ABOUT THE SPEAKER
Abraham Verghese - Physician and author
In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation.

Why you should listen

Before he finished medical school, Abraham Verghese spent a year on the other end of the medical pecking order, as a hospital orderly. Moving unseen through the wards, he saw the patients with new eyes, as human beings rather than collections of illnesses. The experience has informed his work as a doctor -- and as a writer. "Imagining the Patient’s Experience" was the motto of the Center for Medical Humanities & Ethics, which he founded at the University of Texas San Antonio, where he brought a deep-seated empathy. He’s now a professor for the Theory and Practice of Medicine at Stanford, where his old-fashioned weekly rounds have inspired a new initiative, the Stanford 25, teaching 25 fundamental physical exam skills and their diagnostic benefits to interns.

He’s also a best-selling writer, with two memoirs and a novel, Cutting for Stone, a moving story of two Ethiopian brothers bound by medicine and betrayal.

He says: “I still find the best way to understand a hospitalized patient is not by staring at the computer screen but by going to see the patient; it's only at the bedside that I can figure out what is important.”

In 2011, Verghese was elected to the Institute of Medicine, which advises the government and private institutions on medicine and health on a national level.

More profile about the speaker
Abraham Verghese | Speaker | TED.com
TEDGlobal 2011

Abraham Verghese: A doctor's touch

阿布拉罕•韦尔盖塞:医生的关怀

Filmed:
1,719,216 views

现代医学正失去一个旧式但有力的工具:人文关怀。作为医生和作家的阿布拉罕•韦尔盖塞批判如今的世界里病人只是一个个数据,他呼吁重新回到传统的一对一诊断方式。
- Physician and author
In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation. Full bio

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

00:15
A few少数 months个月 ago,
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几个月前
00:17
a 40 year-old woman女人 came来了 to an emergency room房间
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一个40岁的女士来到急诊室
00:20
in a hospital醫院 close to where I live生活,
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这个医院离我住的地方不远
00:22
and she was brought in confused困惑.
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她被带来时神智不清
00:24
Her blood血液 pressure压力 was an alarming惊人
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血压处于警戒值
00:26
230 over 170.
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收缩压230, 舒张压170
00:29
Within a few少数 minutes分钟, she went into cardiac心脏的 collapse坍方.
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几分钟内她就心血管虚脱了
00:32
She was resuscitated复苏, stabilized稳定,
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然后她被救醒,稳定下来
00:35
whisked护送 over to a CAT scan扫描 suite套房
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带到靠着急诊室旁边的
00:37
right next下一个 to the emergency room房间,
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CAT扫描室
00:39
because they were concerned关心 about blood血液 clots血块 in the lung.
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因为医生担心她的肺部有血块
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And the CAT scan扫描 revealed透露
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CAT扫描仪显示
00:44
no blood血液 clots血块 in the lung,
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肺部并没有血块
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but it showed显示 bilateral双边, visible可见, palpable明显的 breast乳房 masses群众,
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但是两侧胸部有清晰可见的肿块
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breast乳房 tumors肿瘤,
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是乳腺肿瘤
00:53
that had metastasized转移 widely广泛
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并且已经转移到
00:55
all over the body身体.
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全身各部位
00:57
And the real真实 tragedy悲剧 was, if you look through通过 her records记录,
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但真正的悲剧是,如果你查看她的纪录
01:00
she had been seen看到
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会发现她已经
01:02
in four or five other health健康 care关心 institutions机构
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在过去几年里
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in the preceding two years年份.
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辗转去过四五家医疗机构
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Four or five opportunities机会
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有四五次机会
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to see the breast乳房 masses群众, touch触摸 the breast乳房 mass,
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发现这些乳腺肿瘤,触碰到它们
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intervene干预 at a much earlier stage阶段
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在早期就介入治疗
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than when we saw her.
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而不是我们发现的时候
01:15
Ladies女士们 and gentlemen绅士,
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诸位
01:17
that is not an unusual异常 story故事.
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这不是个不寻常的故事
01:19
Unfortunately不幸, it happens发生 all the time.
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不幸的是,这样的事一直在发生
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I joke玩笑, but I only half joke玩笑,
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我开个玩笑,不过只是半开玩笑
01:24
that if you come to one of our hospitals医院 missing失踪 a limb,
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如果你缺胳膊少腿去了医院
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no one will believe you till直到 they get a CAT scan扫描, MRIMRI
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没人会相信你丢了个肢体,除非你做了CAT扫描,磁共振成像
01:30
or orthopedic骨科 consult请教.
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还有骨科诊断
01:32
I am not a Luddite勒德.
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我不是勒德分子
01:34
I teach at Stanford斯坦福.
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我在斯坦福大学教书
01:36
I'm a physician医师 practicing with cutting-edge前沿 technology技术.
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我是个掌握尖端技术的内科医生
01:38
But I'd like to make the case案件 to you
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但我将在接下来的
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in the next下一个 17 minutes分钟
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17分钟里想向你们讲述的是
01:42
that when we shortcut捷径 the physical物理 exam考试,
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当我们缩短检查
01:46
when we lean towards ordering排序 tests测试
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给病人开一堆检查单
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instead代替 of talking to and examining检查 the patient患者,
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而不是与病人交流并检查时
01:51
we not only overlook俯瞰 simple简单 diagnoses诊断
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我们不仅忽视了
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that can be diagnosed确诊 at a treatable可治疗, early stage阶段,
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处在早期可治疗阶段的简单诊断
01:57
but we're losing失去 much more than that.
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也失去了更重要的东西
01:59
We're losing失去 a ritual仪式.
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我们失去了一种仪式感
02:01
We're losing失去 a ritual仪式 that I believe is transformative变革, transcendent超然,
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一种我认为是具有影响力并且至高无上的仪式感
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and is at the heart
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这正是
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of the patient-physician医患 relationship关系.
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医患关系的核心
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This may可能 actually其实 be heresy异端 to say this at TEDTED,
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在TED讲这个内容可能有点逆势而行
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but I'd like to introduce介绍 you
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但我想向各位介绍
02:13
to the most important重要 innovation革新,
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在未来十年的
02:15
I think, in medicine医学
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医学界
02:17
to come in the next下一个 10 years年份,
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最重要的发明
02:19
and that is the power功率 of the human人的 hand --
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这就是人类之手的力量-
02:21
to touch触摸, to comfort安慰, to diagnose诊断
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关怀,抚慰,诊断
02:24
and to bring带来 about treatment治疗.
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和治疗
02:26
I'd like to introduce介绍 you first to this person
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首先我想介绍一个人
02:29
whose谁的 image图片 you may可能 or may可能 not recognize认识.
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你们不一定认得出他
02:31
This is Sir先生 Arthur亚瑟 Conan柯南 Doyle多伊尔.
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他是亚瑟·柯南·道尔爵士
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Since以来 we're in Edinburgh爱丁堡, I'm a big fan风扇 of Conan柯南 Doyle多伊尔.
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既然这是爱丁堡,我本人是柯南·道尔的粉丝
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You might威力 not know that Conan柯南 Doyle多伊尔 went to medical school学校
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也许有人听说过柯南·道尔是在爱丁堡
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here in Edinburgh爱丁堡,
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上的医学院
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and his character字符, Sherlock福尔摩斯 Holmes霍姆斯,
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他创造的人物形象,福尔摩斯
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was inspired启发 by Sir先生 Joseph约瑟夫 Bell.
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是受到约瑟夫・贝尔的启发
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Joseph约瑟夫 Bell was an extraordinary非凡 teacher老师 by all accounts账户.
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约瑟夫・贝尔是个无可挑剔的杰出老师
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And Conan柯南 Doyle多伊尔, writing写作 about Bell,
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而柯南·道尔关于贝尔的著述
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described描述 the following以下 exchange交换
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描绘了贝尔和他的学生
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between之间 Bell and his students学生们.
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之间的交流
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So picture图片 Bell sitting坐在 in the outpatient门诊病人 department,
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想像贝尔坐在门诊部
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students学生们 all around him,
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他的学生围坐着
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patients耐心 signing签约 up in the emergency room房间
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病人在急诊室登记
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and being存在 registered注册 and being存在 brought in.
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然后挂号,被带进来
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And a woman女人 comes in with a child儿童,
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一个带小孩的女士进来了
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and Conan柯南 Doyle多伊尔 describes介绍 the following以下 exchange交换.
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柯南・道尔这样写道
03:10
The woman女人 says, "Good Morning早上."
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女人说:早上好
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Bell says, "What sort分类 of crossing路口 did you have
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贝尔说:你从Burntisland坐渡船过来
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on the ferry渡船 from Burntisland泰兰?"
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一路如何?
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She says, "It was good."
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她说:挺好
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And he says, "What did you do with the other child儿童?"
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贝尔说:你的另一个孩子怎么办了?
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She says, "I left him with my sister妹妹 at Leith利思."
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她说,我拜托住在利斯的姐姐照顾了
03:28
And he says,
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他说
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"And did you take the shortcut捷径 down InverleithInverleith酒店 Row
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那你来诊所有没有
03:32
to get here to the infirmary医务室?"
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从 Inverleith Row抄近路?
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She says, "I did."
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她说没错
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And he says, "Would you still be working加工 at the linoleum油布 factory?"
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贝尔道,那你还打算在油毡厂干活吗?
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And she says, "I am."
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她说是的
03:42
And Bell then goes on to explain说明 to the students学生们.
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然后贝尔向他的学生解释说
03:44
He says, "You see, when she said, 'Good'好 morning早上,'
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当她说你好的时候
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I picked采摘的 up her Fife accent口音.
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我听出她的法夫口音
03:49
And the nearest最近的 ferry渡船 crossing路口 from Fife is from Burntisland泰兰.
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而离法夫最近的渡船是在Burntisland
03:52
And so she must必须 have taken采取 the ferry渡船 over.
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所以我推测出她是从那里过来
03:55
You notice注意 that the coat涂层 she's carrying携带
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你也注意到她拿着的外套
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is too small for the child儿童 who is with her,
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对跟她一起小孩子来说太小了
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and therefore因此, she started开始 out the journey旅程 with two children孩子,
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所以她开始肯定带了两个孩子来了
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but dropped下降 one off along沿 the way.
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路上放下一个
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You notice注意 the clay粘土 on the soles鞋底 of her feet.
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还有她鞋底上泥
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Such这样 red clay粘土 is not found发现 within a hundred miles英里 of Edinburgh爱丁堡,
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爱丁堡方圆百里内没有这种红泥
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except in the botanical植物 gardens花园.
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除了植物园
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And therefore因此, she took a short cut down InverleithInverleith酒店 Row
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所以她肯定是从 Inverleith Row抄近路
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to arrive到达 here.
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来这儿的
04:19
And finally最后, she has a dermatitis皮炎
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最后,她右手手指
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on the fingers手指 of her right hand,
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有皮炎
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a dermatitis皮炎 that is unique独特
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这种皮炎是只见于
04:25
to the linoleum油布 factory workers工人 in Burntisland泰兰."
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Burntisland的油毡厂工人
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And when Bell actually其实 strips带子 the patient患者,
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然后贝尔就让她脱了衣服
04:30
begins开始 to examine检查 the patient患者,
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开始检查
04:32
you can only imagine想像 how much more he would discern辨别.
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你无法想像他是多么仔细地察看
04:35
And as a teacher老师 of medicine医学, as a student学生 myself,
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作为一个医学老师,一个学生
04:38
I was so inspired启发 by that story故事.
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我深受这个故事启发
04:40
But you might威力 not realize实现
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也许你们还没有意识到
04:42
that our ability能力 to look into the body身体
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我们的这种利用各种感官
04:44
in this simple简单 way, using运用 our senses感官,
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以一种简单的方式检查身体的能力
04:46
is quite相当 recent最近.
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并没有太久历史
04:48
The picture图片 I'm showing展示 you is of Leopold利奥波德 AuenbruggerAuenbrugger
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这张照片是利奥波德·奥恩布鲁格
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who, in the late晚了 1700s,
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他在18世纪末
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discovered发现 percussion打击乐器.
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发明了叩诊法
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And the story故事 is that Leopold利奥波德 AuenbruggerAuenbrugger
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故事是这样的
04:58
was the son儿子 of an innkeeper店主.
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利奥波德·奥恩布鲁格的父亲是个旅馆老板
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And his father父亲 used to go down into the basement地下室
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他父亲常常去地下室的酒窖
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to tap龙头 on the sides双方 of casks木桶 of wine红酒
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敲敲酒桶
05:06
to determine确定 how much wine红酒 was left
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就能知道还有多少酒
05:08
and whether是否 to reorder重新排序.
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要不要追加订单
05:10
And so when AuenbruggerAuenbrugger became成为 a physician医师,
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所以当奥恩布鲁格成了内科医生
05:12
he began开始 to do the same相同 thing.
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他也开始这么干
05:14
He began开始 to tap龙头 on the chests箱子 of his patients耐心,
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他开始敲病人的胸腔
05:17
on their abdomens腹部.
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还有腹部
05:19
And basically基本上 everything we know about percussion打击乐器,
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基本上我们对叩诊的认识
05:21
which哪一个 you can think of as an ultrasound超声 of its day --
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那是当时的超声波技术-
05:25
organ器官 enlargement放大, fluid流体 around the heart, fluid流体 in the lungs,
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器官扩大,心肺积水
05:28
abdominal腹部的 changes变化 --
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异常变化-
05:30
all of this he described描述 in this wonderful精彩 manuscript手稿
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他在手稿中纪录的一切
05:32
"InventumInventum NovumNovum酒店," "New Invention发明,"
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“新发明”
05:35
which哪一个 would have disappeared消失 into obscurity朦胧,
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很有可能因为它的晦涩而消失在历史中
05:37
except for the fact事实 that this physician医师, CorvisartCorvisart,
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多亏一位叫科维扎卡的内科医生
05:40
a famous著名 French法国 physician医师 --
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一位著名的法国内科医生
05:42
famous著名 only because he was physician医师 to this gentleman绅士 --
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他著名是因为他是奥恩布鲁格的内科医生
05:45
CorvisartCorvisart repopularizedrepopularized and reintroduced重新 the work.
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重新介绍和普及了这部著作
05:49
And it was followed其次 a year or two later后来
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一两年后
05:51
by Laennec拉埃内克 discovering发现 the stethoscope听筒.
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莱尼克发明了听诊器
05:54
Laennec拉埃内克, it is said, was walking步行 in the streets街道 of Paris巴黎
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据说莱尼克走在巴黎的街上
05:57
and saw two children孩子 playing播放 with a stick.
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看见两个小孩在玩一根棍子
05:59
One was scratching搔抓 at the end结束 of the stick,
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一个在挠棍子的一端
06:02
another另一个 child儿童 listened听了 at the other end结束.
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另一个听着另一端
06:04
And Laennec拉埃内克 thought this would be a wonderful精彩 way
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莱尼克认为用他所谓的“圆筒”
06:06
to listen to the chest胸部 or listen to the abdomen腹部
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听胸腔和腹腔
06:08
using运用 what he called "the cylinder圆筒."
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是个很不错的主意
06:10
Later后来 he renamed改名 it the stethoscope听筒.
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后来他重新命名为听诊器
06:12
And that is how stethoscope听筒 and auscultation听诊 was born天生.
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这就是听诊器和听诊法的由来
06:16
So within a few少数 years年份,
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几年后
06:18
in the late晚了 1800s, early 1900s,
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19世纪末,20世纪初
06:20
all of a sudden突然,
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突然
06:22
the barber理发师 surgeon外科医生 had given特定 way
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理发医师被
06:25
to the physician医师 who was trying to make a diagnosis诊断.
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进行诊断的内科医生取代
06:28
If you'll你会 recall召回, prior to that time,
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在那之前
06:30
no matter what ailedailed you, you went to see the barber理发师 surgeon外科医生
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不管你病得多么厉害,去了理发医师那儿
06:33
who wound伤口 up cupping拔罐 you,
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他们给你拔火罐
06:35
bleeding流血的 you, purging清洗 you.
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给你放血,给你冲洗
06:37
And, oh yes, if you wanted,
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当然如果你愿意的话
06:39
he would give you a haircut理发 -- short on the sides双方, long in the back --
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他也给你理个发-两边短后边长
06:42
and pull your tooth齿 while he was at it.
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还顺便给你拔个牙
06:44
He made制作 no attempt尝试 at diagnosis诊断.
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完全没有诊断环节
06:46
In fact事实, some of you might威力 well know
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也许有些人还记得
06:48
that the barber理发师 pole, the red and white白色 stripes条纹,
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理发店的标志,红白条纹
06:51
represents代表 the blood血液 bandages绷带 of the barber理发师 surgeon外科医生,
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象征理发医师的绷带
06:54
and the receptacles插座 on either end结束
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两侧的容器
06:56
represent代表 the pots in which哪一个 the blood血液 was collected.
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象征收集血液的壶
06:59
But the arrival到达 of auscultation听诊 and percussion打击乐器
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但听诊法和叩诊法的出现
07:02
represented代表 a sea change更改,
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意味着一个大变化
07:04
a moment时刻 when physicians医师 were beginning开始 to look inside the body身体.
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内科医生开始能探视人体内部
07:07
And this particular特定 painting绘画, I think,
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这幅画,我认为
07:10
represents代表 the pinnacle巅峰, the peak, of that clinical临床 era时代.
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代表这那个医疗时代的顶峰
07:13
This is a very famous著名 painting绘画:
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这是个非常著名的油画
07:15
"The Doctor医生" by Luke卢克 Fildes菲尔德斯.
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卢克・菲尔德斯的《医生》
07:18
Luke卢克 Fildes菲尔德斯 was commissioned委托 to paint涂料 this by Tate泰特,
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此画是卢克・菲尔德斯受泰特之托
07:21
who then established既定 the Tate泰特 Gallery画廊.
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泰特建立了泰特美术馆
07:23
And Tate泰特 asked Fildes菲尔德斯 to paint涂料 a painting绘画
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他请卢克.菲尔德斯画一幅
07:25
of social社会 importance重要性.
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表现社会重要现状的画
07:27
And it's interesting有趣 that Fildes菲尔德斯 picked采摘的 this topic话题.
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有趣的是菲尔德斯选择了这个主题
07:30
Fildes'菲尔德斯 oldest最老的 son儿子, Philip菲利普,
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菲尔德斯的大儿子,菲利普
07:33
died死亡 at the age年龄 of nine on Christmas圣诞 Eve前夕
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9岁的时候因为一点小病痛
07:36
after a brief简要 illness疾病.
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死在了平安夜
07:38
And Fildes菲尔德斯 was so taken采取 by the physician医师
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菲尔德斯被这位守夜守了两三夜的
07:41
who held保持 vigil守夜 at the bedside床头 for two, three nights,
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医生深深感动
07:45
that he decided决定 that he would try and depict描绘
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于是他决定试着描绘
07:47
the physician医师 in our time --
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这个时代的医生-
07:49
almost几乎 a tribute to this physician医师.
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几乎是对这位医生的赞颂
07:51
And hence于是 the painting绘画 "The Doctor医生," a very famous著名 painting绘画.
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因此《医生》这幅著名的画
07:54
It's been on calendars日历, postage邮资 stamps邮票 in many许多 different不同 countries国家.
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出现在很多国家的挂历上和邮票上
07:57
I've often经常 wondered想知道, what would Fildes菲尔德斯 have doneDONE
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我常想,菲尔德斯会怎么办
08:00
had he been asked to paint涂料 this painting绘画
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如果他被要求在这个时代
08:02
in the modern现代 era时代,
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画那幅画
08:04
in the year 2011?
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在2011年?
08:07
Would he have substituted取代 a computer电脑 screen屏幕
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他是不是得把患者
08:11
for where he had the patient患者?
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换成电脑屏幕?
08:13
I've gotten得到 into some trouble麻烦 in Silicon Valley
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我因为说病床上的病人
08:15
for saying that the patient患者 in the bed
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基本上只是
08:17
has almost几乎 become成为 an icon图标
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电脑里真正病人的图标
08:20
for the real真实 patient患者 who's谁是 in the computer电脑.
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而和硅谷惹上麻烦
08:23
I've actually其实 coined创造 a term术语 for that entity实体 in the computer电脑.
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事实上我为计算机里的那个实体(病人)创造了个新词
08:26
I call it the iPatientiPatient.
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iPatient
08:28
The iPatientiPatient is getting得到 wonderful精彩 care关心 all across横过 America美国.
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全美国的iPatient都得到很好的治疗
08:31
The real真实 patient患者 often经常 wonders奇迹,
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真的病人倒在奇怪
08:33
where is everyone大家?
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人都哪里去了?
08:35
When are they going to come by and explain说明 things to me?
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他们什么时候来给我解释这些玩意儿?
08:38
Who's谁是 in charge收费?
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谁负责啊?
08:40
There's a real真实 disjunction脱节 between之间 the patient's耐心 perception知觉
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病人和医生对最佳医疗的认识
08:43
and our own拥有 perceptions看法 as physicians医师 of the best最好 medical care关心.
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有着很大的距离
08:46
I want to show显示 you a picture图片
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我想给你们展示
08:48
of what rounds looked看着 like
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我当时的临床实习
08:50
when I was in training训练.
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是什么样的
08:52
The focus焦点 was around the patient患者.
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重点都是病人
08:54
We went from bed to bed. The attending出席 physician医师 was in charge收费.
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我们一张病床一张病床走过去 当值的医生负责
08:57
Too often经常 these days,
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现如今
08:59
rounds look very much like this,
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临床实习更像这样
09:01
where the discussion讨论 is taking服用 place地点
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讨论是在一个
09:03
in a room房间 far away from the patient患者.
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远离病人的房间进行的
09:06
The discussion讨论 is all about images图片 on the computer电脑, data数据.
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讨论的场面都是电脑,数据
09:09
And the one critical危急 piece missing失踪
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最重要的部分-病人
09:11
is that of the patient患者.
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却缺失了
09:13
Now I've been influenced影响 in this thinking思维
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我想跟你们分享两个故事
09:16
by two anecdotes轶事 that I want to share分享 with you.
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我本人深受影响
09:19
One had to do with a friend朋友 of mine who had a breast乳房 cancer癌症,
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一个是跟我一个患有乳腺癌的朋友有关
09:22
had a small breast乳房 cancer癌症 detected检测 --
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在发现一个小的乳腺肿瘤后
09:25
had her lumpectomy乳房肿瘤切除术 in the town in which哪一个 I lived生活.
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她在我住的那个城市做了手术切除
09:27
This is when I was in Texas德州.
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这是我在德克萨斯的时候
09:29
And she then spent花费 a lot of time researching研究
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然后她花了很多时间
09:32
to find the best最好 cancer癌症 center中央 in the world世界
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寻找世界上最好的癌症中心
09:35
to get her subsequent随后 care关心.
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接受后续治疗
09:37
And she found发现 the place地点 and decided决定 to go there, went there.
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她找到了然后去了
09:40
Which哪一个 is why I was surprised诧异 a few少数 months个月 later后来
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几个月后我很惊讶地
09:43
to see her back in our own拥有 town,
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看见她回来了
09:46
getting得到 her subsequent随后 care关心 with her private私人的 oncologist肿瘤科医生.
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在她的私人医生那里接受术后康复
09:49
And I pressed压制 her, and I asked her,
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我问她
09:51
"Why did you come back and get your care关心 here?"
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你问什么回来接受康复?
09:54
And she was reluctant不情愿 to tell me.
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她不是很愿意吐露
09:56
She said, "The cancer癌症 center中央 was wonderful精彩.
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她说,”那个癌症中心非常棒
09:59
It had a beautiful美丽 facility设施,
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设施一流
10:01
giant巨人 atrium中庭, valet代客 parking停車處,
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大堂超级大,服务生停车
10:03
a piano钢琴 that played发挥 itself本身,
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自动弹奏的钢琴
10:05
a concierge门房 that took you around from here to there.
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有人待你到处溜达“
10:08
But," she said,
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但是
10:10
"but they did not touch触摸 my breasts乳房."
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“他们根本没碰我的胸部”
10:14
Now you and I could argue争论
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现在我们可以说
10:16
that they probably大概 did not need to touch触摸 her breasts乳房.
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他们也许没有必要碰她的胸部
10:18
They had her scanned扫描 inside out.
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可以扫描嘛
10:20
They understood了解 her breast乳房 cancer癌症 at the molecular分子 level水平;
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他们可以从分子层面了解她的乳腺癌
10:23
they had no need to touch触摸 her breasts乳房.
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没有必要碰
10:25
But to her, it mattered要紧 deeply.
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但对她来说,这很重要
10:28
It was enough足够 for her to make the decision决定
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这足够让她决定
10:32
to get her subsequent随后 care关心 with her private私人的 oncologist肿瘤科医生
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从她私人医生那里接受康复
10:35
who, every一切 time she went,
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她去私人医生那里
10:37
examined检查 both breasts乳房 including包含 the axillary tail尾巴,
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医生会检查两侧乳房包括腋窝端
10:40
examined检查 her axilla腋下 carefully小心,
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很仔细地检查腋窝
10:42
examined检查 her cervical颈椎 region地区, her inguinal腹股沟 region地区,
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检查她的子宫颈和腹股沟
10:44
did a thorough彻底 exam考试.
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一个全面的检查
10:46
And to her, that spoke of a kind of attentiveness注意力 that she needed需要.
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对她来说,这表达了她所需要的关注
10:50
I was very influenced影响 by that anecdote轶事.
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这件事深深影响了我
10:52
I was also influenced影响 by another另一个 experience经验 that I had,
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另外还有一个我的经历同样对我有影响
10:55
again, when I was in Texas德州, before I moved移动 to Stanford斯坦福.
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也是我在德克萨斯的时候,还没搬到斯坦福
10:58
I had a reputation声誉
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我有个名声在外
11:00
as being存在 interested有兴趣 in patients耐心
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就是非常关注患有
11:02
with chronic慢性 fatigue疲劳.
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慢性疲劳的病人
11:05
This is not a reputation声誉 you would wish希望 on your worst最差 enemy敌人.
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这不是个坏名声
11:09
I say that because these are difficult patients耐心.
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我这么说是因为他们都不容易
11:12
They have often经常 been rejected拒绝 by their families家庭,
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他们多被家人拒绝
11:15
have had bad experiences经验 with medical care关心
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有很不如意的医疗经历
11:17
and they come to you fully充分 prepared准备
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他们早准备好了
11:20
for you to join加入 the long list名单 of people
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你是许多人之后
11:22
who's谁是 about to disappoint辜负 them.
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下一个另他们失望的人
11:24
And I learned学到了 very early on with my first patient患者
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我从第一个病人身上就早早认识到
11:27
that I could not do justice正义
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我无法公平地
11:29
to this very complicated复杂 patient患者
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去查看这位复杂病人的
11:31
with all the records记录 they were bringing使
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所有纪录
11:33
in a new patient患者 visit访问 of 45 minutes分钟.
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一个新病人只有45分钟
11:35
There was just no way.
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无可奈何
11:37
And if I tried试着, I'd disappoint辜负 them.
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如果我尝试了,我会令他们失望
11:40
And so I hit击中 on this method方法
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所以我的做法是
11:42
where I invited邀请 the patient患者
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第一次会诊的时候
11:44
to tell me the story故事 for their entire整个 first visit访问,
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我让病人们给我讲述他们的情况
11:47
and I tried试着 not to interrupt打断 them.
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我尝试不去打断
11:50
We know the average平均 American美国 physician医师
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我们知道美国医生平均
11:52
interrupts中断 their patient患者 in 14 seconds.
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14秒后就打断病人说话
11:55
And if I ever get to heaven天堂,
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如果我能进天堂
11:57
it will be because I held保持 my piece for 45 minutes分钟
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肯定是因为我能倾听上45分钟
12:00
and did not interrupt打断 my patient患者.
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而没打断他们
12:02
I then scheduled计划 the physical物理 exam考试 for two weeks hence于是,
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然后我会在两周后安排体检
12:05
and when the patient患者 came来了 for the physical物理,
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当病人来的时候
12:07
I was able能够 to do a thorough彻底 physical物理,
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我就能做一个彻底的体检
12:09
because I had nothing else其他 to do.
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因为这就是我能做的
12:11
I like to think that I do a thorough彻底 physical物理 exam考试,
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我想我做彻底的检查
12:14
but because the whole整个 visit访问 was now about the physical物理,
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是因为这个会诊就是为了体检
12:17
I could do an extraordinarily异常 thorough彻底 exam考试.
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我可以做一个格外细致的检查
12:20
And I remember记得 my very first patient患者 in that series系列
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我记得我第一个慢性疲劳病人
12:24
continued继续 to tell me more history历史
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在他的体检会诊过程中
12:26
during what was meant意味着 to be the physical物理 exam考试 visit访问.
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给我讲述更多她的历史
12:29
And I began开始 my ritual仪式.
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我开始了我的仪式
12:31
I always begin开始 with the pulse脉冲,
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我总是从测脉搏开始
12:33
then I examine检查 the hands, then I look at the nail beds,
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然后检查手,接下来是甲床
12:36
then I slide滑动 my hand up to the epitrochlearepitrochlear node节点,
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然后是滑车上淋巴结
12:38
and I was into my ritual仪式.
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由此进入我的仪式
12:40
And when my ritual仪式 began开始,
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当仪式开始
12:42
this very voluble能言善辩 patient患者
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这个健谈的病人
12:44
began开始 to quiet安静 down.
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开始安静下来
12:46
And I remember记得 having a very eerie怪异 sense
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我记得感受到一种神秘的畏惧感
12:49
that the patient患者 and I
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当我和病人
12:52
had slipped下滑 back into a primitive原始 ritual仪式
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都进入到这种原始性的仪式
12:54
in which哪一个 I had a role角色
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其中我有我的角色
12:56
and the patient患者 had a role角色.
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而病人有病人的角色
12:58
And when I was doneDONE,
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当我完成的时候
13:00
the patient患者 said to me with some awe威严,
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病人怀着敬畏对我说
13:02
"I have never been examined检查 like this before."
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“我从来没有被这样检查过”
13:05
Now if that were true真正,
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如果这是真的话
13:07
it's a true真正 condemnation非难 of our health健康 care关心 system系统,
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是对医疗保健系统的一个真实的谴责
13:09
because they had been seen看到 in other places地方.
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因为他们从来没在别的地方经历过
13:12
I then proceeded继续 to tell the patient患者,
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等病人穿戴完毕
13:14
once一旦 the patient患者 was dressed连衣裙的,
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我接着告诉他
13:16
the standard标准 things that the person must必须 have heard听说 in other institutions机构,
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他肯定在其他医疗机构都听过的内容:
13:19
which哪一个 is, "This is not in your head.
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“这不是你想像的
13:21
This is real真实.
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这是真的
13:23
The good news新闻, it's not cancer癌症, it's not tuberculosis结核,
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好消息是,得的不是癌症,不是肺结核
13:26
it's not coccidioidomycosis球孢子菌病 or some obscure朦胧 fungal真菌 infection感染.
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不是球孢子菌病或者什么真菌感染
13:29
The bad news新闻 is we don't know exactly究竟 what's causing造成 this,
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坏消息是我们不清楚是什么导致的
13:32
but here's这里的 what you should do, here's这里的 what we should do."
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你应该做这些,我应该做这些”
13:35
And I would lay铺设 out all the standard标准 treatment治疗 options选项
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我会列出病人在其他地方也听过的
13:38
that the patient患者 had heard听说 elsewhere别处.
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所有标准治疗的选项
13:41
And I always felt
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我总觉得
13:43
that if my patient患者 gave up the quest寻求
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如果我的病人放弃追着
13:45
for the magic魔法 doctor医生, the magic魔法 treatment治疗
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某个神奇医生,神奇疗法
13:48
and began开始 with me on a course课程 towards wellness健康,
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而转投我开始走向健康
13:51
it was because I had earned the right
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那是因为我一丝不苟的检查
13:53
to tell them these things
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为我赢得了
13:55
by virtue美德 of the examination检查.
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告诉他们这些的权利
13:57
Something of importance重要性 had transpired蒸腾 in the exchange交换.
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通过交流一些重要的信息已经透露
14:01
I took this to my colleagues同事
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我将此讲给
14:03
at Stanford斯坦福 in anthropology人类学
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在斯坦福大学人类学的同事们
14:05
and told them the same相同 story故事.
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告诉他们这个故事
14:07
And they immediately立即 said to me,
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他们立刻对我说
14:09
"Well you are describing说明 a classic经典 ritual仪式."
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“你描述了一个经典仪式”
14:11
And they helped帮助 me understand理解
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他们帮助我理解了
14:13
that rituals仪式 are all about transformation转型.
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仪式意味着转变
14:16
We marry结婚, for example,
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举例说,我们结婚
14:18
with great pomp盛况 and ceremony仪式 and expense费用
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用舞会,仪式和花费
14:21
to signal信号 our departure离开
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来宣告
14:23
from a life of solitude孤独 and misery苦难 and loneliness孤单
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孤独寂寞的悲惨生活
14:25
to one of eternal永恒 bliss.
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变成永恒的幸福
14:28
I'm not sure why you're laughing.
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我不知道你们为什么笑
14:30
That was the original原版的 intent意图, was it not?
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我们结婚原本是这么希望的,是吧?
14:32
We signal信号 transitions过渡 of power功率
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我们通过仪式表达
14:34
with rituals仪式.
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力量的转变
14:36
We signal信号 the passage通道 of a life with rituals仪式.
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我们用仪式表达生命
14:38
Rituals仪式 are terribly可怕 important重要.
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仪式非常重要
14:40
They're all about transformation转型.
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全部都与转变有关
14:42
Well I would submit提交 to you
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我想告诉你这种仪式
14:44
that the ritual仪式
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一个人
14:46
of one individual个人 coming未来 to another另一个
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来到另一个人面前
14:48
and telling告诉 them things
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告诉他一些
14:50
that they would not tell their preacher牧师 or rabbi拉比,
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连神父都不告诉的的事
14:53
and then, incredibly令人难以置信 on top最佳 of that,
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除此之外
14:55
disrobing脱衣 and allowing允许 touch触摸 --
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还换衣解带并让他触碰
14:58
I would submit提交 to you that that is a ritual仪式 of exceeding超额 importance重要性.
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我想告诉你们这是个极度重要的仪式
15:02
And if you shortchange奸商 that ritual仪式
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如果你在仪式上玩花样
15:04
by not undressing脱衣 the patient患者,
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比如不解衣服
15:06
by listening with your stethoscope听筒 on top最佳 of the nightgown睡衣,
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隔着睡裙听诊
15:09
by not doing a complete完成 exam考试,
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或者检查不完整
15:11
you have bypassed绕过 on the opportunity机会
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你已经错过了
15:13
to seal密封 the patient-physician医患 relationship关系.
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在医患关系上留下鉴印的机会
15:17
I am a writer作家,
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我是个作家
15:19
and I want to close by reading you a short passage通道 that I wrote
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我想以我写的一段话结尾
15:23
that has to do very much with this scene现场.
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它与这个场景契合
15:25
I'm an infectious传染病 disease疾病 physician医师,
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我是个传染病医生
15:27
and in the early days of HIVHIV, before we had our medications药物治疗,
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在HIV传染早期,还没有治疗方法的时候
15:30
I presided主持 over so many许多 scenes场景 like this.
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我经历过如此之多的这样的场景
15:34
I remember记得, every一切 time I went to a patient's耐心 deathbed临终,
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我记得,每次去医院或者病人家里的
15:37
whether是否 in the hospital醫院 or at home,
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临死的卧床
15:39
I remember记得 my sense of failure失败 --
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我总有种失败感-
15:43
the feeling感觉 of I don't know what I have to say;
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一种无话可说的感觉
15:45
I don't know what I can say;
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我不知道说什么好
15:47
I don't know what I'm supposed应该 to do.
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我不知道做什么好
15:49
And out of that sense of failure失败,
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带着那种失败感
15:51
I remember记得, I would always examine检查 the patient患者.
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我记得,我总会检查病人
15:54
I would pull down the eyelids眼皮.
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看看眼皮
15:56
I would look at the tongue.
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看看舌头
15:58
I would percuss叩诊 the chest胸部. I would listen to the heart.
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敲敲胸部 听听心跳
16:01
I would feel the abdomen腹部.
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按压腹腔
16:03
I remember记得 so many许多 patients耐心,
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我记得很多病人
16:06
their names still vivid生动 on my tongue,
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他们的名字仍犹如在耳
16:08
their faces面孔 still so clear明确.
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他们的脸庞仍历历在目
16:10
I remember记得 so many许多 huge巨大, hollowed挖空 out, haunted闹鬼 eyes眼睛
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我记得很多大而空洞的眼睛
16:14
staring凝视 up at me as I performed执行 this ritual仪式.
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在我进行仪式的时候盯着我
16:17
And then the next下一个 day,
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次日
16:19
I would come, and I would do it again.
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我会再来,再做
16:21
And I wanted to read you this one closing关闭 passage通道
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我想给各位读的结束语
16:24
about one patient患者.
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是关于一位病人的
16:26
"I recall召回 one patient患者
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“我记得一位病人
16:28
who was at that point
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当时的他
16:30
no more than a skeleton骨架
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瘦骨嶙峋
16:32
encased封闭式 in shrinking萎缩 skin皮肤,
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如同干柴
16:34
unable无法 to speak说话,
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无法言语
16:36
his mouth crusted结痂 with candida念珠菌
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嘴里长满念珠菌
16:38
that was resistant to the usual通常 medications药物治疗.
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这种真菌对普通药物具有抗药性
16:41
When he saw me
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当他看见我时
16:43
on what turned转身 out to be his last hours小时 on this earth地球,
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已是他活在人世的最后几个小时
16:45
his hands moved移动 as if in slow motion运动.
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他的手像慢镜头一样移动
16:48
And as I wondered想知道 what he was up to,
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我想他要表达点什么
16:50
his stick fingers手指 made制作 their way
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他的干柴一样的手指
16:52
up to his pajama睡衣 shirt衬衫,
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伸向他的睡衣
16:54
fumbling摸索 with his buttons纽扣.
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要解开扣子
16:57
I realized实现 that he was wanting希望
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我意识到
16:59
to expose暴露 his wicker-basket柳条筐 chest胸部 to me.
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他是想给我们看他骨瘦如柴的胸膛
17:02
It was an offering, an invitation请帖.
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那是个邀请
17:05
I did not decline下降.
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我没有拒绝
17:07
I percussed叩痛. I palpated触诊. I listened听了 to the chest胸部.
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我叩诊 触诊 听诊了胸腔
17:10
I think he surely一定 must必须 have known已知 by then
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我认为他一定知道
17:12
that it was vital重要 for me
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那对我的重要
17:14
just as it was necessary必要 for him.
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就想对他的必要一样
17:16
Neither也不 of us could skip跳跃 this ritual仪式,
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谁也不能省略这个仪式
17:19
which哪一个 had nothing to do with detecting检测 rales罗音 in the lung,
415
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不是为了听肺部的水泡
17:22
or finding发现 the gallop驰骋 rhythm韵律 of heart failure失败.
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或是心脏衰弱的跳动
17:25
No, this ritual仪式 was about the one message信息
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不,这个仪式
17:28
that physicians医师 have needed需要 to convey传达 to their patients耐心.
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是医生向患者传达的一个信息
17:31
Although虽然, God knows知道, of late晚了, in our hubris傲慢,
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虽然后来因为我们的傲慢
17:33
we seem似乎 to have drifted漂流 away.
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我们把它弄丢了
17:35
We seem似乎 to have forgotten忘记了 --
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我们好像忘了-
17:37
as though虽然, with the explosion爆炸 of knowledge知识,
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虽然有了知识大爆炸
17:39
the whole整个 human人的 genome基因组 mapped映射 out at our feet,
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整个人类的基因组被绘制出来
17:42
we are lulled哄骗 into inattention注意力不集中,
424
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我们渐渐变得冷漠
17:44
forgetting遗忘 that the ritual仪式 is cathartic泻药 to the physician医师,
425
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忘记了仪式是医生的泻药
17:47
necessary必要 for the patient患者 --
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病人很需要-
17:49
forgetting遗忘 that the ritual仪式 has meaning含义
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我们忘了仪式具有意义
17:51
and a singular单数 message信息 to convey传达 to the patient患者.
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并且将信息传达给病人
17:55
And the message信息, which哪一个 I didn't fully充分 understand理解 then,
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这个信息虽然我当时传递给了病人
17:58
even as I delivered交付 it,
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但我并没有完全理解
18:00
and which哪一个 I understand理解 better now is this:
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现在我更好地理解了:
18:03
I will always, always, always be there.
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我会永远,永远,永远在这里
18:06
I will see you through通过 this.
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我会陪你经历这一切
18:08
I will never abandon放弃 you.
434
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我永远不会抛弃你
18:10
I will be with you through通过 the end结束."
435
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我会陪你到最后
18:12
Thank you very much.
436
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谢谢
18:14
(Applause掌声)
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(掌声)
Translated by Chunxiang Qian
Reviewed by Jing Gao

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ABOUT THE SPEAKER
Abraham Verghese - Physician and author
In our era of the patient-as-data-point, Abraham Verghese believes in the old-fashioned physical exam, the bedside chat, the power of informed observation.

Why you should listen

Before he finished medical school, Abraham Verghese spent a year on the other end of the medical pecking order, as a hospital orderly. Moving unseen through the wards, he saw the patients with new eyes, as human beings rather than collections of illnesses. The experience has informed his work as a doctor -- and as a writer. "Imagining the Patient’s Experience" was the motto of the Center for Medical Humanities & Ethics, which he founded at the University of Texas San Antonio, where he brought a deep-seated empathy. He’s now a professor for the Theory and Practice of Medicine at Stanford, where his old-fashioned weekly rounds have inspired a new initiative, the Stanford 25, teaching 25 fundamental physical exam skills and their diagnostic benefits to interns.

He’s also a best-selling writer, with two memoirs and a novel, Cutting for Stone, a moving story of two Ethiopian brothers bound by medicine and betrayal.

He says: “I still find the best way to understand a hospitalized patient is not by staring at the computer screen but by going to see the patient; it's only at the bedside that I can figure out what is important.”

In 2011, Verghese was elected to the Institute of Medicine, which advises the government and private institutions on medicine and health on a national level.

More profile about the speaker
Abraham Verghese | Speaker | TED.com