TED演講：醫(yī)生們會(huì)犯錯(cuò)誤，我們能否談?wù)撍麄兯高^(guò)的錯(cuò)誤

　　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 enough that I can afford to give away some of my false prestige to be able to do that.

　　我覺(jué)得在當(dāng)今的醫(yī)學(xué)文化中， 有一部份文化必須要開(kāi)始改變。 而這個(gè)改變可以從一個(gè)醫(yī)生開(kāi)始，那就是我。 或許是因?yàn)槲乙呀?jīng)行醫(yī)多年， 我可以承受放棄一些虛無(wú)的名利 來(lái)開(kāi)始這樣的改變。

　　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 getting 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.

　　在進(jìn)入主題之前， 讓我們先談?wù)劙羟虬伞?為什么不呢? 常規(guī)賽季就快結(jié)束，世界職業(yè)棒球大賽即將開(kāi)始。 我們都喜愛(ài)棒球，不是嗎? (笑聲) 棒球的世界中充斥著成千上百種 讓人咋舌的統(tǒng)計(jì)數(shù)據(jù)。 即將上映的電影 “點(diǎn)球成金”，便是完全關(guān)于統(tǒng)計(jì)數(shù)據(jù)， 以及如何在這些數(shù)據(jù)的基礎(chǔ)上建造一個(gè)偉大的球隊(duì)。

　　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 ballplayer 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.

　　我想講一個(gè) 我希望大家都聽(tīng)說(shuō)過(guò)的數(shù)據(jù)， 叫做擊球率。 當(dāng)我們說(shuō)一名揮棒球員的擊球率為三成的時(shí)候， 我們是指這位球員的打擊非常穩(wěn)定， 每十次種就會(huì)有三次安打。 安打意味著球會(huì)被擊中并被打入外野， 而且并不會(huì)被立刻接殺， 球也不會(huì)在跑者成功上到一壘之前 被及時(shí)的傳回。 十次中有三次安打。 各位知道棒球大聯(lián)盟如何評(píng)論 這些擊球率上了三成的球員嗎? 很棒，非常棒， 明星球員一般的棒。

　　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'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.

　　各位知道他們又是如何稱(chēng)呼一位 擊球率有著四成， 也就是每十次打擊 就會(huì)打出四個(gè)安打的球員嗎。 是傳奇 -- 像泰德. 威廉斯那樣的傳奇-- 他是棒球大聯(lián)盟里最后一個(gè)在常規(guī)賽中 擁有超過(guò)四成擊球率的球員。

　　Now let's 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.

　　現(xiàn)在讓我們回到我的世界 - 醫(yī)療領(lǐng)域。 這個(gè)領(lǐng)域我比較熟悉， 但我接下來(lái)要說(shuō)的 卻讓我有些困擾。 假設(shè)你得了闌尾炎， 然后你被推薦給了一位 在闌尾移除手術(shù)中有著四成“擊球率”的外科醫(yī)生。

　　(Laughter)

　　(笑聲)

　　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 cardiologist who's batting 200 on angioplasties. But, but, you know what?

　　這聽(tīng)起來(lái)怪怪的，對(duì)吧? 又假設(shè)你住在 某一個(gè)較為偏遠(yuǎn)的地區(qū)， 而你所愛(ài)的人的 兩條冠狀動(dòng)脈都被堵塞。 你的家庭醫(yī)生將她推薦給了一位在血管成形手術(shù)上 有著兩成“擊球率”的心臟科醫(yī)師。 但是，等等，你知道嗎? 她今年的表現(xiàn)有著很大的提高，她的水準(zhǔn)也在恢復(fù)。

　　She's doing a lot better this year. She's on the comeback trail. And she's hitting a 257. Somehow this isn't working.

　　她的“擊球率”達(dá)到了兩成五。 但是這樣還是不能被接受。

　　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, nobody knows in all of medicine what a good surgeon or physician or paramedic is supposed to bat.

　　這聽(tīng)起來(lái)怪怪的，對(duì)吧? 又假設(shè)你住在 某一個(gè)較為偏遠(yuǎn)的地區(qū)， 而你所愛(ài)的人的 兩條冠狀動(dòng)脈都被堵塞。 你的家庭醫(yī)生將她推薦給了一位在血管成形手術(shù)上 有著兩成“擊球率”的心臟科醫(yī)師。 但是，等等，你知道嗎? 她今年的表現(xiàn)有著很大的提高，她的水準(zhǔn)也在恢復(fù)。

　　What we do though is we send each one of them, including myself, out into the world with the admonition, be perfect. Never ever, ever make a mistake, but you worry about the details, about how that's going to happen.

　　我們將他們每個(gè)人，包括我自己， 送上職業(yè)崗位后 便告誡他們以完美來(lái)要求自己 -- 絕對(duì)，絕對(duì)不能作出錯(cuò)誤的診斷 -- 但我們讓他們自己考慮細(xì)節(jié)，考慮如何達(dá)到這樣的標(biāo)準(zhǔn)。

　　And that was the message that I absorbed when I was in med school. I was an obsessive compulsive 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.

　　這就是我在醫(yī)學(xué)院時(shí) 得到的信息。 我是一個(gè)有著強(qiáng)迫癥傾向的學(xué)生。 在中學(xué)時(shí)，有個(gè)同學(xué)曾經(jīng)說(shuō) 布萊恩.高德曼會(huì)為了血液測(cè)驗(yàn)復(fù)習(xí)。 (笑聲) 而我的確這么做了。 我在離這不遠(yuǎn)處的多倫多總醫(yī)院里 護(hù)士住宅里的一個(gè)小閣樓中， 完成了我的學(xué)業(yè)。

　　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 renal tubular acidosis. And all the while, I was amassing more and more knowledge.

　　我背下了所有東西。 我背下了解剖課中 提到的每一塊肌肉的起端和伸展方式， 每一條從主動(dòng)脈延伸出來(lái)的動(dòng)脈的分支系統(tǒng)， 以及一切鮮為人知的或者常見(jiàn)的鑒別診斷。 我甚至知道如何鑒別診斷 不同的腎小管性酸中毒癥。 在這段時(shí)間中， 我積累了越來(lái)越多的知識(shí)。

　　And I did well, I graduated with honors, cum laude. And I came out of medical school with the impression 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.

　　我的表現(xiàn)很好， 并以?xún)?yōu)等的成績(jī)畢業(yè)。 當(dāng)我從醫(yī)學(xué)院出來(lái)時(shí)， 我覺(jué)得 我只要記下和明白了所有的東西 – 或者稍退一步 – 將近所有的東西， 那我犯醫(yī)療錯(cuò)誤的幾率就會(huì)微乎其微。 而我在一段時(shí)間之內(nèi) 的確沒(méi)有犯錯(cuò)。 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 called 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 女士被帶入多倫多的 一家教學(xué)醫(yī)院的急診室時(shí)， 我正作為一個(gè)實(shí)習(xí)醫(yī)生在那里工作。 當(dāng)時(shí)我正因心臟科輪調(diào) 而被指派在心血管診所。 我的工作是， 當(dāng)緊急救護(hù)人員需要有關(guān)于心臟的專(zhuān)業(yè)會(huì)診時(shí)， 在急癥室診斷病人， 并在之后向負(fù)責(zé)我的主治醫(yī)生匯報(bào)。

　　And when I listened to 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 the blood backs up into the lung, the lungs fill up with blood, and that's why you have shortness of breath.

　　當(dāng)我見(jiàn)到Drucker女士的時(shí)候，她的氣息已經(jīng)很微弱。 在我與她交談時(shí)，我聽(tīng)到她的呼吸有喘息的聲音。 當(dāng)我用聽(tīng)診器聆聽(tīng)她的胸腔時(shí)， 兩邊都傳來(lái)的爆裂的聲音告訴我， 這是郁血性心臟衰竭。 這是由于心臟在衰竭后， 無(wú)法將所有的血液完全的輸送出去， 而導(dǎo)致部分血液回流入肺臟。肺臟里充滿(mǎn)了血液， 而造成呼吸短促。

　　And that wasn't a difficult diagnosis to 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 feel better. And I felt really good. And that's when I made my first mistake; I sent her home.

　　這不是一個(gè)困難的診斷。 作出診斷后我開(kāi)始著手幫她治療。 我開(kāi)給了她阿司匹林，并給了她一些可以減輕她心臟負(fù)擔(dān)的藥物。 我還給了她一些利尿劑，俗稱(chēng)水丸， 幫助她將體內(nèi)多余的水分排出。 在接下來(lái)的一兩個(gè)小時(shí)里， 她開(kāi)始覺(jué)得好轉(zhuǎn)， 我也感到高興。 而就在此時(shí)我犯了第一個(gè)錯(cuò)誤： 我讓她回了家。

　　Actually, I made two more mistakes. I sent her home without speaking to 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 reason. 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.

　　正確的來(lái)說(shuō)，我還犯了兩個(gè)錯(cuò)誤。 我在和我的主治匯報(bào)之前 便讓她回了家。 我沒(méi)有做我照著我應(yīng)該做的， 拿起電話打給我的主治并讓他看一下這個(gè)案例， 給他一個(gè)親自見(jiàn)見(jiàn)這名病患的機(jī)會(huì)。 我的主治認(rèn)識(shí)她， 因此可以提供更詳細(xì)的病歷資料。 或許我有這么做的理由。 或許我并不想做一個(gè)需要經(jīng)常地指導(dǎo)的實(shí)習(xí)醫(yī)生。 也許我太想 可以獨(dú)當(dāng)一面， 可以不需要 和我的主治溝通 便照顧好他的病患。

　　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 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 remember that like it was yesterday.

　　而我犯的第二個(gè)錯(cuò)誤更加嚴(yán)重。 在讓她回家時(shí)， 我忽視了我內(nèi)心一個(gè)微小的聲音。 這個(gè)聲音試圖告訴我： “高德曼，這樣不好，不要這么做。” 其實(shí)，當(dāng)時(shí)的我是如此的沒(méi)有自信， 以至于我甚至向照顧Drucker女士 的護(hù)士尋求了意見(jiàn)： “你覺(jué)得讓她回家好么?” 那位護(hù)士想了想， 然后就事論事的說(shuō)：“嗯，我覺(jué)得沒(méi)有問(wèn)題。” 這一切對(duì)我來(lái)說(shuō)，都還像是發(fā)生在了昨天。

　　So I signed the discharge papers, and an ambulance came, paramedics came to take her home. 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 did something that I don't usually do. I walked through the emergency department on my way home.

　　我在出院?jiǎn)紊虾灹嗣?一輛救護(hù)車(chē)來(lái)后急救人員將她送回了家。 之后我回到了我在診所的工作。 在接下來(lái)的一天中， 那天下午， 我的腸胃有著一種翻滾的感覺(jué)。 但我還是照常的繼續(xù)工作。 在工作結(jié)束后，我整理了下便離開(kāi)了醫(yī)院。 在我走向停車(chē)場(chǎng) 去取我的車(chē)的路程中， 我做了一件我平常不會(huì)做的事情。 我從急診室借了道。

　　And it was there that another nurse, not the nurse who was 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 words 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，另外一位護(hù)士， 不是之前照顧Drucker女士的那位， 對(duì)我說(shuō)了 絕大部分急診醫(yī)生 都害怕聽(tīng)到的三個(gè)字。 其他科系的醫(yī)生也害怕這三個(gè)字， 但因?yàn)榧痹\醫(yī)生看的病人都來(lái)去匆匆， 這三個(gè)字對(duì)我們有著特別的意義。 這三個(gè)字是： 記得嗎? “記得嗎?你送回家的那個(gè)患者?” 那位護(hù)士就事論事的問(wèn)道。 “她又回來(lái)了。” 她就用了這樣平常的語(yǔ)調(diào)。

　　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 pressure 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.

　　她的確回來(lái)了。 回來(lái)時(shí)已經(jīng)瀕臨死亡。 在我讓她回家后 大約一個(gè)小時(shí)后， 她昏倒在了地上，她的家人打了911， 急救人員將她重新帶回了急診室。 此時(shí)的她已嚴(yán)重休克， 血壓只有 50。 她的呼吸極其微弱，面色發(fā)青。 急救人員們使出了渾身解數(shù)。 他們給了她提升血壓的藥物， 并將她連接上了人工呼吸器。

　　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 clear 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.

　　我震驚不已， 嚇得不得了。 之后我的心情便像是做著云霄飛車(chē)一般， 因?yàn)楫?dāng)他們將她的情況穩(wěn)定下來(lái)后， 便將她送進(jìn)了加護(hù)病房， 我在絕望中希望她能夠醒過(guò)來(lái)。 但在接下來(lái)的兩三天中， 她再也不會(huì)醒來(lái)的可能性越來(lái)越大。 她的腦部已經(jīng)受到了無(wú)法逆轉(zhuǎn)的損傷。 她的家人聚在了一起。 在接下來(lái)的八到九天里， 他們慢慢的接受了這件事實(shí)。 在第九天，他們選擇讓她離開(kāi)人間 -- Drucker女士， 一個(gè)家庭的妻子，母親， 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. Over 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.

　　有人說(shuō)你永遠(yuǎn)不會(huì)忘記那些 (因你的疏忽而過(guò)世的)人的名字， 而那是我第一次意識(shí)到這句話的現(xiàn)實(shí)。 在接下來(lái)的幾個(gè)星期內(nèi)， 我無(wú)比的沮喪， 并第一次經(jīng)歷了 那種在醫(yī)學(xué)文化中存在的 危險(xiǎn)的羞愧感 -- 我覺(jué)得孤單無(wú)助。 這不是那種健康的羞愧感， 因?yàn)槟悴荒芎湍愕耐绿崞鹩懻撍?/p>

　　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 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.

　　– 就是那種， 當(dāng)你背叛了對(duì)摯友的承諾而說(shuō)出了答應(yīng)要保守的秘密， 并被他知道了以后， 你的摯友找你算賬時(shí)， 雖然你們會(huì)爭(zhēng)執(zhí)不休， 但最后那層罪惡感仍然會(huì)主導(dǎo)你， 你告訴自己，我絕對(duì)不會(huì)再犯同樣的錯(cuò)誤。 如是，你做了修正的承諾，然后你永不會(huì)再犯那樣的錯(cuò)。 這種羞愧有著教導(dǎo)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 attending; 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 mistake? Why did I go into medicine?

　　而我所說(shuō)的那種非良性的羞愧 會(huì)讓你愧對(duì)于心。 它會(huì)對(duì)你說(shuō)， 并非你做的是錯(cuò)的， 而是你根本就是壞人。 這便是我當(dāng)時(shí)的感覺(jué)。 而這也不是因?yàn)槲业闹髦?他人非常好。 他和那家人好好的談過(guò)。我確定他為了確保 我沒(méi)有被控告而替我打了圓場(chǎng)。 但我仍然不斷問(wèn)我自己這些問(wèn)題： 為什么當(dāng)時(shí)我沒(méi)有聯(lián)系我的主治?為什么我當(dāng)時(shí)會(huì)讓她回家? 更加沮喪時(shí)，我會(huì)問(wèn)： 我為什么會(huì)犯下如此愚蠢的錯(cuò)誤? 為什么我會(huì)選擇進(jìn)入醫(yī)學(xué)界?

　　Slowly but surely, it lifted. I began to feel a bit better. And on a cloudy day, 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. And then it happened again.

　　慢慢的但穩(wěn)定地， 那糟糕的感覺(jué)開(kāi)始淡化了。 我開(kāi)始覺(jué)得緩和了些。 然后在一個(gè)陰云密布的日子里， 當(dāng)我看到一束陽(yáng)光從云隙中探出， 我覺(jué)得， 或許我能再次感覺(jué)好起來(lái)。 然后我和自己做了一個(gè)約定： 如果我加倍努力做到完美， 不再犯錯(cuò)， 請(qǐng)就此讓那自責(zé)的聲音消去。 那個(gè)聲音的確停止了。 我回到了工作崗位。 但錯(cuò)誤又發(fā)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-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.

　　兩年后，當(dāng)我在一家多倫多北部一間社區(qū)醫(yī)院的 急癥室做主治醫(yī)生時(shí)， 我看了一位喉嚨酸痛的25歲的男人。 當(dāng)時(shí)診所很忙，所以我也有些急。 他不停的指著這里。 我看了看，他的喉嚨有些紅腫。 我給他開(kāi)了盤(pán)尼西林的處方后 便讓他離開(kāi)了。 即便當(dāng)他走出診所的大門(mén)的時(shí)候， 他似乎還在指著他的喉嚨。

　　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 remember? "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 actually cause the airway to close.

　　兩天后，又輪到我在急診室值班。 那時(shí)我的主任要我去她的辦公室里私下談?wù)劇?她說(shuō)了那三個(gè)字： 記得嗎? “記得嗎?那位你看過(guò)的喉嚨酸痛的患者?” 原來(lái)，他并沒(méi)有得鏈球菌性咽喉炎。 得的是一種有可能威脅到生命的病癥， 叫會(huì)厭炎。 各位可以在谷歌上查詢(xún)， 但它不是喉嚨，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 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，他并沒(méi)有過(guò)世。 在被安排做抗生素靜脈注射的幾天之后， 他便痊愈了。 而我又回到了那個(gè)愧疚和自責(zé)的時(shí)光中， 然后等情緒平復(fù)后，又回到了工作崗位， 直到這些錯(cuò)誤再度重復(fù)的發(fā)生。

　　Twice in one emergency shift, I missed appendicitis. 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.

　　在同一個(gè)急診的值班中，我兩次沒(méi)有發(fā)現(xiàn)病患得了盲腸炎。 這是很難想象會(huì)發(fā)生的事情， 尤其是當(dāng)你在一間一個(gè)晚上 只見(jiàn)十四名病患的醫(yī)院工作。 雖然對(duì)這兩個(gè)病例，我都沒(méi)有讓他們回家， 而我也不覺(jué)得在治療照顧過(guò)程中有任何空隙和差錯(cuò)。

　　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. 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.

　　其中一位我診斷他有腎結(jié)石， 并安排了腎臟X光，但結(jié)果正常。 我的同事當(dāng)時(shí)正在對(duì)病人的病情做重新的診斷。 在他留意到病人右下腹的地方有些柔軟時(shí)，便聯(lián)系了外科醫(yī)生。 另一位病患有嚴(yán)重的腹瀉。 我給了他一些液體幫助他補(bǔ)充水分， 并讓我的同事重新看了看。 他照做了。 當(dāng)他注意到病人右下腹有些柔軟時(shí)，也聯(lián)系了外科醫(yī)生。 這兩名病患 都做了手術(shù)并康復(fù)了。 但每當(dāng)我想到這兩起病例， 那種感覺(jué)都會(huì)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 of 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 really 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訴你 我造成的最嚴(yán)重的錯(cuò)誤只發(fā)生在了我開(kāi)始行醫(yī)的前五年， 像我眾多的同事所稱(chēng)一般。但這完全是扯淡。 (笑聲) 在最近的五年中，我也犯了一些錯(cuò)誤。 我依然覺(jué)得孤獨(dú)，羞愧，無(wú)助。 但問(wèn)題的癥結(jié)是： 如果我不能理清 和談?wù)撐宜高^(guò)的錯(cuò)誤， 如果我無(wú)法找到那可以告訴我錯(cuò)誤的源頭的 那仍然微小的聲音， 我又如何能和我的同事分享我的經(jīng)驗(yàn)? 我又如何教導(dǎo)他們， 讓他們不再重蹈我的覆轍? 當(dāng)我走入一個(gè)場(chǎng)合時(shí) -- 就像現(xiàn)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 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 before they would start to get really uncomfortable, somebody would crack a joke, they'd change the subject and we would move on. And in fact, if I knew and my colleagues knew that one of my orthopedic colleagues took off the wrong leg in my hospital, believe me, I'd have trouble making eye contact with that person.

　　你們上一次聽(tīng)到別人談?wù)撟约?一次又一次的失敗是什么時(shí)候的事情? 是的，如果你們?nèi)⒓右粓?chǎng)聚會(huì)， 你或許會(huì)聽(tīng)到某些關(guān)于其他醫(yī)生的錯(cuò)誤的閑聊， 但你不會(huì)聽(tīng)到有人 談?wù)撟约核傅腻e(cuò)誤。 如果我現(xiàn)在走入一間坐滿(mǎn)我的同事的房間， 向他們尋求幫助 并開(kāi)始和他們說(shuō)我剛才告訴各位的事情， 或許在我還沒(méi)講超過(guò)兩個(gè)故事之前， 他們就會(huì)開(kāi)始感到非常的不自在。 有人就會(huì)講個(gè)笑話， 然后他們會(huì)改變?cè)掝}。 事實(shí)上，如果我，或者我的同事， 知道醫(yī)院中一位骨科的同事幫病人截錯(cuò)了腿， 相信我，當(dāng)我遇到他時(shí)， 我也無(wú)法與他有正常眼神的交匯。

　　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 those who don't, those who can't handle sleep deprivation and those who can, those who have lousy outcomes and those who have great outcomes. And it's almost like an ideological reaction, like the antibodies begin to attack that person. And we have this idea that if we drive the people who make mistakes out of medicine, what will we be left with, but a safe system.

　　這就是我們所擁有的體系 -- 一個(gè)完完全全的否定錯(cuò)誤的體系。 在這個(gè)制度當(dāng)中 只有兩種人 -- 犯錯(cuò)的 不犯錯(cuò)的， 可以調(diào)適睡眠不足的和不可以忍受的， 以及那些有著糟糕的結(jié)果 和有著優(yōu)秀的結(jié)果的。 這幾乎就像免疫系統(tǒng)的自我反應(yīng)， 像抗體一般開(kāi)始攻擊那個(gè)不一樣的人。 我們有著一種想法： 當(dāng)我們將所有的會(huì)犯錯(cuò)的人 趕出醫(yī)學(xué)界后， 我們便會(huì)得到一個(gè)安全的系統(tǒng)。

　　But there are two problems with that. In my 20 years or so of medical broadcasting and journalism, I've made a personal study of medical malpractice and medical errors to learn everything I can, from one of the first articles I wrote for the Toronto Star to my show "White Coat, Black Art." And what I've learned is that errors are absolutely ubiquitous.

　　但這種想法會(huì)衍生出兩個(gè)問(wèn)題。 在我二十余年的 醫(yī)療廣播和新聞工作中， 從我為多倫多星報(bào)所寫(xiě)的第一篇文章 到我的節(jié)目《白袍魔藝》， 我自行研究了我可以接觸到的 一切醫(yī)療疏失和醫(yī)療錯(cuò)誤。 而我所學(xué)到的， 便是錯(cuò)誤絕對(duì)是無(wú)處不在。

　　We work in a system where errors happen every day, where one in 10 medications are either the wrong medication given in hospital or at the wrong dosage, where hospital-acquired infections are getting more and more numerous, causing havoc and death. In this country, as many as 24,000 Canadians die of preventable medical errors. In the United States, the Institute of Medicine pegged it at 100,000. In both cases, these are gross underestimates, because we really aren't ferreting out the problem as we should.

　　我們工作在一個(gè) 每天都會(huì)發(fā)生錯(cuò)誤的制度中。 醫(yī)院有十分之一的幾率 會(huì)給錯(cuò)藥 或者給了錯(cuò)誤的劑量， 而在醫(yī)院內(nèi)被傳染的病例正在日漸增多， 造成不必要的傷害和死亡。 在這個(gè)國(guó)家中， 有將近2萬(wàn)4千多加拿大人死于 可以避免的醫(yī)療錯(cuò)誤。 在美國(guó)，據(jù)醫(yī)學(xué)學(xué)院統(tǒng)計(jì)，這個(gè)人數(shù)達(dá)到了10萬(wàn)之多。 即使如此，這兩項(xiàng)數(shù)據(jù)也還是過(guò)于低估了現(xiàn)實(shí)， 因?yàn)槲覀儚奈聪裎覀冊(cè)撟龅哪前?深入地探究這個(gè)問(wèn)題。

　　And here's the thing. In a hospital system where medical knowledge is doubling every two or three years, we can't keep up with it. Sleep deprivation is absolutely pervasive. We can't get rid of it. We have our cognitive biases, so that I can take a perfect history on a patient with chest pain. Now take the same patient with chest pain, make them moist and garrulous and put a little bit of alcohol on their breath, and suddenly my history is laced with contempt. I don't take the same history. I'm not a robot; I don't do things the same way each time. And my patients aren't cars; they don't tell me their symptoms in the same way each time. Given all of that, mistakes are inevitable. So if you take the system, as I was taught, and weed out all the error-prone health professionals, well there won't be anybody left.

　　重點(diǎn)是， 在一個(gè)醫(yī)療知識(shí) 以?xún)傻饺隇閱挝怀杀对鲩L(zhǎng)的 醫(yī)院體系中，我們無(wú)法緊跟著這些知識(shí)的增長(zhǎng)。 睡眠不足的情形絕對(duì)是非常普遍的， 而我們也無(wú)法擺脫這個(gè)問(wèn)題。 我們自己的直覺(jué)偏差也會(huì)直接影響到我們的結(jié)論。 比如說(shuō)，我可以為一位胸痛的病人記錄下完美的病歷。 但如果這位同樣的胸痛的病人 當(dāng)時(shí)胡言亂語(yǔ) 再加上呼吸帶著些許的酒精味的話， 我寫(xiě)下的病歷便會(huì)挾帶著些許的輕蔑。 而這份病歷便會(huì)截然不同。 我不是機(jī)器人， 不會(huì)每次都做同樣的事情。 我的病患也不是車(chē)子， 他們不會(huì)每次都用相同的方式去描述他們的癥狀。 因此錯(cuò)誤是無(wú)可避免的。 如果真像我被教導(dǎo)的體系那般 趕出所有易出錯(cuò)的醫(yī)護(hù)專(zhuān)業(yè)人員， 那么這個(gè)領(lǐng)域便不會(huì)有人留下。

　　And you know that business about people not wanting to talk about their worst cases? On my show, on "White Coat, Black Art," I made it a habit of saying, "Here's my worst mistake," I would say to everybody from paramedics to the chief of cardiac surgery, "Here's my worst mistake," blah, blah, blah, blah, blah, "What about yours?" and I would point the microphone towards them.

　　還有就是關(guān)于 人們不愿 談?wù)撍麄兯傅淖钤愀獾腻e(cuò)誤一事。 在我的節(jié)目《白袍魔藝》中， 我已經(jīng)會(huì)習(xí)慣性地說(shuō)：“這是我最糟糕的錯(cuò)誤”。 我會(huì)對(duì)從急救醫(yī)士 到心臟外科首席醫(yī)師的每個(gè)人這么說(shuō)： “這是我最糟糕的錯(cuò)誤，如是，如是。” 然后我會(huì)把麥克風(fēng)遞給他們，問(wèn)：“你呢?” 此時(shí)他們的瞳孔會(huì)放大， 他們會(huì)退卻。

　　And their pupils would dilate, they would recoil, then they would look down and swallow hard and start to tell me their stories. They want to tell their stories. They want to share their stories. They want to be able to say, "Look, don't make the same mistake I did." What they need is an environment to be able to do that. What they need is a redefined medical culture. And it starts with one physician at a time.

　　然后他們會(huì)看著地上，猛吞著口水 并開(kāi)始向我傾訴他們的故事。 他們想說(shuō)他們的故事，他們也想分享他們的故事。 他們想能夠說(shuō)： “聽(tīng)著，別犯和我一樣的錯(cuò)。” 他們只是需要一個(gè)場(chǎng)合來(lái)吐露心聲。 他們需要的是一個(gè)重新定義的醫(yī)學(xué)文化， 從一位又一位個(gè)別的醫(yī)生開(kāi)始。

　　The redefined physician is human, knows she's human, accepts it, isn't proud of making mistakes, but strives to learn one thing from what happened that she can teach to somebody else. She shares her experience with others. She's supportive when other people talk about their mistakes. And she points out other people's mistakes, not in a gotcha way, but in a loving, supportive way so that everybody can benefit.

　　重新定義過(guò)的醫(yī)生也是人類(lèi)， 明白她自己是人， 并接受這個(gè)事實(shí)。她并不覺(jué)得犯錯(cuò)誤是光榮的， 卻可以 從其中學(xué)習(xí) 并教于他人。 她會(huì)與他人分享她的經(jīng)驗(yàn)， 并在別人談?wù)撟约哼^(guò)錯(cuò)的時(shí)候給于支持。 她不會(huì)有一種落井下石的心態(tài)， 而會(huì)以一種 可以讓每個(gè)人都從中受惠的關(guān)懷，了解的方式 來(lái)指出他人的錯(cuò)誤。

　　And she works in a culture of medicine that acknowledges that human beings run the system, and when human beings run the system, they will make mistakes from time to time. So the system is evolving to create backups that make it easier to detect those mistakes that humans inevitably make and also fosters in a loving, supportive way places where everybody who is observing in the health care system can actually point out things that could be potential mistakes and is rewarded for doing so, and especially people like me, when we do make mistakes, we're rewarded for coming clean.

　　而她所工作的醫(yī)學(xué)文化 承認(rèn) 整個(gè)體系是由人在運(yùn)作， 而當(dāng)人在運(yùn)作一個(gè)體系的時(shí)候，時(shí)不時(shí)地錯(cuò)誤在所難免。 這樣系統(tǒng)才可以不斷地進(jìn)化改革， 產(chǎn)生可以讓人更加容易察覺(jué) 這些無(wú)法避免的錯(cuò)誤的 補(bǔ)救方案。 與此同時(shí)，我們可以培養(yǎng)一個(gè)熱心關(guān)懷的工作環(huán)境， 鼓勵(lì)每一位 在觀察我們的 醫(yī)療系統(tǒng)的人 隨時(shí)指出一些潛在的錯(cuò)誤。 尤其是鼓勵(lì)像我一樣的人，當(dāng)我們犯錯(cuò)后， 我們可以去正面面對(duì)并加以改正。

　　My name is Brian Goldman. I am a redefined physician. I'm human. I make mistakes. I'm sorry about that, but I strive to learn one thing that I can pass on to other people. I still don't know what you think of me, but I can live with that.

　　我是布萊恩.高德曼， 我是一位重新定義后的醫(yī)生。 我是一個(gè)人類(lèi)，我也會(huì)犯錯(cuò)。 我為此感到抱歉， 但我會(huì)盡力從中學(xué)習(xí) 并教于他人。 我仍然不知各位如何看待我， 但我想我對(duì)此可以接受。

　　And let me close with three words of my own: I do remember.

　　最后讓我以我自己的三個(gè)字做為結(jié)語(yǔ)： 我記得。

　　(Applause)

　　(掌聲)