ABOUT THE SPEAKER
Leana Wen - Emergency physician, public health advocate
Dr. Leana Wen is Baltimore City's Health Commissioner.

Why you should listen

Dr. Leana Wen is the Baltimore City Health Commissioner. A physician and public health advocate, she has traveled the world listening to patients’ stories. Born in Shanghai, she was a Rhodes Scholar at Oxford, a reporter with The New York Times’ Nick Kristof, a fellow at the World Health Organization and the Director of Patient-Centered Care Research in the Department of Emergency Medicine at George Washington University.

Inspired by struggles during her mother’s long illness, she wrote When Doctors Don't Listen, a book about empowering patients to avoid misdiagnoses and unnecessary tests.

As an outspoken leader among a new generation of physicians, she served as President of the American Medical Student Association and as Chair of the International Young Professionals Commission. She also helped create Who’s My Doctor, a campaign for radical transparency in medicine. Read her own transparency statement, and find more resources on TEDMED.

In October 2015, she wrote a blanket prescription, or "standing order," in Baltimore City which covers anyone trained to administer naloxone, a medication that reverses the effects of drug overdoses. Under the order, medication will be available on demand to everyone with the proper training to use it, potentially saving many lifes that might have been lost to overdoses.

More profile about the speaker
Leana Wen | Speaker | TED.com
TEDMED 2014

Leana Wen: What your doctor won’t disclose

莲娜∙文: 你的医生不愿透露什么?

Filmed:
2,030,830 views

难道你不想知道你的医生是否是被制药公司付费的发言人吗?或者说他们个人的信念和你想要的治疗是矛盾的?在美国,你的医生至少根本不需要去告诉你这些。当莲娜∙文问她的同行医生们去公开这些信息,她收到的反映是让人不安的。
- Emergency physician, public health advocate
Dr. Leana Wen is Baltimore City's Health Commissioner. Full bio

Double-click the English transcript below to play the video.

00:13
They told me that I'm a traitor叛徒
to my own拥有 profession职业,
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他们告诉我, 我背叛了自己的职业,
00:17
that I should be fired解雇,
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我应该被解雇,
00:19
have my medical license执照 taken采取 away,
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我的医生执照应该被吊销,
00:21
that I should go back to my own拥有 country国家.
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我应该回到自己的国家。
我的邮箱被入侵了。
00:26
My email电子邮件 got hacked砍死.
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00:28
In a discussion讨论 forum论坛 for other doctors医生,
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在一个其他医生开设的论坛上
00:31
someone有人 took credit信用
for "Twitter-bombingTwitter的轰炸" my account帐户.
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有人轰炸我的推特账户,
而且还得到了其他人的赞赏。
00:35
Now, I didn't know if this
was a good or bad thing,
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当时, 我不知道是一件好事还是坏事,
00:38
but then came来了 the response响应:
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但是接着有人回复了:
00:40
"Too bad it wasn't a real真实 bomb炸弹."
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"可惜不是真的炸弹。“
我从来没有想到过我做的事情
00:44
I never thought that I would do something
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00:46
that would provoke this level水平 of anger愤怒
among其中 other doctors医生.
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能激起其他医生们这种程度的愤怒。
00:50
Becoming变得 a doctor医生 was my dream梦想.
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成为一个医生曾是我的梦想。
00:52
I grew成长 up in China中国,
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我在中国长大,
00:53
and my earliest最早 memories回忆
are of being存在 rushed to the hospital醫院
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我最早的记忆是被匆忙送到医院
00:57
because I had such这样 bad asthma哮喘
that I was there nearly几乎 every一切 week.
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因为我有很严重的哮喘,
以至于当时几乎每周都在那里。
01:01
I had this one doctor医生, Dr博士. Sam山姆,
who always took care关心 of me.
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我有一个总是照顾我的医生, 山姆医生。
01:04
She was about the same相同 age年龄 as my mother母亲.
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她当时和我的妈妈一个年纪。
01:06
She had this wild野生, curly卷曲 hair头发,
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她有一头狂乱的卷发,
01:08
and she always wore穿着
these bright yellow黄色 flowery如花 dresses礼服.
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而且她总是穿着一条明黄色的花裙子。
01:12
She was one of those doctors医生 who,
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她是那些医生中的一个,
01:13
if you fell下跌 and you broke打破 your arm,
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如果你跌倒并摔伤了胳膊,
01:16
she would ask you why you weren't laughing
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她会问你是为什么不笑
01:18
because it's your humerus. Get it?
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因为那是你的肱骨(与搞笑同音), 明白吗?
01:22
See, you'd groan呻吟,
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你会痛得哇哇叫,
01:24
but she'd always make you feel better
after having seen看到 her.
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但是在见到她之后她总是会让你感觉很好。
01:27
Well, we all have that childhood童年 hero英雄
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我们所有人都有
01:29
that we want to grow增长 up
to be just like, right?
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我们想长大后成为的儿时英雄, 对吗?
01:32
Well, I wanted to be just like Dr博士. Sam山姆.
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我想成为像山姆的医生。
01:35
When I was eight,
my parents父母 and I moved移动 to the U.S.,
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当我八岁的时候, 我的父母和我搬到了美国,
01:39
and ours我们的 became成为
the typical典型 immigrant移民 narrative叙述.
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我们成为了典型的移民家庭。
01:41
My parents父母 cleaned清洗 hotel旅馆 rooms客房
and washed dishes碗碟 and pumped gas加油站
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我的父母去清理酒店房间、
洗盘子和给瓦斯充气
01:46
so that I could pursue追求 my dream梦想.
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来让我追逐我的梦想。
01:49
Well, eventually终于 I learned学到了 enough足够 English英语,
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最后, 我学了足够的英语,
01:51
and my parents父母 were so happy快乐
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我的父母很开心
01:53
the day that I got into medical school学校
and took my oath誓言 of healing复原 and service服务.
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对于我进入医学院学习,
并为治疗服务宣下了誓言。
01:58
But then one day, everything changed.
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但是有一天, 所有的事情都变了。
02:01
My mother母亲 called me to tell me
that she wasn't feeling感觉 well,
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我的妈妈打电话和我说
她感觉不是很好,
02:04
she had a cough咳嗽 that wouldn't不会 go away,
she was short of breath呼吸 and tired.
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她得的咳嗽一直没有好
她喘不过气而且一直很疲累。
02:07
Well, I knew知道 that my mother母亲 was someone有人
who never complained抱怨 about anything.
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我知道我的妈妈是那种
从来不向他人抱怨的人。
02:11
For her to tell me
that something was the matter,
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所以当她告诉我她觉得不对劲的时候,
02:14
I knew知道 something had to be really wrong错误.
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我就知道事情不妙了。
02:16
And it was:
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结果:
02:17
We found发现 out that she had
stage阶段 IVIV breast乳房 cancer癌症,
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我们发现她已经到了乳腺癌四期,
02:20
cancer癌症 that by then had spread传播
to her lungs, her bones骨头, and her brain.
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癌细胞当时已经扩散到她的肺,骨头和大脑里。
02:26
My mother母亲 was brave勇敢,
though虽然, and she had hope希望.
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我的妈妈是勇敢的, 她一直抱有希望。
02:28
She went through通过 surgery手术 and radiation辐射,
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她经历了手术和放射治疗,
02:30
and was on her third第三 round回合 of chemotherapy化疗
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在她在进行第三轮的化疗的时候
02:32
when she lost丢失 her address地址 book.
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她弄丢了她的通讯薄。
02:34
She tried试着 to look up her oncologist's肿瘤学家的
phone电话 number on the Internet互联网
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她想从网上找到她的肿瘤科医生的电话
她找到了, 并且也找到了一些其他的东西。
02:37
and she found发现 it,
but she found发现 something else其他 too.
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02:40
On several一些 websites网站,
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在一些网站上,
02:41
he was listed上市 as a highly高度 paid支付
speaker扬声器 to a drug药物 company公司,
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他是一家药物公司高薪聘请的代言人,
02:45
and in fact事实 often经常 spoke on behalf代表
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而且, 事实上经常为他给我妈定的化疗方案
02:47
of the same相同 chemo化疗 regimen方案
that he had prescribed规定 her.
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作代表宣传。
02:50
She called me in a panic恐慌,
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她很慌张的给我打电话,
02:52
and I didn't know what to believe.
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我不知道该相信什么。
02:54
Maybe this was the right
chemo化疗 regimen方案 for her,
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可能为她做的化疗方案是对的,
02:56
but maybe it wasn't.
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但是也可能不是,
02:58
It made制作 her scared害怕 and it made制作 her doubt怀疑.
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这使她非常害怕并产生怀疑。
03:01
When it comes to medicine医学,
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当我们遇到药物问题时,
03:03
having that trust相信 is a must必须,
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这种信任非常重要,
03:06
and when that trust相信 is gone走了,
then all that's left is fear恐惧.
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当信任失去了, 那么剩下的就只有害怕了。
03:11
There's another另一个 side to this fear恐惧.
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这份恐惧也有着另外一面。
03:13
As a medical student学生, I was taking服用 care关心
of this 19-year-old-岁
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作为一个医学院的学生,
我一直照顾一个19岁的
03:17
who was biking骑自行车 back to his dorm宿舍
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骑自行车回他的宿舍的路上
03:18
when he got struck来袭 and hit击中,
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被撞倒, 卡在
03:20
run over by an SUVSUV.
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一辆越野车里的人。
03:23
He had seven broken破碎 ribs肋骨,
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他有七根断掉的肋骨,
03:24
shattered破灭 hip臀部 bones骨头,
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破裂的臀部骨头,
03:26
and he was bleeding流血的 inside
his belly肚皮 and inside his brain.
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他的腹部和脑袋一直在流血。
03:29
Now, imagine想像 being存在 his parents父母
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现在,想象一下他的父母
03:31
who flew in from Seattle西雅图,
2,000 miles英里 away,
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要从2000英里外的西雅图飞过来,
03:33
to find their son儿子 in a coma昏迷.
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为了去见正在昏迷的儿子。
03:35
I mean, you'd want to find out
what's going on with him, right?
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我意思是, 他们真的想找出
到底发生了什么在他的身上?
03:38
They asked to attend出席 our bedside床头 rounds
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他们要求去参加我们的查房,
03:40
where we discussed讨论
his condition条件 and his plan计划,
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听取我们的诊疗经过。
我认为是个合理的请求。
03:42
which哪一个 I thought was a reasonable合理 request请求,
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同时也给我们一个机会去向他们展示
03:44
and also would give us
a chance机会 to show显示 them
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我们有多努力和关心,
03:46
how much we were trying
and how much we cared照顾.
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03:49
The head doctor医生, though虽然, said no.
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尽管主治医生说不行。
03:52
He gave all kinds of reasons原因.
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他给了很多方面的原因。
03:53
Maybe they'll他们会 get in the nurse's护士 way.
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可能他们会妨碍护士的工作.
03:55
Maybe they'll他们会 stop students学生们
from asking questions问题.
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可能他们会阻止学生问问题。
03:59
He even said,
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他甚至说,
04:01
"What if they see mistakes错误 and sue起诉 us?"
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“如果他们看到错误并起诉我们怎么办?”
04:05
What I saw behind背后 every一切 excuse借口
was deep fear恐惧,
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我看到的是每个借口后面深深的恐惧,
04:08
and what I learned学到了
was that to become成为 a doctor医生,
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我学到的是去成为一个医生,
04:11
we have to put on our white白色 coats大衣,
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我们不得不穿上白大褂,
04:13
put up a wall, and hide隐藏 behind背后 it.
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筑起一道墙, 并藏在后面。
04:17
There's a hidden epidemic疫情 in medicine医学.
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这其实是一种在医学领域里隐藏的风气。
04:20
Of course课程, patients耐心 are scared害怕
when they come to the doctor医生.
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当然, 患者会害怕当他们去看医生的时候。
04:23
Imagine想像 you wake唤醒 up
with this terrible可怕 bellyache腹痛,
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想象你因肚子痛而醒来,
04:25
you go to the hospital醫院,
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你去医院,
你躺在一个一个陌生的地方,
你在医院的轮床上,
04:26
you're lying说谎 in this strange奇怪 place地点,
you're on this hospital醫院 gurney格尼,
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04:29
you're wearing穿着 this flimsy单薄 gown,
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你穿着单薄的病人服,
04:31
strangers陌生人 are coming未来
to poke and prod at you.
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陌生人过来对你一通摆弄,
04:33
You don't know what's going to happen发生.
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你不知道将发生什么。
04:35
You don't even know if you're going to get
the blanket you asked for 30 minutes分钟 ago.
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你甚至不知道你会不会
拿到你30分钟前要的毛毯。
04:39
But it's not just patients耐心 who are scared害怕;
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但是这不仅仅是患者害怕;
04:41
doctors医生 are scared害怕 too.
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医生也一样害怕,
04:43
We're scared害怕 of patients耐心
finding发现 out who we are
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我们害怕患者找出我们是谁
04:46
and what medicine医学 is all about.
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和医学是关于什么的,
04:48
And so what do we do?
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所以我们做什么呢?
04:50
We put on our white白色 coats大衣
and we hide隐藏 behind背后 them.
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我们穿上我们的白大褂并藏在后面,
04:53
Of course课程, the more we hide隐藏,
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当然, 我们越是想隐藏,
04:54
the more people want to know
what it is that we're hiding.
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人们就越想知道我们隐藏的是什么.
04:57
The more fear恐惧 then spirals螺旋
into mistrust不信任 and poor较差的 medical care关心.
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越多的害怕就会造成医患之间不信任,
以及贫乏的医疗救助。
05:01
We don't just have a fear恐惧 of sickness疾病,
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我们不仅仅有着对疾病的害怕,
05:03
we have a sickness疾病 of fear恐惧.
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我们也患上了恐惧病。
05:07
Can we bridge this disconnect断开
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我们能在患者需求和医生之间
05:09
between之间 what patients耐心 need
and what doctors医生 do?
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的这种隔阂搭建桥梁吗?
05:13
Can we overcome克服 the sickness疾病 of fear恐惧?
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我们能克服这种恐惧吗?
05:15
Let me ask you differently不同:
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让我换种方式问你:
05:17
If hiding isn't the answer回答,
what if we did the opposite对面?
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如果隐藏并不是解决问题的答案,
假使我们反方向而行之了呢?
05:21
What if doctors医生 were to become成为
totally完全 transparent透明 with their patients耐心?
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如果医生和患者之间变得完全透明呢?
去年秋天, 我做了一个研究学习去找出
05:26
Last fall秋季, I conducted进行
a research研究 study研究 to find out
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05:29
what it is that people want
to know about their healthcare卫生保健.
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人们想知道关于他们医疗保健的哪些事情。
05:32
I didn't just want to study研究
patients耐心 in a hospital醫院,
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我不仅是想了解医院病人们的想法,
05:34
but everyday每天 people.
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而是所有人。
05:35
So my two medical students学生们,
SuhaviSuhavi Tucker塔克 and Laura劳拉 Johns约翰斯,
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所以我的两个实习生,
苏诃毗·塔克和劳拉·约翰,
05:39
literally按照字面 took their research研究
to the streets街道.
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到街上做了这个研究。
05:41
They went to banks银行,
coffee咖啡 shops商店, senior前辈 centers中心,
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他们去了医院, 咖啡店, 老人中心,
05:45
Chinese中文 restaurants餐馆 and train培养 stations.
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中餐厅和火车站。
他们发现了什么呢?
05:49
What did they find?
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05:50
Well, when we asked people,
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当我们问他们,
05:51
"What do you want to know
about your healthcare卫生保健?"
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你们想知道关于你们的医疗保健的什么?
05:54
people responded回应 with what they want
to know about their doctors医生,
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人们回应他们想知道
关于他们的医生的信息,
05:58
because people understand理解 health健康 care关心
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因为人们知道医疗保健
05:59
to be the individual个人 interaction相互作用
between之间 them and their doctors医生.
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是他们和他们医生之间的个人互动。
06:03
When we asked, "What do you
want to know about your doctors医生?"
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当我们问, "你们想知道关于医生的什么?"
人们给了三个不同的回答。
06:06
people gave three different不同 answers答案.
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06:08
Some want to know
that their doctor医生 is competent胜任
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一些人想知道他们的医生是有能力
06:11
and certified认证 to practice实践 medicine医学.
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和资格去行医。
06:13
Some want to be sure
that their doctor医生 is unbiased不偏不倚
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一些人想确定他们的医生公正的
06:16
and is making制造 decisions决定
based基于 on evidence证据 and science科学,
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做决定是基于科学依据,
而不是谁给他们付钱。
06:19
not on who pays支付 them.
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令我们惊讶的是,
06:21
Surprisingly出奇 to us,
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06:23
many许多 people want to know
something else其他 about their doctors医生.
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许多人想知道关于医生的其他事情。
06:26
Jonathan乔纳森, a 28-year-old-岁 law student学生,
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乔纳森, 一个28岁的法律学生,
06:29
says he wants to find someone有人
who is comfortable自在 with LGBTQLGBTQ patients耐心
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说他想找一些愿意为同性
双性恋及跨性别患者治疗,
06:34
and specializes专业 in LGBTLGBT health健康.
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而且是这一类别相关疾病的专家。
06:36
Serena小威, a 32-year-old-岁 accountant会计,
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塞丽娜, 一个32岁的会计,
06:38
says that it's important重要 to her
for her doctor医生 to share分享 her values
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说她的医生分享她的价值观
06:41
when it comes to reproductive生殖 choice选择
and women's女士的 rights权利.
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在生育选择上和女性权力上
对她说是重要的。
06:45
Frank坦率, a 59-year-old-岁
hardware硬件 store商店 owner所有者,
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弗兰克, 一个59岁的五金店老板,
06:47
doesn't even like going to the doctor医生
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甚至不喜欢去看医生
06:50
and wants to find someone有人
who believes相信 in prevention预防 first,
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只是想找以预防为先,
06:53
but who is comfortable自在
with alternative替代 treatments治疗.
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而且愿意进行替代疗法的医生。
06:56
One after another另一个,
our respondents受访者 told us
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一个接一个的, 我们的回应者告诉我们
06:59
that that doctor-patient医患 relationship关系
is a deeply intimate亲密 one —
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医生和患者之间的关系是紧密到可以
07:02
that to show显示 their doctors医生 their bodies身体
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让他们的医生去看他们的身体
07:04
and tell them their deepest最深 secrets秘密,
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并可以告诉他们最深秘密的。
07:06
they want to first understand理解
their doctor's医生 values.
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他们想先了解他们的医生的价值观。
07:09
Just because doctors医生
have to see every一切 patient患者
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仅仅是因为医生可以去看每一个患者
07:12
doesn't mean that patients耐心
have to see every一切 doctor医生.
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并不代表每个患者就不得不去看每个医生。
07:15
People want to know
about their doctors医生 first
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人们想先了解他们的医生
07:17
so that they can make an informed通知 choice选择.
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所以他们可以在知情情况下做出选择,
07:20
As a result结果 of this, I formed形成 a campaign运动,
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通过这个结果, 我组织一个活动,
07:22
Who's谁是 My Doctor医生?
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我的医生是谁?
07:24
that calls电话 for total
transparency透明度 in medicine医学.
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来呼吁医疗界的透明化。
07:27
Participating参与 doctors医生 voluntarily自行 disclose透露
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自愿参与的医生公开信息
07:29
on a public上市 website网站
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在一个公共网站上,
07:30
not just information信息
about where we went to medical school学校
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不仅仅我们上了哪家医学院
我们的专业是什么,
07:33
and what specialty专业 we're in,
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07:35
but also our conflicts冲突 of interest利益.
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而且还有我们的经济利益冲突。
07:36
We go beyond
the Government政府 in the Sunshine阳光 Act法案
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我们已经超出了政府关于
07:39
about drug药物 company公司 affiliations隶属关系,
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制药从属公司的阳光行动,
07:41
and we talk about how we're paid支付.
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我们讨论了我们是如何得到报酬的。
07:44
Incentives激励 matter.
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诱因很重要。
07:46
If you go to your doctor医生
because of back pain疼痛,
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如果你去看医生因为背痛,
07:48
you might威力 want to know he's getting得到 paid支付
5,000 dollars美元 to perform演出 spine脊柱 surgery手术
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你可能想知道, 他做一个
脊柱手术就能拿到5000美金,
07:52
versus 25 dollars美元 to refer参考 you
to see a physical物理 therapist治疗师,
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而引荐你去看物理治疗只能拿到25美金。
07:56
or if he's getting得到 paid支付 the same相同 thing
no matter what he recommends建议.
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或者说不管他推荐你什么,
他得到的支付都是一样的。
08:00
Then, we go one step further进一步.
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然后, 我们更进一步。
08:03
We add our values
when it comes to women's女士的 health健康,
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我们带来了更多的好处:比如女性健康,
08:05
LGBTLGBT health健康, alternative替代 medicine医学,
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同性双性恋及跨性者的健康问题, 替代疗法,
08:08
preventive预防 health健康,
and end-of-life生命尽头 decisions决定.
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卫生预防, 以及临终决定。
08:11
We pledge保证 to our patients耐心
that we are here to serve服务 you,
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我们向我们的患者
保证我们在这里是为你服务。
08:14
so you have a right to know who we are.
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所以你有权利知道我们是谁,
08:17
We believe that transparency透明度
can be the cure治愈 for fear恐惧.
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我们相信这种透明可以治疗恐惧。
08:21
I thought some doctors医生 would sign标志 on
and others其他 wouldn't不会,
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我当时认为一些医生
会签下这份协议, 一些不会,
08:24
but I had no idea理念 of the huge巨大 backlash反弹
that would ensue接踵而至.
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但是我不知道接下来
会产生这么大的反对意见。
08:29
Within one week of starting开始
Who's谁是 My Doctor医生?
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在这项活动开始的一周内
08:31
Medscape'sMedscape表示的 public上市 forum论坛
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知名医学网站医景的公共论坛
08:33
and several一些 online线上 doctors'医生 communities社区
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和一些网上医生社区
08:35
had thousands数千 of posts帖子 about this topic话题.
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有了上千个关于这个话题的帖子。
08:39
Here are a few少数.
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这里有一些
08:40
From a gastroenterologist肠胃病 in Portland波特兰:
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来自于波特兰的一个胃肠病专家:
08:42
"I devoted忠诚 12 years年份 of my life
to being存在 a slave奴隶.
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"我奉献了我生命中的12年去成为一个奴隶,
08:45
I have loans贷款 and mortgages抵押贷款.
190
513760
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我有贷款和抵押贷款,
08:47
I depend依靠 on lunches午餐 from
drug药物 companies公司 to serve服务 patients耐心."
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我依靠制药公司给的饭碗去给患者服务。“
08:51
Well, times may可能 be hard for everyone大家,
192
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这个时代对于每一个人都是困难的,
08:54
but try telling告诉 your patient患者
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但是尝试去告诉你的患者
08:55
making制造 35,000 dollars美元 a year
to serve服务 a family家庭 of four
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一年赚35,000美金去养活一家四口
08:58
that you need the free自由 lunch午餐.
195
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使你需要这个免费午餐。
09:02
From an orthopedic骨科 surgeon外科医生 in Charlotte夏洛特:
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这个是来自夏洛特的一名矫形外科医生:
09:05
"I find it an invasion侵入 of my privacy隐私
to disclose透露 where my income收入 comes from.
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“我认为公开我的收入来源
是一种对我隐私的侵犯,
09:09
My patients耐心 don't disclose透露
their incomes收入 to me."
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我的病人也不向我公开他们的收入情况。“
09:13
But your patients'耐心' sources来源 of income收入
don't affect影响 your health健康.
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但是你病人的收入来源不影响你的健康。
09:17
From a psychiatrist心理医生 in New York纽约 City:
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这个是来自一名纽约的精神科的医生:
09:19
"Pretty漂亮 soon不久 we will have to disclose透露
whether是否 we prefer比较喜欢 cats to dogs小狗,
201
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"不久之后我们将不得不公开
我们是否喜欢喜欢猫比狗多一点,
09:23
what model模型 of car汽车 we drive驾驶,
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我们开什么类型的车,
09:24
and what toilet厕所 paper we use."
203
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我们用什么厕纸。“
09:27
Well, how you feel
about Toyotas丰田 or CottonelleCottonelle
204
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你的丰田汽车和斯科特纸的看法
09:30
won't惯于 affect影响 your patients'耐心' health健康,
205
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不会影响你的病人的健康,
09:32
but your views意见
on a woman's女人的 right to choose选择
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但是你对女性权利的选择,
09:34
and preventive预防 medicine医学
and end-of-life生命尽头 decisions决定 just might威力.
207
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预防医学和临终决定的看法是可能的。
09:38
And my favorite喜爱,
from a Kansas堪萨斯 City cardiologist心脏病:
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还有我最喜欢的一条,
来自于堪萨斯城的心脏科医生:
09:41
"More government-mandated政府规定 stuff东东?
209
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“更多国家指定的医生?
09:44
Dr博士. Wen温家宝 needs需求 to move移动
back to her own拥有 country国家."
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文医生需要搬回自己的国家。“
这有两条好消息,
09:48
Well, two pieces of good news新闻.
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09:50
First of all, this is meant意味着 to be
voluntary自主性 and not mandatory强制性,
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第一, 这应该是自愿的而不是强制的,
09:53
and second第二 of all, I'm American美国
and I'm already已经 here.
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第二, 我是美国人, 而且我已经在这了。
09:57
(Laughter笑声) (Applause掌声)
214
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(掌声)
10:05
Within a month, my employers雇主
were getting得到 calls电话
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一个月之内, 我的雇主接到过几通电话
10:08
asking for me to be fired解雇.
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要求解雇我。
10:10
I received收到 mail邮件
at my undisclosed未公开 home address地址
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在我的一个私人的居所里, 收到了一封邮件
10:13
with threats威胁 to contact联系
the medical board to sanction制裁 me.
218
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威胁说要去联系医委会制裁我,
10:17
My friends朋友 and family家庭 urged敦促 me
to quit放弃 this campaign运动.
219
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我的朋友和家庭强烈要求我
从这个活动里退出,
10:21
After the bomb炸弹 threat威胁, I was doneDONE.
220
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在收到炸弹威胁后, 我受够了。
10:24
But then I heard听说 from patients耐心.
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但是然后我从患者那里听说,
10:26
Over social社会 media媒体, a TweetChatTweetChat,
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基于大众评价, Tweetchat,
10:29
which哪一个 I'd learned学到了 what that was by then,
223
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是我在当时用的社交工具,
10:31
generated产生 4.3 million百万 impressions印象,
224
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已经产生了430万的留言,
10:34
and thousands数千 of people wrote
to encourage鼓励 me to continue继续.
225
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上千人留言鼓励我继续。
10:38
They wrote with things like,
226
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他们写下一些如,
10:40
"If doctors医生 are doing something
they're that ashamed羞愧 of,
227
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“如果医生做了一些让他们感到羞愧的事情,
10:43
they shouldn't不能 be doing it."
228
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他们就不应该那样做。“
10:46
"Elected当选 officials官员 have to disclose透露
campaign运动 contributions捐款.
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“当选官员在公开他们的竞选资金来源,
10:49
Lawyers律师 have to disclose透露
conflicts冲突 of interests利益.
230
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律师在公开他们的经济利益冲突的情况下,
10:51
Why shouldn't不能 doctors医生?"
231
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医生怎么就不能公开了?“
10:53
And finally最后, many许多 people wrote and said,
232
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最后, 许多人留言说,
10:56
"Let us patients耐心 decide决定
233
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“让我们患者决定
10:58
what's important重要
when we're choosing选择 a doctor医生."
234
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当我们选一个医生的时候,什么才是重要的。”
11:02
In our initial初始 trial审讯,
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在我们初期的实验里,
11:03
over 300 doctors医生 have taken采取
the total transparency透明度 pledge保证.
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超过300个医生参与了这个透明承诺。
多么疯狂的想法, 对吗?
11:08
What a crazy new idea理念, right?
237
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11:10
But actually其实, this is not
that new of a concept概念 at all.
238
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但是事实上, 这一点都不算是新的概念。
11:13
Remember记得 Dr博士. Sam山姆, my doctor医生 in China中国,
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记得山姆医生,
11:15
with the goofy高飞 jokes笑话 and the wild野生 hair头发?
240
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那个会讲傻傻的笑话和
狂野的头发的中国医生吗?
11:18
Well, she was my doctor医生,
241
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她曾是我的医生,
11:19
but she was also our neighbor邻居
242
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但是她同时也是
11:21
who lived生活 in the building建造
across横过 the street.
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住在街对面的邻居。
11:23
I went to the same相同 school学校 as her daughter女儿.
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我和她的女儿去的同一所学校,
11:26
My parents父母 and I trusted信任 her
245
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我的父母和我相信她
11:28
because we knew知道 who she was
and what she stood站在 for,
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因为我们知道她是怎样的一个人
和她的信仰是什么,
11:30
and she had no need to hide隐藏 from us.
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她不需要向我们隐藏什么。
11:33
Just one generation ago,
this was the norm规范 in the U.S. as well.
248
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仅仅这一代之前, 这在美国也是常态。
11:37
You knew知道 that your family家庭 doctor医生
was the father父亲 of two teenage青少年 boys男孩,
249
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你知道你的家庭医生
是两个十几岁男孩的父亲,
11:40
that he quit放弃 smoking抽烟 a few少数 years年份 ago,
250
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1845
他几年前把烟戒掉了,
11:42
that he says he's a regular定期 churchgoer礼拜的,
251
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1991
经常去做礼拜,
11:44
but you see him twice两次 a year:
once一旦 at Easter复活节
252
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但是你见他一年两次: 要么是在复活节
11:46
and once一旦 when his mother-in-law岳母
comes to town.
253
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要么就是他的岳母到访的时候。
11:50
You knew知道 what he was about,
254
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你知道关于他的事情,
11:51
and he had no need to hide隐藏 from you.
255
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他不需要向你隐藏什么。
11:54
But the sickness疾病 of fear恐惧 has taken采取 over,
256
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但是现在已经恐惧占据了,
11:57
and patients耐心 suffer遭受 the consequences后果.
257
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患者为其承担后果。
11:59
I know this firsthand第一手.
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我亲身经历过的。
12:02
My mother母亲 fought战斗
her cancer癌症 for eight years年份.
259
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我的妈妈和癌症做了八年的斗争,
12:05
She was a planner规划人员,
260
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1143
她是一个有计划的人,
12:06
and she thought a lot
about how she wanted to live生活
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她想了很多关于她想如何活
12:08
and how she wanted to die.
262
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和她想如何死去。
12:10
Not only did she sign标志 advance提前 directives指令,
263
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她不仅签了预留医疗指示协议,
12:13
she wrote a 12-page-页 document文件
about how she had suffered遭遇 enough足够,
264
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而且她写下了12页,
关于她遭受的是怎样的痛苦,
12:16
how it was time for her to go.
265
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是时候让她走了。
12:19
One day, when I was a resident居民 physician医师,
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一天, 当我是一名住院医师的时候,
12:21
I got a call to say that she was
in the intensive集约 care关心 unit单元.
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我接到电话说她在特护病房。
12:25
By the time I got there,
she was about to be intubated插管
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我到那儿时, 她正要被插管
12:29
and put on a breathing呼吸 machine.
269
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装上呼吸机。
12:31
"But this is not what she wants,"
I said, "and we have documents文件."
270
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“但是这不是她想要的,“
我说, “我们有协议的。“
重症加护病房的医生看着我的眼睛,
12:36
The ICUICU doctor医生 looked看着 at me in the eye,
271
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12:38
pointed at my then 16-year-old-岁
sister妹妹, and said,
272
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指着我16岁的妹妹说,
12:43
"Do you remember记得 when you were that age年龄?
273
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“你记得当你是这个年纪的时候吗?
12:45
How would you have liked喜欢 to grow增长 up
without your mother母亲?"
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你会想要没有妈妈陪在你身边吗?“
12:49
Her oncologist肿瘤科医生 was there too, and said,
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她的肿瘤医生也在那里对我说,
12:52
"This is your mother母亲.
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“这是你的妈妈。
12:54
Can you really face面对 yourself你自己
for the rest休息 of your life
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在你接下去的日子里, 你真的能面对你自己
12:56
if you don't do everything for her?"
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如果你没有为她尽全力?“
13:00
I knew知道 my mother母亲 so well.
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我非常了解我的妈妈。
13:02
I understood了解 what
her directives指令 meant意味着 so well,
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我明白她签的协议是什么,
13:05
but I was a physician医师.
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但是我也是一名医生。
13:09
That was the single hardest最难
decision决定 I ever made制作,
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这曾是我人生当中做的一个最难的决定:
13:13
to let her die in peace和平,
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让她在平静地死去,
13:16
and I carry携带 those words
of those doctors医生 with me
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我每一天都在想
13:19
every一切 single day.
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这些医生的话
13:23
We can bridge the disconnect断开
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我们能在患者需求和医生之间
13:25
between之间 what doctors医生 do
and what patients耐心 need.
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的这种隔阂搭建桥梁。
13:30
We can get there,
because we've我们已经 been there before,
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我们可以做到, 因为之前我们做到过,
13:32
and we know that transparency透明度
gets得到 us to that trust相信.
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我们知道这种透明让我们得到信任。
13:35
Research研究 has shown显示 us
that openness透明度 also helps帮助 doctors医生,
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研究已经表明公开也可以帮助医生,
13:38
that having open打开 medical records记录,
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有一个公开的的病历,
13:39
being存在 willing愿意 to talk
about medical errors错误,
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就会愿意去讨论医疗差错,
13:41
will increase增加 patient患者 trust相信,
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这将增加患者的信任
13:43
improve提高 health健康 outcomes结果,
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改善健康结果,
13:45
and reduce减少 malpractice弊端.
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减少治疗不当。
13:47
That openness透明度, that trust相信,
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公开, 信任,
13:48
is only going to be more important重要
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只会变得更加重要,
13:50
as we move移动 from the infectious传染病
to the behavioral行为的 model模型 of disease疾病.
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因为我们关注的是疾病的行为模式,
而不是它的传染模式。
13:54
Bacteria may可能 not care关心 so much
about trust相信 and intimacy亲密关系,
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822013
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细菌可能不关心信任和亲密
13:57
but for people to tackle滑车
the hard lifestyle生活方式 choices选择,
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3943
但是为了帮助患者彻底改变他们不良生活嗜好,
14:01
to address地址 issues问题 like smoking抽烟 cessation戒烟,
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为了让患者戒烟,
14:03
blood-pressure血压 management管理
and diabetes糖尿病 control控制,
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831728
3037
为了让患者控制血压,控制血糖,
14:06
well, that requires要求 us to establish建立 trust相信.
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这些都要求我们去建立医患信任感。
14:11
Here's这里的 what other transparent透明
doctors医生 have said.
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839003
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以下是其他参与透明活动的医生说的。
14:13
Brandon布兰登 Combs库姆斯, an internist内科医生 in Denver丹佛:
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841873
2917
布兰登∙库姆斯, 在丹佛的内科医生:
14:16
"This has brought me
closer接近 to my patients耐心.
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“这让我和我的患者亲近。
14:19
The type类型 of relationship关系 I've developed发达
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这种我一直以来建立起来的
医患关系恰恰就是
14:22
that's why I entered进入 medicine医学."
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850547
2015
为什么当初我行医的原因。“
14:26
Aaron亚伦 StuppleStupple, an internist内科医生 in Denver丹佛:
309
854117
2673
亚伦, 丹佛的一名内科医生
14:28
"I tell my patients耐心
that I am totally完全 open打开 with them.
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我告诉我的患者们,我对他们完全公开。
14:32
I don't hide隐藏 anything from them.
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我不向他们隐藏任何什么。
14:34
This is me. Now tell me about you.
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862360
2926
这就是我, 你呢。
14:37
We're in this together一起."
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865286
2232
我们同心协力。“
14:39
May可能 Nguyen, a family家庭 physician医师 in Houston休斯顿:
314
867518
2402
五月阮, 休斯顿的一名家庭医生:
14:41
"My colleagues同事 are astounded震惊
by what I'm doing.
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4078
"我的同事对于我在做什么都很震惊。
14:45
They ask me how I could be so brave勇敢.
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2586
他们问我, 我怎么这么勇敢。
14:48
I said, I'm not being存在 brave勇敢,
317
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2888
我说, 这不是勇敢,
14:51
it's my job工作."
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1389
这是我的工作。"
14:55
I leave离开 you today今天 with a final最后 thought.
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2194
今天我留给你们最后一个思考。
14:58
Being存在 totally完全 transparent透明 is scary害怕.
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3304
成为完全透明是令人害怕的,
15:01
You feel naked, exposed裸露 and vulnerable弱势,
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3330
你感觉很不安, 脆弱,
15:05
but that vulnerability漏洞, that humility谦逊,
322
893102
3638
但是那些脆弱, 谦卑,
15:08
it can be an extraordinary非凡 benefit效益
to the practice实践 of medicine医学.
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4516
对于我们行医来说,
会带来非同凡响的益处。
15:13
When doctors医生 are willing愿意
to step off our pedestals基座,
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901256
2408
当医生愿意放下架子,
15:15
take off our white白色 coats大衣,
325
903664
1476
脱下白大褂,
15:17
and show显示 our patients耐心 who we are
and what medicine医学 is all about,
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905140
3381
向我们的患者展示我们是谁
和医学是关于什么的,
15:20
that's when we begin开始
to overcome克服 the sickness疾病 of fear恐惧.
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那就是我们开始去克服恐惧的时候,
15:23
That's when we establish建立 trust相信.
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1929
那就是我们建立信任的时候,
15:25
That's when we change更改
the paradigm范例 of medicine医学
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2460
那就是我们改变医学模式
15:28
from one of secrecy保密 and hiding
330
916175
1810
从秘密和隐藏
15:29
to one that is fully充分 open打开 and engaged订婚
331
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2359
到完全开放
15:32
for our patients耐心.
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920344
1374
并参与我们的患者中去。
15:35
Thank you.
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谢谢。
(掌声)
15:36
(Applause掌声)
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4000
Translated by Chenyang Lin
Reviewed by Yulan Zhang

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ABOUT THE SPEAKER
Leana Wen - Emergency physician, public health advocate
Dr. Leana Wen is Baltimore City's Health Commissioner.

Why you should listen

Dr. Leana Wen is the Baltimore City Health Commissioner. A physician and public health advocate, she has traveled the world listening to patients’ stories. Born in Shanghai, she was a Rhodes Scholar at Oxford, a reporter with The New York Times’ Nick Kristof, a fellow at the World Health Organization and the Director of Patient-Centered Care Research in the Department of Emergency Medicine at George Washington University.

Inspired by struggles during her mother’s long illness, she wrote When Doctors Don't Listen, a book about empowering patients to avoid misdiagnoses and unnecessary tests.

As an outspoken leader among a new generation of physicians, she served as President of the American Medical Student Association and as Chair of the International Young Professionals Commission. She also helped create Who’s My Doctor, a campaign for radical transparency in medicine. Read her own transparency statement, and find more resources on TEDMED.

In October 2015, she wrote a blanket prescription, or "standing order," in Baltimore City which covers anyone trained to administer naloxone, a medication that reverses the effects of drug overdoses. Under the order, medication will be available on demand to everyone with the proper training to use it, potentially saving many lifes that might have been lost to overdoses.

More profile about the speaker
Leana Wen | Speaker | TED.com