What started as a matter of circumstances-the doctor's busy schedule, her need to get back to work-turned out to be a positive addition to this particular patient's health care experience. She saw the nurse practitioner that day for her routine gynecological exam, but also began to see her nearly every visit to her ob/gyn. When she became pregnant a couple of years later, the nurse practitioner followed her throughout her pregnancy.

"I wish I had gotten to know (my nurse practitioner) years ago," said the patient, a 40 year-old teacher. "She always took time to explain everything about what she was doing. I felt very comfortable asking her questions."

As patients take a more active role in managing their health care, they work in partnership not only with their doctors, but often with other health professionals. Gone are the days when patients passively received medical advice or treatment. Staying healthy today means teamwork and you, the patient, are the central member of the team. Along with your doctor, your teammates may include your nurse practitioner, nurse midwife, physician assistant and pharmacist, among others. Here's a look at what you can expect from this kind of teamwork, and suggestions from experts on getting the most out of the collaborative relationship.

Routine screening, health checks, and education today can keep you out of the doctor's office tomorrow. Think about your visits to your health care provider during the last year, and ask yourself these questions:

• Has someone reviewed my personal and family medical history with me?
• Has someone examined my breasts? Done a Pap smear?
• Do I know whom to see about common illnesses or symptoms like sore throats?
• Does someone have a complete inventory of medications I am currently taking, and have taken in the past?

If you answered "yes" to these individual questions and can name the individual who helps you with each of these issues, congratulations! You get high marks for prevention. If you need help filling in the blanks, read on.

More and more doctors team up with nurse practitioners, nurse midwives or physician assistants as part of their office staff or through a hospital or clinic where they are affiliated. Sometimes called "mid-level professionals", these health care providers can play an important role in strengthening your partnership with your doctor and in increasing your chances of positive health outcomes.

The doctor's role usually focuses on treating symptoms or illness, while other members of the health care team often serve as teachers. Educating patients is a key role of nurse practitioners, says Ida Gear, RNC, of Physicians Plus in Madison, Wisconsin. A nurse practitioner for 23 years, Ms. Gear says, "Preventing health problems down the road is my main function." She explains, "Sometimes patients still don't know what's available to them and they don't always think to ask. A bone density test for women is a good example of that. Women, and certainly men too, need to be educated about tools that can help them make good decisions."

During pregnancy, a nurse midwife may take the lead in this educational role. "Nurse midwives approach the whole person," says Gwen Spears, CNM, MS, chief of nurse midwifery services and education at King-Drew Medical Center in Los Angeles. "They'll have a conversation with you about how you're managing at home, what you're eating, and whether you're taking any time for yourself." she says. "This is different from the approach of some physicians, who might look at a pregnancy complication like high blood pressure, and focus more on the symptom or disease. The pregnancy becomes incidental."

"Though patient education during pregnancy is especially important to foster bonding and attachment between the mother and her baby early," Ms. Spears adds.

Nurse practitioners and nurse midwives play an increasingly responsible part in managing minor illnesses. "We take care of all kinds of common health problems," says nurse midwife Ms. Spears. "Just the other day I saw a lady who had chicken pox. We treat eye and ear infections, upper respiratory infections, and diet-controlled diabetics."

"That's quite a change," observes Ida Gear, who recently cleared out her files and found old nurse practitioner protocols from the early 70's. "They said I couldn't treat anyone under 18 or over 35," she says. "There was concern at that time that nurse practitioners would miss significant pathology in a patient. Physicians and patients are much more comfortable with our role now. We do a lot of things doctors used to do in the old days."

A physician assistant may also administer a patient's physical exam and take care of routine conditions, says Nancy Hughes, Vice President of Information and Research Services for the American Academy of Physician Assistants. In addition, physician assistants are trained to suture, assist in surgery and set and cast broken bones, according to Ms. Hughes.

You can establish a relationship with your nurse practitioner, nurse midwife or physician assistant that is long-lasting. "I've had some patients for more than 20 years," says Ms. Gear. And Ms. Spears points out that the relationship between a woman and her nurse midwife doesn't necessarily begin with pregnancy and end when the baby is born. "In some settings nurse midwives are responsible for the continuity of care," she says. "They follow-up on contraception, the baby's growth and development, and immunizations."

In many states, nurse practitioners, nurse midwives and physicians assistants can prescribe medication. If you're under the care of more than one healthcare professional, your pharmacist is an excellent resource for information about your medications and how they should be taken. "Someone should have an overview of everything a patient is taking," says Judy Rapp, R.Ph., Director of Pharmacy at Madison Pharmacy Associates. "There are potential interactions between medications, or sometimes a dosage of one has to be adjusted when you're taking it in conjunction with another." It's best to fill all your prescriptions at one pharmacy, says Mr. Stamper. If that isn't possible, he recommends making sure you know at least one pharmacist "who will be responsible enough to ask you the name of everything you're taking."

The relationship between a patient, her nurse practitioner, nurse midwife or physician assistant often allows a patient to take more responsibility for her health. Ms. Spears is clear about what she expects: "We need patients to help us out in increasing the likelihood that their pregnancy will have a safe outcome," she says. "We teach pregnant women to record kick counts to make sure fetal movement is normal." She adds, "We have a lot of contact with patients and can influence them to be responsible for their care. We empower them."

Patient responsibility means letting your health care provider know what you need, according to Ms. Gear. "Women need to be assertive and speak out," she says. She often helps patients do that by reviewing their choices with them. "Some patients still need to the used to the idea that they don't have to just take what is given to them."

To learn more about how can partner with Women's Health America and your healthcare team when considering hormone therapy options, click here for the Restore Program.