In the early 1990s, while the American Academy of Pediatrics was formalizing its vision of the “medical home,” we were already living it, without a name, without a policy statement, and without institutional applause. At Minot Air Force Base in North Dakota, our pediatric team operationalized what would later be codified: interdisciplinary care, family partnership, coordinated services, and continuity across settings. We did not call it a medical home. We called it survival.

What emerged was not theory; it was necessity, shaped by military logistics, rural isolation, and the moral imperative to serve children with complex needs. This is the story of a prototype built in parallel with policy, but left out of its history.

While Dr. Calvin Sia was shaping the idea of the medical home from his Honolulu practice and national platforms, I was already living it, on the windswept plains of Minot. Sia’s advocacy was visionary: he urged the AAP to define and promote the medical home as early as the 1970s, and by 1992, the Academy formalized the concept. But by then, I had already built one.

In 1986, as a newly minted pediatrician, I walked down University Avenue to Minot State University and asked early childhood and speech-language leaders, “How can I help?” That question began a four-year renaissance of interdisciplinary collaboration. I had learned the model at Yale’s Child Study Center. Now I was living it.

When I arrived in Minot, I found no developmental milestones in the well-child visit forms. At Yale, every outpatient record included a Denver Developmental Screening Test (DDST) sheet. I asked to revise the medical record to include “Key Denver items.” My supervisor allowed me to work on it, off duty. I used the fold-out DDST from Harriet Lane, never knowing Pasquale Accardo, my future mentor, had written it.

One morning, a six-month-old boy came in. His mother was concerned about his ability to reach for toys and track movement. DDST screening revealed subtle delays. With follow-up testing and collaboration with Lt. Col. Quentin Humberd, Army Developmental Consultant from Fitzsimons, we diagnosed acquired hypothyroidism, early enough to prevent irreversible damage. This was not just screening. It was surveillance, and it changed everything.

In 1988, upon my promotion to chief of the pediatric clinic, I asked Col. Lloyd Dodd for permission to implement a unified care model rooted in continuity, interdisciplinary coordination, and family partnership. He approved immediately. From that moment, we were not chasing concepts; we were living them.

I empaneled Children with Special Health Care Needs (CSHCN) for exclusive care by our pediatric clinic, 24/7/365. These were children followed by our staff and pediatric subspecialists from Fitzsimons. They deserved the best, not episodic care from clinicians with minimal pediatric training. Col. Dodd granted the request, knowing full well that the chief of medical services, a family practitioner, would object; his own attempt to empanel patients had failed due to public distrust.

I expanded access and redesigned scheduling. I built a team of skilled allies, including a Hopkins-trained pediatrician and a nurse practitioner whose family shaped disability law. By 1989, we had both civilian and military NPs. We were a medical home in practice, years before the AAP formalized the term in 1992. I implemented Bright Futures principles before the book was published in 1994. I created a mini-developmental-behavioral pediatric clinic on the prairie.

I received the Air Force Commendation Medal in June 1990. The citation read: Major Lindsay’s exemplary leadership and professional skills advanced the pediatric clinic through a period of unprecedented growth. His expertise led to the development and implementation of a streamlined developmental history and physical examination which has found favor at national meetings, with recognized authorities in child development. His ability to attract major consultants in pediatrics and related subspecialties to hold specialty clinics, lectures, and case management seminars was phenomenal.

Then came the airport shuttle moment.

I was on that van in 1996, not as a passive attendee, but as a bridge-builder, mending fences between MO-AAP, Early Intervention, MCHB, and Parents as Teachers. I was to present my work from an AAP Mini-fellowship funded by the CSHCN-Continuing Education Institute. While Calvin Sia described his efforts to create a medical home, I had already seeded them across systems. I was the virus of the medical home, spreading where no vaccine could stop me. Not theoretical. Not aspirational. Contagiously operational.

The AAP did not know what to do with me. I could steal the limelight from Cal. They did nothing.

But MCHB had other ideas.

They saw the infrastructure I had built in Minot, not as anomaly, but as prototype. During my DBP fellowship at UNC in 1991, they invited me to return to Minot to lead a LEND clinic. Years later, I resurrected the LEND program at Ohio State University in 2009.

I was not waiting for recognition. I was building legacy.

Ronald L. Lindsay is a pediatrician.