In a previous post, I covered the main components of a total healthcare team that midlife women need begin building as they get serious about their long-term well-being. Just a few of those slots should be devoted to providers such as a primary care physician, a dentist, a gynecologist familiar treating women beyond the realm of fertility and pregnancy, and a dermatologist, among others.

These core practitioners should be able to fulfill and treat the most pressing and common healthcare needs we face going into middle age and beyond. These are the type of providers who are usually covered by your insurance within your networks, with the only payments rendered being whatever it takes to meet your deductibles and contribute your co-pays.

But what else is out there? What other tools should middle-aged women have in their well-being grab bag?

Well, there is more. This could be looked at negatively or positively, depending on your viewpoint. You may be thinking, “Great! At least there are all sorts of trained people out there to meet my needs.” Or you may instead be saying to yourself, “What kind of BS is this, and how expensive is this going to be.”

No matter your paradigm, the truth is that our holistic mind-body needs can be vast. And conventional doctors, even specialists, are not always the best, most comprehensive resources for information when it comes to things that cannot be prescribed and picked up at the pharmacy, or that are not necessarily part of a diagnosable condition, illness, disease or pathology.

Other types of wellness providers that may be discretionary (depending on your situation) and “nice to have” include:

Acupuncturist. Acupuncture has been indicated as being helpful for menopause symptoms. Some research has linked improvement in sleep problems, vasomotor symptoms and overall mood with acupuncture. For those who don’t know, acupuncture is a form of alternative medicine rooted in Chinese medicine. It involves superficially inserting small needs in the body. Ranges for the cost of acupuncture vary, often between $50-$95 per session.

Dietician. Despite their name, dieticians do much more than just put clients on diet. Dieticians are experts in nutrition who usually have an undergraduate degree from an accredited university or college with coursework that has been vetted by the Accreditation Council for Education in Nutrition and the Academy of Nutrition and Dietetics. Many dieticians have master’s degrees, have completed industry internships, have passed national examinations and are required to complete continuing education requirements. A dietician helps people focus on healthy eating habits and sound nutrition practices. These specialists can help women struggling with midlife weight loss or medical conditions that make weight loss or weight maintenance challenging.

Massage Therapist. Massage therapists are trained to understand bodily mechanics as they use touch to manipulate the muscles and soft tissues of the body. Massage therapy has been associated with stress reduction, circulation improvement, lymphatic system stimulation, recovery from injury and a general feeling of well-being. Medically, massage can help with nerve pain, fibromyalgia, anxiety and other physical pain syndromes or symptoms. According to national averages, the typical cost for a massage session is $50-$150.

Personal Trainer. Personal trainers are credentialed to provide custom workout plans and supervised exercise sessions for clients. They often serve individuals interested in specific goals, usually weight loss, muscle gain, injury recovery and foundational bodily function. Based on their training, the not only provide motivation, accountability and support, but they also know how to prevent injury during training and to develop modifications based on a client’s limitations. Personal trainers are usually certified by one of the prevailing industry bodies – NASM, ACE or ISSA.

Therapist. Therapists are not psychiatrists – they cannot prescribe medications. Sometimes a therapist may also be classified as a psychologist or social worker, but not always. Therapists help people deal with particular issues, such as addiction or marital challenges, but they also provide overall support for a variety of emotional, mental or physical health problems.

* Some insurance carriers will cover the cost of dieticians or nutritionists. 

Now that you’ve decided to finally get that long-delayed annual physical and have gathered an understanding of what to look for in a good doctor, it’s time to take things up a notch. Finding a quality physician and getting a yearly checkup provides a solid baseline for the fuller continuum of your personal healthcare portfolio.

And that broader picture requires building your total healthcare team. As you get older, having a complete medical squad ready to deploy in the backdrop of your ongoing wellness is vital. Sure, you’ll still see your core primary care physician (PCP) for routine office visits and once-a-year follow-ups to monitor your baseline health and get meds for things like sinus infections or UTIs. But creating a comprehensive care team goes beyond these minimums.

In some cases, it can be challenging to construct your healthcare team due to insurance red tape. For example, your internal medicine doctor may be the gatekeeper – the one you through which you must funnel most specialized medical requests. In such cases, the PCP largely holds the cards in determining whether, or when, you get that prized referral to see a specialist who focuses on a particular area of the body (e.g. a cardiologist for heart concerns, a neurologist for nerve-related issues). However, even if this is true for you, you can still build a go-to care team by doing the legwork now to determine precisely which doctors in what areas you want to see if or when circumstances dictate.

For those who have a primary care physician but who also have the autonomy to see other doctors without going through PCPs for a referral, you’re probably wondering, “What is a healthcare team? What kind of doctors need to be on it?”

A care team is akin to a team in sports: Everyone has a role, a position to play, with expectations of what that title conveys. Similarly, it is understood that most people who are 40+ years old currently need, or will need, more than the garden variety family medicine doctor to deal with all the medical concerns they face. Your PCP cannot be all things to all of your problems. So let’s call the other care providers “reinforcements,” though this is not intended to belittle the critical role they play.

Your body is unique, and the needs you have from a medical standpoint are, too. So these are simply recommendations, or considerations, of the various provider types who you’ll need to recruit as part of your total healthcare team.

Dentist. Oral health is important. People should visit their dentist twice a year for cleanings. Assuming no other issues are discovered, such as early stage periodontal disease or failing teeth, these two outings will be the only times you see your dentist annually. Though this may seem “low level” when it comes to overall health, it’s not: oral health is connected to diabetes, heart disease, oral cancer and stroke, according to many reputable health sources.

Dermatologist. Skin changes at midlife. You may start to see more moles, new wrinkles, a return of acne and changes in skin texture. Yes, in most cases these are more superficial, aesthetic considerations rather than medical needs. But feeling good about how you look is an important aspect of well-being. Dermatologists provide treatments and medications that can help women feel better about their changing selves at middle age without going under the knife.

Endocrinologist. With hormonal havoc happening during perimenopause, some women in the 40-and-over camp may find themselves visiting an endocrinologist for the first time. Most endocrinologists don’t treat perimenopause, but instead focus on diabetes, cholesterol issues, thyroid problems, adrenal disorders and hypoglycemia. The caveat to note is that reproductive endocrinologists are trained to deal with hormonal problems and can be well suited to manage hormone replacement therapy (HRT).

Gynecologist. This is perhaps the most obvious recommendation to have on your personal care team as a woman. Though we may not be entertaining the idea of reproduction at this stage, there are other elements of your reproductive health to maintain. It is now recommended to get Pap smears every three years (often along with HPV testing). Some women still opt to visit their GYN annually for an exam. It is important to find a doctor or practice skilled in, and attentive to, treating patients who are not obstetrical cases (in other words, women who are neither pregnant nor interested in being so).

Optometrist / Ophthalmologist. Most people’s vision changes around the age of 40, even for those who’ve never needed glasses before. Getting your eyes checked every year or two should be pretty customary for the 40+ set. This evaluates any changes to your vision and ensures you get the right prescription to see clearly, and also checks for any underlying eye diseases, like the beginnings of glaucoma.
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Orthopedist. The aches and pains of advancing stage start to hit many people going into their 40s or 50s. In many cases, the discomforts are short-lived and benign; other times, there is actually a structural and functional problem involving the musculoskeletal system. These problems could be degenerative in nature (think arthritis), acute (think runners knee) or require surgery (like bone spurs impinging on nerves). Achy necks, back pain, knee stiffness and the like are common symptoms that lead to orthopedic care.

Psychiatrist. A perimenopausal woman, or one going through the menopausal transition, has at least double the risk of first-time anxiety or depression than a pre-menopausal woman. The risk ratio is higher for women who’ve previously experienced postpartum depression or who’ve had prior depressive episodes. For many women, this will be the first time in their lives that they are offered or prescribed an antidepressant or anti-anxiety medication. Sometimes these medications have other benefits, such as treating hot flashes or reducing hormonal headaches. In any event, it’s probably better to have a professional trained in this pharmacology to manage this than a general medicine doctor. And this type of physician just happens to be a psychiatrist.

Your situation is as unique as your biology, and you may need other types of providers in your wheelhouse as you navigate the changes of age and time. Coming up soon in this series will be a list of the specialists and providers that are “nice to haves” in enhancing your total well-being and health.

​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.