Anticipating the celebration of the 25th anniversary of the Portuguese Association of General Practitioners in 2008, the Editorial Board of the PJGP was requested to produce a Special English Edition consisting of a few original contributions from renowned international authors previously published in the Journal, an original paper describing the development of Portuguese General Practice and some editorials, and a sample of abstracts of original articles published in the last three years.

Over the years, evidence of importance of family medicine has accumulated and there is more than enough evidence from research showing that the strength of a country’s primary care system is associated with improved population health outcomes, that health systems with a strong primary care orientation tend to be more equitable and accessible and that using primary care physicians reduces costs and increases patient satisfaction with no adverse effects on patient outcomes.

In view of the high frequency and impact of co-morbidity and its variability in different populations, co-morbidity should be ascertained and taken into consideration in characterizing different primary care practices. Practices caring for populations with greater co-morbidity need more resources. Co-morbidity can be counted and characterized.
There is every reason to do so – in the interests of improving the recognition of people’s health problems, their interaction, and their appropriate management.

The notion of patient empowerment is a powerful and far-reaching concept because it challenges many of our fundamental concepts of the nature and the tasks of medicine. How can an empowered or enabled patient population working in an egalitarian environment contribute to good medical care? How can doctors and patients be educated towards an egalitarian style of practice?
Much work needs to be done in educating patients and the profession on the paths to empowerment. Research is also required to assess the effects of patient empowerment on medical outcomes.

Portuguese Family Medicine has always tried to observe study and accompany the successes of colleagues abroad; despite following a path of its own, the support and cultural influence of systems where family medicine already enjoyed great prestige and experience has been paramount, and without it many of the achievements of Portuguese family medicine would not have been possible. This paper gives a picture of the present situation and describes the importance and position accomplished by family medicine, its strengths and weaknesses, and the opportunities created by the newly proposed reforms.

I feel most grateful for the sequence of occasions when I have been invited to witness the progress of generalist primary care in Portugal – and for the exceptional generosity I have encountered. I have seen notable developments over twenty-five years and gained many friends.