ABOUT THE SPEAKER
Brian Goldman - Physician, broadcaster
Brian Goldman is an emergency-room physician in Toronto, and the host of CBC Radio’s "White Coat, Black Art."

Why you should listen

Brian Goldman is an emergency room physician who has worked at Mount Sinai Hospital in downtown Toronto for more than 20 years. He is also a prominent medical journalist and the host of CBC Radio’s White Coat, Black Art. In Dr. Goldman’s first book, The Night Shift, published in 2010, he shares his experiences of working through the witching hours at Mount Sinai, as well as at the other hospitals where he has spent his long career.

More profile about the speaker
Brian Goldman | Speaker | TED.com
TEDxToronto 2010

Brian Goldman: Doctors make mistakes. Can we talk about that?

Brian Goldman: 醫生犯錯了,我們能說嗎?

Filmed:
1,589,793 views

每位醫生都會犯錯。但是醫生Brian Goldman說,醫界的文化拒絕(或羞於)談論那些錯誤,或是從錯誤中學習和改正。從他個人長期的經驗中,他呼籲醫生們開始從錯誤中學習。
- Physician, broadcaster
Brian Goldman is an emergency-room physician in Toronto, and the host of CBC Radio’s "White Coat, Black Art." Full bio

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

00:15
I think we have to do something
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我想我們該做些事
00:17
about a piece of the culture文化 of medicine醫學 that has to change更改.
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去改變醫界一部份的文化
00:20
And I think it starts啟動 with one physician醫師, and that's me.
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我想該從一位醫生開始,就是我。
00:23
And maybe I've been around long enough足夠
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我想我在這一行夠久了
00:25
that I can afford給予 to give away some of my false prestige聲望
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我承受得了失去一些虛名
00:27
to be able能夠 to do that.
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來做這樣的改變。
00:29
Before I actually其實 begin開始 the meat of my talk,
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在我開始進入主題之前
00:31
let's begin開始 with a bit of baseball棒球.
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我們來談點棒球。
00:33
Hey, why not?
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嗯! 有何不可?
00:35
We're near the end結束, we're getting得到 close to the World世界 Series系列.
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球季就快結束,就要打到世界大賽了。
00:38
We all love baseball棒球, don't we?
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我們都愛棒球,不是嗎?
00:41
(Laughter笑聲)
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(笑聲)
00:43
Baseball棒球 is filled填充 with some amazing驚人 statistics統計.
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棒球有許多驚人的統計數據
00:46
And there's hundreds數以百計 of them.
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有上百個
00:49
"Moneyball點球成金" is about to come out, and it's all about statistics統計
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電影《魔球》就要上映,裡頭都在講統計數據
00:52
and using運用 statistics統計 to build建立 a great baseball棒球 team球隊.
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和如何用統計數據來組成一隊棒球隊。
00:54
I'm going to focus焦點 on one stat統計
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我要來談其中一項數據
00:57
that I hope希望 a lot of you have heard聽說 of.
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我希望在座有許多人聽過。
00:59
It's called batting棉絮 average平均.
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叫做打擊率。
01:01
So we talk about a 300, a batter麵糊 who bats蝙蝠 300.
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我們說打擊率有三成的打者。
01:04
That means手段 that ballplayer球壇 batted擊中的 safely安然, hit擊中 safely安然
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是指這位打者,打擊很穩定
01:08
three times out of 10 at bats蝙蝠.
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每十次就有三次會打安打。
01:11
That means手段 hit擊中 the ball into the outfield外場,
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能把球打去外野
01:13
it dropped下降, it didn't get caught抓住,
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球會落在外野,不會被接殺
01:15
and whoever tried試著 to throw it to first base基礎 didn't get there in time
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不管誰試著要把球傳往一壘也來不及刺殺
01:18
and the runner跑步者 was safe安全.
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跑者會安全上壘。
01:20
Three times out of 10.
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每十次中有三次可以打安打。
01:23
Do you know what they call a 300 hitter打者
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各位知道在大聯盟裡
01:26
in Major重大的 League聯盟 Baseball棒球?
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怎麼說這些打擊率三成的打者
01:28
Good, really good,
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好,真的很好。
01:31
maybe an all-star全明星.
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可以說是明星球員。
01:34
Do you know what they call
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各位知道他們又是如何稱呼
01:36
a 400 baseball棒球 hitter打者?
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一位打擊率四成的打者嗎?
01:38
That's somebody who hit擊中, by the way,
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也就是一位每十次打擊
01:40
four times safely安然 out of every一切 10.
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就有四次打出安打的打者。
01:42
Legendary傳奇的 --
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是傳奇
01:45
as in Ted攤曬 Williams威廉姆斯 legendary傳奇的 --
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是像Ted Williams那樣的傳奇
01:47
the last Major重大的 League聯盟 Baseball棒球 player播放機
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他是在球季大聯盟賽中最新傳奇球員,
01:49
to hit擊中 over 400 during a regular定期 season季節.
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擁有超過四成打擊率的打者
01:52
Now let's take this back into my world世界 of medicine醫學
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現在回來談我的世界--醫療領域。
01:54
where I'm a lot more comfortable自在,
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這個主題我比較在行,
01:56
or perhaps也許 a bit less comfortable自在
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但可能也有點困擾
01:58
after what I'm going to talk to you about.
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特別是在我的演說之後。
02:01
Suppose假設 you have appendicitis闌尾炎
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假設各位得了盲腸炎
02:03
and you're referred簡稱 to a surgeon外科醫生
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而且交由一位執行盲腸炎手術
02:05
who's誰是 batting棉絮 400 on appendectomies闌尾切除術.
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有四成成功率的外科醫生。
02:07
(Laughter笑聲)
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(笑聲)
02:10
Somehow不知何故 this isn't working加工 out, is it?
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這聽起來不太行,對吧?
02:13
Now suppose假設 you live生活
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現在假設你住在
02:15
in a certain某些 part部分 of a certain某些 remote遠程 place地點
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一個特定的偏遠地區
02:18
and you have a loved喜愛 one
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你所鍾愛的人
02:20
who has blockages堵塞 in two coronary冠狀動脈 arteries動脈
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她的兩條冠狀動脈都有堵塞
02:23
and your family家庭 doctor醫生 refers that loved喜愛 one to a cardiologist心髒病
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你的家庭醫師將你所鐘愛的人引介給一位心臟科醫師
02:26
who's誰是 batting棉絮 200 on angioplasties成形術.
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該醫師在心血管手術上有兩成的成功率。
02:30
But, but, you know what?
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但是,等等 你知道嗎?
02:32
She's doing a lot better this year. She's on the comeback回來 trail落後.
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她今年的成功率提高,她的水準又回來了。
02:34
And she's hitting a 257.
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她有兩成五七的成功率。
02:37
Somehow不知何故 this isn't working加工.
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但是這樣還是不能被接受。
02:39
But I'm going to ask you a question.
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我現在要問各位一個問題
02:41
What do you think a batting棉絮 average平均
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各位認為所謂的"成功率"
02:43
for a cardiac心臟的 surgeon外科醫生 or a nurse護士 practitioner從業者
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對一位心臟外科醫生或是職業護士
02:45
or an orthopedic骨科 surgeon外科醫生,
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或是整形外科醫生
02:47
an OBGYN婦產科, a paramedic護理人員
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一位婦產科醫生,或一位合格的醫護人員
02:49
is supposed應該 to be?
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應該是多少?
02:52
1,000, very good.
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十成,很好.。
02:55
Now truth真相 of the matter is,
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但事實上,
02:57
nobody沒有人 knows知道 in all of medicine醫學
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沒有人知道在醫界
02:59
what a good surgeon外科醫生
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一位好的外科醫生
03:01
or physician醫師 or paramedic護理人員
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一位醫生,或護理人員
03:03
is supposed應該 to bat蝙蝠.
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應該"成功率"是多少.。
03:05
What we do though雖然 is we send發送 each one of them, including包含 myself,
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而我們所做的是,讓他們每一位,包括我自己
03:07
out into the world世界
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在世人眼前
03:09
with the admonition警告, be perfect完善.
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是訓練有素的,是完美的。
03:11
Never ever, ever make a mistake錯誤,
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從不會犯錯的.。
03:13
but you worry擔心 about the details細節, about how that's going to happen發生.
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但你還是會擔心,這是如何達成。
03:16
And that was the message信息 that I absorbed吸收
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這是我在醫學院時
03:18
when I was in medMED school學校.
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所得到的訊息。
03:20
I was an obsessive強迫症 compulsive強迫 student學生.
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我是一位有學習強迫症的學生
03:23
In high school學校, a classmate同學 once一旦 said
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在高中時,曾有同學說
03:26
that Brian布賴恩 Goldman高盛 would study研究 for a blood血液 test測試.
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我會去學習血液檢驗學
03:28
(Laughter笑聲)
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(笑聲)
03:31
And so I did.
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我的確去學了。
03:33
And I studied研究 in my little garret閣樓
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我在多倫多總醫院
03:35
at the nurses'護士 residence住宅 at Toronto多倫多 General一般 Hospital醫院,
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護士宿舍的小閣樓學習
03:37
not far from here.
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離這裡不遠。
03:39
And I memorized記憶 everything.
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我強記每一件事
03:41
I memorized記憶 in my anatomy解剖學 class
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我背下解剖課時
03:43
the origins起源 and exertions賣力 of every一切 muscle肌肉,
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每一塊肌肉的來源,伸展方式
03:45
every一切 branch of every一切 artery動脈 that came來了 off the aorta大動脈,
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每一條從主動脈延伸出來的小動脈和分支系統
03:48
differential微分 diagnoses診斷 obscure朦朧 and common共同.
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細分診斷上的隱蔽症狀,和通常症狀。
03:51
I even knew知道 the differential微分 diagnosis診斷
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我甚至知道鑑別診斷上
03:53
in how to classify分類 renal tubular管狀的 acidosis酸中毒.
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要如何區分不同的腎小管酸中毒症
03:55
And all the while,
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這段時間
03:57
I was amassing再再 more and more knowledge知識.
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我累積越來越多知識。
03:59
And I did well, I graduated畢業 with honors榮譽,
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我表現良好,高分畢業
04:01
cum附帶 laude以優異成績.
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拿到優等。
04:03
And I came來了 out of medical school學校
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我從醫學院畢業
04:06
with the impression印象
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以為如果
04:08
that if I memorized記憶 everything and knew知道 everything,
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我記得每件事,知道每件事
04:10
or as much as possible可能,
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或幾乎記得所有全部的事,
04:12
as close to everything as possible可能,
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還有跟每件事情有關的也都記得,
04:14
that it would immunize免疫 me against反對 making製造 mistakes錯誤.
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那我犯醫療錯誤機會就微乎其微。
04:17
And it worked工作
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有好一段時間
04:19
for a while,
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我的確沒有犯任何錯
04:22
until直到 I met會見 Mrs太太. Drucker德魯克.
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直到我遇見Drucker女士。
04:25
I was a resident居民 at a teaching教學 hospital醫院 here in Toronto多倫多
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我當時是多倫多一間教學醫院的住院醫生
04:27
when Mrs太太. Drucker德魯克 was brought to the emergency department
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當Drucker女士被送來
04:30
of the hospital醫院 where I was working加工.
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我所工作醫院的急診室時。
04:32
At the time I was assigned分配 to the cardiology心髒病 service服務
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當時我在心臟科的輪調時
04:34
on a cardiology心髒病 rotation迴轉.
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被分配到心臟門診
04:36
And it was my job工作,
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我的工作是
04:38
when the emergency staff員工 called for a cardiology心髒病 consult請教,
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當急診室人員尋求心臟科的諮詢時
04:40
to see that patient患者 in emergEMERG.
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去急診室診斷病人
04:43
and to report報告 back to my attending出席.
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再回來報告給我的主治。
04:45
And I saw Mrs太太. Drucker德魯克, and she was breathless咋舌.
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我見到Drucker女士,她當時呼吸困難
04:48
And when I listened聽了 to her, she was making製造 a wheezy喘息 sound聲音.
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當我跟她交談時,聽到她有喘息的聲音。
04:51
And when I listened聽了 to her chest胸部 with a stethoscope聽筒,
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當我用聽診器聽她的胸腔時
04:53
I could hear cracklycrackly sounds聲音 on both sides雙方
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我可以聽到兩邊都傳來爆裂的聲音
04:55
that told me that she was in congestive充血性 heart failure失敗.
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這告訴我, 這是充血性心臟衰竭。
04:58
This is a condition條件 in which哪一個 the heart fails失敗,
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這是造成心臟衰竭的原因之一
05:01
and instead代替 of being存在 able能夠 to pump all the blood血液 forward前鋒,
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心臟不能將血液往前輸送
05:03
some of the blood血液 backs up into the lung, the lungs fill up with blood血液,
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有部分的血液流回肺臟,肺裡充滿的血液,
05:06
and that's why you have shortness短小 of breath呼吸.
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這也是造成呼吸短促的原因。
05:08
And that wasn't a difficult diagnosis診斷 to make.
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這在診斷上並不困難。
05:11
I made製作 it and I set to work treating治療 her.
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我做了診斷,安排治療。
05:14
I gave her aspirin阿司匹林. I gave her medications藥物治療 to relieve緩解 the strain應變 on her heart.
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我開了阿斯匹靈和一些藥物來減輕她心臟的收縮。
05:17
I gave her medications藥物治療 that we call diuretics利尿劑, water pills,
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我給她的藥物,是我們稱之為利尿劑,水丸
05:20
to get her to pee撒尿 out the access訪問 fluid流體.
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幫助她將多餘的水分排出。
05:23
And over the course課程 of the next下一個 hour小時 and a half or two,
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接下來的一個半小時​​或兩小時
05:25
she started開始 to feel better.
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她開始覺得好轉。
05:27
And I felt really good.
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我也感到高興。
05:30
And that's when I made製作 my first mistake錯誤;
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但那時我開始犯第一個錯
05:33
I sent發送 her home.
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我讓她回家。
05:35
Actually其實, I made製作 two more mistakes錯誤.
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事實上,我犯了兩個錯。
05:38
I sent發送 her home
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我讓她回家前
05:40
without speaking請講 to my attending出席.
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沒有告知我的上級主治醫生。
05:42
I didn't pick up the phone電話 and do what I was supposed應該 to do,
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我甚至沒有把電話機拿起,做我應該做的事
05:45
which哪一個 was call my attending出席 and run the story故事 by him
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就是打電話給主治醫生,報告整件事情。
05:47
so he would have a chance機會 to see her for himself他自己.
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他原本有機會親自前來診斷。
05:50
And he knew知道 her,
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主治認識她,
05:52
he would have been able能夠 to furnish裝設 additional額外 information信息 about her.
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他可以提供更詳細的病情資料。
05:55
Maybe I did it for a good reason原因.
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也許我有我的理由。
05:57
Maybe I didn't want to be a high-maintenance高維護 resident居民.
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也許我不想成為一位老是被指導的住院醫生。
06:00
Maybe I wanted to be so successful成功
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也許我太想成功
06:02
and so able能夠 to take responsibility責任
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想證明我是可以獨當一面的
06:04
that I would do so
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我可以做,
06:06
and I would be able能夠 to take care關心 of my attending's主治的 patients耐心
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我有能力照護主治醫生的病人,
06:08
without even having to contact聯繫 him.
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而且不需要聯繫他。
06:10
The second第二 mistake錯誤 that I made製作 was worse更差.
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但第二個錯誤是更嚴重的。
06:14
In sending發出 her home,
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讓她出院回家,
06:16
I disregarded忽視 a little voice語音 deep down inside
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我忽視心裡一個很小的聲音
06:18
that was trying to tell me,
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這個聲音試圖告訴我,
06:20
"Goldman高盛, not a good idea理念. Don't do this."
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「Goldman,這樣不對,別這麼做」。
06:23
In fact事實, so lacking不足 in confidence置信度 was I
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事實上,我當時沒什麼自信,
06:26
that I actually其實 asked the nurse護士
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所以我詢問了
06:28
who was looking after Mrs太太. Drucker德魯克,
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看顧Drucker女士的護士。
06:30
"Do you think it's okay if she goes home?"
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「你覺得她回家好嗎?」
06:33
And the nurse護士 thought about it
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然後護士想了一下,
06:35
and said very matter-of-factly物質實事求是地, "Yeah, I think she'll貝殼 do okay."
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就事論事地說「嗯,我想她可以的。」
06:37
I can remember記得 that like it was yesterday昨天.
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在我記憶裡, 那就像是昨天發生的事。
06:40
So I signed the discharge卸貨 papers文件,
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所以我簽了出院文件
06:42
and an ambulance救護車 came來了, paramedics醫護人員 came來了 to take her home.
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救護車來了,醫務人員帶她回家。
06:45
And I went back to my work on the wards病房.
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我回到我的工作崗位。
06:48
All the rest休息 of that day,
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之後的那一整天。
06:50
that afternoon下午,
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那個下午
06:52
I had this kind of gnawing feeling感覺 inside my stomach.
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我一直被惱人的情緒干擾。
06:55
But I carried攜帶的 on with my work.
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但我還是繼續工作。
06:58
And at the end結束 of the day, I packed打包 up to leave離開 the hospital醫院
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那天結束,我收拾東西離開醫院
07:00
and walked to the parking停車處 lot
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然後走到停車場
07:02
to take my car汽車 and drive駕駛 home
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取車回家
07:04
when I did something that I don't usually平時 do.
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當時我做了一件我平常不會做的事。
07:08
I walked through通過 the emergency department on my way home.
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我穿越急診室去停車場
07:11
And it was there that another另一個 nurse護士,
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那裡有另一位護士,
07:13
not the nurse護士 who was looking after Mrs太太. Drucker德魯克 before, but another另一個 nurse護士,
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不是原先那位看顧Druker女士的那位,是另一位
07:16
said three words to me
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她告訴我三個字
07:19
that are the three words
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就這三個字
07:21
that most emergency physicians醫師 I know dread恐懼.
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大部分我認識的急診室醫生都害怕。
07:24
Others其他 in medicine醫學 dread恐懼 them as well,
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其他醫界的人也害怕,
07:26
but there's something particular特定 about emergency medicine醫學
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但對急診醫學來說這件事比較特別
07:28
because we see patients耐心 so fleetingly稍縱即逝.
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因為我們看診的病人來去匆匆。
07:32
The three words are:
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那三個字是
07:34
Do you remember記得?
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"記得嗎?"
07:38
"Do you remember記得 that patient患者 you sent發送 home?"
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"你記得你讓她出院的那病人嗎?"
07:41
the other nurse護士 asked matter-of-factly物質實事求是地.
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那位護士就事論事地說
07:43
"Well she's back,"
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「她又回來了」
07:45
in just that tone of voice語音.
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用那種就事論事的聲調。
07:47
Well she was back all right.
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好吧,她回來了
07:49
She was back and near death死亡.
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她回來,而且差點過世
07:52
About an hour小時 after she had arrived到達 home,
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我讓她回家後
07:54
after I'd sent發送 her home,
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到家後的一小時
07:56
she collapsed倒塌 and her family家庭 called 911
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她昏倒了,她家人打緊急電話求救
07:59
and the paramedics醫護人員 brought her back to the emergency department
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然後救護人員把她送回急診室
08:01
where she had a blood血液 pressure壓力 of 50,
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當時她的血壓只有50
08:03
which哪一個 is in severe嚴重 shock休克.
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嚴重休克
08:05
And she was barely僅僅 breathing呼吸 and she was blue藍色.
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她幾乎沒有呼吸,臉色發青。
08:08
And the emergEMERG. staff員工 pulled out all the stops停止.
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然後急診室人員使出渾身解數
08:11
They gave her medications藥物治療 to raise提高 her blood血液 pressure壓力.
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要使她血壓恢復。
08:14
They put her on a ventilator換氣扇.
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他們讓她戴上呼吸器。
08:16
And I was shocked吃驚
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我震驚不已
08:19
and shaken動搖 to the core核心.
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我嚇得不得了。
08:21
And I went through通過 this roller滾筒 coaster杯墊,
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我像坐上雲霄飛車
08:23
because after they stabilized穩定 her,
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因為後來他們穩住了她的病情
08:25
she went to the intensive集約 care關心 unit單元,
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她被送到加護病房
08:27
and I hoped希望 against反對 hope希望 that she would recover恢復.
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但我希望她有機會好轉。
08:29
And over the next下一個 two or three days,
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在接下來的兩三天
08:31
it was clear明確 that she was never going to wake喚醒 up.
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很明顯地她再也不會醒來。
08:33
She had irreversible不可逆轉 brain damage損傷.
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她的腦部受損已經不會好轉。
08:36
And the family家庭 gathered雲集.
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她的家人聚在一起
08:38
And over the course課程 of the next下一個 eight or nine days,
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在之後八九天的治療期間
08:41
they resigned辭職 themselves他們自己 to what was happening事件.
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他們接受了這件事實。
08:43
And at about the nine day mark標記, they let her go --
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九天後,他們放棄治療,讓她離開人間
08:46
Mrs太太. Drucker德魯克,
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Druker女士,
08:48
a wife妻子, a mother母親
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一位妻子,一位母親
08:50
and a grandmother祖母.
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也是一位祖母。
08:53
They say you never forget忘記 the names
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他們說你會永遠忘不了
08:55
of those who die.
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那些(因你疏忽而死的)名字
08:57
And that was my first time to be acquainted熟悉 with that.
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那是我第一次意識到。
09:00
Over the next下一個 few少數 weeks,
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在接下來的幾週,
09:02
I beat擊敗 myself up
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我非常自責。
09:05
and I experienced有經驗的 for the first time
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我也第一次經歷了
09:07
the unhealthy不良 shame恥辱 that exists存在
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那種不健康的羞愧
09:09
in our culture文化 of medicine醫學 --
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存在於我們醫界的文化中--
09:11
where I felt alone單獨, isolated孤立,
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在那兒我感到孤單無助
09:14
not feeling感覺 the healthy健康 kind of shame恥辱 that you feel,
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不是像各位會感受到的那種的羞愧
09:16
because you can't talk about it with your colleagues同事.
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因為你沒辦法和你的同事訴說。
09:18
You know that healthy健康 kind,
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有一種健康的羞愧是
09:20
when you betray背叛 a secret秘密 that a best最好 friend朋友 made製作 you promise諾言 never to reveal揭示
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當你背叛了對摯友的承諾
09:23
and then you get busted破獲
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你說出了原先答應要保守的秘密
09:25
and then your best最好 friend朋友 confronts面對 you
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而當你的摯友找你算帳時
09:27
and you have terrible可怕 discussions討論,
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你們爭執不休
09:29
but at the end結束 of it all that sick生病 feeling感覺 guides導遊 you
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但最後罪感主導著你
09:32
and you say, I'll never make that mistake錯誤 again.
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然後你說,我絕對不會再犯相同的錯。
09:34
And you make amends賠償 and you never make that mistake錯誤 again.
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你做了修正承諾,然後你永不再犯同樣的錯。
09:37
That's the kind of shame恥辱 that is a teacher老師.
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這種羞愧可以教導我們
09:40
The unhealthy不良 shame恥辱 I'm talking about
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而我所說那種非良性的羞愧
09:42
is the one that makes品牌 you so sick生病 inside.
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是那種會讓人愧對於心的
09:45
It's the one that says,
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是那種
09:47
not that what you did was bad,
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不是你做了壞事
09:49
but that you are bad.
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而是你根本就是壞人。
09:51
And it was what I was feeling感覺.
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這是我當時候的感受。
09:54
And it wasn't because of my attending出席; he was a doll娃娃.
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由於我跟隨的主治樂心助人
09:57
He talked to the family家庭, and I'm quite相當 sure that he smoothed平滑 things over
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和他的家人好好談過,我確定他替我打了圓場
10:00
and made製作 sure that I didn't get sued起訴.
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才能確保我不會被控告。
10:03
And I kept不停 asking myself these questions問題.
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我不斷問自己這些問題。
10:06
Why didn't I ask my attending出席? Why did I send發送 her home?
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為什麼當時我沒有聯繫主治醫生?為什麼我讓她回家?
10:09
And then at my worst最差 moments瞬間:
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我最糟的回憶是:
10:11
Why did I make such這樣 a stupid mistake錯誤?
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我為什麼犯了這麼愚蠢的錯?
10:14
Why did I go into medicine醫學?
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為什麼我選擇進入醫界?
10:16
Slowly慢慢地 but surely一定,
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慢慢地,但穩定地
10:18
it lifted取消.
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糟糕的感覺漸淡了。
10:20
I began開始 to feel a bit better.
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我的感覺緩和了些。
10:22
And on a cloudy多雲的 day,
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然後在一個天氣陰陰的日子裡
10:24
there was a crack裂紋 in the clouds and the sun太陽 started開始 to come out
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陽光開始從雲隙間探出
10:26
and I wondered想知道,
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我思考著
10:28
maybe I could feel better again.
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也許我能讓自己再次快樂起來。
10:30
And I made製作 myself a bargain討價還價
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我告訴自己
10:33
that if only I redouble加倍 my efforts努力 to be perfect完善
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我要加倍努力,做到完美
10:38
and never make another另一個 mistake錯誤 again,
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不要再犯錯了
10:40
please make the voices聲音 stop.
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請就讓那個(自責)聲音停止。
10:42
And they did.
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那個聲音的確停止了。
10:44
And I went back to work.
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我回到工作崗位
10:46
And then it happened發生 again.
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但錯誤又發生了。
10:49
Two years年份 later後來 I was an attending出席 in the emergency department
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兩年後,我在多倫多北部
10:52
at a community社區 hospital醫院 just north of Toronto多倫多,
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一間社區醫院擔任急診室的主治醫生。
10:54
and I saw a 25 year-old man with a sore throat.
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我看了一位二十五歲的病人,他有喉嚨痛
10:57
It was busy, I was in a bit of a hurry匆忙.
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那天很忙,我也有點手忙腳亂
10:59
He kept不停 pointing指點 here.
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他不斷指著這裡
11:01
I looked看著 at his throat, it was a little bit pink.
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我看了他的喉嚨,有點紅色。
11:03
And I gave him a prescription處方 for penicillin青黴素
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我開給他盤尼西林的處方籤,
11:05
and sent發送 him on his way.
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就讓他離開。
11:07
And even as he was walking步行 out the door,
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即便他要走出大門時
11:09
he was still sort分類 of pointing指點 to his throat.
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他仍然指著他的喉嚨。
11:12
And two days later後來 I came來了 to do my next下一個 emergency shift轉移,
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兩天後,我又輪到在急診室值班
11:15
and that's when my chief首席 asked to speak說話 to me quietly悄悄 in her office辦公室.
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那時候我的主任要我過去她的辦公室私下談談
11:18
And she said the three words:
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她說了那三個字:
11:22
Do you remember記得?
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"記得嗎?"
11:25
"Do you remember記得 that patient患者 you saw with the sore throat?"
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"你記得你看過的那位喉嚨痛的病人嗎?"
11:28
Well it turns out, he didn't have a strep鏈球菌 throat.
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原來,他並沒有鍊球菌性咽喉炎。
11:30
He had a potentially可能 life-threatening危及生命 condition條件
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他得到的是一種會嚴重威脅生命的病症
11:32
called epiglottitis會厭炎.
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叫做急性會厭炎。
11:34
You can Google谷歌 it,
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各位可以上網查詢
11:36
but it's an infection感染, not of the throat, but of the upper airway空中航線,
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不是喉嚨感染,而是上呼吸道感染,
11:39
and it can actually其實 cause原因 the airway空中航線 to close.
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會造成呼吸道阻塞。
11:42
And fortunately幸好 he didn't die.
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幸好他沒過世。
11:45
He was placed放置 on intravenous靜脈 antibiotics抗生素
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他被安排去做抗生素靜脈注射
11:48
and he recovered恢復 after a few少數 days.
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幾天之後,他痊癒了。
11:50
And I went through通過 the same相同 period of shame恥辱 and recriminations相互指責
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我又回到那個愧疚和責難的時光中
11:54
and felt cleansed清洗 and went back to work,
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然後情緒平復後,回到工作崗位
11:58
until直到 it happened發生 again and again and again.
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直到這些錯誤再發生, 歷史一直重複。
12:03
Twice兩次 in one emergency shift轉移, I missed錯過 appendicitis闌尾炎.
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一個急診的輪班裡發生兩次,我沒發現病人得了盲腸炎。
12:06
Now that takes some doing,
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這是很難想像會發生的事
12:09
especially特別 when you work in a hospital醫院
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特別是當你在醫院工作
12:11
that at the time saw but 14 people a night.
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整個晚上你只有十四名病患。
12:14
Now in both cases, I didn't send發送 them home
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對這兩個病人,我沒有讓他們回家
12:17
and I don't think there was any gap間隙 in their care關心.
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我也不覺得在治療過程中有任何差錯。
12:19
One I thought had a kidney stone.
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其中一位我判斷他有腎結石。
12:21
I ordered有序 a kidney X-rayX-射線. When it turned轉身 out to be normal正常,
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我安排照了腎臟X光,但結果正常。
12:23
my colleague同事 who was doing a reassessment重新評估 of the patient患者
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我同事當時正在對病人病情重新診斷
12:26
noticed注意到 some tenderness壓痛 in the right lower降低 quadrant象限 and called the surgeons外科醫生.
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注意到病人右下腹的地方按壓會痛,就聯繫了外科醫生。
12:29
The other one had a lot of diarrhea腹瀉.
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另一個病人有嚴重的腹瀉
12:31
I ordered有序 some fluids流體 to rehydrate補充水分 him
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我開了一些藥水幫助他補充水分
12:34
and asked my colleague同事 to reassess重新評估 him.
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也要求我同事重新診斷。
12:37
And he did
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他做了
12:39
and when he noticed注意到 some tenderness壓痛 in the right lower降低 quadrant象限, called the surgeons外科醫生.
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他注意到病人右下腹的地方按壓會痛,也聯繫了外科醫生。
12:41
In both cases,
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這兩個病例
12:43
they had their operations操作 and they did okay.
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他們都動了手術,狀況良好。
12:46
But each time,
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但每次想到這兩例子
12:48
they were gnawing at me, eating at me.
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那種感覺折磨啃噬我。
12:50
And I'd like to be able能夠 to say to you
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我非常想要告訴各位
12:52
that my worst最差 mistakes錯誤 only happened發生 in the first five years年份 of practice實踐
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我最嚴重的錯誤只發生在頭五年的行醫歷史中
12:55
as many許多 of my colleagues同事 say, which哪一個 is total B.S.
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像我眾多同事們所說的一樣,但是這是鬼扯。
12:58
(Laughter笑聲)
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(笑聲)
13:00
Some of my dooziesdoozies have been in the last five years年份.
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在最近的五年內, 我也發生一些糗事。
13:06
Alone單獨, ashamed羞愧 and unsupported不支持.
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孤單,羞愧,無助。
13:08
Here's這裡的 the problem問題:
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問題的癥結是:
13:10
If I can't come clean清潔
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如果我不能理清楚
13:12
and talk about my mistakes錯誤,
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談論我犯的錯,
13:16
if I can't find the still-small還是小 voice語音
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如果我不能找到那微小的聲音
13:18
that tells告訴 me what really happened發生,
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告訴著我事實是如何。
13:20
how can I share分享 it with my colleagues同事?
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我該如何跟我的同事分享經驗?
13:22
How can I teach them about what I did
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我該如何教導他們, 我犯的錯誤。
13:25
so that they don't do the same相同 thing?
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讓他們不再重蹈覆轍呢?
13:29
If I were to walk步行 into a room房間 --
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如果我進入一個場合 --
13:31
like right now, I have no idea理念 what you think of me.
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就像現在,我不知道各位會如何看待我。
13:34
When was the last time you heard聽說 somebody talk
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上一次各位聽到別人談論
13:36
about failure失敗 after failure失敗 after failure失敗?
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有關自己一次又一次的失敗是什麼時候?
13:38
Oh yeah, you go to a cocktail雞尾酒 party派對
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是的,如果各位去參加一場宴會
13:40
and you might威力 hear about some other doctor醫生,
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你或許會聽到某些醫生的閒聊,
13:42
but you're not going to hear somebody
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但各位不會聽到有人
13:44
talking about their own擁有 mistakes錯誤.
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談論自己的過錯。
13:46
If I were to walk步行 into a room房間 filled填充 with my colleagescolleages
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如果我走進一個場合,裡頭坐滿我的同事
13:49
and ask for their support支持 right now
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我向他們尋求認同
13:51
and start開始 to tell what I've just told you right now,
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然後開始跟他們說,我剛告訴各位的事情
13:53
I probably大概 wouldn't不會 get through通過 two of those stories故事
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在我還沒講超過兩個故事前
13:56
before they would start開始 to get really uncomfortable不舒服,
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他們就會感到非常不自在。
13:58
somebody would crack裂紋 a joke玩笑,
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有人就會開始說笑話,
14:00
they'd他們會 change更改 the subject學科 and we would move移動 on.
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想要改變話題,然後拋棄前個話題。
14:05
And in fact事實, if I knew知道 and my colleagues同事 knew知道
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事實上,如果我知道或我同事知道
14:08
that one of my orthopedic骨科 colleagues同事 took off the wrong錯誤 leg in my hospital醫院,
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我們其中一位骨科同事在醫院裡幫病人截錯肢
14:12
believe me, I'd have trouble麻煩
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相信我,我會有困難
14:14
making製造 eye contact聯繫 with that person.
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跟他有任何正面的交會。
14:16
That's the system系統 that we have.
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這就是我們的制度。
14:18
It's a complete完成 denial否認 of mistakes錯誤.
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完全否認錯誤的系統。
14:21
It's a system系統
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這個制度下
14:23
in which哪一個 there are two kinds of physicians醫師 --
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只有兩種情況--
14:27
those who make mistakes錯誤
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一邊是犯錯的
14:29
and those who don't,
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一邊是沒犯錯的
14:31
those who can't handle處理 sleep睡覺 deprivation剝奪 and those who can,
347
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一邊是不能調適眠眠被剝削,一邊則可以
14:34
those who have lousy糟糕 outcomes結果
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一邊是糟糕的結果
14:36
and those who have great outcomes結果.
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一邊則有優秀的結果
14:39
And it's almost幾乎 like an ideological思想 reaction反應,
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這幾乎像是意識形態的反應
14:41
like the antibodies抗體 begin開始 to attack攻擊 that person.
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像抗體一樣,開始攻擊那個人
14:45
And we have this idea理念
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我們有這個想法:
14:47
that if we drive駕駛 the people who make mistakes錯誤
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如果我們趕走那些犯錯的人
14:49
out of medicine醫學,
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讓他們離開醫界,
14:51
what will we be left with, but a safe安全 system系統.
355
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我們就會留下一個安全的制度。
14:55
But there are two problems問題 with that.
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但這樣做會衍生兩個問題。
14:58
In my 20 years年份 or so
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這二十多年來
15:00
of medical broadcasting廣播 and journalism新聞學,
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我從事醫療報導和新聞工作
15:03
I've made製作 a personal個人 study研究 of medical malpractice弊端 and medical errors錯誤
359
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我自行探討了醫療疏失和醫療錯誤
15:06
to learn學習 everything I can,
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所有相關的事。
15:08
from one of the first articles用品 I wrote for the Toronto多倫多 Star
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從我為多倫多星報所寫的第一則新聞
15:10
to my show顯示 "White白色 Coat塗層, Black黑色 Art藝術."
362
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到我的節目《白袍與黑色藝術》。
15:13
And what I've learned學到了
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我所學到的是
15:15
is that errors錯誤 are absolutely絕對 ubiquitous普及.
364
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錯誤絕對無所不在。
15:18
We work in a system系統
365
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我們在一個
15:20
where errors錯誤 happen發生 every一切 day,
366
905000
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每天都會發生錯誤的制度下工作。
15:22
where one in 10 medications藥物治療
367
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有十分之一的機會,
15:24
are either the wrong錯誤 medication藥物治療 given特定 in hospital醫院
368
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醫院會給錯藥
15:26
or at the wrong錯誤 dosage劑量,
369
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或是給了錯誤的劑量。
15:28
where hospital-acquired醫院獲得 infections感染 are getting得到 more and more numerous眾多,
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而在醫院內的感染越來越多
15:31
causing造成 havoc浩劫 and death死亡.
371
916000
3000
造成傷害和死亡。
15:34
In this country國家,
372
919000
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在這個國家
15:36
as many許多 as 24,000 Canadians加拿大人 die
373
921000
2000
有24,000加拿大人
15:38
of preventable預防的 medical errors錯誤.
374
923000
2000
死於可避免的醫療疏失。
15:40
In the United聯合的 States狀態, the Institute研究所 of Medicine醫學 pegged釘住 it at 100,000.
375
925000
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在美國, 醫學統計則有100,000人。
15:44
In both cases, these are gross underestimates低估,
376
929000
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這兩項數據都是低估了
15:47
because we really aren't ferreting深挖 out the problem問題
377
932000
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因為我們未曾深入探究問題
15:49
as we should.
378
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而這是我們應該這麼做的。
15:51
And here's這裡的 the thing.
379
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事實是這樣
15:54
In a hospital醫院 system系統
380
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在醫療體系裡
15:57
where medical knowledge知識 is doubling加倍
381
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醫療知識是每二到三年就倍數成長
15:59
every一切 two or three years年份, we can't keep up with it.
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我們跟不上這樣的速度。
16:02
Sleep睡覺 deprivation剝奪 is absolutely絕對 pervasive無處不在.
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睡眠不足絕對是普遍的。
16:05
We can't get rid擺脫 of it.
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我們擺脫不了這問題。
16:07
We have our cognitive認知 biases偏見,
385
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而我們有自己的直覺偏差,
16:09
so that I can take a perfect完善 history歷史 on a patient患者 with chest胸部 pain疼痛.
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對相同病歷史完整的胸痛病人,會有不同診斷結果。
16:12
Now take the same相同 patient患者 with chest胸部 pain疼痛,
387
957000
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拿一個有胸痛病症的病人來說
16:14
make them moist and garrulous貧嘴
388
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如果當時他胡言亂語,再加上他的呼吸
16:16
and put a little bit of alcohol on their breath呼吸,
389
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有酒精味,那我們會認為他其實是喝醉了。
16:18
and suddenly突然 my history歷史 is laced花邊 with contempt鄙視.
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因為這樣誤診, 然後我的醫療生涯突然蒙羞。
16:20
I don't take the same相同 history歷史.
391
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我不會做同樣的事
16:22
I'm not a robot機器人;
392
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我不是機器人;
16:24
I don't do things the same相同 way each time.
393
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我不會每次都做同樣的動作。
16:26
And my patients耐心 aren't cars汽車;
394
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我的病人不是車子;
16:28
they don't tell me their symptoms症狀 in the same相同 way each time.
395
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他們不會每次都用相同的方式描述他們的病症。
16:31
Given特定 all of that, mistakes錯誤 are inevitable必然.
396
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有鑑於此,錯誤是無可避免的。
16:34
So if you take the system系統, as I was taught,
397
979000
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如果是在我所被教導的制度下
16:37
and weed野草 out all the error-prone容易出錯 health健康 professionals專業人士,
398
982000
4000
趕出所有易出錯的醫療專業人員,
16:41
well there won't慣於 be anybody任何人 left.
399
986000
3000
那麼這個領域會無人留下。
16:46
And you know that business商業
400
991000
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你知道嗎? 在那領域
16:48
about people not wanting希望
401
993000
2000
人們不願意談論
16:50
to talk about their worst最差 cases?
402
995000
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有關他們所犯糟糕的過往。
16:53
On my show顯示, on "White白色 Coat塗層, Black黑色 Art藝術,"
403
998000
2000
在我的節目《白袍與黑色藝術》中,
16:55
I made製作 it a habit習慣 of saying, "Here's這裡的 my worst最差 mistake錯誤,"
404
1000000
2000
我習慣會說「這是我最糟糕的錯誤」。
16:57
I would say to everybody每個人
405
1002000
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我可以對每個人這麼說
16:59
from paramedics醫護人員 to the chief首席 of cardiac心臟的 surgery手術,
406
1004000
3000
從一般的醫務人員到心臟外科的首席外科醫生
17:02
"Here's這裡的 my worst最差 mistake錯誤," blah胡說, blah胡說, blah胡說, blah胡說, blah胡說,
407
1007000
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「我最糟糕的錯誤,是什麼,什麼,什麼諸如此類的」
17:04
"What about yours你的?" and I would point the microphone麥克風 towards them.
408
1009000
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然後我會把麥克風遞給他們,問說「你呢?」
17:07
And their pupils學生 would dilate膨脹,
409
1012000
2000
他們的瞳孔會放大,
17:09
they would recoil畏縮,
410
1014000
2000
他們會退卻,
17:11
then they would look down and swallow hard
411
1016000
3000
他們會看著地上,猛吞口水。
17:14
and start開始 to tell me their stories故事.
412
1019000
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然後開始告訴我他們的故事。
17:17
They want to tell their stories故事. They want to share分享 their stories故事.
413
1022000
3000
他們想說他們的故事,他們想分享他們的故事。
17:20
They want to be able能夠 to say,
414
1025000
2000
他們想要說,
17:22
"Look, don't make the same相同 mistake錯誤 I did."
415
1027000
2000
「聽著,別犯跟我一樣的錯」。
17:24
What they need is an environment環境 to be able能夠 to do that.
416
1029000
2000
他們需要的是一個場合讓他們吐露心聲。
17:26
What they need is a redefined重新定義 medical culture文化.
417
1031000
4000
他們需要的是重新定義醫界文化。
17:30
And it starts啟動 with one physician醫師 at a time.
418
1035000
3000
從一位醫生接另一位醫生開始,
17:33
The redefined重新定義 physician醫師 is human人的,
419
1038000
3000
重新定義醫生是人類,
17:36
knows知道 she's human人的,
420
1041000
2000
知道自己是人類。
17:38
accepts接受 it, isn't proud驕傲 of making製造 mistakes錯誤,
421
1043000
2000
接受了事實,我不是說犯錯是光榮的,
17:40
but strives努力打造 to learn學習 one thing
422
1045000
2000
但努力學習一件事:
17:42
from what happened發生
423
1047000
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從錯誤中學習。
17:44
that she can teach to somebody else其他.
424
1049000
2000
讓醫師能教導別人發生過的事
17:46
She shares分享 her experience經驗 with others其他.
425
1051000
2000
分享了她的經驗
17:48
She's supportive支持 when other people talk about their mistakes錯誤.
426
1053000
3000
當別人談論自己的過錯時,她能給予諒解。
17:51
And she points out other people's人們 mistakes錯誤,
427
1056000
2000
然後她也能指出別人所犯的錯
17:53
not in a gotcha疑難雜症 way,
428
1058000
2000
不是用落井下石的方式。
17:55
but in a loving愛心, supportive支持 way
429
1060000
3000
而是關懷體諒的方式
17:58
so that everybody每個人 can benefit效益.
430
1063000
2000
所以每一個人都能受惠。
18:00
And she works作品 in a culture文化 of medicine醫學
431
1065000
2000
醫師在醫界工作
18:02
that acknowledges承認
432
1067000
2000
能瞭解
18:04
that human人的 beings眾生 run the system系統,
433
1069000
2000
這是由人所掌控的制度
18:06
and when human人的 beings眾生 run the system系統, they will make mistakes錯誤 from time to time.
434
1071000
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當人們執行制度時,錯誤就是免不了要會發生的。
18:09
So the system系統 is evolving進化
435
1074000
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所以制度可以會改革
18:13
to create創建 backups備份
436
1078000
4000
來產生補救方案
18:17
that make it easier更輕鬆 to detect檢測 those mistakes錯誤
437
1082000
3000
能夠更簡單檢查出那些錯誤
18:20
that humans人類 inevitably必將 make
438
1085000
3000
那些人類無可避免的錯誤。
18:23
and also fosters福斯特 in a loving愛心, supportive支持 way
439
1088000
3000
同時培養一種關懷扶持的方式
18:26
places地方 where everybody每個人 who is observing觀察
440
1091000
3000
建構一個讓每一個人
18:29
in the health健康 care關心 system系統
441
1094000
2000
都能觀察的健康保障的制度
18:31
can actually其實 point out things that could be potential潛在 mistakes錯誤
442
1096000
3000
可以真正檢查出那些潛在的錯誤
18:34
and is rewarded獎勵 for doing so,
443
1099000
2000
並獲得鼓勵。
18:36
and especially特別 people like me, when we do make mistakes錯誤,
444
1101000
2000
特別是像我一樣的人,當我們犯了錯
18:38
we're rewarded獎勵 for coming未來 clean清潔.
445
1103000
4000
我們可以被鼓勵面對錯誤並改正。
18:42
My name名稱 is Brian布賴恩 Goldman高盛.
446
1107000
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我是Brian Goldman。
18:45
I am a redefined重新定義 physician醫師.
447
1110000
3000
我是位有新定義的醫療人員。
18:48
I'm human人的. I make mistakes錯誤.
448
1113000
2000
我是一個人類,我會犯錯。
18:50
I'm sorry about that,
449
1115000
2000
我對此感到抱歉,
18:52
but I strive努力 to learn學習 one thing
450
1117000
2000
但我努力學習某件事
18:54
that I can pass通過 on to other people.
451
1119000
3000
讓它可以薪傳下去。
18:57
I still don't know what you think of me,
452
1122000
3000
我仍然不知道大家會如何看我,
19:00
but I can live生活 with that.
453
1125000
2000
但我想我能接受。
19:02
And let me close with three words of my own擁有:
454
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讓我用三個字來總結
19:05
I do remember記得.
455
1130000
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我記得。
19:09
(Applause掌聲)
456
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(掌聲)
Translated by Joyce Chou
Reviewed by Inder Peng(彭)

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ABOUT THE SPEAKER
Brian Goldman - Physician, broadcaster
Brian Goldman is an emergency-room physician in Toronto, and the host of CBC Radio’s "White Coat, Black Art."

Why you should listen

Brian Goldman is an emergency room physician who has worked at Mount Sinai Hospital in downtown Toronto for more than 20 years. He is also a prominent medical journalist and the host of CBC Radio’s White Coat, Black Art. In Dr. Goldman’s first book, The Night Shift, published in 2010, he shares his experiences of working through the witching hours at Mount Sinai, as well as at the other hospitals where he has spent his long career.

More profile about the speaker
Brian Goldman | Speaker | TED.com