Preparation key to getting the best care.

Byline: GUEST VIEWPOINT By Jessie Gruman For The Register-Guard

Complexity is a price of progress. In modern medicine, that price is a painfully high one. It imposes responsibilities that patients find tough to meet. As technology gets better, complexity will grow, increasing the need to educate patients about how to navigate the system.

Americans are living longer because of medical progress for those of us who know how to take advantage of it. But too few of us know how the system works.

When our grandparents got seriously ill, they were cared for by a physician with whom they had a continuing relationship. Frequently, their doctor was more familiar with the patient than the disease. Today's seriously ill patients typically are cared for by a team of experts they probably never met before.

Few of us aspire to become expert patients. So ultimately, most of us will have to choose between accepting the dangerous posture of being a passive patient or undergoing some stressful on-the-job training. But learning how to find and use good information, to interact effectively with health care providers and to manage the financial side of sickness doesn't come easily.

Patients are strangers in a land governed by unclear rules expressed in an unfamiliar language. It is a brave patient who, through asking questions and seeking additional opinions, risks seeming to challenge a polished expert who may literally hold the patient's life in his hands.

It is hard to make cost-benefit decisions and choose among treatment options when good information is difficult to find and the trade-offs of different approaches are complex. But ultimately, these responsibilities can't be prudently delegated to outsiders.

At the start, we must not only confirm our diagnosis, identify treatment options and find the right doctors and hospitals to care for us. We also must decide whether we can continue to work, determine how to fulfill our family and community responsibilities and figure out how we are going to pay for the services that will help us continue to live.

What can we do now that might lighten the burden?

When I received my most recent cancer diagnosis, I had put a few simple things in place that made me feel a touch less burdened, a little less alone. One was to establish a relationship with a primary care doctor I trusted.

Another was to call my health plan: Was a nurse coach available by phone? Had any participating local hospitals been recognized for excellence? What about the comparative quality of providers?

I also forced myself to do those difficult tasks we all put off: I completed an advance directive and will. I vowed that I would never again postpone these onerous chores. They are matters that should be addressed carefully with a clear mind.

Finally, I thought carefully about who I wanted to be with me and help me make decisions should another crisis occur. I have lots of friends and family members, and every one of them has a strong opinion. I knew I needed to have around me people who were calm and trustworthy, who could listen to me deliberate and assist without imposing their ideas.

Advances in medical science mean that many diseases that were fatal are now curable. But access to these advances is not automatic. Patients and their families must focus to find care that will aid each patient to live as well and as long as she can.

Jessie Gruman is president of the Center for the Advancement of Health in Washington, D.C., and author of "AfterShock - What to Do When the Doctor Gives You - or Someone You Love - a Devastating Diagnosis." She will speak at the Eugene Public Library at 3 p.m. Saturday.