Dr. Coshow is Changing the Focus of Her Practice

After 23 years providing primary care, I will be changing the focus of my practice. As of March 31, 2021, I will no longer provide primary care services.

This means that if I have been your primary care physician, you need to establish care with a new PCP before that time. Your new provider can request your medical records by faxing a signed request to 206 801 7767.

After March 31st I will no longer manage chronic conditions that fall under the auspices of primary care, including hypertension, cholesterol issues, diabetes, GERD. I will no longer provide annual exams, checkups, or well-child visits, nor will I manage immunization schedules, health screening schedules or referrals for screening procedures. I will no longer be on call for urgent medical problems.

I will continue to work with patients regarding specific issues, and to provide excellent, highly personalized care. Craniosacral therapy, trigger point and neural prolotherapy injections, pelvic and genital pain syndromes, homeopathy, complex medical conditions, and hormone management continue to be areas of special interest and expertise.

It is important to me to make it clear how heart-breaking this decision has been. I love practicing medicine, but over the past 20 years it has changed so much as to be nearly unrecognizable. I’m not sure that patients understand the volume of administrative work involved today in the practice of primary care medicine, or the number of third-party companies that come between the patient and the medical provider. For every minute a doctor spends actually caring for a patient, she spends 10 minutes dealing with the insurance company or the go-betweens the insurance company has hired to make the doctor jump through hoops to prove an evaluation or treatment is needed, or proving to a regulatory agency that a patient is up to date on screening procedures. If examined even cursorily, the underlying assumption is that doctors don’t follow well-established best practices unless they have some giant corporation making them click boxes on one of 100 different websites used to “streamline” the process. It is exhausting and it is not conducive to providing the best care. It is a waste of everyone’s time and energy and, more than any other challenge that comes with practicing primary care medicine, these data-driven, inhuman processes have pushed me past my ability to grit my teeth and keep going for the good of my patients.

Also, the sometimes unacknowledged truth is that doctors are human beings. Human beings who spend many, many hours every day bringing deep, hard-earned knowledge and understanding to bear on the health concerns of fellow human beings who are hurt, sick, scared, angry, depressed, anxious, in pain, or all of the above. This takes a lot of cognitive and emotional energy.

As much as I would like to be impervious to the cognitive fatigue and emotional turmoil that comes from doing this day after day, I am actually a very sensitive person. I have been available 24 hours a day, 7 days a week for more than 20 years. During the past year I have had 10 days off. This year has been really difficult and stressful for everyone, and I know I am not the only one. But it’s time for me to say “uncle.”

I appreciate the loyalty, support, and love I have been lucky to receive from you all. I am truly grieving the end of my dream job, which was such a great dream, and such a great job. Time for a new way of doing my dream job.

Selah.