The season premiere of “Grey’s Anatomy” marked a refreshing return to form for the medical drama. After a third season that went from so-so to abysmal in the later episodes, creator Shonda Rhimes obviously took a back-to-basics approach for the Season Four debut, and it paid off.

As main character Meredith Grey iterated in the voice-over monologue that opened the episode, “We either adapt to change or we get left behind.” Well, the new season, which picks up 17 days after the Season 3 finale, certainly comes with plenty of changes that require adaptation on the part of the characters as well as the audience. Dr. Addison Montgomery (Kate Walsh) has defected to Los Angeles (see “Private Practice”), Dr. Preston Burke (Isaiah Washington) has resigned after leaving his bride-to-be at the altar (or, at least that’s the fictional explanation behind Washington’s departure in the wake of uttering a gay slur towards co-star T.R. Knight earlier this year), and the interns – with the exception of T.R. Knight’s George – are now residents with interns of their own to boss around.

But some things haven’t changed. Recently Burke-less Cristina Yang (Sandra Oh, who was robbed of an Emmy earlier this month by co-star Katherine Heigl) is back to being her snappy, condescending self – a nice recovery from her final scene in Season 3, when she was wailing on the floor of her apartment trying to shed her wedding dress. On-again, off-again Meredith (Ellen Pompeo) and Derek (Patrick Dempsey) are off again – with a little break-up sex thrown in for good measure and to leave room for a (second? third? I’ve lost count) reconciliation. Let’s just say now that that storyline needs to be resolved once and for all.

For the first time in a long time, a “Grey’s” episode gave audiences a reason to care about what happens in future weeks. The coupling of George (Knight) and Izzie (Heigl) has polarized fans, but Rhimes has at least kept it interesting and the final moments of the premiere indicate this will be a major plot point this season. And might Mark Sloan (Eric Dane) actually become a sympathetic character after a hilarious moment in which he reveals that he came to Seattle not for Addison, but to win back Derek’s friendship? Only time will tell.

New character Lexie Grey (Meredith’s half-sister, played by Chyler Leigh), who breaks the news of their shared DNA to Meredith in the middle of dealing with a multi-victim car crash, might become a nuisance. But putting her personal life ahead of professionalism? She’ll fit in nicely at Seattle Grace. And viewers were given reason to suspect that Rhimes might be contemplating a serious misstep in a potential Lexie/Derek pairing.

All in all, “Grey’s” fans should breathe a sigh of relief that the season premiere at least partially made up for the atrocity that is spin-off “Private Practice.” Now, if there was only a way to get Addison back to Seattle, they’d have a real reason to celebrate.

About The Author

Elizabeth Raftery is senior editor of Blast. Follow her on Twitter.

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