WHen it comes to health care, the term “comprehensive” has often been applied to make us think about a medical system that can provide care for all aspects of an individual’s life that are affected by a disease or disorder. It’s not a bad term, and the phrase “comprehensive epilepsy care” is something that likely started in the United States when standards were passed to create specialized epilepsy centres to improve access to services for those with epilepsy. It is a term that reminds us that there is more to epilepsy than anti-seizure medications (ASM), and that to be effective for an individual with epilepsy, the health care system must provide a whole host of other services. Although I don’t really mind the term comprehensive, I would like to introduce a few other terms to round out this concept. These new terms are being born out of the changes that are occurring to our health care systems, and the realization that how we actually provide health care—not only to those with epilepsy, but to all those with a chronic condition—must change. What is a chronic condition? The first term I would like to define is the term “chronic condition.” I am sure that most of you reading this have an intuitive idea as to what this means. An important part of the definition of a chronic condition is that it affects individuals not only biologically, but also has profound effects on an individual socially and psychologically. For example, although a seizure may last only a couple of minutes and have after-effects that may even last for days, losing one’s job because of a seizure can have profound social and psychological effects that far outlast the seizure itself and its biological after-effects. It is also important to realize that chronic conditions may last for many years, or possibly for a person’s entire lifetime. The second term incorporates this concept of a chronic condition. This term is “chronic disease management” (CDM) . CDM is an emerging idea, realizing that people with chronic conditions require a health care system that is organized in a very different fashion to how medical care is presently organized and provided. CDM argues that the health care system (from the big downtown hospital to the family doctor’s office) is only a small part of the picture. It realizes that that the ultimate goal of improving our health care system is to not only strengthen health care organizations, but also to empower the very people dealing personally with their own chronic conditions. They need to become part of the system and participate fully in their health care. CDM is much broader than a comprehensive solution, but it contains many similar concepts. The common ideas are those that involve making health care organizations more fit (equipped) to deal with chronic conditions. Where it differs is that CDM (which is based on a lot of good, solid evidence) argues that the person with epilepsy is not a passive player is all this health care stuff, but is an active participant. As they say, “it takes two to tango,” So not only does the health care system need to become actively involved in managing a chronic condition, it is vitally important that the individual with that condition participate fully in their care. The role of community organizations CDM also recognizes the indispensable role of community organizations across Canada that are part of the Canadian Epilepsy Alliance. These organizations provide services that hospitals will never provide, and they should work seamlessly with health care organizations so that we are all on the same page and speak the same language. The glue that binds this network is the individual living with epilepsy. They need to make the network accountable and raise their voice if something is not working. Knowledge is power I have already slipped in another term, which is “network,” and I will also round out the picture by including integration. In my mind these two words go together, since a well-functioning network needs to incorporate (integrate) all those things that are running separately on their own into a web of connected people, ideas and services. The one thing that networks can do exquisitely well and with very little cost is spread information very quickly. As the adage goes, “knowledge is power,” and if we are all well connected and informed then we can make choices. If we are without information, we are without options. If all of this seems a little pie in the sky, it is important to realize that major changes are already happening in the health care system. CDM will be coming to Ontario, and health integration is already taking place through 14 different Local Health Integration Networks. For those with epilepsy, however, there is much work still to be done. Recently, the Ontario Health Technology Advisory Committee, in a report to the Ministry of Health of Ontario, estimated that among the 10,000 or so individuals in Ontario who could benefit from surgery for their epilepsy, only 2% of these individuals are receiving this service. A common voice requires a common language. Integration and chronic disease management are part of a new language, a language that we will need to speak if we are to continue to improve.