Brian Goldman在Ted英语演讲：医生们会犯错误,我们能否谈论他们所犯过的错误呢

1、 Headoffice管理总部Brian Goldman: Doctors make mistakes. Can we talk about that布莱恩.高德曼:医生们会犯错误,我们能否谈论他们所犯过的错误呢?I think we have to do something about a piece of the culture of medicine that has to change. And I think it starts with one physician, and that's me. And maybe I've been around long eno

2、ugh that I can afford to give away some of my false prestige to be able to do that.我觉得在当今的医学文化中,有一部份文化必须要开始改变。而这个改变可以从一个医生开始,那就是我。或许是因为我已经行医多年,我可以承受放弃一些虚无的名利来开始这样的改变。Before I actually begin the meat of my talk, let's begin with a bit of baseball. Hey, why not? We're near the end, we're g

3、etting close to the World Series. We all love baseball, don't we? (Laughter Baseball is filled with some amazing statistics. And there's hundreds of them. "Moneyball" is about to come out, and it's all about statistics and using statistics to build a great baseball team.在进入主题之前

4、,让我们先谈谈棒球吧。为什么不呢?常规赛季就快结束,世界职业棒球大赛即将开始。我们都喜爱棒球,不是吗?(笑声棒球的世界中充斥着成千上百种让人咋舌的统计数据。即将上映的电影“点球成金”,便是完全关于统计数据,以及如何在这些数据的基础上建造一个伟大的球队。I'm going to focus on one stat that I hope a lot of you have heard of. It's called batting average. So we talk about a 300, a batter who bats 300. That means that bal

5、lplayer batted safely, hit safely three times out of 10 at bats. That means hit the ball into the outfield, it dropped, it didn't get caught, and whoever tried to throw it to first base didn't get there in time and the runner was safe. 我想讲一个我希望大家都听说过的数据,叫做击球率。当我们说一名挥棒球员的击球率为三成的时候,我们是指这位球员的打击

6、非常稳定,每十次种就会有三次安打。安打意味着球会被击中并被打入外野,而且并不会被立刻接杀,球也不会在跑者成功上到一垒之前被及时的传回。十次中有三次安打。各位知道棒球大联盟如何评论这些击球率上了三成的球员吗?很棒,非常棒,明星球员一般的棒。Three times out of 10. Do you know what they call a 300 hitter in Major League Baseball? Good, really good, maybe an all-star. Do you know what they call a 400 baseball hitter? That

7、's somebody who hit, by the way, four times safely out of every 10. Legendary - as in Ted Williams legendary - the last Major League Baseball player to hit over 400 during a regular season.各位知道他们又是如何称呼一位击球率有着四成,也就是每十次打击就会打出四个安打的球员吗。是传奇- 像泰德. 威廉斯那样的传奇- 他是棒球大联盟里最后一个在常规赛中拥有超过四成击球率的球员。Now let's

8、take this back into my world of medicine where I'm a lot more comfortable, or perhaps a bit less comfortable after what I'm going to talk to you about. Suppose you have appendicitis and you're referred to a surgeon who's batting 400 on appendectomies.现在让我们回到我的世界- 医疗领域。这个领域我比较熟悉,但我接下来

9、要说的却让我有些困扰。假设你得了阑尾炎,然后你被推荐给了一位在阑尾移除手术中有着四成“击球率”的外科医生。(Laughter(笑声Somehow this isn't working out, is it? Now suppose you live in a certain part of a certain remote place and you have a loved one who has blockages in two coronary arteries and your family doctor refers that loved one to a cardiolog

10、ist who's batting 200 on angioplasties. But, but, you know what? Headoffice管理总部这听起来怪怪的,对吧?又假设你住在某一个较为偏远的地区,而你所爱的人的两条冠状动脉都被堵塞。你的家庭医生将她推荐给了一位在血管成形手术上有着两成“击球率”的心脏科医师。但是,等等,你知道吗?她今年的表现有着很大的提高,她的水准也在恢复。She's doing a lot better this year. She's on the comeback trail. And she's hitting a 25

11、7. Somehow this isn't working.她的“击球率”达到了两成五。但是这样还是不能被接受。But I'm going to ask you a question. What do you think a batting average for a cardiac surgeon or a nurse practitioner or an orthopedic surgeon, an OBGYN, a paramedic is supposed to be? 1,000, very good. Now truth of the matter is, nobo

12、dy knows in all of medicine what a good surgeon or physician or paramedic is supposed to bat.这听起来怪怪的,对吧?又假设你住在某一个较为偏远的地区,而你所爱的人的两条冠状动脉都被堵塞。你的家庭医生将她推荐给了一位在血管成形手术上有着两成“击球率”的心脏科医师。但是,等等,你知道吗?她今年的表现有着很大的提高,她的水准也在恢复。What we do though is we send each one of them, including myself, out into the world with

13、the admonition, be perfect. Never ever, ever make a mistake, but you worry about the details, about how that's going to happen.我们将他们每个人,包括我自己,送上职业岗位后便告诫他们以完美来要求自己- 绝对,绝对不能作出错误的诊断- 但我们让他们自己考虑细节,考虑如何达到这样的标准。And that was the message that I absorbed when I was in med school. I was an obsessive compu

14、lsive student. In high school, a classmate once said that Brian Goldman would study for a blood test. (Laughter And so I did. And I studied in my little garret at the nurses' residence at Toronto General Hospital, not far from here.这就是我在医学院时得到的信息。我是一个有着强迫症倾向的学生。在中学时,有个同学曾经说布莱恩.高德曼会为了血液测验复习。(笑声而我

15、的确这么做了。我在离这不远处的多伦多总医院里护士住宅里的一个小阁楼中,完成了我的学业。And I memorized everything. I memorized in my anatomy class the origins and exertions of every muscle, every branch of every artery that came off the aorta, differential diagnoses obscure and common. I even knew the differential diagnosis in how to classify

16、 renal tubular acidosis. And all the while, I was amassing more and more knowledge.我背下了所有东西。我背下了解剖课中提到的每一块肌肉的起端和伸展方式,每一条从主动脉延伸出来的动脉的分支系统,以及一切鲜为人知的或者常见的鉴别诊断。我甚至知道如何鉴别诊断不同的肾小管性酸中毒症。在这段时间中,我积累了越来越多的知识。And I did well, I graduated with honors, cum laude. And I came out of medical school with the impressi

17、on that if I memorized everything and knew everything, or as much as possible, as close to everything as possible, that it would immunize me against making mistakes. And it worked for a while, until I met Mrs. Drucker.我的表现很好,并以优等的成绩毕业。当我从医学院出来时,我觉得我只要记下和明白了所有的东西或者稍退一步将近所有的东西,那我犯医疗错误的几率就会微乎其微。而我在一段时间

18、之内的确没有犯错。直到我遇到了Drucker 女士。I was a resident at a teaching hospital here in Toronto when Mrs. Drucker was brought to the emergency department of the hospital where I was working. At the time I was assigned to the cardiology service on a cardiology rotation. And it was my job, when the emergency staff

19、called Headoffice管理总部for a cardiology consult, to see that patient in emerg. and to report back to my attending. And I saw Mrs. Drucker, and she was breathless.Drucker 女士被带入多伦多的一家教学医院的急诊室时,我正作为一个实习医生在那里工作。当时我正因心脏科轮调而被指派在心血管诊所。我的工作是,当紧急救护人员需要有关于心脏的专业会诊时,在急症室诊断病人,并在之后向负责我的主治医生汇报。And when I listened to

20、 her, she was making a wheezy sound. And when I listened to her chest with a stethoscope, I could hear crackly sounds on both sides that told me that she was in congestive heart failure. This is a condition in which the heart fails, and instead of being able to pump all the blood forward, some of th

21、e blood backs up into the lung, the lungs fill up with blood, and that's why you have shortness of breath.当我见到Drucker女士的时候,她的气息已经很微弱。在我与她交谈时,我听到她的呼吸有喘息的声音。当我用听诊器聆听她的胸腔时,两边都传来的爆裂的声音告诉我,这是郁血性心脏衰竭。这是由于心脏在衰竭后,无法将所有的血液完全的输送出去,而导致部分血液回流入肺脏。肺脏里充满了血液,而造成呼吸短促。And that wasn't a difficult diagnosis to

22、make. I made it and I set to work treating her. I gave her aspirin. I gave her medications to relieve the strain on her heart. I gave her medications that we call diuretics, water pills, to get her to pee out the access fluid. And over the course of the next hour and a half or two, she started to fe

23、el better. And I felt really good. And that's when I made my first mistake; I sent her home.这不是一个困难的诊断。作出诊断后我开始着手帮她治疗。我开给了她阿司匹林,并给了她一些可以减轻她心脏负担的药物。我还给了她一些利尿剂,俗称水丸,帮助她将体内多余的水分排出。在接下来的一两个小时里,她开始觉得好转,我也感到高兴。而就在此时我犯了第一个错误:我让她回了家。Actually, I made two more mistakes. I sent her home without speaking to

24、 my attending. I didn't pick up the phone and do what I was supposed to do, which was call my attending and run the story by him so he would have a chance to see her for himself. And he knew her, he would have been able to furnish additional information about her. Maybe I did it for a good reaso

25、n. Maybe I didn't want to be a high-maintenance resident. Maybe I wanted to be so successful and so able to take responsibility that I would do so and I would be able to take care of my attending's patients without even having to contact him.正确的来说,我还犯了两个错误。我在和我的主治汇报之前便让她回了家。我没有做我照着我应该做的,拿起电话

26、打给我的主治并让他看一下这个案例,给他一个亲自见见这名病患的机会。我的主治认识她,因此可以提供更详细的病历资料。或许我有这么做的理由。或许我并不想做一个需要经常地指导的实习医生。也许我太想可以独当一面,可以不需要和我的主治沟通便照顾好他的病患。The second mistake that I made was worse. In sending her home, I disregarded a little voice deep down inside that was trying to tell me, "Goldman, not a good idea. Don't

27、 do this." In fact, so lacking in confidence was I that I actually asked the nurse who was looking after Mrs. Drucker, "Do you think it's okay if she goes home?" And the nurse thought about it and said very matter-of-factly, "Yeah, I think she'll do okay." I can reme

28、mber that like it was yesterday.而我犯的第二个错误更加严重。在让她回家时,我忽视了我内心一个微小的声音。这个声音试图告诉我:“高德曼,这样不好,不要这么做。”其实,当时的我是如此的没有自信,以至于我甚至向照顾Drucker女士的护士寻求了意见:“你觉得让她回家好么?”那位护士想了想,然后就事论事的说:“嗯,我觉得没有问题。”这一切对我来说,都还像是发生在了昨天。So I signed the discharge papers, and an ambulance came, paramedics came to take her home. Headoffice管

29、理总部And I went back to my work on the wards. All the rest of that day, that afternoon, I had this kind of gnawing feeling inside my stomach. But I carried on with my work. And at the end of the day, I packed up to leave the hospital and walked to the parking lot to take my car and drive home when I d

30、id something that I don't usually do. I walked through the emergency department on my way home.我在出院单上签了名,一辆救护车来后急救人员将她送回了家。之后我回到了我在诊所的工作。在接下来的一天中,那天下午,我的肠胃有着一种翻滚的感觉。但我还是照常的继续工作。在工作结束后,我整理了下便离开了医院。在我走向停车场去取我的车的路程中,我做了一件我平常不会做的事情。我从急诊室借了道。And it was there that another nurse, not the nurse who was

31、looking after Mrs. Drucker before, but another nurse, said three words to me that are the three words that most emergency physicians I know dread. Others in medicine dread them as well, but there's something particular about emergency medicine because we see patients so fleetingly. The three wor

32、ds are: Do you remember? "Do you remember that patient you sent home?" the other nurse asked matter-of-factly. "Well she's back," in just that tone of voice.而就在那里,另外一位护士,不是之前照顾Drucker女士的那位,对我说了绝大部分急诊医生都害怕听到的三个字。其他科系的医生也害怕这三个字,但因为急诊医生看的病人都来去匆匆,这三个字对我们有着特别的意义。这三个字是:记得吗?“记得吗?你送回

33、家的那个患者?”那位护士就事论事的问道。“她又回来了。”她就用了这样平常的语调。Well she was back all right. She was back and near death. About an hour after she had arrived home, after I'd sent her home, she collapsed and her family called 911 and the paramedics brought her back to the emergency department where she had a blood press

34、ure of 50, which is in severe shock. And she was barely breathing and she was blue. And the emerg. staff pulled out all the stops. They gave her medications to raise her blood pressure. They put her on a ventilator.她的确回来了。回来时已经濒临死亡。在我让她回家后大约一个小时后,她昏倒在了地上,她的家人打了911,急救人员将她重新带回了急诊室。此时的她已严重休克,血压只有50。她的呼

35、吸极其微弱,面色发青。急救人员们使出了浑身解数。他们给了她提升血压的药物,并将她连接上了人工呼吸器。And I was shocked and shaken to the core. And I went through this roller coaster, because after they stabilized her, she went to the intensive care unit, and I hoped against hope that she would recover. And over the next two or three days, it was cle

36、ar that she was never going to wake up. She had irreversible brain damage. And the family gathered. And over the course of the next eight or nine days, they resigned themselves to what was happening. And at about the nine day mark, they let her go - Mrs. Drucker, a wife, a mother and a grandmother.我

37、震惊不已,吓得不得了。之后我的心情便像是做着云霄飞车一般,因为当他们将她的情况稳定下来后,便将她送进了加护病房,我在绝望中希望她能够醒过来。但在接下来的两三天中,她再也不会醒来的可能性越来越大。她的脑部已经受到了无法逆转的损伤。她的家人聚在了一起。在接下来的八到九天里,他们慢慢的接受了这件事实。在第九天,他们选择让她离开人间- Drucker女士,一个家庭的妻子,母亲,和祖母。They say you never forget the names of those who die. And that was my first time to be acquainted with that. O

38、ver the next few weeks, I beat myself up and I experienced for the first time the unhealthy shame that exists in our culture of medicine - where I felt alone, isolated, not feeling the healthy kind of shame that you feel, because you can't talk about it with your colleagues.有人说你永远不会忘记那些(因你的疏忽而过世

39、的人的名字,而那是我第一次意识到这句话的现实。在接下来的几个星期内,我无比的沮丧,并第一次经历了那种在医学文 Headoffice管理总部化中存在的危险的羞愧感- 我觉得孤单无助。这不是那种健康的羞愧感,因为你不能和你的同事提起讨论它。You know that healthy kind, when you betray a secret that a best friend made you promise never to reveal and then you get busted and then your best friend confronts you and you have

40、terrible discussions, but at the end of it all that sick feeling guides you and you say, I'll never make that mistake again. And you make amends and you never make that mistake again. That's the kind of shame that is a teacher.就是那种,当你背叛了对挚友的承诺而说出了答应要保守的秘密,并被他知道了以后,你的挚友找你算账时,虽然你们会争执不休,但最后那层罪恶

41、感仍然会主导你,你告诉自己,我绝对不会再犯同样的错误。如是,你做了修正的承诺,然后你永不会再犯那样的错。这种羞愧有着教导的作用。The unhealthy shame I'm talking about is the one that makes you so sick inside. It's the one that says, not that what you did was bad, but that you are bad. And it was what I was feeling. And it wasn't because of my attendin

42、g; he was a doll. He talked to the family, and I'm quite sure that he smoothed things over and made sure that I didn't get sued. And I kept asking myself these questions. Why didn't I ask my attending? Why did I send her home? And then at my worst moments: Why did I make such a stupid mi

43、stake? Why did I go into medicine?而我所说的那种非良性的羞愧会让你愧对于心。它会对你说,并非你做的是错的,而是你根本就是坏人。这便是我当时的感觉。而这也不是因为我的主治;他人非常好。他和那家人好好的谈过。我确定他为了确保我没有被控告而替我打了圆场。但我仍然不断问我自己这些问题:为什么当时我没有联系我的主治?为什么我当时会让她回家?更加沮丧时,我会问:我为什么会犯下如此愚蠢的错误?为什么我会选择进入医学界?Slowly but surely, it lifted. I began to feel a bit better. And on a cloudy day

44、, there was a crack in the clouds and the sun started to come out and I wondered, maybe I could feel better again. And I made myself a bargain that if only I redouble my efforts to be perfect and never make another mistake again, please make the voices stop. And they did. And I went back to work. An

45、d then it happened again.慢慢的但稳定地,那糟糕的感觉开始淡化了。我开始觉得缓和了些。然后在一个阴云密布的日子里,当我看到一束阳光从云隙中探出,我觉得,或许我能再次感觉好起来。然后我和自己做了一个约定:如果我加倍努力做到完美,不再犯错,请就此让那自责的声音消去。那个声音的确停止了。我回到了工作岗位。但错误又发生了。Two years later I was an attending in the emergency department at a community hospital just north of Toronto, and I saw a 25 year-

46、old man with a sore throat. It was busy, I was in a bit of a hurry. He kept pointing here. I looked at his throat, it was a little bit pink. And I gave him a prescription for penicillin and sent him on his way. And even as he was walking out the door, he was still sort of pointing to his throat.两年后,

47、当我在一家多伦多北部一间社区医院的急症室做主治医生时,我看了一位喉咙酸痛的25岁的男人。当时诊所很忙,所以我也有些急。他不停的指着这里。我看了看,他的喉咙有些红肿。我给他开了盘尼西林的处方后便让他离开了。即便当他走出诊所的大门的时候,他似乎还在指着他的喉咙。And two days later I came to do my next emergency shift, and that's when my chief asked to speak to me quietly in her office. And she said the three words: Do you reme

48、mber? "Do you remember that patient you saw with the sore throat?" Well it turns out, he didn't have a strep throat. He had a potentially life-threatening condition called epiglottitis. You can Google it, but it's an infection, not of the throat, but of the upper airway, and it can

49、 actually cause the airway to close.两天后,又轮到我在急诊室值班。那时我的主任要我去她的办公室里私下谈谈。她说了Headoffice 管理总部 那三个字： 记得吗？ “记得吗？那位你看过的喉咙酸痛的患者？” 原来，他并没有得链 球菌性咽喉炎。 得的是一种有可能威胁到生命的病症， 叫会厌炎。 各位可以在谷歌上查 询， 但它不是喉咙，而是上呼吸道的感染， 并有可能造成呼吸道阻塞。 And fortunately he didn't die. He was placed on intravenous antibiotics and he recovered

50、 after a few days. And I went through the same period of shame and recriminations and felt cleansed and went back to work, until it happened again and again and again. 幸好，他并没有过世。 在被安排做抗生素静脉注射的几天之后， 他便痊愈了。 而我又 回到了那个愧疚和自责的时光中， 然后等情绪平复后，又回到了工作岗位， 直到这些错 误再度重复的发生。 Twice in one emergency shift, I missed a

51、ppendicitis. Now that takes some doing, especially when you work in a hospital that at the time saw but 14 people a night. Now in both cases, I didn't send them home and I don't think there was any gap in their care. One I thought had a kidney stone. I ordered a kidney X-ray. 在同一个急诊的值班中，我两次没

52、有发现病患得了盲肠炎。 这是很难想象会发生的事情， 尤其是当你在一间一个晚上 只见十四名病患的医院工作。 虽然对这两个病例，我都没有 让他们回家， 而我也不觉得在治疗照顾过程中有任何空隙和差错。 When it turned out to be normal, my colleague who was doing a reassessment of the patient noticed some tenderness in the right lower quadrant and called the surgeons. The other one had a lot of diarrhea

53、. I ordered some fluids to rehydrate him and asked my colleague to reassess him. And he did and when he noticed some tenderness in the right lower quadrant, called the surgeons. In both cases, they had their operations and they did okay. But each time, they were gnawing at me, eating at me. 其中一位我诊断他

54、有肾结石， 并安排了肾脏 X 光，但结果正常。 我的同事当时正在对病 人的病情做重新的诊断。 在他留意到病人右下腹的地方有些柔软时，便联系了外科医生。 另一位病患有严重的腹泻。 我给了他一些液体帮助他补充水分， 并让我的同事重新看了 看。 他照做了。 当他注意到病人右下腹有些柔软时，也联系了外科医生。 这两名病患 都 做了手术并康复了。 但每当我想到这两起病例， 那种感觉都会折磨啃噬我。 And I'd like to be able to say to you that my worst mistakes only happened in the first five years o

55、f practice as many of my colleagues say, which is total B.S. (Laughter Some of my doozies have been in the last five years. Alone, ashamed and unsupported. Here's the problem: If I can't come clean and talk about my mistakes, if I can't find the still-small voice that tells me what reall

56、y happened, how can I share it with my colleagues? How can I teach them about what I did so that they don't do the same thing? If I were to walk into a room - like right now, I have no idea what you think of me. 而我也希望我可以告诉你 我造成的最严重的错误只发生在了我开始行医的前五年， 像我 众多的同事所称一般。但这完全是扯淡。 （笑声） 在最近的五年中，我也犯了一些错误。 我

57、依然觉得孤独，羞愧，无助。 但问题的症结是： 如果我不能理清 和谈论我所犯过的错 误， 如果我无法找到那可以告诉我错误的源头的 那仍然微小的声音， 我又如何能和我的 同事分享我的经验？ 我又如何教导他们， 让他们不再重蹈我的覆辙？ 当我走入一个场合 时 - 就像现在，我完全不知道各位如何看待我。 When was the last time you heard somebody talk about failure after failure after failure? Oh yeah, you go to a cocktail party and you might hear about

58、some other doctor, but you're not going to hear somebody talking about their own mistakes. If I were to walk into a room filled with my colleages and ask for their support right now and start to tell what I've just told you right now, I probably wouldn't get through two of those stories

59、before they would start to get really uncomfortable, somebody would crack a joke, they'd change the subject and we would move on. World International English 6 Headoffice 管理总部 And in fact, if I knew and my colleagues knew that one of my orthopedic colleagues took off the wrong leg in my hospital

60、, believe me, I'd have trouble making eye contact with that person. 你们上一次听到别人谈论自己 一次又一次的失败是什么时候的事情？ 是的，如果你们去 参加一场聚会， 你或许会听到某些关于其他医生的错误的闲聊， 但你不会听到有人 谈论 自己所犯的错误。 如果我现在走入一间坐满我的同事的房间， 向他们寻求帮助 并开始和 他们说我刚才告诉各位的事情， 或许在我还没讲超过两个故事之前， 他们就会开始感到 非常的不自在。 有人就会讲个笑话， 然后他们会改变话题。 事实上，如果我，或者我的 同事， 知道医院中一位骨科的同事帮病人截错了腿， 相信我，当我遇到他时， 我也无法 与他有正常眼神的交汇。 That's the system that we have. It's a complete denial of mistakes. It's a system in which there are two kinds of physicians - those who make mistakes and tho