ABOUT THE SPEAKER
Atul Gawande - Surgeon, writer, public health innovator
Surgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching.

Why you should listen

Atul Gawande is author of several best-selling books, including Complications: A Surgeon's Notes on an Imperfect ScienceBetter: A Surgeon's Notes on Performance, Being Mortal: Medicine and What Matters in the End and The Checklist Manifesto.

He is also a surgeon at Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation and chair of Lifebox, a nonprofit organization making surgery safer globally.

In June 2018, Gawande was chosen to lead the new healthcare company set up by Amazon, JPMorgan and Berkshire Hathaway.

Photo: Aubrey Calo

More profile about the speaker
Atul Gawande | Speaker | TED.com
TED2012

Atul Gawande: How do we heal medicine?

阿图尔-葛王德:拿什么拯救你,我们的医疗?

Filmed:
2,001,183 views

我们的医疗系统破败不堪。医生们开出昂贵无比的诊断书和处方,但他们却忽视了核心问题:真真切切地治疗患者。医生、作家阿图尔-葛王德建议我们退一步思考,换一个角度看待医疗行业——摈弃个人主义,建立团队合作
- Surgeon, writer, public health innovator
Surgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching. Full bio

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

00:15
I got my start开始
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我的职业生涯
00:18
in writing写作 and research研究
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从写作、研究开始
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as a surgical外科 trainee实习生,
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当时还是个外科实习医生
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as someone有人 who was a long ways方法 away
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像很多人一样,需要经历漫漫长路
00:25
from becoming变得 any kind of an expert专家 at anything.
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才能成为某个领域的专家
00:28
So the natural自然 question you ask then at that point
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因而,在当时那个阶段你自然要问
00:31
is, how do I get good at what I'm trying to do?
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我该如何做好自己所尝试做的这一领域?
00:33
And it became成为 a question of,
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这个问题会演变成
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how do we all get good
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我们怎样才能做好
00:37
at what we're trying to do?
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我们正在努力做的这件事?
00:40
It's hard enough足够 to learn学习 to get the skills技能,
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要掌握技术着实不易
00:44
try to learn学习 all the material材料 you have to absorb吸收
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需要对所学内容都吸收消化
00:47
at any task任务 you're taking服用 on.
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无论做什么
00:49
I had to think about how I sew and how I cut,
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就拿我来说,我必须学会如何缝合、如何开刀
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but then also how I pick the right person
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还得知道如何选择对的人
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to come to an operating操作 room房间.
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进入手术室
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And then in the midst中间 of all this
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在以上思考过程中
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came来了 this new context上下文
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还隐藏这一个问题
01:00
for thinking思维 about what it meant意味着 to be good.
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那就是:究竟什么才是造福于人?
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In the last few少数 years年份
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在过去几年中
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we realized实现 we were in the deepest最深 crisis危机
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我们意识到自己深陷
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of medicine's医学的 existence存在
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医学危机
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due应有 to something you don't normally一般 think about
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原因在于有些事情
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when you're a doctor医生
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作为医生很难考虑到
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concerned关心 with how you do good for people,
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关于如何造福于人
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which哪一个 is the cost成本
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例如,医疗卫生的
01:18
of health健康 care关心.
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成本问题
01:20
There's not a country国家 in the world世界
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世界上没有一个国家
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that now is not asking
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不在问
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whether是否 we can afford给予 what doctors医生 do.
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自己是否能支付医疗行为的代价
01:28
The political政治 fight斗争 that we've我们已经 developed发达
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这也引发了政治上的争论
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has become成为 one around
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争论焦点围绕着
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whether是否 it's the government政府 that's the problem问题
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究竟是政府
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or is it insurance保险 companies公司 that are the problem问题.
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还是保险公司才是罪魁祸首
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And the answer回答 is yes and no;
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答案既“是”,也“否”
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it's deeper更深 than all of that.
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还有更深层次的回答
01:47
The cause原因 of our troubles麻烦
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造成麻烦的根源
01:49
is actually其实 the complexity复杂 that science科学 has given特定 us.
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其实是科学带来的复杂性
01:52
And in order订购 to understand理解 this,
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为了让大家更好地理解这个观点
01:54
I'm going to take you back a couple一对 of generations.
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让我带大家回顾几代人之前的情况
01:58
I want to take you back
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我想带大家回到
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to a time when Lewis刘易斯 Thomas托马斯 was writing写作 in his book, "The Youngest最年轻的 Science科学."
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刘易斯-托马斯写下《最年轻的科学》的那个时代
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Lewis刘易斯 Thomas托马斯 was a physician-writer医生作家,
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刘易斯-托马斯是一位医生兼作家
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one of my favorite喜爱 writers作家.
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也是我最喜爱的作家之一
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And he wrote this book to explain说明, among其中 other things,
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他在书中描述了
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what it was like to be a medical intern实习生
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作一名实习医生的生活
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at the Boston波士顿 City Hospital醫院
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在当时的波士顿市立医院
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in the pre-penicillin预青霉素 year
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在盘尼西林尚未发现的年代
02:17
of 1937.
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那是1937年
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It was a time when medicine医学 was cheap低廉
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当时药物很便宜
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and very ineffective不灵.
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但疗效也不好
02:28
If you were in a hospital醫院, he said,
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他写道:如果你去看病
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it was going to do you good
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医院对你的唯一帮助
02:34
only because it offered提供 you
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就是提供了
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some warmth热情, some food餐饮, shelter庇护,
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给你提供了温暖、食物、住所,
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and maybe the caring爱心 attention注意
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或许还有来自护士的
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of a nurse护士.
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关怀
02:44
Doctors医生 and medicine医学
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医生和药物的作用
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made制作 no difference区别 at all.
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无关紧要
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That didn't seem似乎 to prevent避免 the doctors医生
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即使这样
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from being存在 frantically疯狂 busy in their days,
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当时的医生们还是忙得不可开交
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as he explained解释.
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对此,他解释道
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What they were trying to do
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他们努力想做的
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was figure数字 out whether是否 you might威力 have one of the diagnoses诊断
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就是弄清楚患者是否适用于某种诊断
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for which哪一个 they could do something.
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是他们可以治疗的
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And there were a few少数.
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这样的病症不多
03:06
You might威力 have a lobar pneumonia肺炎, for example,
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比如说,你患有大叶性肺炎
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and they could give you an antiserum抗血清,
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医生可以对你进行抗血清治疗
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an injection注射 of rabid疯狂的 antibodies抗体
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为你注射狂犬病抗体
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to the bacterium细菌 streptococcus链球菌,
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以此对抗链球菌
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if the intern实习生 sub-typed子类型化 it correctly正确地.
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前提是实习医生分类正确
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If you had an acute急性 congestive充血性 heart failure失败,
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如果你不幸突发急性充血性心脏衰竭
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they could bleed流血 a pint品脱 of blood血液 from you
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医生可以给你放一品脱的血
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by opening开盘 up an arm vein静脉,
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从割开的手臂静脉里
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giving you a crude原油 leaf preparation制备 of digitalis洋地黄
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他们会为你准备一剂粗糙的洋地黄叶制剂
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and then giving you oxygen by tent帐篷.
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然后让你在氧幕里吸氧
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If you had early signs迹象 of paralysis麻痹
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如果你出现瘫痪的前期症状
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and you were really good at asking personal个人 questions问题,
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如果你很善于问个人问题
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you might威力 figure数字 out
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你或许会发现
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that this paralysis麻痹 someone有人 has is from syphilis梅毒,
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这个病人的瘫痪很有可能是梅毒引发的
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in which哪一个 case案件 you could give this nice不错 concoction药汁
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因此你可以开出
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of mercury and arsenic --
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汞和砷的混合药剂
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as long as you didn't overdose过量 them and kill them.
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只要不过量使用,不会置他们于死地
04:01
Beyond these sorts排序 of things,
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除此之外
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a medical doctor医生 didn't have a lot that they could do.
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医师能做的事并不多
04:08
This was when the core核心 structure结构体 of medicine医学
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也就在那个时代,医疗的核心
04:10
was created创建 --
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形成了
04:12
what it meant意味着 to be good at what we did
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那就是如何做好我们所做的事
04:15
and how we wanted to build建立 medicine医学 to be.
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以及如何建立医疗体系
04:17
It was at a time
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当时
04:19
when what was known已知 you could know,
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医生能知道当时所有的医疗技术
04:21
you could hold保持 it all in your head, and you could do it all.
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一个人就可以记住所有的医疗知识,也能实施所有的医疗行为
04:24
If you had a prescription处方 pad,
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如果你有处方权
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if you had a nurse护士,
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如果你有一名护士
04:28
if you had a hospital醫院
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如果你有一所医院
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that would give you a place地点 to convalesce疗养, maybe some basic基本 tools工具,
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或许可以给你一个栖身之所,得到一些基本的工具
04:33
you really could do it all.
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你凭一己之力可以完成所有的事
04:35
You set the fracture断裂, you drew德鲁 the blood血液,
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你可以处理骨折,可以抽血
04:38
you spun the blood血液,
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可以验血
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looked看着 at it under the microscope显微镜,
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可以用显微镜观察
04:42
you plated the culture文化, you injected注射 the antiserum抗血清.
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你可以组织切片,可以注射抗血清
04:45
This was a life as a craftsman.
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这是工匠一般的生活
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As a result结果, we built内置 it around
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最终,我们成功
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a culture文化 and set of values
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建立起了医疗文化和价值体系
04:55
that said what you were good at
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医生最应擅长的事
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was being存在 daring大胆,
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就是行事大胆
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at being存在 courageous勇敢,
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充满勇气
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at being存在 independent独立 and self-sufficient自给.
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并且要独立工作,自给自足
05:06
Autonomy自治 was our highest最高 value.
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自主是至高无上的价值观
05:12
Go a couple一对 generations forward前锋
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往后推几代人
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to where we are, though虽然,
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来看今天
05:16
and it looks容貌 like a completely全然 different不同 world世界.
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世界好像完全变了个样
05:18
We have now found发现 treatments治疗
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我们现在的治疗手段
05:21
for nearly几乎 all of the tens of thousands数千 of conditions条件
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几乎能处理上万种
05:25
that a human人的 being存在 can have.
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人类可能患上的疑难杂症
05:27
We can't cure治愈 it all.
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尽管不能治愈所有疾病
05:29
We can't guarantee保证 that everybody每个人 will live生活 a long and healthy健康 life.
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我们不能保证每个人都长命百岁、无病无患
05:32
But we can make it possible可能
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但是我们可以让多数人
05:34
for most.
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过上健康长寿的生活
05:37
But what does it take?
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但是,实现这一结果的代价是什么呢?
05:39
Well, we've我们已经 now discovered发现
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如今我们已经发现了
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4,000 medical and surgical外科 procedures程序.
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4000种药物介入和外科手术
05:45
We've我们已经 discovered发现 6,000 drugs毒品
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我们研制了6000种药物
05:48
that I'm now licensed领有牌照 to prescribe规定.
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这还仅仅是我现在处方权允许的范围
05:51
And we're trying to deploy部署 this capability能力,
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我们正在尝试把这些治疗手段和药物,推广到更多地方
05:53
town by town,
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挨家挨户地
05:55
to every一切 person alive --
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深入大众
05:59
in our own拥有 country国家,
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覆盖我们国家的每一寸土地
06:01
let alone单独 around the world世界.
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乃至全球各个角落
06:03
And we've我们已经 reached到达 the point where we've我们已经 realized实现,
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我们已经到了这样的地步
06:06
as doctors医生,
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作为医生
06:08
we can't know it all.
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我们认识到自己不能知晓一切
06:10
We can't do it all
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也不能一一做到
06:13
by ourselves我们自己.
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仅凭一己之力是不行的
06:15
There was a study研究 where they looked看着
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曾经有一项研究
06:17
at how many许多 clinicians临床医生 it took to take care关心 of you
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调查了不同时代下,照顾一名患者
06:19
if you came来了 into a hospital醫院,
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在医院里
06:21
as it changed over time.
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需要多少医务人员
06:23
And in the year 1970,
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在1970年
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it took just over two full-time全职 equivalents当量 of clinicians临床医生.
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一般需要两名全职临床医务人员
06:28
That is to say,
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也就是说
06:30
it took basically基本上 the nursing看护 time
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基本上是护士照料时间
06:33
and then just a little bit of time for a doctor医生
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加上医生的一点点时间
06:35
who more or less checked检查 in on you
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医生的时间只用来做查房
06:37
once一旦 a day.
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一般一天一次
06:39
By the end结束 of the 20th century世纪,
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到了20世纪末年
06:42
it had become成为 more than 15 clinicians临床医生
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这一数字上升到15名临床医务人员
06:45
for the same相同 typical典型 hospital醫院 patient患者 --
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照顾同样一名典型的住院患者
06:48
specialists专家, physical物理 therapists治疗师,
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包括专科医生、普科医生
06:51
the nurses护士.
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以及护士
06:54
We're all specialists专家 now,
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如今我们都是专科医生
06:56
even the primary care关心 physicians医师.
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即便是基本卫生医疗单位的医生
06:58
Everyone大家 just has
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每个人也只
07:00
a piece of the care关心.
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提供自己专业范围内的一点点关怀
07:03
But holding保持 onto that structure结构体 we built内置
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但是为了坚持我们建立的医疗价值体系
07:05
around the daring大胆, independence独立,
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针对“勇敢”、“独立”
07:07
self-sufficiency自给自足
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“自给自足”
07:09
of each of those people
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对所有这些人而言
07:12
has become成为 a disaster灾害.
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就会变成一场灾难
07:14
We have trained熟练, hired雇用 and rewarded奖励 people
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我们培训、雇佣、奖励医生
07:18
to be cowboys牛仔.
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把他们变成牛仔那样
07:21
But it's pit crews船员 that we need,
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但是我们真正需要的是赛车维修队
07:24
pit crews船员 for patients耐心.
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针对病人的维修队
07:26
There's evidence证据 all around us:
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我们身边就有这样的实例证明
07:28
40 percent百分 of our coronary冠状动脉 artery动脉 disease疾病 patients耐心
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我们社区中40%的
07:31
in our communities社区
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冠状动脉患者
07:33
receive接收 incomplete残缺 or inappropriate不当 care关心.
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接受的治疗是不全面或不妥当的
07:37
60 percent百分
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60%
07:39
of our asthma哮喘, stroke行程 patients耐心
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哮喘、中风病人
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receive接收 incomplete残缺 or inappropriate不当 care关心.
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接受的治疗是不全面或不妥当的
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Two million百万 people come into hospitals医院
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200万人在医院的时候
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and pick up an infection感染
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受到感染
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they didn't have
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这些感染是他们原本所没有的
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because someone有人 failed失败 to follow跟随
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因为有人忽略了
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the basic基本 practices做法 of hygiene卫生.
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最基本的卫生问题
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Our experience经验
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我们的经验表明
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as people who get sick生病,
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当人们生病时
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need help from other people,
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需要得到别人的帮助
08:05
is that we have amazing惊人 clinicians临床医生
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应该是医生们的帮助
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that we can turn to --
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可以让我们找到那些令人放心的医生
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hardworking用功, incredibly令人难以置信 well-trained训练有素 and very smart聪明 --
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勤奋努力、受过良好培训、并且聪明过人
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that we have access访问 to incredible难以置信 technologies技术
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还可以得益于尖端技术
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that give us great hope希望,
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这些都会给我们莫大的希望
08:18
but little sense
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但极少能见到
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that it consistently始终如一 all comes together一起 for you
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所有这些持续地共同作用于你
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from start开始 to finish
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贯穿整个医疗过程
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in a successful成功 way.
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并且确保成功
08:30
There's another另一个 sign标志
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另外一个征兆
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that we need pit crews船员,
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我们需要维修队的原因
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and that's the unmanageable不可收拾 cost成本
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是现有医疗体系高昂到无法控制的
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of our care关心.
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成本问题
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Now we in medicine医学, I think,
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我想,在我们的医疗行业
08:42
are baffled困惑 by this question of cost成本.
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百思不得其解的就是这个成本问题
08:44
We want to say, "This is just the way it is.
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我们想说:“这就是现实……
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This is just what medicine医学 requires要求."
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这就是医药行业必需的“
08:50
When you go from a world世界
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当你从
08:52
where you treated治疗 arthritis关节炎 with aspirin阿司匹林,
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用阿司匹林治疗关节炎的地方
08:55
that mostly大多 didn't do the job工作,
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那往往是没有效果的
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to one where, if it gets得到 bad enough足够,
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到现在,对于严重病患
09:00
we can do a hip臀部 replacement替代, a knee膝盖 replacement替代
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我们可以做手术更换人工髋关节或膝盖
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that gives you years年份, maybe decades几十年,
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那将帮助病人恢复原本可能丧失的功能
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without disability失能,
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安好地度过几十年
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a dramatic戏剧性 change更改,
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这是一个多戏剧化的改变啊
09:09
well is it any surprise
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因此,如果说
09:11
that that $40,000 hip臀部 replacement替代
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花4万美元进行个髋关节移植手术
09:14
replacing更换 the 10-cent-cent aspirin阿司匹林
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而不是花10美分买阿司匹林来缓解
09:16
is more expensive昂贵?
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哪个更昂贵呢?
09:18
It's just the way it is.
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这就是现实
09:21
But I think we're ignoring无视 certain某些 facts事实
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但我认为,我们忽略了一些事实
09:23
that tell us something about what we can do.
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这些事实告诉我们,我们能做的其实有很多
09:28
As we've我们已经 looked看着 at the data数据
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我们看到一些数据
09:30
about the results结果 that have come
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关于医疗行为的结果
09:33
as the complexity复杂 has increased增加,
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尽管环境日益复杂
09:35
we found发现
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我们发现
09:37
that the most expensive昂贵 care关心
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最昂贵的医疗
09:39
is not necessarily一定 the best最好 care关心.
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不见得是最好的
09:42
And vice versa反之亦然,
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反之亦然
09:44
the best最好 care关心
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最好的医疗
09:46
often经常 turns out to be the least最小 expensive昂贵 --
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通常花不了几个钱
09:49
has fewer complications并发症,
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而且更简单
09:52
the people get more efficient高效 at what they do.
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人们在那种情况下效率更高
09:55
And what that means手段
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这一发现的含义在于
09:57
is there's hope希望.
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我们还有希望
10:00
Because [if] to have the best最好 results结果,
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因为,假如我们想要获得最好的结果
10:03
you really needed需要 the most expensive昂贵 care关心
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要用到最贵的医疗
10:06
in the country国家, or in the world世界,
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在一国范围内、或者在世界范围内最贵
10:08
well then we really would be talking about rationing配给
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那么我们真的要去讨论的就是配额制度
10:11
who we're going to cut off from Medicare医保.
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决定哪些人不能享受医疗保险
10:15
That would be really our only choice选择.
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那将会成为唯一的选择
10:19
But when we look at the positive deviants离经叛道 --
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但如果我们看看积极的反面事例
10:21
the ones那些 who are getting得到 the best最好 results结果
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确实存在以最低的成本
10:24
at the lowest最低 costs成本 --
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获得最佳效果的例子
10:26
we find the ones那些 that look the most like systems系统
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我们发现最像“系统”的
10:29
are the most successful成功.
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是最成功的
10:31
That is to say, they found发现 ways方法
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也就是说,我们发现了
10:34
to get all of the different不同 pieces,
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平衡所有不同部分
10:36
all of the different不同 components组件,
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不同因素的方法
10:38
to come together一起 into a whole整个.
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让各个部分变成一个整体
10:41
Having great components组件 is not enough足够,
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仅有好的组成部分是远远不够的
10:44
and yet然而 we've我们已经 been obsessed痴迷 in medicine医学 with components组件.
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然而我们正是对医药的组成部分太过痴迷了
10:48
We want the best最好 drugs毒品, the best最好 technologies技术,
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我们想要最好的药物、最好的技术
10:51
the best最好 specialists专家,
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最好的专科医生
10:54
but we don't think too much
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但我们却不曾想过
10:56
about how it all comes together一起.
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这些如何组合在一起
10:59
It's a terrible可怕 design设计 strategy战略 actually其实.
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这其实是个很糟糕的战略设计
11:03
There's a famous著名 thought experiment实验
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有一个很著名的思考实验
11:06
that touches触摸 exactly究竟 on this
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验证了这个想法
11:08
that said, what if you built内置 a car汽车
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实验是这样的,假如你用最好的汽车零件
11:10
from the very best最好 car汽车 parts部分?
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能造出怎样一辆车?
11:13
Well it would lead you to put in Porsche保时捷 brakes刹车,
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你可以用保时捷的刹车
11:16
a Ferrari法拉利 engine发动机,
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法拉利的引擎
11:18
a Volvo沃尔沃 body身体, a BMW宝马 chassis机壳.
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沃尔沃的车身,宝马的底盘
11:21
And you put it all together一起 and what do you get?
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你把这些都组装在一起会得到一辆怎样的车呢?
11:24
A very expensive昂贵 pile of junk破烂 that does not go anywhere随地.
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答案是:一堆很贵的垃圾,一辆完全不能开的车
11:28
And that is what medicine医学 can feel like sometimes有时.
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有时候医药行业也是这样
11:33
It's not a system系统.
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它并非一个系统
11:36
Now a system系统, however然而,
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然而,为了组建一个体系
11:38
when things start开始 to come together一起,
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当所有部分都组合到一起
11:41
you realize实现 it has certain某些 skills技能
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你需要有特定的技巧
11:44
for acting演戏 and looking that way.
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来让它运作起来,让它看起来像回事儿
11:47
Skill技能 number one
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首当其冲的是
11:49
is the ability能力 to recognize认识 success成功
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辨识成功的能力
11:51
and the ability能力 to recognize认识 failure失败.
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以及辨识失败的能力
11:54
When you are a specialist专家,
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假如你是一名专科医生
11:56
you can't see the end结束 result结果 very well.
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如果你无法很好地设想最终结果
11:59
You have to become成为 really interested有兴趣 in data数据,
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你必须认真分析数据
12:02
unsexyunsexy as that sounds声音.
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这听上去非常无趣
12:04
One of my colleagues同事 is a surgeon外科医生 in Cedar雪松 Rapids急流, Iowa爱荷华州,
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我的一个外科医生同事,在爱荷华州锡达拉皮兹工作
12:07
and he got interested有兴趣 in the question of,
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他对一个问题产生了兴趣
12:11
well how many许多 CTCT scans扫描 did they do
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那就是:他们在锡达拉皮兹
12:13
for their community社区 in Cedar雪松 Rapids急流?
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做了多少个CT扫描?
12:15
He got interested有兴趣 in this
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他对此很感兴趣
12:17
because there had been government政府 reports报告,
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因为政府报告
12:19
newspaper报纸 reports报告, journal日志 articles用品
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新闻报道、期刊论文
12:21
saying that there had been too many许多 CTCT scans扫描 doneDONE.
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都在说现在做的CT扫描过量了
12:24
He didn't see it in his own拥有 patients耐心.
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但他没在自己的病人中看到这个问题
12:28
And so he asked the question, "How many许多 did we do?"
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因此他提出这一疑问:”我们究竟做了多少CT扫描呢?“
12:30
and he wanted to get the data数据.
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他想得到这一数据
12:32
It took him three months个月.
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于是他花了3个月时间
12:34
No one had asked this question in his community社区 before.
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此前,在他的社区,没人有过这个疑问
12:37
And what he found发现 was that,
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后来,他发现
12:39
for the 300,000 people in their community社区,
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在社区的300,000人中
12:41
in the previous以前 year
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过去一年间
12:43
they had doneDONE 52,000 CTCT scans扫描.
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他们曾做了52,000次CT扫描
12:48
They had found发现 a problem问题.
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于是他们发现了一个问题
12:51
Which哪一个 brings带来 us to skill技能 number two a system系统 has.
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也就引出了我要说的运作系统的第二项技巧
12:56
Skill技能 one, find where your failures故障 are.
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技巧1是:发现我们错在哪里
12:59
Skill技能 two is devise设计 solutions解决方案.
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技巧2是:设计解决方案
13:03
I got interested有兴趣 in this
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我对此也颇感兴趣
13:05
when the World世界 Health健康 Organization组织 came来了 to my team球队
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世界卫生组织曾来找我的团队
13:07
asking if we could help with a project项目
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问我们是否能帮他们做一个项目
13:09
to reduce减少 deaths死亡 in surgery手术.
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来降低外科手术的死亡率
13:11
The volume of surgery手术 had spread传播
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如今外科手术在世界范围内
13:13
around the world世界,
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数量日益增长
13:15
but the safety安全 of surgery手术
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但是手术的安全性
13:17
had not.
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却令人担忧
13:19
Now our usual通常 tactics策略 for tackling抢断 problems问题 like these
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现在我们普遍的做法是
13:22
are to do more training训练,
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开展更多培训
13:24
give people more specialization专业化
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让医生更加专业
13:27
or bring带来 in more technology技术.
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或者提高技术
13:30
Well in surgery手术, you couldn't不能 have people who are more specialized专门
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所以,在手术中,我们的医生都是非常专业的
13:33
and you couldn't不能 have people who are better trained熟练.
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受过非常好的教育和培训
13:36
And yet然而 we see unconscionable过度的 levels水平
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然而我们还是看到高得不正常的
13:39
of death死亡, disability失能
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死亡率和致残率
13:43
that could be avoided避免.
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这些原本都是可以避免的
13:45
And so we looked看着 at what other high-risk高风险 industries行业 do.
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因此我们参考了其他高风险行业的做法
13:47
We looked看着 at skyscraper摩天大楼 construction施工,
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我们观察了摩天大楼的建设
13:49
we looked看着 at the aviation航空 world世界,
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我们研究了飞机制造业
13:52
and we found发现
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然后发现
13:54
that they have technology技术, they have training训练,
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他们有技术、他们有培训
13:56
and then they have one other thing:
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而且他们还有一样东西
13:59
They have checklists清单.
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那就是检查表
14:02
I did not expect期望
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我没有想到自己
14:04
to be spending开支 a significant重大 part部分
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作为一名哈佛外科医生
14:06
of my time as a Harvard哈佛 surgeon外科医生
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会把大部分时间
14:08
worrying令人担忧 about checklists清单.
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用来烦恼检查表这个东西
14:11
And yet然而, what we found发现
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然而,我们发现
14:13
were that these were tools工具
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正是这个工具
14:16
to help make experts专家 better.
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帮助专家达到最佳效果
14:19
We got the lead safety安全 engineer工程师 for Boeing波音 to help us.
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我们得到了波音公司首席安全工程师的帮助
14:23
Could we design设计 a checklist清单 for surgery手术?
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我们请教他如何设计一张用于外科手术的清单?
14:26
Not for the lowest最低 people on the totem图腾 pole,
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并非为了社会底层人士
14:28
but for the folks乡亲
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而是针对
14:30
who were all the way around the chain,
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在这条产业链的每个环节上的人
14:32
the entire整个 team球队 including包含 the surgeons外科医生.
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包括外科医生在内的整个团队
14:34
And what they taught us
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他们教我们的是
14:36
was that designing设计 a checklist清单
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要设计好检查表
14:38
to help people handle处理 complexity复杂
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来帮助人们处理复杂问题
14:40
actually其实 involves涉及 more difficulty困难 than I had understood了解.
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其实比想象的要难
14:43
You have to think about things
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你必须考虑很多问题
14:45
like pause暂停 points.
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比如“暂停时点”
14:47
You need to identify鉴定 the moments瞬间 in a process处理
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你需要认识到整个流程中的一些时刻
14:50
when you can actually其实 catch抓住 a problem问题 before it's a danger危险
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能够在危险来临前及时发现问题
14:52
and do something about it.
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作出处理以免酿成大祸
14:54
You have to identify鉴定
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你必须把它当做
14:56
that this is a before-takeoff前起飞 checklist清单.
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是一张飞机起飞前的检查表
14:59
And then you need to focus焦点 on the killer凶手 items项目.
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你一定要关注一些至关重要的项目
15:02
An aviation航空 checklist清单,
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在一份飞机制造检查表上
15:04
like this one for a single-engine单引擎 plane平面,
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就像这张针对单引擎飞机的检查清单
15:06
isn't a recipe食谱 for how to fly a plane平面,
339
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它可不是驾驶飞机的窍门
15:08
it's a reminder提醒 of the key things
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而是对关键问题的提醒
15:10
that get forgotten忘记了 or missed错过
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如果他们不去检查
15:13
if they're not checked检查.
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很可能会遗漏这些问题
15:15
So we did this.
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因此我们也效仿了他们的做法
15:17
We created创建 a 19-item-项目 two-minute两分钟 checklist清单
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我们设计了一张检查表,19个项目,用时2分钟
15:20
for surgical外科 teams球队.
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针对手术团队
15:22
We had the pause暂停 points
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其中包含“暂停时点”
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immediately立即 before anesthesia麻醉 is given特定,
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例如,实施麻醉前
15:27
immediately立即 before the knife hits点击 the skin皮肤,
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手术刀接触病人皮肤之前
15:30
immediately立即 before the patient患者 leaves树叶 the room房间.
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病人离开手术室之前
15:33
And we had a mix混合 of dumb stuff东东 on there --
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检查表上不乏很多看上去很简单的事情
15:36
making制造 sure an antibiotic抗生素 is given特定 in the right time frame
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例如,确保在正确的时间使用抗生素
15:39
because that cuts削减 the infection感染 rate by half --
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光这一点就让感染率下降了一半
15:41
and then interesting有趣 stuff东东,
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还有些有意思的事
15:43
because you can't make a recipe食谱 for something as complicated复杂 as surgery手术.
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你无法为手术这样复杂的事情事先开出处方
15:46
Instead代替, you can make a recipe食谱
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然而,你却可以开处方
15:48
for how to have a team球队 that's prepared准备 for the unexpected意外.
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给这个团队,使他们能更好地去面对突发状况
15:51
And we had items项目 like making制造 sure everyone大家 in the room房间
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我们列出的项目中就包括:确保每个在房间的人
15:54
had introduced介绍 themselves他们自己 by name名称 at the start开始 of the day,
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都在手术开始前互相做了自我介绍
15:57
because you get half a dozen people or more
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因为很多时候,起码有六个人
15:59
who are sometimes有时 coming未来 together一起 as a team球队
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在这个新组建的团队中
16:02
for the very first time that day that you're coming未来 in.
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都是初次见面
16:05
We implemented实施 this checklist清单
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后来,我们在世界上8所医院
16:07
in eight hospitals医院 around the world世界,
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执行、推广了这份检查表
16:10
deliberately故意 in places地方 from rural乡村 Tanzania坦桑尼亚
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其中包括坦桑尼亚的乡村
16:12
to the University大学 of Washington华盛顿 in Seattle西雅图.
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也包括在西雅图的华盛顿大学
16:15
We found发现 that after they adopted采用 it
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我们发现,当他们使用了这份检查表之后
16:18
the complication并发症 rates利率 fell下跌
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复杂程度大大降低
16:20
35 percent百分.
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降低了35%
16:22
It fell下跌 in every一切 hospital醫院 it went into.
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每所医院都是如此
16:25
The death死亡 rates利率 fell下跌
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死亡率也降低了
16:27
47 percent百分.
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降低了47%
16:30
This was bigger than a drug药物.
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这比任何一种药物都管用
16:32
(Applause掌声)
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(掌声)
16:38
And that brings带来 us
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这将引出
16:40
to skill技能 number three,
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第三项技巧
16:43
the ability能力 to implement实行 this,
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执行能力
16:45
to get colleagues同事 across横过 the entire整个 chain
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让所有产业链上的同事
16:48
to actually其实 do these things.
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都能切实地这样做事
16:51
And it's been slow to spread传播.
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推广这些很花时间
16:53
This is not yet然而 our norm规范 in surgery手术 --
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这还不是我们做手术的规范
16:57
let alone单独 making制造 checklists清单
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更别说
16:59
to go onto childbirth分娩 and other areas.
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应用于例如分娩等其他紧迫的领域
17:02
There's a deep resistance抵抗性
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在执行中往往会遇到强大的阻力
17:04
because using运用 these tools工具
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因为使用这些工具
17:06
forces军队 us to confront面对
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会迫使我们去面对
17:08
that we're not a system系统,
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我们还未成为“系统”这一事实
17:10
forces军队 us to behave表现 with a different不同 set of values.
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会迫使我们不得不用另一套价值观去操作
17:13
Just using运用 a checklist清单
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使用一份检查表
17:15
requires要求 you to embrace拥抱 different不同 values from the ones那些 we've我们已经 had,
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需要你用与以往不同的价值操守
17:18
like humility谦逊,
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例如谦虚
17:22
discipline学科,
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纪律
17:25
teamwork团队合作.
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团队合作
17:27
This is the opposite对面 of what we were built内置 on:
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这与我们所建立的价值观刚好背道而驰:
17:30
independence独立, self-sufficiency自给自足,
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独立、自给自足
17:32
autonomy自治.
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自治
17:35
I met会见 an actual实际 cowboy牛仔, by the way.
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说到这儿,我想起来曾经遇到过一个真正的牛仔
17:38
I asked him, what was it like
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我问他:牛仔到底是如何
17:41
to actually其实 herd放牧 a thousand cattle黄牛
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将上千头牛
17:43
across横过 hundreds数以百计 of miles英里?
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放牧几百英里
17:45
How did you do that?
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你们是怎么做的?
17:47
And he said, "We have the cowboys牛仔 stationed at distinct不同 places地方 all around."
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他回答说:“我们有牛仔驻扎在牧区的几个地点”
17:50
They communicate通信 electronically电子 constantly经常,
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他们通过电子设备不断交流
17:53
and they have protocols协议 and checklists清单
403
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他们有规章制度和各种检查表
17:55
for how they handle处理 everything --
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去处理发生的各种情况
17:57
(Laughter笑声)
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(笑声)
17:59
-- from bad weather天气
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比如,恶劣天气
18:01
to emergencies紧急情况 or inoculations接种 for the cattle黄牛.
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1066000
3000
比如,突发事件,或者为牛群接种
18:04
Even the cowboys牛仔 are pit crews船员 now.
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如今,就连牛仔们也组成了维修队
18:08
And it seemed似乎 like time
409
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似乎是时候
18:10
that we become成为 that way ourselves我们自己.
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我们也变成那样了
18:12
Making制造 systems系统 work
411
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靠“系统”来工作
18:14
is the great task任务 of my generation
412
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这正是我们这代人
18:17
of physicians医师 and scientists科学家们.
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作为医生和科学家的的首要任务
18:19
But I would go further进一步 and say
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进一步说
18:21
that making制造 systems系统 work,
415
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要让“系统”运转起来
18:23
whether是否 in health健康 care关心, education教育,
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2000
无论是医疗、教育
18:25
climate气候 change更改,
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还是气候变化
18:27
making制造 a pathway out of poverty贫穷,
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还是消除贫困
18:29
is the great task任务 of our generation as a whole整个.
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都是我们这代人,作为一个整体需要完成的重要任务
18:33
In every一切 field领域, knowledge知识 has exploded爆炸,
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在各个领域都有知识爆炸
18:36
but it has brought complexity复杂,
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情况更加复杂
18:38
it has brought specialization专业化.
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专业性更强
18:41
And we've我们已经 come to a place地点 where we have no choice选择
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我们别无选择
18:43
but to recognize认识,
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只能去认识到
18:45
as individualistic个人主义的 as we want to be,
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尽管我们都崇尚个人主义
18:48
complexity复杂 requires要求
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但复杂性要求我们
18:51
group success成功.
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取得集体成功
18:53
We all need to be pit crews船员 now.
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我们全都需要成为维修队
18:57
Thank you.
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谢谢大家
18:59
(Applause掌声)
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(掌声)
Translated by Kang Rong SUN
Reviewed by Karen SONG

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ABOUT THE SPEAKER
Atul Gawande - Surgeon, writer, public health innovator
Surgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching.

Why you should listen

Atul Gawande is author of several best-selling books, including Complications: A Surgeon's Notes on an Imperfect ScienceBetter: A Surgeon's Notes on Performance, Being Mortal: Medicine and What Matters in the End and The Checklist Manifesto.

He is also a surgeon at Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation and chair of Lifebox, a nonprofit organization making surgery safer globally.

In June 2018, Gawande was chosen to lead the new healthcare company set up by Amazon, JPMorgan and Berkshire Hathaway.

Photo: Aubrey Calo

More profile about the speaker
Atul Gawande | Speaker | TED.com