Think back even a few years: Would you have said that the AMA might elect a female president the same year it snowed in hell? Surely Nancy Dickey's election is a sign of significant change in the weather. If it's not exactly snowing in hell, at least the effects of global warming seem a little lessened in Chicago.

Whatever you think of the AMA, you may like much of what Dr. Dickey has to say in the interview based on reader questions that's published in this issue. Of particular interest to me are her remarks about trends in health care — the winds that fill the sails carrying us into the future. Since her success as AMA president will depend in large measure on how well she reads the wind and how well she trims sails to it, her weather report is particularly important.

What Dr. Dickey warns about are forces threatening to subvert the physician-patient relationship: especially gatekeeper approaches that turn partnership into opposition and attractive financial arrangements that function only at the cost of patient choice and continuity of care. I would be surprised if many readers disagreed with Dr. Dickey that these are major challenges facing physicians today. Where the disagreement may creep in is in deciding how to respond to them — which course to take in trying to avoid driving onto the rocks (or, in Dr. Dickey's phrase, “ending up in the dark ages of medicine.”) Everyone has his or her own ideas about how to preserve the patient-physician relationship, minimize regulatory burdens, maximize autonomy and promote continuity of care. In fact, many of the novel financial arrangements we hear so much about these days are attempts to reach those goals. Amazing how much dissent there can be about the route to an agreed-upon goal.

It's not coincidental that this issue contains, in addition to Dr. Dickey's interview, two other major articles offering glimpses of some proposed routes to the future. “When a Physician Practice Management Company Comes Calling” examines one of the financial arrangements offered as a way to let physicians concentrate on dealing with patients rather than with the hassles of running a practice, and “It's Time to Start Practicing Population-Based Health Care” challenges family physicians to take advantage of the strengths of managed care as a way of promoting and enhancing continuity of care and taking the physician-patient relationship to the next level. Both articles offer glimpses through doors that purport to lead to the future. Whether either will take us there, only time will tell.

The problem is, of course, that we can never wait to see what time tells. The future begins now, and we can't go anywhere that doesn't involve stepping through some door or another. While articles such as these offer only flashes of possible futures, they may be the best guides we have.