TED@Intel
Eric Dishman: Health care should be a team sport
Erik Dišman (Eric Dishman): Zdravstvena nega treba da je timski sport
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1,053,887 views
Kada je Erik Dišman bio na fakultetu, lekari su mu rekli da ima 2 do 3 godine života. To je bilo pre mnogo vremena. Nakon ispravljene dijagnoze i jednog transplanta bubrega, Dišman koristi lično iskustvo zajedno sa svojim iskustvom vodećeg medicinskog tehničkog specijaliste, da predloži neke smele ideje za prekrojavanje zdravstvenog sistema - postavljanjem pacijenta u središte tima lekara. (Snimljeno na TED@Intel)
Eric Dishman - Social scientist
Eric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us. Full bio
Eric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us. Full bio
Double-click the English transcript below to play the video.
00:13
I want to share some personal friends and stories with you
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Želim da podelim sa vama nekoliko
ličnih prijatelja i priča
ličnih prijatelja i priča
00:17
that I've actually never talked about in public before
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o kojima nikada nisam
pre pričao u javnosti
pre pričao u javnosti
00:19
to help illustrate the idea
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da pomogne da ilustrujem ideju
00:21
and the need and the hope
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i potrebu i nadu
00:23
for us to reinvent our health care system around the world.
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da ponovo osmislimo
sistem zdravstvene zaštite širom sveta.
sistem zdravstvene zaštite širom sveta.
00:26
Twenty-four years ago, I had -- a sophomore in college,
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Pre dvadeset četiri godine,
bio sam student druge godine fakulteta,
bio sam student druge godine fakulteta,
00:30
I had a series of fainting spells. No alcohol was involved.
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imao sam čitav niz nesvestica.
Alkohol nije bio uključen.
Alkohol nije bio uključen.
00:33
And I ended up in student health,
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Završio sam u studentskoj ambulanti,
00:35
and they ran some labwork and came back right away,
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uradili su nekoliko analiza
i odmah sam dobio rezultate,
i odmah sam dobio rezultate,
00:38
and said, "Kidney problems."
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i rekli su: "Problemi sa bubrezima."
00:40
And before I knew it, I was involved and thrown into
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Pre nego što sam i shvatio,
bio sam uključen i bačen
bio sam uključen i bačen
00:43
this six months of tests and trials and tribulations
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u testiranja i ispitivanja i teškoće
u trajanju od šest meseci
u trajanju od šest meseci
00:46
with six doctors across two hospitals
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sa šest doktora u dve bolnice,
00:49
in this clash of medical titans
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u tom sudaru medicinskih titana
00:52
to figure out which one of them was right
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da ustanove koji od njih je u pravu
00:54
about what was wrong with me.
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o tome šta nije u redu sa mnom.
00:56
And I'm sitting in a waiting room some time later for an ultrasound,
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Nešto kasnije, sedim u čekaonici za ultrazvuk
01:00
and all six of these doctors actually show up in the room at once,
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i svih šest doktora
se pojave u sobi odjednom,
se pojave u sobi odjednom,
01:02
and I'm like, "Uh oh, this is bad news."
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a ja mislim: "O-o, to su loše vesti."
01:07
And their diagnosis was this:
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A njihova dijagnoza je bila:
01:08
They said, "You have two rare kidney diseases
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rekli su: "Imaš dve retke bolesti bubrega
01:10
that are going to actually destroy your kidneys eventually,
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koje je će ti uništiti bubrege s vremenom,
01:13
you have cancer-like cells in your immune system
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imaš ćelije slične raku
u svom imunom sistemu
u svom imunom sistemu
01:15
that we need to start treatment right away,
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i potrebno je početi odmah sa lečenjem,
01:17
and you'll never be eligible for a kidney transplant,
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i nikad nećeš biti podložan
za transplantaciju bubrega,
za transplantaciju bubrega,
01:20
and you're not likely to live more than two or three years."
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nije verovatno da ćeš živeti
više od dve ili tri godine."
više od dve ili tri godine."
01:23
Now, with the gravity of this doomsday diagnosis,
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Sa težinom ove dijagnoze sudnjeg dana,
01:26
it just sucked me in immediately,
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u momentu me usisalo,
01:29
as if I began preparing myself as a patient
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kao da sam počeo da se pripremam, kao pacijent
01:31
to die according to the schedule that they had just given to me,
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da umrem u skladu sa rasporedom
koji su mi upravo dali,
koji su mi upravo dali,
01:35
until I met a patient named Verna in a waiting room,
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dok nisam u čekaonici upoznao
pacijentkinju zvanu Verna,
pacijentkinju zvanu Verna,
01:38
who became a dear friend, and she grabbed me one day
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koja mi je postala draga prijateljica,
i zgrabila me jednog dana
i zgrabila me jednog dana
01:40
and took me off to the medical library
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i odvela me u medicinsku biblioteku
01:42
and did a bunch of research on these diagnoses and these diseases,
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i uradila gomilu istraživanja
ovih dijagnoza i bolesti,
ovih dijagnoza i bolesti,
01:45
and said, "Eric, these people who get this
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i rekla: "Erik, ljudi koji dobiju te bolesti
01:48
are normally in their '70s and '80s.
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su obično u svojim 70-im i 80-im.
01:49
They don't know anything about you. Wake up.
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Oni ne znaju ništa o tebi. Probudi se.
01:53
Take control of your health and get on with your life."
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Uzmi kontrolu nad svojim zdravljem
u svoje ruke i nastavi sa svojim životom."
u svoje ruke i nastavi sa svojim životom."
01:56
And I did.
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I jesam.
01:57
Now, these people making these proclamations to me
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Ljudi koji su mi davali ta saopštenja
02:00
were not bad people.
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nisu bili loši ljudi.
02:01
In fact, these professionals were miracle workers,
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Zapravo, ovi stručnjaci su čudotvorci,
02:03
but they're working in a flawed, expensive system that's set up the wrong way.
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ali rade u skupom sistemu sa greškama
koji je osnovan na pogrešan način.
koji je osnovan na pogrešan način.
02:08
It's dependent on hospitals and clinics for our every care need.
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Zavise od bolnica i klinika
za svaku našu potrebu brige.
za svaku našu potrebu brige.
02:11
It's dependent on specialists who just look at parts of us.
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Zavise od specijalista koji samo
gledaju pojedine naše delove.
gledaju pojedine naše delove.
02:14
It's dependent on guesswork of diagnoses and drug cocktails,
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Zavise od nagađanja dijagnoza
i koktela lekova,
i koktela lekova,
02:18
and so something either works or you die.
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tako da nešto ili deluje ili umrete.
02:21
And it's dependent on passive patients
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Takođe zavise od pasivnih pacijenata
02:25
who just take it and don't ask any questions.
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koji samo uzimaju i ne pitaju ništa.
02:29
Now the problem with this model
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Problem sa ovim modelom
02:31
is that it's unsustainable globally.
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je to što je neodrživ na globalnom nivou.
02:33
It's unaffordable globally.
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Nepriuštiv je na globalnom nivou.
02:35
We need to invent what I call a personal health system.
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Treba da izmislimo nešto što ja zovem
ličnim zdravstvenim sistemom.
ličnim zdravstvenim sistemom.
02:38
So what does this personal health system look like,
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Na šta liči taj lični zdravstveni sistem,
02:41
and what new technologies and roles is it going to entail?
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i koje nove tehnologije
i uloge će zahtevati?
i uloge će zahtevati?
02:46
Now, I'm going to start by actually sharing with you
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Počeću tako što ću vas upoznati
02:48
a new friend of mine, Libby,
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sa mojom novom prijateljicom, Libi,
02:50
somebody I've become quite attached to over the last six months.
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s kojom sam se poprilično zbližio
tokom poslednjih šest meseci.
tokom poslednjih šest meseci.
02:53
This is Libby, or actually, this is an ultrasound image of Libby.
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Ovo je Libi, odnosno ovo je
ultrazvučna slika Libi.
ultrazvučna slika Libi.
02:56
This is the kidney transplant I was never supposed to have.
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Ovo je transplantacija bubrega
koju nikad nije trebalo da imam.
koju nikad nije trebalo da imam.
02:59
Now, this is an image that we shot a couple of weeks ago for today,
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Ova slika je snimljena
pre nekoliko nedelja za danas,
pre nekoliko nedelja za danas,
03:03
and you'll notice, on the edge of this image,
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i primetićete, na ivici ove slike,
03:05
there's some dark spots there, which was really concerning to me.
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postoje neke crne tačke
koje su me jako zabrinjavale.
koje su me jako zabrinjavale.
03:08
So we're going to actually do a live exam
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Tako da ćemo uraditi pregled uživo
03:11
to sort of see how Libby's doing.
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da na neki način vidimo kako je Libi.
03:12
This is not a wardrobe malfunction. I have to take my belt off here.
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Ovo nije kvar garderobe.
Moram da skinem kaiš ovde.
Moram da skinem kaiš ovde.
03:15
Don't you in the front row worry or anything.
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Ne brinite vi iz prvog reda.
03:17
(Laughter)
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(Smeh)
03:18
I'm going to use a device from a company called Mobisante.
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Koristiću jednu spravu
kompanije zvane Mobisante.
kompanije zvane Mobisante.
03:22
This is a portable ultrasound.
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Ovo je prenosivi ultrazuvk.
03:23
It can plug into a smartphone. It can plug into a tablet.
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Može da se prikljući na pametni telefon.
Može da se priključi na tablet.
Može da se priključi na tablet.
03:26
Mobisante is up in Redmond, Washington,
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Mobisante se nalazi u Redmondu,
u državi Vašington
u državi Vašington
03:28
and they kindly trained me to actually do this on myself.
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i ljubazno su me osposobili
da mogu da ga koristim na sebi.
da mogu da ga koristim na sebi.
03:32
They're not approved to do this. Patients are not approved to do this.
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Pacijentima nije odobreno
da ovo rade.
da ovo rade.
03:34
This is a concept demo, so I want to make that clear.
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Ovo je konceptualna demonstracija,
da to odmah raščistim.
da to odmah raščistim.
03:37
All right, I gotta gel up.
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Dobro, moram da se namažem gelom.
03:38
Now the people in the front row are very nervous. (Laughter)
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Ljudi u prvim redovima
su jako nervozni sada. (Smeh)
su jako nervozni sada. (Smeh)
03:42
And I want to actually introduce you to Dr. Batiuk,
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Želim da vas upoznam sa dr Batukom,
03:46
who's another friend of mine.
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koji je takođe moj prijatelj.
03:48
He's up in Legacy Good Samaritan Hospital in Portland, Oregon.
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On je u bolnici Nasleđa dobrog Samarićanina
u Portlandu, u Oregonu.
u Portlandu, u Oregonu.
03:52
So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay?
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Samo da se uverim. Hej, dr Batuk.
Da li me čujete dobro?
Da li me čujete dobro?
03:55
And actually, can you see Libby?
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Zapravo, da li vidite Libi?
03:57
Thomas Batuik: Hi there, Eric.
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Tomas Batuk: Zdravo Erik.
03:58
You look busy. How are you?
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Izgledate zauzeto.
Kako ste?
Kako ste?
04:00
Eric Dishman: I'm good. I'm just taking my clothes off
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Erik Dišman: Dobro sam.
Samo skidam odeću
Samo skidam odeću
04:02
in front of a few hundred people. It's wonderful.
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ispred nekoliko stotina ljudi.
Divno je.
Divno je.
04:05
So I just wanted to see, is this the image you need to get?
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Hteo sam da vidim, je li ovo slika
koju treba da dobijete?
koju treba da dobijete?
04:10
And I know you want to look and see if those spots are still there.
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I znam da želite da pogledate
da li su još te tačke tamo.
da li su još te tačke tamo.
04:13
TB: Okay. Well let's scan around a little bit here,
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TB: U redu, Hajde da malo
pretražimo okolo,
pretražimo okolo,
04:16
give me a lay of the land.
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dajte mi pregled površine.
04:17
ED: All right.TB: Okay. Turn it a little bit inside,
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ED: U redu.
TB: Dobro. Okreni ga malo unutra,
TB: Dobro. Okreni ga malo unutra,
04:21
a little bit toward the middle for me.
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malčice prema sredini.
04:23
Okay, that's good. How about up a little bit?
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Dobro, to je dobro.
Kako bi bilo malo na gore?
Kako bi bilo malo na gore?
04:28
Okay, freeze that image. That's a good one for me.
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Dobro, zamrzni tu sliku.
Ta mi odgovara.
Ta mi odgovara.
04:31
ED: All right. Now last week, when I did this,
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ED: U redu. Prošle nedelje,
kada sam ovo uradio,
kada sam ovo uradio,
04:34
you had me measure that spot to the right.
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trebalo je da izmerim to mesto udesno.
04:37
Should I do that again?
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Treba li da to uradim ponovo?
04:38
TB: Yeah, let's do that.
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TB: Da, hajde uradite ponovo.
04:39
ED: All right. This is kind of hard to do
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ED: U redu. Ovo je malo teško uraditi
04:43
with one hand on your belly and one hand on measuring,
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sa jednom rukom na stomaku
i jednom na merenju,
i jednom na merenju,
04:45
but I've got it, I think,
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ali mi uspeva, mislim,
04:46
and I'll save that image and send it to you.
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sačuvaću tu sliku i poslati je vama.
04:49
So tell me a little bit about what this dark spot means.
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Recite mi nešto o tome
šta te tamne tačke znače.
šta te tamne tačke znače.
04:51
It's not something I was very happy about.
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Nije nešto čemu sam se radovao.
04:53
TB: Many people after a kidney transplant
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TB: Mnogo ljudi nakon transplantacije bubrega
04:55
will develop a little fluid collection around the kidney.
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će razviti malo skupljanje tečnosti
oko bubrega.
oko bubrega.
04:58
Most of the time it doesn't create any kind of mischief,
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U većini slučajeva
to neće naneti nikakvu štetu,
to neće naneti nikakvu štetu,
05:02
but it does warrant looking at,
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ali ne škodi proveriti,
05:04
so I'm happy we've got an opportunity to look at it today,
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tako da sam srećan što imamo
priliku da danas pogledamo.
priliku da danas pogledamo.
05:07
make sure that it's not growing, it's not creating any problems.
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da se uverimo da ne raste,
i da ne stvara probleme.
i da ne stvara probleme.
05:10
Based on the other images we have,
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Na osnovu drugih slika koje imamo,
05:12
I'm really happy how it looks today.
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jako sam zadovoljan
time kako izgleda danas.
time kako izgleda danas.
05:15
ED: All right. Well, I guess we'll double check it when I come in.
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ED: U redu. Pa, mislim da ćemo
proveriti još jednom kada dođem.
proveriti još jednom kada dođem.
05:17
I've got my six month biopsy in a couple of weeks,
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Imam šestomesečnu biopsiju za koju nedelju,
05:20
and I'm going to let you do that in the clinic,
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pustiću vas da to vi uradite u klinici,
05:21
because I don't think I can do that one on myself.
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jer mislim da to ne mogu
da uradim sam na sebi.
da uradim sam na sebi.
05:24
TB: Good choice.ED: All right, thanks, Dr. Batiuk.
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TB: Dobar izbor.
ED: U redu, hvala, dr Batuk.
ED: U redu, hvala, dr Batuk.
05:26
All right. So what you're sort of seeing here
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U redu. Dakle ono što vidite su otprilike
05:28
is an example of disruptive technologies,
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primeri tehnologije koja remeti,
05:31
of mobile, social and analytic technologies.
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mobilne, socijalne i analitičke tenhologije.
05:34
These are the foundations of what's going to make personal health possible.
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Ovo su osnove koje će učiniti
lično zdravstvo mogućim.
lično zdravstvo mogućim.
05:37
Now there's really three pillars
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Postoje tri stuba
05:39
of this personal health I want to talk to you about now,
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ličnog zdravstva
o kojim želim da vam pričam,
o kojim želim da vam pričam,
05:41
and it's care anywhere, care networking and care customization.
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a to je nega svugde, umrežavanje nege
i prilagođavanje nege.
i prilagođavanje nege.
05:45
And you just saw a little bit of the first two
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Videli ste samo malo od prva dva
05:47
with my interaction with Dr. Batiuk.
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kroz moju interakciju s dr Batukom.
05:48
So let's start with care anywhere.
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Dakle, da počnemo sa negom svugde.
05:51
Humans invented the idea of hospitals and clinics
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Ljudi su izumeli ideju bolnica i klinika
05:54
in the 1780s. It is time to update our thinking.
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1780-ih. Vreme je
da unapredimo naše razmišljanje.
da unapredimo naše razmišljanje.
05:58
We have got to untether clinicians and patients
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Moramo da razvežemo lekare i pacijente
06:01
from the notion of traveling to a special
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od pojma putovanja do specijalnog mesta
06:04
bricks-and-mortar place for all of our care,
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od cigle i maltera za našu negu,
06:06
because these places are often the wrong tool,
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jer ova mesta su obično pogrešan alat,
06:09
and the most expensive tool, for the job.
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i najskuplji alat za posao.
06:11
And these are sometimes unsafe places to send our sickest patients,
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To su ponekad nesigurna mesta
za slanje najbolesnijih pacijenata,
za slanje najbolesnijih pacijenata,
06:15
especially in an era of superbugs
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posebno u doba superbakterija
06:17
and hospital-acquired infections.
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i infekcija zarađenih u bolnici.
06:19
And many countries are going to go brickless from the start
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Mnoge države će ostati
bez cigala od samog početka
bez cigala od samog početka
06:22
because they're never going to be able to afford
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jer nikada neće biti u mogućnosti da priušte
06:24
the mega-medicalplexes that a lot of the rest of the world has built.
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mega medicinske komplekse
koje je izgradio ostatak sveta.
koje je izgradio ostatak sveta.
06:28
Now I personally learned that hospitals
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Lično sam naučio da bolnice
06:31
can be a very dangerous place at a young age.
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mogu da budu jako opasna mesta
u ranim godinama.
u ranim godinama.
06:34
This was me in third grade.
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Ovo sam ja u trećem razredu.
06:35
I broke my elbow very seriously, had to have surgery,
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Veoma ozbiljno sam polomio lakat,
morao sam na operaciju,
morao sam na operaciju,
06:38
worried that they were going to actually lose the arm.
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brinuo sam se da ću stvarno izgubiti ruku.
06:40
Recovering from the surgery in the hospital, I get bedsores.
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Oporavljajući se od operacije u bolnici,
dobio sam rane od ležanja.
dobio sam rane od ležanja.
06:43
Those bedsores become infected,
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Rane su se inficirale,
06:45
and they give me an antibiotic which I end up being allergic to,
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dali su mi antibiotik
na koji sam na kraju bio alergičan,
na koji sam na kraju bio alergičan,
06:48
and now my whole body breaks out,
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po celom telu mi izbije koprivnjača,
06:50
and now all of those become infected.
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i sve se inficiralo.
06:53
The longer I stayed in the hospital, the sicker I became,
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Što sam duže bio u bolnici,
to sam bio bolesniji,
to sam bio bolesniji,
06:55
and the more expensive it became,
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i sve je bilo skuplje,
06:57
and this happens to millions of people around the world every year.
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ovo se dešava milionima ljudi
širom sveta svake godine.
širom sveta svake godine.
07:00
The future of personal health that I'm talking about
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Budućnost ličnog zdravstva
o kojem ja pričam
o kojem ja pričam
07:03
says care must occur at home as the default model,
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je nega koja mora da se odvija kod kuće
kao podrazumevani model,
kao podrazumevani model,
07:07
not in a hospital or clinic.
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a ne u bolnici ili klinici.
07:09
You have to earn your way into those places
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Morate da zaradite boravak u tim mestima,
07:10
by being sick enough to use that tool for the job.
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da budete dovoljno bolesni
da koristite taj alat za posao.
da koristite taj alat za posao.
07:14
Now the smartphones that we're already carrying
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Telefoni koje nosimo sa sobom
07:16
can clearly have diagnostic devices like ultrasounds plugged into them,
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mogu da imaju priključene
dijagnostičke uređaje poput ultrazvuka,
dijagnostičke uređaje poput ultrazvuka,
07:19
and a whole array of others, today,
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i čitav niz drugih, danas,
07:22
and as sensing is built into these,
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i kako imaju ugrađene senzore,
07:23
we'll be able to do vital signs monitor
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bićemo u stanju da pratimo vitalne znakove
07:25
and behavioral monitoring like we've never had before.
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i da pratimo ponašanje kao nikada ranije.
07:28
Many of us will have implantables that will actually look
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Mnogi od nas će imati
implante koji će pratiti
implante koji će pratiti
07:31
real-time at what's going on with our blood chemistry
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u stvarnom vremenu
šta se dešava sa krvnom hemijom
šta se dešava sa krvnom hemijom
07:33
and in our proteins right now.
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i sa našim proteinima u momentu.
07:36
Now the software is also getting smarter, right?
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Čak i softver postaje pametniji, zar ne?
07:38
Think about a coach, an agent online,
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Zamislite trenera, internet agenta,
07:41
that's going to help me do safe self-care.
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koji će vam pomoći
oko sigurne sopstvene nege.
oko sigurne sopstvene nege.
07:43
That same interaction that we just did with the ultrasound
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Ista interakcija, kao što smo
upravo uradili sa ultrazvukom,
upravo uradili sa ultrazvukom,
07:46
will likely have real-time image processing,
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imaće verovatno obradu slika
u realnom vremenu,
u realnom vremenu,
07:48
and the device will say, "Up, down, left, right,
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a uređaj će reći:
"Gore, dole, levo, desno,
"Gore, dole, levo, desno,
07:50
ah, Eric, that's the perfect spot to send that image
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ah, Erik, to je savršeno mesto
da se pošalje slika
da se pošalje slika
07:53
off to your doctor."
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tvom lekaru."
07:55
Now, if we've got all these networked devices
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Ako već imamo sve ove umrežene uređaje
07:57
that are helping us to do care anywhere,
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koji nam pomažu oko nege bilo gde,
07:59
it stands to reason that we also need a team
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razumno je da nam takođe treba i tim
08:01
to be able to interact with all of that stuff,
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da bismo mogli komunicirati
sa svim tim stvarima,
sa svim tim stvarima,
08:03
and that leads to the second pillar I want to talk about,
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i to nas dovodi do drugog stuba
o kojem želim da pričam,
o kojem želim da pričam,
08:06
care networking.
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umrežavanje nege.
08:07
We have got to go beyond this paradigm
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Moramo da idemo izvan paradigme
08:10
of isolated specialists doing parts care
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izolovanih specijalista
koji brinu o delovima
koji brinu o delovima
08:14
to multidisciplinary teams doing person care.
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do multidiscipliniranih timova
koji rade na ličnoj nezi.
koji rade na ličnoj nezi.
08:18
Uncoordinated care today is expensive at best,
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Danas je nekoordinisana nega
preskupa u najboljem slučaju
preskupa u najboljem slučaju
08:22
and it is deadly at worst.
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i smrtonosna u najgorem.
08:24
Eighty percent of medical errors are actually caused
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80% medicinskih grešaka je izvazvano
08:26
by communication and coordination problems
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problemima komunikacije i koordinacije
08:28
amongst medical team members.
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među članovima medicinskog tima.
08:30
I had my own heart scare years ago in graduate school,
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Pre nekoliko godina na postdiplomskim studijama
i ja sam se uplašio,
i ja sam se uplašio,
08:33
when we're under treatment for the kidney,
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kada sam bio na tretmanu za bubrege,
08:35
and suddenly, they're like, "Oh, we think you have a heart problem."
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i odjednom čujem:
"O, mislimo da imate srčane probleme."
"O, mislimo da imate srčane probleme."
08:37
And I have these palpitations that are showing up.
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Imam ta mala lupanja srca.
08:39
They put me through five weeks of tests --
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Idem pet nedelja na testiranja -
08:42
very expensive, very scary -- before the nurse finally notices
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veoma skupa, veoma strašna -
pre nego što medicinska sestra primeti
pre nego što medicinska sestra primeti
08:45
the piece of the paper, my meds list
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komad papira, moju listu lekova
08:47
that I've been carrying to every single appointment,
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koju sam nosio na svaki pregled,
08:49
and says, "Oh my gosh."
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i kaže: "O moj bože!"
08:51
Three different specialists had prescribed
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Tri različita specijalista su mi prepisali
08:53
three different versions of the same drug to me.
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tri različite verzije istog leka.
08:55
I did not have a heart problem. I had an overdose problem.
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Nisam imao srčanih problema.
Imao sam problem predoziranja.
Imao sam problem predoziranja.
08:59
I had a care coordination problem.
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Imao sam problem koordinacije nege.
09:02
And this happens to millions of people every year.
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To se dešava milionima ljudi svake godine.
09:05
I want to use technology that we're all working on and making happen
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Želim da koristim tehnologiju
na kojoj svi radimo da ostvarimo
na kojoj svi radimo da ostvarimo
09:09
to make health care a coordinated team sport.
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da zdravstvena nega bude
koordinirani timski sport.
koordinirani timski sport.
09:12
Now this is the most frightening thing to me.
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Ovo me najviše plaši.
09:15
Out of all the care I've had in hospitals and clinics around the world,
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Od sve nege koju sam dobio
u bolnicama i klinikama svuda u svetu,
u bolnicama i klinikama svuda u svetu,
09:19
the first time I've ever had a true team-based care experience
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prvi put kada sam iskusio
pravu timsku negu
pravu timsku negu
09:22
was at Legacy Good Sam these last six months
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je bilo u Nasleđu dobrog Sema
ovih poslednjih šest meseci
ovih poslednjih šest meseci
09:25
for me to go get this.
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da bih ovo dobio.
09:26
And this is a picture of my graduation team from Legacy.
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Ovo je slika mog diplomskog tima iz Nasleđa.
09:29
There's a couple of the folks here. You'll recognize Dr. Batiuk.
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Ima tu nekoliko ljudi.
Prepoznaćete dr Batuka.
Prepoznaćete dr Batuka.
09:32
We just talked to him. Here's Jenny, one of the nurses,
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Upravo smo pričali sa njim. Ovo je Dženi,
jedna od medicinskih sestara,
jedna od medicinskih sestara,
09:34
Allison, who helped manage the transplant list,
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Alison, koja je pomogla
u rukovođenju transplantne liste,
u rukovođenju transplantne liste,
09:36
and a dozen other people who aren't pictured,
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i desetak drugih ljudi koji nisu na slici,
09:39
a pharmacist, a psychologist, a nutritionist,
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apotekar, psiholog, nutricionista,
09:41
even a financial counselor, Lisa,
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čak i finansijski savetnik, Lisa,
09:43
who helped us deal with all the insurance hassles.
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koja nam je pomogla da rešimo
osiguravajuće poteškoće.
osiguravajuće poteškoće.
09:46
I wept the day I graduated.
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Plakao sam na dan diplomiranja.
09:49
I should have been happy, because I was so well
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Trebalo je da budem srećan,
jer sam sam bio toliko dobro
jer sam sam bio toliko dobro
09:50
that I could go back to my normal doctors,
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da sam mogao da se vratim
svojim normalnim lekarima,
svojim normalnim lekarima,
09:52
but I wept because I was so actually connected to this team.
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ali sam plakao jer sam se toliko
povezao sa ovim timom.
povezao sa ovim timom.
09:55
And here's the most important part.
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A evo i najvažnijeg dela.
09:57
The other people in this picture are me and my wife, Ashley.
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Ostali ljudi na ovoj slici
smo moja žena Ešli i ja.
smo moja žena Ešli i ja.
10:00
Legacy trained us on how to do care for me at home
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U Nasleđu su nas obučili
kako da se staramo o meni kod kuće
kako da se staramo o meni kod kuće
10:04
so that they could offload the hospitals and clinics.
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kako bi mogli da rasterete
bolnice i klinike.
bolnice i klinike.
10:07
That's the only way that the model works.
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To je jedini način da model radi.
10:09
My team is actually working in China
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Moj tim zapravo radi u Kini
10:11
on one of these self-care models
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na jednom od tih modela
sopstvene nege
sopstvene nege
10:13
for a project we called Age-Friendly Cities.
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za projekat koji smo nazvali
Starosno naklonjeni gradovi.
Starosno naklonjeni gradovi.
10:15
We're trying to help build a social network
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Pomažemo da se izgradi društvena mreža
10:17
that can help track and train the care of seniors
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koja može da prati i obuči negu starih
10:19
caring for themselves
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koji se sami brinu za sebe,
10:21
as well as the care provided by their family members
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kao i negu koju pružaju
njihovi članovi porodice
njihovi članovi porodice
10:23
or volunteer community health workers,
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ili dobrovoljni zdravstveni radnici
u zajednici,
u zajednici,
10:26
as well as have an exchange network online,
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i da takođe postoji mreža
razmene na internetu,
razmene na internetu,
10:28
where, for example, I can donate three hours of care a day to your mom,
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gde, na primer, mogu da doniram
tri sata negovanja vaše majke dnevno,
tri sata negovanja vaše majke dnevno,
10:31
if somebody else can help me with transportation to meals,
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ako neko drugi može
da pomogne sa prenosom obroka,
da pomogne sa prenosom obroka,
10:34
and we exchange all of that online.
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i to sve razmenimo preko interneta.
10:37
The most important point I want to make to you about this
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Najvažnija tačka na koju želim da ukažem
10:39
is the sacred and somewhat over-romanticized
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je sveti i malo previše romantizovan
10:43
doctor-patient one-on-one
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odnos lekara i pacijenta,
jedan na jedan,
jedan na jedan,
10:45
is a relic of the past.
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to je relikvija prošlosti.
10:48
The future of health care is smart teams,
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Budućnost zdravstvene nege
su pametni timovi,
su pametni timovi,
10:50
and you'd better be on that team for yourself.
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i bolje je da budete u tom timu za sebe.
10:54
Now, the last thing that I want to talk to you about
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Poslednje o čemu želim da vam govorim
10:56
is care customization,
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je prilagođavanje nege,
10:57
because if you've got care anywhere and you've got care networking,
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jer ako imate negu bilo gde
i imate umrežavanje nege,
i imate umrežavanje nege,
11:00
those are going to go a long way towards improving our health care system,
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te stvari će mnogo pomoći u poboljšanju
našeg zdravstvenog sistema,
našeg zdravstvenog sistema,
11:03
but there's still too much guesswork.
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ali još uvek ima previše nagađanja.
11:06
Randomized clinical trials were actually invented in 1948
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Nasumične kliničke probe
su smišljene još 1948.
su smišljene još 1948.
11:10
to help invent the drugs that cured tuberculosis,
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da pomognu oko stvaranja
leka koji leči tuberkulozu,
leka koji leči tuberkulozu,
11:13
and those are important things, don't get me wrong.
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to su važne stvari,
nemojte me pogrešno shvatiti.
nemojte me pogrešno shvatiti.
11:16
These population studies that we've done have created
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Ova istraživanja populacije
koje smo sproveli su stvorila
koje smo sproveli su stvorila
11:17
tons of miracle drugs that have saved millions of lives,
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tonu čudotvornih lekova
koji su spasili milione života,
koji su spasili milione života,
11:20
but the problem is that health care
255
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2435
ali je problem u tome
što zdravstveni sistem
što zdravstveni sistem
11:22
is treating us as averages, not unique individuals,
256
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tretira nas kao prosečne,
a ne kao jedinstvene pojedince,
a ne kao jedinstvene pojedince,
11:27
because at the end of the day,
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jer na kraju krajeva,
11:28
the patient is not the same thing as the population
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pacijent nije isto što i populacija
11:31
who are studied. That's what's leading to the guesswork.
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koja se proučava.
To nas vodi ka nagađanjima.
To nas vodi ka nagađanjima.
11:35
The technologies that are coming,
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Tehnologije koje dolaze,
11:36
high-performance computing, analytics,
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računarstvo visokih performansi,
analitika,
analitika,
11:39
big data that everyone's talking about,
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veliki podaci o kojima svi govore,
11:40
will allow us to build predictive models for each of us
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omogućiće nam da izgradimo
prognostičke modele za sve nas
prognostičke modele za sve nas
11:43
as individual patients.
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1954
pojedinačne pacijente.
11:45
And the magic here is, experiment on my avatar
265
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4459
Magija je, eksperimentisanje
na mom avataru
na mom avataru
11:50
in software, not my body in suffering.
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u softveru, ne na mom telu koje pati.
11:55
Now, I've had two examples I want to quickly share with you
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Želim brzo da podelim sa vama dva primera
11:57
of this kind of care customization on my own journey.
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ovakve vrste prilagođavanja nege
na svom putovanju.
na svom putovanju.
12:00
The first was quite simple. I finally realized some years ago
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Prvi je bio poprilično jednostavan.
Napokon sam shvatio pre nekoliko godina
Napokon sam shvatio pre nekoliko godina
12:03
that all my medical teams were optimizing my treatment for longevity.
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da su mi svi medicinski timovi optimizovali
tretman za dugovečnost.
tretman za dugovečnost.
12:07
It's like a badge of honor to see how long they can get the patient to live.
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To je kao bedž časti da vide koliko dugo
mogu da održe pacijenta u životu.
mogu da održe pacijenta u životu.
12:09
I was optimizing my life for quality of life,
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Ja sam optimizovao svoj život
za kvalitetan život,
za kvalitetan život,
12:13
and quality of life for me means time in snow.
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a za mene kvalitetan život
znači vreme u snegu.
znači vreme u snegu.
12:17
So on my chart, I forced them to put, "Patient goal:
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Tako sam ih naterao da na mom kartonu
piše: "Ciljevi pacijenta:
piše: "Ciljevi pacijenta:
12:20
low doses of drugs over longer periods of time,
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728251
3766
male doze lekova
tokom dugog perioda vremena,
tokom dugog perioda vremena,
12:24
side effects friendly to skiing."
276
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nuspojave -
prijateljski nastrojen za skijanje."
prijateljski nastrojen za skijanje."
12:27
And I think that's why I achieved longevity.
277
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Mislim da sam zbog toga
postigao dugovečnost.
postigao dugovečnost.
12:29
I think that time-in-snow therapy was as important
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Mislim da je snežna terapija
bila jednako važna
bila jednako važna
12:32
as the pharmaceuticals that I had.
279
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kao i lekovi koje sam uzimao.
12:34
Now the second example of customization -- and by the way,
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Drugi primer prilagođavanja - i uzgred
12:36
you can't customize care if you don't know your own goals,
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ne možete prilagoditi negu
ako ne znate sopstvene ciljeve,
ako ne znate sopstvene ciljeve,
12:38
so health care can't know those until you know your own health care goals.
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tako da zdravstvo ne može da ih zna dok
vi ne znate sopstvene zdravstvene ciljeve.
vi ne znate sopstvene zdravstvene ciljeve.
12:41
But the second example I want to give you is,
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Ali drugi primer koji želim da vam ispričam je,
12:43
I happened to be an early guinea pig,
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bio sam rano zamorče,
12:45
and I got very lucky to have my whole genome sequenced.
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imao sam jako puno sreće
da mi sekvenciraju ceo genom.
da mi sekvenciraju ceo genom.
12:48
Now it took about two weeks of processing
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Trebalo je oko dve nedelje obrade
12:51
on Intel's highest-end servers to make this happen,
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na Intelovim vrhunskim serverima
da bi se to dogodilo,
da bi se to dogodilo,
12:53
and another six months of human and computing labor
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i još šest meseci
ljudskog i računarskog rada
ljudskog i računarskog rada
12:56
to make sense of all of that data.
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da se da smisao svim tim podacima.
12:59
And at the end of all of that, they said, "Yes,
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Na kraju svega toga,
rekli su: "Da,
rekli su: "Da,
13:02
those diagnoses of that clash of medical titans
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te dijagnoze u sudaru medicinskih titana
13:04
all of those years ago were wrong,
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svih onih godina su pogrešne,
13:06
and we have a better path forward."
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imamo bolji put za napredak."
13:09
The future that Intel's working on now is to figure out
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Budućnost na kojoj radi Intel
je da se shvati
je da se shvati
13:11
how to make that computing for personalized medicine
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kako da se računanje
za personalizovanu medicinu
za personalizovanu medicinu
13:13
go from months and weeks to even hours,
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smanji sa meseca i nedelja pa i na sate,
13:17
and make this kind of tool available,
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i da se stavi takav alat na raspolaganje,
13:19
not just in the mainframes of tier-one research hospitals around the world,
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ne samo u glavnom okviru prvoklasnih
istraživačkih bolnica širom sveta,
istraživačkih bolnica širom sveta,
13:22
but in the mainstream -- every patient, every clinic
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nego u glavnom toku -
svaki pacijent, svaka klinika
svaki pacijent, svaka klinika
13:25
with access to whole genome sequencing.
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koja ima pristup sekvenciranju celog genoma.
13:27
And I tell you, this kind of care customization
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Kažem vam, ova vrsta
prilagođavanja nege
prilagođavanja nege
13:30
for everything from your goals to your genetics
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za sve od vaših ciljeva
do vaše genetike
do vaše genetike
13:33
will be the most game-changing transformation
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će biti najveća promena
13:34
that we witness in health care during our lifetime.
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zdravstvenog sistema naših života
kojoj ćemo biti svedoci.
kojoj ćemo biti svedoci.
13:38
So these three pillars of personal health,
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Tako da ti stubovi ličnog zdravstva,
13:41
care anywhere, care networking, care customization,
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nega bilo gde, umrežavanje nege,
prilagođavanje nege,
prilagođavanje nege,
13:44
are happening in pieces now,
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dešavaju se u delićima,
13:45
but this vision will completely fail if we don't step up
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ali će vizija potpuno propasti
ako se ne pokažemo
ako se ne pokažemo
13:49
as caregivers and as patients to take on new roles.
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kao negovatelji i kao pacijenti
i zauzmemo nove uloge.
i zauzmemo nove uloge.
13:53
It's what my friend Verna said:
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Kao što je moja prijateljica Verna rekla:
13:54
Wake up and take control of your health.
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Probudi se i preuzmi kontrolu
nad svojim zdravljem.
nad svojim zdravljem.
13:57
Because at the end of the day these technologies
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Jer na kraju dana ove tehnologije
13:58
are simply about people caring for other people
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se jednostavno koriste za brigu
o ljudima koji se brinu o drugima
o ljudima koji se brinu o drugima
14:02
and ourselves in some powerful new ways.
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i o sebi na neki moćniji, novi način.
14:05
And it's in that spirit that I want to introduce you
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I u tom duhu želim da vam predstavim
14:07
to one last friend, very quickly.
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poslednjeg prijatelja, veoma brzo.
14:10
Tracey Gamley stepped up to give me the impossible kidney
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Trejsi Gemli se odvažila da
mi da nemogući bubreg
mi da nemogući bubreg
14:13
that I was never supposed to have.
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koji nikad nije trebalo da dobijem.
14:18
(Applause)
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(Aplauz)
14:34
So Tracey, just tell us a little bit quickly about what the donor experience was like with you.
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Trejsi, samo nam ispričajte brzo nešto
o tome kakvo je bilo iskustvo donora za vas.
o tome kakvo je bilo iskustvo donora za vas.
14:39
Tracey Gamley: For me, it was really easy.
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Trejsi Gemli: Za mene,
bilo je jako lako.
bilo je jako lako.
14:41
I only had one night in the hospital.
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Provela sam samo jednu noć u bolnici.
14:43
The surgery was done laparoscopically,
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Operacija je odrađena laparoskopski,
14:44
so I have just five very small scars on my abdomen,
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tako da imam pet veoma malih ožiljaka
na svom stomaku,
na svom stomaku,
14:48
and I had four weeks away from work
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i imala sam četiri nedelje odsustva sa posla
14:50
and went back to doing everything I'd done before
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i radila sam sve kao i pre,
14:52
without any changes.
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bez ikakvih promena.
14:53
ED: Well, I probably will never get a chance to say this to you
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ED: Verovatno neću imati priliku
da kažem ovo
da kažem ovo
14:56
in such a large audience ever again.
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ponovo pred tako velikom publikom.
14:58
So "thank you" feel likes a really trite word,
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"Hvala" zvuči kao zaista banalna reč,
15:01
but thank you from the bottom of my heart for saving my life.
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ali hvala od srca što ste mi spasili život.
15:04
(Applause)
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(Aplauz)
15:10
This TED stage and all of the TED stages
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Ova TED bina i sve TED bine
15:12
are often about celebrating innovation
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su obično za proslavu inovacije
15:15
and celebrating new technologies,
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i proslavu novih thenologija,
15:16
and I've done that here today,
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to sam danas ovde uradio,
15:18
and I've seen amazing things coming from TED speakers,
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video sam zapanjujuće stvari
od TED govornika,
od TED govornika,
15:21
I mean, my gosh, artificial kidneys, even printable kidneys, that are coming.
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mislim, bože, veštački bubrezi, čak i bubrezi
za štampanje, koji su na pomolu.
za štampanje, koji su na pomolu.
15:25
But until such time that these amazing technologies
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Ali dok ove zapanjujuće tehnologije
15:28
are available to all of us, and even when they are,
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ne budu raspoložive svima nama,
i čak i kada budu,
i čak i kada budu,
15:31
it's up to us to care for, and even save, one another.
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na nama je da se brinemo jedni o drugima,
i spasimo jedni druge.
i spasimo jedni druge.
15:35
I hope you will go out and make personal health happen
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Nadam se da ćete ostvariti
lično zdravstvo
lično zdravstvo
15:38
for yourselves and for everyone. Thanks so much.
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zbog sebe i svih ostalih.
Hvala vam puno.
Hvala vam puno.
15:42
(Applause)
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(Aplauz)
ABOUT THE SPEAKER
Eric Dishman - Social scientistEric Dishman does health care research for Intel -- studying how new technology can solve big problems in the system for the sick, the aging and, well, all of us.
Why you should listen
Eric Dishman is an Intel Fellow and general manager of Intel's Health Strategy & Solutions Group. He founded the product research and innovation team responsible for driving Intel’s worldwide healthcare research, new product innovation, strategic planning, and health policy and standards activities.
Dishman is recognized globally for driving healthcare reform through home and community-based technologies and services, with a focus on enabling independent living for seniors. His work has been featured in The New York Times, Washington Post and Businessweek, and The Wall Street Journal named him one of “12 People Who Are Changing Your Retirement.” He has delivered keynotes on independent living for events such as the annual Consumer Electronics Show, the IAHSA International Conference and the National Governors Association. He has published numerous articles on independent living technologies and co-authored government reports on health information technologies and health reform.
He has co-founded organizations devoted to advancing independent living, including the Technology Research for Independent Living Centre, the Center for Aging Services Technologies, the Everyday Technologies for Alzheimer’s Care program, and the Oregon Center for Aging & Technology.
Eric Dishman | Speaker | TED.com