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Fam Pract Manag. 2003;10(1):8

January. This is supposed to be a month of new beginnings, new promise, new possibilities and New Year’s resolutions. Do you feel invigorated and optimistic – or just cold?

I confess to feeling a little cold and a little less than optimistic. I occasionally wonder whether some Newtonian law decrees that every improvement in one aspect of life is balanced by an equal and opposite worsening in another aspect. It would make sense, given that Newtonian concepts of mass and inertia and friction seem to have their analogs in human behavior. A bad situation tends to remain bad unless acted upon by some external force, for instance. The bigger the mess, the bigger the required force. And change, once instituted, will slow to a stop without the continued infusion of energy. It’s like a physics of human organizations.

Learning to make change

Jack Silversin and Mary Jane Kornacki’s article in this issue gives excellent advice on how to bring about change (see page 57). But I can’t help seeing it also as a demonstration of how hard it is to bring about change. If you internalize their precepts, you may very well be able to effect change in your practice or organization. But the faith, patience, cleverness and energy required to bring about a big change or to change a big organization are enormous. Working alone, you may be able to improve your monthly staff meetings, lead a patient to quit smoking or improve mammogram rates in your practice. But even these are hard, and the difficulty level increases exponentially with the size of the change.

One test: By the time this issue appears on your desk, we should know whether the concerted efforts of thousands of physicians and others were enough to correct the Medicare payment formula and prevent the second cut in Medicare payments in two years. As I write, success seems unlikely. And this is just trying to correct one problem in a health care system that has some positively gangrenous appendages.

I don’t want to denigrate Silversin and Kornacki’s article in the least. Its importance made it our cover story, and most of us can benefit enormously from its wisdom. And after all, the mission of FPM is to give you tools you can use to improve practice. But the overarching insanity of the American health care system can be dispiriting. How can we bring sanity to something so vast, so constrained by conflicting economic forces and so screwed up?

The only answer I can find, and the one I keep coming back to is this: Start somewhere. Change something – something that matters. If you make part of the world better, you make the world better. You light your candle, and I’ll light mine.

A farewell

Speaking of changes, I need to announce one that I wish I didn’t have to. Marc Rivo, MD, MPH, is leaving as medical editor of FPM after six years. You can read his parting words on page 11. The ideals we share with Marc have helped shape the development of FPM in that time. It was Marc who formalized the curriculum of topics FPM covers; and it was he who suggested the motto that appears under the journal name on the cover. His ideas have influenced the content of FPM in numerous ways, most of which wouldn’t be evident to the reader.

At this point, we have no plans to fill the position Marc is leaving. Given the current financial climate and given the invaluable guidance the FPM staff receives from the members of the FPM Board of Editors – all family physicians – the prudent course seems to be to leave the position empty, at least for a while. Besides, thanks in part to Marc, the FPM staff currently has a good sense of the journal’s editorial mission. Marc leaves us aimed and moving in the right direction, and we’re likely to keep moving in the right direction for the foreseeable future.

Not content with just a day job, and always the editor, Marc will continue to find an outlet for his energy in his editorship of Wonca News, the newsletter of the World Organization of Family Doctors. We wish him all the best.

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