01/17/17  Portland, Ore.

In Family Medicine, we pride ourselves on "being there" for patients and for each other.  We work diligently to ensure that our lines of communication are open 24/7, that everyone works to the top of their license and has an essential role on the team, and that we consistently hire, train, and retain people who are the very best at what they do. And then a snow-pocalypse event hits the state, and we get to put all of this commitment, dedication, training, and planning to the test.

With more snow in January than Oregon has seen in several years, it was heartwarming to see everyone jump into action. From those who worked diligently to make sure every patient received a call, to others who bussed, 4-wheeled, and cross-country skied their way to the hospital to make sure patients were cared for and their colleagues were covered. No questions, no hesitation. No one wishes for a disaster, but everyone wishes for a team as extraordinary as ours, just in case.

Shortly after watching, with great pride, colleagues across the state exemplify our mission of caring for our patients and each other, Atul Gawande, M.D.'s most recent article, "The Heroism of Incremental Care" made its way across my desk. I have enjoyed reading Dr. Gawande's work over the years, but this article and its amazing timing was special in that he called out "primary care" as the starting point for a healthier world.

In his article, Dr. Gawande talks about a visit to a colleague's primary care clinic, and he marvels at its "Teeming variousness." He continued, "It didn't matter if patients had psoriasis or psychosis, the clinic had to have something useful to offer them. At any given moment, someone there might be suturing a laceration, lancing an abscess, aspirating a gouty joint, biopsying a suspicious skin lesion, managing a bipolar-disorder crisis, assessing a geriatric patient who had taken a fall, placing an intrauterine contraceptive device, or stabilizing a patient who'd had an asthma attack."

To us, Gawande's description might sound a lot like last Tuesday at the clinic, but to a surgeon who's made a lifelong career of searching for the key to better patient care, we are downright heroic.

Throughout the rest of his article, Dr. Gawande emphasizes that while society has learned to idolize and prioritize "quick-fixes" to acute health problems, the real healthcare crisis lies in the fact that we've ignored the importance of "incremental" care. The care that happens in the clinic when we uncover behavioral barriers to medical adherence, or when we sit down with patients to carefully pen care plans that will take months –or years –to come to fruition. But those plans will work, and we're okay with giving up instant gratification for something that works.

So while we're skiing, snow shoeing, logging into our laptops at home and making sure our patients have enough warm clothes to wear, let's take a minute to be proud of ourselves and to congratulate and thank each other for the amazing –if not incremental –work that we are doing.

In the next few months and years we will face a lot of uncertainty, but people are beginning to notice the work of primary care, and I believe this appreciation and awe for the work we do will continue to grow. I am also now, more than ever, sure of our capability to weather any (literal or metaphorical) storm.