1/19/2022: Looking to the Future | Wise Patient Internal Medicine

January 19, 2022

Hello Wise Patient Community,

As Dr. Lee’s patients already know, Naomi recently made the decision to leave Wise Patient at the end of February to work at another Direct Primary Care practice in Bellevue called Bellevue Medical Partners. We wish Naomi all the success and career satisfaction we know she will achieve, and Rachel, Abum, Gina, Ryan, and I will miss her personality and doctoring in big ways. We openly invite Dr. Lee’s patients here at Wise Patient to follow her to her new practice. Wise Patient has always believed the highest priority is the continuous doctor-patient relationship.

For those patients who would like to remain at Wise Patient, you will continue to receive the same high level of care and availability as we have a new Physician starting March 1st. While the onboarding of our new physician and Dr. Lee’s transition are independent of each other (we have been recruiting the new physician for a few months now), we feel fortunate to have a wonderful doctor already in place to join the practice. You will learn all about Wise Patient’s new doctor in a newsletter in the near future. She has had ties to Wise Patient for a few years now and her outsized reputation for intelligence and service is much deserved. She has agreed to assume the care of Naomi’s patients who stay at Wise Patient. If you are a patient of Naomi’s roster on March 1st, your membership will automatically shift to the care of our new physician who will spend lots of time getting to know you via your chart and reaching out to you.

This news will likely delay our acceptance of new members from our waiting list which is currently 120 patients long. Many of you know people on our waiting list and have asked us about its timeline. You have my personal pledge to prioritize our recruiting efforts for MD#4 in a way that doesn’t waste time but more importantly doesn’t compromise our high bar for quality of primary care medicine.

Thank you for your patience,

Sam

COVID Update

At this point in the pandemic, it is rare to find anyone who has not had a friend or family member who has had COVID. The Omicron variant with it’s high rate of transmission is widespread in the community. In King County, over the last 7 days, there were 1,416 new cases per 100,000 residents. Anything >100 cases per 100,000 people is considered “high transmission”. It’s kind of everywhere. There are more patients with COVID in our hospitals than any other point during the pandemic. And yet, I remember when this time last year, they were shutting down kids soccer games when the level reached >75 cases per 100,000. In contrast, I spent the last two weekends at kids’ soccer tournaments (outdoors). Reflecting on this makes me grateful for the vaccines/boosters, the emerging treatments and the fact that it seems to have held true that while the Omicron variant is more transmissible, it generally causes less severe symptoms. This is especially true for people who have been vaccinated, but experience breakthrough infections. Boosters are appearing to add another layer of protection. So while the number of hospitalized patients is higher than it has been, a lower percentage of patients with COVID are in the ICU and some have been hospitalized for other reasons and then found to have COVID.

Some people have looked at the mild symptoms and favorable outcomes and thought “let’s just have a COVID party and get this over with. We are all going to get it eventually anyway”. It does seem inevitable that in spite of continuing efforts with masking, hand washing and social distancing, we may all be exposed to the virus. However, those measures plus vaccination continue to be our best path forward. In the beginning of the pandemic, we talked a lot about “flattening the curve” and we should still be aiming for this. Our healthcare system is made up of people. And the number of staff that are infected or need to quarantine due to a family member who is isolating at home is impacting how care is delivered in our hospitals. So we need to continue to be vigilant about transmission.

Above are some infographics from the CDC summarizing the most recent recommendations for what to do if you are exposed or infected with COVID-19 as far as testing, isolation and quarantine – note the differences based on your vaccination and booster status. A couple of reminders on vocabulary: when you have an infection you ISOLATE, when you have been exposed (but do not yet know if you have an infection ) you QUARANTINE.

Many of you have experienced significant delays in test results. This can be really frustrating (especially when a result is required for travel). The pressure on the system for testing comes from the fact that the rates of transmission and infection are higher, so more people are getting tested. It is compounded by the fact that the higher positivity rate means that they can no longer batch samples. It used to be that they could mix 6-10 samples, run it together as one sample and if it was negative, all samples were negative. But with the positivity rate as high as it is, they can no longer batch samples. So it takes longer to get through the same number of samples.

Home testing is also an option. The sensitivity is not as good (you can get more false negatives), but the specificity is good (meaning a positive is very unlikely to be false. If you have symptoms and have a positive at home test, you do not need to confirm with a PCR test.

You can now get a 4 at home COVID tests from the government at: COVIDtests.gov

Invitation

by Mary Oliver

Oh do you have time
to linger
for just a little while
out of your busy

and very important day
for the goldfinches
that have gathered
in a field of thistles

for a musical battle,
to see who can sing
the highest note,
or the lowest,

or the most expressive of mirth,
or the most tender?
Their strong, blunt beaks
drink the air

as they strive
melodiously
not for your sake
and not for mine

and not for the sake of winning
but for sheer delight and gratitude –
believe us, they say,
it is a serious thing

just to be alive
on this fresh morning
in the broken world.
I beg of you,

do not walk by
without pausing
to attend to this
rather ridiculous performance.

It could mean something.
It could mean everything.
It could be what Rilke meant, when he wrote:
You must change your life.

Mary Oliver, “Invitation,” A Thousand Mornings (New York: Penguin Books, 2013).