Midlife Medical Minute: Building a Care Team

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.

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