One of the most critical components of the health care delivery process is the interaction between the care provider and the patient and family. Research tells us that people do better when they understand and clearly participate in their health care. However, participating and understanding is not always easy, for a variety of reasons. The purpose of this article is to discuss barriers to effective communication with your physician and offer tools to assist in communicating in an effective way.

Have you ever said to yourself or someone else?

"I felt so nervous with the doctor that I never asked my important question."

"The doctor thinks I'm just another hysterical mother."

"The doctor does not seem to have enough time."

"This medication, forget it! I feel awful and two days on it, I know I should stop."

The patient-doctor relationship feels unequal to many people. Being a recipient of medical care and the reality of needing help may set off alarms for an individual. When confronted with being a patient, feeling powerless is common. If you feel powerless, you can come to expect the doctor to be all-powerful. When the doctor is perceived to have all of the power, expectations—some realistic and some unrealistic—develop. Unrealistic expectations can lead you to assume that the doctor "should know" your needs, concerns, and symptoms without direct communication from you. If the doctor doesn't meet these unrealistic expectations, you may feel ignored, misunderstood, and alone.

Feeling powerless and projecting a larger-than-life image onto the doctor all contribute to an unequal relationship and impede good communication regarding care. Values, culture, status, and emotions impact communication.

It is important to understand the nature of your relationship with your doctor and how you view the process. Feeling confident to assist the doctor in your care can have far-reaching benefits to both of you.

Overcoming communication stress and becoming an active member of your health care team will take some initiative but it is well worth it. Think of it as the 4 A's:

• Acknowledge&#151 Face the reality of what is and how you are feeling about it. Learn about epilepsy and what others have done. Acknowledge that this is a part of you but not all of you.
• Advocate&#151 Write down questions, concerns, even ideas. Seek second opinions if necessary.
• Assert&#151 Communicate your needs effectively. Let your health care team know what your goals are. Prioritize your questions and concerns.
• Assist&#151 You are part of the process. Keep logs of seizures, auras, and side effects. Keep the information organized and concise. Bring the logs for the doctor to review when you visit the office.

You are your most important tool. Trust yourself and your instincts. Empower yourself with knowledge. Surround yourself with people who respect and treat you well. Become a real member of the healthcare team and greatly improve the quality of your care.