I wouldn’t expect you to get excited by the fact that this is the 100th issue of FPM, so I won’t get emotional about it here – although I am certainly happy about it, and mildly astonished that we got to issue 100 so quickly. Instead, I’ll just point out what’s in it for you:

• It’s sort of a “best of FPM” issue, since the articles were chosen from among the hundreds we’ve already published for their enduring utility to family physicians. They’re FPM “classics.” (If you’re a regular reader, you may remember many of them, but so many FPs have found out about FPM along the way that I’ll wager most of the articles will be new to most of you. And even if they’re not, I think you’ll find them useful to revisit.)

• It offers five hours of CME credit – more than any earlier issue of FPM, as far as I know. (We added 16 pages of content to this issue to pack in as many useful articles as possible.)

• It contains up-to-date versions of several of the most popular tools published by FPM, including the FPM Pocket Guide to the E/M Documentation Guidelines and the “short list” of ICD-9 codes (now updated for 2004).

• It offers a wider-than-usual range of topics. Even though it doesn’t approach the variety presented by FPM over time, it has something for almost everyone.

No nostalgia

The 10 years that FPM has been around may be too short a time for old days to become good old days; I don’t know. In any case, beyond the staff’s fond memories of the early days of figuring out what FPM was going to be and how it was going to work, there’s not much in the last 10 years to inspire nostalgia. That is, unless you pine for the dear old days of the Clinton health care plan or long to be wooed by a Med Partners or PhyCor again.

In some respects, we’ve spent the past 10 years going around in circles. E/M vignettes in the CPT Manual have given way to documentation guidelines, then to more stringent documentation guidelines, and now to … the prospect of returning to vignettes in the CPT manual. Small practices have integrated into IPAs and PPOs and PHOs and various other acronymic behemoths, which have, in turn, disintegrated into small practices again. It’s hard to be nostalgic for the old days if you’re actually reliving them.

Of course, it’s not all a matter of tail chasing. Things have gotten better – and worse – in the past 10 years. That’s progress. We now have a full-fledged malpractice crisis. Evidence-based medicine is making inroads. Medicare reimbursement levels have decreased. Clinical quality improvement has gotten more sophisticated and effective. We’re adding HIPAA regulations on privacy, security and transactions to OSHA, CLIA and all the other golden oldies. Technological advances are making electronic medical records more affordable and useable. The health care system is a mess, but it’s a different mess from the one we started with.

Fertile chaos

All in all, I’d have to say that this has its good points. Chaos and change can be more fruitful than stasis. Given that the health care system has no effective central management, I would expect the future of the system – the next 10 years, say – will be a product of Darwinian evolution. One reason FPM features articles on family physicians who are trying out new and different variants on traditional practice models is that some of the variants may exhibit traits with survival value. The future of family practice, of primary care and even of health care at large may descend from some of these mutations.

I’m far from optimistic, but I’m intrigued and excited by the possibilities that may be born of our current chaos, and I hope and expect that FPM will be around to help chronicle and foster their growth for many years to come.