What follows is an excerpt from a keynote address I gave at this year's certificate ceremony at Quinnipiac University. As I was delivering this message to the outgoing class of PA students, it occurred to me that we could all use a reminder to pay attention to the little things, and so I share it here with you today. I hope you enjoy it.

In anatomy, we spend much of our time studying these fantastic (and rather obvious) organs and structures. We talk about the lobes of the liver. The glistening peritoneal covering. How you can see the gallbladder and understand how a stone could block the common bile duct. The heart and its chambers and (believe it or not) the coronary arteries, distinct enough to identify and recognize. The once open fossa ovale. The broad flaring of the tibial plateau. The ACL (the bane of the athlete's knee). Each of these things is large enough to appreciate the impact that they have on the function of the whole body. And, certainly, we can see what would happen if there was damage to any of these large structures. But in anatomy, as in life, the little things matter too.

The femur is the large bone of the thigh and, as you know, it is enormous (even in the slightest little woman). Even my mother would recognize this bone! The top part of this bone forms the hip joint (together with the acetabulum). This whole thing, this joint, it's big. Now at the top of this bone, maybe 1/2 mm in diameter, there is a bridge formed by a ligament and within this bridge, a branch of the obturator artery. It's TINY. Think: angel hair pasta. Or maybe dental floss. This little artery is precariously stretched across the inside of the joint. Who designed this thing?

But somehow, despite the smallness of the vessel and the distance through the weight-bearing joint it runs to get to its destination, most of the time this system of delivery of nutrition to the hip WORKS. Except when it doesn't.

As you read about the smallness of the artery, you might be thinking: but I know there are more vessels supplying this large, important joint, and, after all, we are all walking upright on these things daily. It can't be all about the branch of obturator artery. Of course the joint has other, larger vessels—but the thing is, to truly understand the value of this little thing, you need to know what happens when the artery DOESN'T WORK. When the artery stretches and breaks or closes up. Without it, you could not have completed the Susan Komen three-day walk for the cure in honor of your mother, a breast cancer survivor. Or walked down the aisle at your brother's wedding. Instead, you would be having your hip replaced. Can you imagine? Just if that little artery didn't work. Little things matter.

As you know, the spinal column is the foundation of our body. The axis around which we turn, walk, move. It allows us to stand upright, to turn our heads to see the kid in the road before we step on the accelerator. To bend down to pick up our child's binky when they drop it. The spine: it's a big thing, but what would it be without that little atlas perched on top? The washer that our head sits upon. Without it, you couldn't have nodded “yes” when your fiancée asked, “will you marry me?” Can you imagine?

As a physician assistant, you will spend a lot of your energy looking at the big things—the “big picture”—and it is important to do that. But don't overlook the little things.

You get your patient's lab report back. It's 4 pages long, and you are at the end of a 9-hour day. Your wife is at home waiting for you, and as you try to leave the office (hand on the doorknob), you receive a call: your patient would like to know what the labs showed. That lab report is big! At a quick glance, these labs might look good. The big picture.

But there is one little thing. Your patient's creatinine has risen from previous labs. It's a little change, but if you miss it and it keeps rising, she might have to leave her job in order to have dialysis three times weekly. And she is a single mother of three. Can you imagine? Just for overlooking that little thing.

The small nerve under the pisiform, a smile, an abnormal pupillary change, a compliment, a 2-millimeter elevation, your hand on your patient's shoulder. Little things can have big impact, both negative and positive. These are all little things that matter a lot. Don't overlook the little things. And don't miss an opportunity to offer little things to others.

Dawn Colomb-Lippa is a professor of physician assistant studies at Quinnipiac University in Hamden, Connecticut.