Article Figures & Data
Tables
* An earlier version of this table was posted in TRACK on April 26, 2004. The author is grateful to the many discussants who provided helpful feedback for its revision. References 1 Hashim MJ. Future trends in primary care: lessons for family medicine [eletter]. http://www.annfammed.org/cgi/eletters/2/suppl_1/s3#592, 20 April 2004. 2 Franklin TL. A truly new approach to family medicine [eletter]. http://www.annfammed.org/cgi/eletters/2/suppl_1/s3#575, 20 April 2004. 3 Starfield B. Whither family medicine [eletter]? http://www.annfammed.org/cgi/eletters/2/suppl_1/s3#483, 6 April 2004. 4 Lamberts H. Complexity and benificence [eletter]. http://www.annfammed.org/cgi/eletters/2/suppl_1/s3#478, 6 April 2004. Times are changing1 Change and the current health care reality is causing great frustration Among family physicians, patients, others Loss of relationships, system fragmentation Financial crisis, malpractice crisis Pain from being part of a dysfunctional system Distress is an impetus for calls for retrenchment or further change Some feel isolated from the report and its proponent organizations; some are energized A sense that the reports, and therefore the organizations, in trying to see beyond the current frustration, are not adequately acknowledging the current reality The call is about something larger, a crusade about which family medicine is only a part Restructuring and greater equity in health care financing and reimbursement Health care for all A medical home for high-quality, integrated medical care Diverse strategies are emerging Local practice and system innovation Appreciative medicine2 A viable economic model can provide “breathing space” to pursue innovation, but with current financing, this can involve sacrificing access for all to primary care Concierge practice Safety-net projects National advocacy and partnerships for health care, financial and tort reform Frameworks for understanding and fostering change Return to old values and approaches Retain some core values and develop new approaches Take the offensive based on the unique and valuable generalist role3 A complexity science perspective4 Anticipate nonlinear results and unintended consequences Well-planned social interaction can result in a partial agreement Initial conditions and evolving relationships are key Challenges for individuals and organizations Adapting to (and thus enabling) a dysfunctional system while working to change the system Engaging and activating traditional and new partners Being true to core ideals AND open to new ideas Getting enough margin to make proactive changes Costs (eg, electronic health record) of transition to any new model To be effective in fostering the big changes their members need, organizations need to engage outside groups that are not sympathetic to the financial concerns of doctors, while not losing the support of their members Managing the short term, in which things might have to get worse before they get better
