Spotting the “pearls in the muck”—those inspiring moments in day-to-day practice that make family medicine such a special calling—is perhaps one of things that Walter L. Larimore, M.D., and his co-workers do best. In this issue, Walt and six other family physicians in a private practice in Kissimmee, Fla., provide the 100th entry in “Diary from a Week in Practice,” an ever-popular AFP feature that offers slices of life from everyday practice.

In 1990, AFP's editor Jay Siwek, M.D., envisioned a new feature that would “highlight the joys and sorrows, the discoveries and disappointments of day-to-day family practice,” and he began a search for someone who could capture the magic of routine practice. Walt and his partner, John R. Hartman, M.D., rose to the challenge, filling entry after entry with stories of successes, anecdotal remedies and observations, memories of special patients, and moments of crisis and quiet reflection.

Since January 1992, when the first Diary entry was published, readers have seen many changes in Walt and John's practice—changes that are reflected in Diary and that parallel changes occurring in family medicine. Walt and John experienced the increasing trend toward larger group practices, with their own practice growing from two physicians to a group of seven physicians and two nurse practitioners. As the practice has grown and changed, the number of contributors to Diary has increased, with authors coming and going, each bringing a special perspective.

Walt says another important trend that has affected Diary is a growing recognition of spirituality in the medical literature, with more emphasis on mind, body and spirit, helping patients cope with illness, healing, and dealing with death. Other trends, such as the increasing popularity of alternative medicine among patients, will continue to have an impact on Diary as they will, no doubt, on your practice.

Through the years, Walt and his colleagues have found that writing Diary has helped keep them focused. Instead of letting their practice become mundane, they start out each day knowing how much can happen that will not only be special to them but also may become life-long memories for their patients. If Walt were to communicate one message through Diary, he says, it would be this: “No matter how hard it gets, you should always think back to why you were called to this profession and what effect you have from day to day and minute to minute; recapture that vision, that enthusiasm, and then use it to add good to what good you've already done.” How well does that message come through? Turn to page 71 and see.