utility of the concept of enablement.1 Their paper raises two themes, one on the meaning of enablement, and the second on whether its use as a quality measure would be practical and fair.The most interesting issue in the first theme arises from the observation that patients from ethnic minority groups report higher enablement while possibly receiving care that might otherwise be expected to produce the opposite effect (in particular, having shorter consultations). In our papers on the same subject,2,3 we not only found that ethnic minority groups reported higher enablement, but also that the difference was even greater when the consultation took place in the patient's own language.3 This is compatible with Mead et al's suggestion that ethnic minority patients are more likely to have their possibly different expectations of health care met than are native UK patients,1 but also suggests that these needs are most likely to be met when the cultural context of doctor and patient are well matched. But the situation may well be even more complex. In a small student study in west London, Hindi and Urdu speaking patients appeared to have different understandings of individual items in the patient enablement instrument (PEI), and also showed different levels of respect towards their GPs (S Khan and GK Freeman, unpublished data, 2004).We completely agree with Mead et al that more qualitative work is needed to help … ER -