The Chinese characters for “crisis” embody 2 concepts: the top represents danger and the bottom, opportunity.
January 1 marks the end of my first official year as Editor of The Journal of Family Practice. And I feel as if I have been traversing this fine line between danger and opportunity—wanting to proactively change JFP to better meet your needs for immediate relevancy, while wishing to preserve its scholarly, evidence-based approach. Let me share a few observations about this experience.
First, I’m impressed with our readers! I am delighted how closely you scrutinize the journal, passionately highlight the shortcomings of the studies we review, and enthusiastically endorse most of the changes we’ve made. You are a practical lot: you want articles that are going to change your practice tomorrow. You want information to guide decisions, even when evidence is scant. To this end, we’ve expanded our coverage of Applied Evidence (from narrower systematic reviews, such as “Incontinence” in this issue of the Journal, to broader analyses of important topics).
Many of you voice reservations about evidence-based medicine. Some of you have been around long enough to know that today’s evidence (dogma?) is often viewed as tomorrow’s quackery (witness hormone replacement therapy) and question the reductionistic approach to evidence. You fear the EBM movement will limit appropriate variation in practice. You wonder who is paying attention to the art of medicine. You remain suspicious of attempts to standardize diagnosis and management. Our ongoing critical review of guidelines, discussions of controversies in EBM, and original research articles continue to challenge our assumptions.
Finally, some of you express worry about the pace of change and direction in which medicine is moving: concierge medicine, maintenance of certification, Medicare HMOs. You worry that our commitment to healthcare for all is vanishing, that stewardship of our communities is eroding, and that personal satisfaction is slipping. You see crises at every turn. Essays on the art of medicine and future articles on hot topics, such as hospitalists, will continue to address these controversies.
As we face the New Year, I trust we all will find the opportunities in the crises we face.
