Background Within the vague system of primary care and COVID‐19 infection control in Japan, we explored how primary care (PC) physicians exhibited adaptive performance in their institutions and communities to cope with the COVID‐19 pandemic from January to May 2020. Methods Narrative analysis conducted by a team of medical professionals and anthropologists. We purposefully selected 10 PC physicians in community‐based hospitals and clinics and conducted a total of 17 individual and group interviews. The verbatim transcript data were analyzed using the conceptual framework of adaptive performance. Results We identified three “phases” of the time period (January–May 2020). In Phase 1, PC physicians initially perceived the disease as a problem unrelated to them. In Phase 2, the Diamond Princess outbreak triggered adaptive performance of the physicians, who began to deal with medical issues related to COVID‐19 by using social networking services and applying the collected information to their organization and/or communities. Following this, in Phase 3, the PC physicians’ adaptive performance in their own communities and institutions emerged in the face of the pandemic. Reflecting their sensitivity to local context, the PC physicians were seen to exhibit adaptive performance through dealing with context‐dependent problems and relationships. Conclusions PC physicians exhibited adaptive performance in the course of coping with the realities of COVID‐19 in shifting phases and in differing localities in the early stages of the pandemic. The trajectories of adaptive performance in later stages of the pandemic remain to be seen.

Many patients preferred to entrust the end-of-life decisions to others rather than utilizing advance directives, which made surrogates more dependent on doctors for decision making. Qualified advance care planning is required to promote familial discussion and surrogates' decision readiness.

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