​Whether you’re approaching or are already in midlife, one thing is for sure: it’s important to begin taking your health and well-being seriously. This includes various lifestyle enhancements, like getting serious about diet and nutrition, taking up regular exercise, reducing stress and getting basic checkups, like annual physicals.

The truth is, middle age is when health problems usually start making an appearance. After the age of 50, the most common diagnoses are hypertension, high cholesterol, diabetes, arthritis, osteoporosis, cancer, and anxiety or depression. Other relatively common medical problems that can pop up from age 40 onward include kidney stones, urinary tract infections, food allergies, overactive bladder and, yes, perimenopause.

With so much going on and so many health issues at stake, it’s critical to find a quality healthcare provider. But where to start? Of course, there are the practical concerns, like finding a physician who accepts your insurance, but what else?

The most important variable, in my estimation, is finding a good doctor. In my experience, a truly good doctor is like finding a needle in a haystack. The odds are better than winning the lottery, but the climb is still steep.

Here are some things to consider in determining if a doctor is a good one:

They don’t have medical Board violations. In each state, you can look up doctors’ medical board records. This enables you to check on the licensing status of physicians and also see if there are any complaints or findings against them. You can also see basics, such as where they completed their education and residencies, as well as any supplemental information they’ve disclosed, such as medical publications.

They have positive online reviews. Just as you search social media and other sites for recommendations on restaurants, plumbers and carpet installers, you can do the same for doctors. There are a variety of sites that post reviews expressly about medical providers, but I find the data integrity of those results are somewhat questionable. From my perspective, there are often far too many gloating, overwhelmingly positive reviews on the medical review sites. This may be because there are ties to insurers or certain healthcare practices operating in the advertising or sponsorship backdrop. So, to that end, I think Google reviews can provide a more realistic snapshot of how doctors perform and how patients feel about them. You will want to pay attention to the overall star ratings but even more attention to the actual narratives of the reviews themselves. Be mindful of how patients report being treated, listened to and followed up.

Their office experience is up to par. Sometimes decent doctors deliver horrendous patient experiences. Just like you probably wouldn’t keep going to a restaurant with great food but horrible wait staff, you shouldn’t tolerate a negative patient experience in order to see a pretty good doctor. Signs of poor patient experience outside the clinical scope include ridiculously long wait times, onerous times to be able to get in and see a provider (e.g. calling in May for an appointment but unable to get on the calendar until December), inadequate insurance processing or improper medical billing, dirty patient rooms and unkempt waiting rooms, rude or dismissive front office staff, condescending or unfriendly nurses, and outdated facilities and equipment.

They went to quality medical schools. The average person has no idea where his or her doctor went to school. But some people would actually benefit from knowing. When you look up a doctor’s bio, or pull their Medical Board record, you can see where they went to school and did their training. For those interested in taking quality control up a notch, they can then see how the medical school ranks, what its reputation is and how rigorous its programs are considered.

You get a good personal referral. Just like the best jobs are usually captured through a personal reference, having a positive referral of a doctor from a trusted friend, relative, neighbor or colleague can be a good baseline for sound medicine. If someone you know well and whose judgement you have faith in attests to a doctor being great, that is an added boost of confidence.

The doctor – himself or herself – delivers on the promise of good patient care. Sometimes you won’t know . . . until you go. The best indication of whether a doctor is a good one is going to be your own personal experience and judgement call. Things to look for are the doctor’s bedside manner – that is, how he or she interacts with you. Did he introduce himself? Did she ask how you’d been? Make sure the doctor seems to have reviewed your chart before entering the room. See if they seem familiar with your medical history and the reason for your visit. Check and see if they listen to your concerns, not interrupting or minimizing any questions you may have. Monitor if they talk “on your level” – for some people, that may mean not feeling like the doctor is “dumbing down” or oversimplifying information in talking to them; for others, it can mean that the doctor speaks in commonsense, plain language, not medical jargon. Does the doctor look you in the eye? Do they not rush through the visit? Do they follow up with you as needed or as they said they would?

They promptly respond to medical portal questions and concerns. Most modern medical practices now have patient portals that hold information related to previous appointments, test results, prescriptions and more. They also often feature a messaging platform where doctors and patients can communicate about non-emergency matters. If you send a doctor a question, and they either respond after a very long time (over a week) or not at all (which is unconscionable), that can be a tell-tale sign that you cannot trust this person with your life. After all, that is what is really at stake in designating a doctor to monitor your health and make vital decisions as a result.  

If all else fails, you can fire your doctor! One of the only good things about living in a capitalistic medical system is that people have choices. On that front, if you’re dissatisfied with your doctors, you can “fire” them. And one of the best parts about this is that it can be very undramatic. You don’t have to write a breakup note or give them notice. You simply find another doctor! Sometimes the best medicine is to vote with your feet and your wallet.

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If you’re in midlife and are still managing your medical health like you did in your early 20s, then it’s time for a reboot. We are past the age of relying purely on just-in-time medical care and only queueing up the corner walk-in clinic whenever the sniffles or a sore throat gets us down . . . and getting by fine on that alone.
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By the time you hit your 30s and beyond, it’s time to take a more proactive and decisive approach to your healthcare. Part of that means no longer being reactionary to potential problems – only going to the doctor when you think something is wrong. It requires a shift in mindset and a new understanding that you need to get proactive about your well-being.

Being proactive means to get ready for something before you need to. It means anticipating, predicting and preparing ahead of time.

One of the most proactive things you can do for your health is to get an annual physical. An annual physical is exactly what it sounds like; it is a yearly visit to a primary care doctor to do a general review of your health status and to check on the vitals that keep you running. The doctor who performs a physical may go by different titles, such as general medicine physician, adult medicine doctor, internal medicine physician, general practitioner (GP) and family medicine doctor. Whatever the name, these doctors are basically generalists who have broad-based knowledge about the body, its systems and its functions. This is different from, say, a specialist whose expertise lies in a specific organ, system or part of the body, like a cardiologist focuses on the heart, a psychiatrist deals with the brain, an endocrinologist concentrates on hormones and an oncologist addresses cancer.

Ideally, a physical should happen every year. Why? Because the initial physical helps to establish your baseline and every future visit then can be used to monitor current health but also reflect on patterns that merit more consideration.

What Happens During a Physical?

A physical is nothing to fear. Even for the most doctor-phobic, a regular yearly physical is little to feel apprehensive about. This is what usually happens:

You sign in and let the staff know you’re there. You may need to provide additional information, like your insurance card and ID. You may also need to complete forms about your health history and current medications. After this, you may wait for a bit – maybe 15-30 minutes on average. (If it takes 45 minutes or longer to get called back, this may be a sign the practice has poor scheduling practices [overbooks], poor patient service skills or other issues that may be worth seeking another doctor later on.)

A nurse will usually call you back. Once in the clinical area, you will typically be weighed, asked about your height (or measured) and your blood pressure will be taken. Then you are escorted to the actual patient room, usually asked to disrobe from the waist up and wear a paper gown, and will wait for the doctor. (Again, the wait should not be too long – 20-25 minutes max.)

The doctor will come in and greet you, and introduce himself or herself if it’s the first encounter with you. They will ask you some general questions about your health history and the information you’ve already indicated on intake forms. Usually this will relate to prior surgeries, current medications, any allergies and any recent health problems or ongoing diagnoses / conditions that are being managed.

You should have the opportunity to ask questions or bring up any concerns about your health. This is a good time to bring up any symptoms you’ve noticed, changes in the effectiveness of any medications you’re on or general questions about your health and wellness.

The doctor will typically perform a few cursory examinations – listening to your pulse, heart and lungs; checking your ears and eyes; checking your reflexes; looking at your skin; appraising your general demeanor (though this will go unmentioned usually); and asking about your mental health, sexual health (behavior), fitness level and dietary habits.

The doctor will then typically order routine bloodwork. The things they check for in these labs are usually the complete blood counts, blood sugar, indicators of kidney function, cholesterol and, in some cases, thyroid. Note that you can request any labs you desire. If you want a hormone panel, ask for one. If you want to check for an autoimmune condition, ask for those labs. If you need a clear head about your STD status, ask for those tests, too.

Assuming no potential problems are noticed, your appointment will conclude uneventfully. You will be told that your lab results will be available via the patient portal (if the practice has one) or that they will call you with the results or send them in the mail. It is important to read the lab results for yourself. Even if there are no current problems “on paper,” there could be signs that something is amiss or just not quite right, especially for numbers that are trending on the higher end of normal or the lower end of normal. The entire office visit for a physical may take about an hour and certainly no more than two hours, though this should be at the upper limit for sure.

Most insurance plans cover annual physicals in full, or they cover all of the costs except for the initial visit copay, assuming you go to an in-network doctor. Realize that on some occasions the lab work will later be billed separately, sometimes by a separate company or a different department within the practice. In those instances, insurance will usually cover most of the costs.

You should get a physical every year. Why? For starters, it helps to maintain an established relationship with your primary care provider. This is the go-to doctor for your basic needs, like antibiotics for a sinus infection or a UTI. They are also who you’ll need to go through, in many cases, if you end up needing a specialist; the primary care doctor provides the referral. Additionally, a lot can change in a year. Preventive care is often the first step in identifying and treating a medical issue before it becomes a bigger problem.