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

Abraham Verghese:醫生的觸診

Filmed:
1,719,216 views

現代醫學面臨一套威力強大、久遠經典的法門失傳的危機:人類接觸。醫師兼作家Abraham Verghese描述,我們所在的陌生新世界中,病人僅是數據點,呼籲回歸傳統一對一診察方式。
- 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少數 months個月 ago,
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幾個月前,
00:17
a 40 year-old woman女人 came來了 to an emergency room房間
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一位四十歲的婦人來到急診室
00:20
in a hospital醫院 close to where I live生活,
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在我住處附近的一家醫院內
00:22
and she was brought in confused困惑.
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她被送進來時,身體狀況混亂
00:24
Her blood血液 pressure壓力 was an alarming驚人
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她的血壓拉警報
00:26
230 over 170.
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收縮壓230,舒張壓170
00:29
Within a few少數 minutes分鐘, she went into cardiac心臟的 collapse坍方.
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幾分鐘內,她的心臟衰竭
00:32
She was resuscitated復甦, stabilized穩定,
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她被施以心肺復甦、穩定下來
00:35
whisked護送 over to a CAT scan掃描 suite套房
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快速送到電腦斷層掃瞄室
00:37
right next下一個 to the emergency room房間,
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就在急診室旁
00:39
because they were concerned關心 about blood血液 clots血塊 in the lung.
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因為他們擔心肺部有血塊
00:42
And the CAT scan掃描 revealed透露
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電腦斷層掃瞄顯示
00:44
no blood血液 clots血塊 in the lung,
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在肺部沒有血塊
00:46
but it showed顯示 bilateral雙邊, visible可見, palpable明顯的 breast乳房 masses群眾,
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但胸部兩邊,有許多明顯、觸即可知的腫塊
00:51
breast乳房 tumors腫瘤,
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胸部腫瘤
00:53
that had metastasized轉移 widely廣泛
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已經轉移擴散
00:55
all over the body身體.
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遍及全身
00:57
And the real真實 tragedy悲劇 was, if you look through通過 her records記錄,
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真正可悲的是,若你翻閱其病歷表記錄
01:00
she had been seen看到
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她已在其他四、五家
01:02
in four or five other health健康 care關心 institutions機構
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醫療照護機構中接受過檢查
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in the preceding two years年份.
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接著幾年下來
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Four or five opportunities機會
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有四到五次的機會
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to see the breast乳房 masses群眾, touch觸摸 the breast乳房 mass,
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可以發現那些胸部腫塊
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intervene干預 at a much earlier stage階段
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甚至也摸的出更早期就出現的胸部腫塊
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than when we saw her.
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不用等到我們見到她
01:15
Ladies女士們 and gentlemen紳士,
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各位女士、各位先生
01:17
that is not an unusual異常 story故事.
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這不是一個非比尋常的故事
01:19
Unfortunately不幸, it happens發生 all the time.
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很遺憾的是,這事老是發生
01:22
I joke玩笑, but I only half joke玩笑,
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我開玩笑;但只是半開玩笑
01:24
that if you come to one of our hospitals醫院 missing失踪 a limb,
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如果你斷了一肢手臂或腿來到全美任何一家醫院
01:27
no one will believe you till直到 they get a CAT scan掃描, MRIMRI
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沒有人會相信你,除非他們做了電腦斷層掃瞄、磁共振造影
01:30
or orthopedic骨科 consult請教.
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或骨外科會診
01:32
I am not a Luddite勒德.
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我不是一個反科技的人(Luddite)
01:34
I teach at Stanford斯坦福.
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我在史丹佛授課
01:36
I'm a physician醫師 practicing with cutting-edge前沿 technology技術.
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我是一個以尖端科技執業的醫生
01:38
But I'd like to make the case案件 to you
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但我在接下來的
01:40
in the next下一個 17 minutes分鐘
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17分鐘想向你們證實
01:42
that when we shortcut捷徑 the physical物理 exam考試,
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當我們省略檢查身體的步驟
01:46
when we lean towards ordering排序 tests測試
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當我們依賴安排測試
01:48
instead代替 of talking to and examining檢查 the patient患者,
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而非跟病人談話、檢查病人
01:51
we not only overlook俯瞰 simple簡單 diagnoses診斷
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我們不只輕忽簡單的診斷 --
01:54
that can be diagnosed確診 at a treatable可治療, early stage階段,
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在可療癒的初期階段就能被診斷 --
01:57
but we're losing失去 much more than that.
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而且我們錯失的還不只是那樣
01:59
We're losing失去 a ritual儀式.
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我們遺失一項儀式
02:01
We're losing失去 a ritual儀式 that I believe is transformative變革, transcendent超然,
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我們正失掉了一種我相信是能改變、能超越的儀式
02:04
and is at the heart
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這同時也是
02:06
of the patient-physician醫患 relationship關係.
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醫病關係中的核心
02:08
This may可能 actually其實 be heresy異端 to say this at TEDTED,
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在TED大會說這個,也許確實怪異,
02:11
but I'd like to introduce介紹 you
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但我想向你們推介
02:13
to the most important重要 innovation革新,
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這個極重要的變革
02:15
I think, in medicine醫學
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我認為,在醫學方面
02:17
to come in the next下一個 10 years年份,
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在下一個十年的來臨
02:19
and that is the power功率 of the human人的 hand --
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是人類手的威力 --
02:21
to touch觸摸, to comfort安慰, to diagnose診斷
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去碰觸、紓解、診斷
02:24
and to bring帶來 about treatment治療.
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並且帶入治療
02:26
I'd like to introduce介紹 you first to this person
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我首先想介紹你們這個人
02:29
whose誰的 image圖片 you may可能 or may可能 not recognize認識.
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他的照片你們也許認得,也許不認得
02:31
This is Sir先生 Arthur亞瑟 Conan柯南 Doyle多伊爾.
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這是亞瑟‧柯南‧道爾先生( Sir Arthur Conan Doyle)
02:33
Since以來 we're in Edinburgh愛丁堡, I'm a big fan風扇 of Conan柯南 Doyle多伊爾.
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從我們在愛丁堡,我就是個超級柯南‧道爾迷
02:36
You might威力 not know that Conan柯南 Doyle多伊爾 went to medical school學校
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你們可能不曉得柯南‧道爾進入醫學院
02:38
here in Edinburgh愛丁堡,
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在愛丁堡這兒
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and his character字符, Sherlock福爾摩斯 Holmes霍姆斯,
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而他筆下的人物夏洛克‧福爾摩斯(Sherlock Holmes)
02:42
was inspired啟發 by Sir先生 Joseph約瑟夫 Bell.
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是以喬瑟夫‧貝爾 (Sir Joseph Bell)為創作靈感
02:45
Joseph約瑟夫 Bell was an extraordinary非凡 teacher老師 by all accounts賬戶.
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根據各方說法,喬瑟夫‧貝爾是一位超凡出色的老師
02:48
And Conan柯南 Doyle多伊爾, writing寫作 about Bell,
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柯南‧道爾描寫貝爾
02:51
described描述 the following以下 exchange交換
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描述下述
02:53
between之間 Bell and his students學生們.
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貝爾和其學生間的交流
02:55
So picture圖片 Bell sitting坐在 in the outpatient門診病人 department,
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想像貝爾坐在門診部
02:58
students學生們 all around him,
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學生們包圍住他
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patients耐心 signing簽約 up in the emergency room房間
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病人在急診室填寫資料
03:02
and being存在 registered註冊 and being存在 brought in.
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然後被登記並領入
03:05
And a woman女人 comes in with a child兒童,
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一位女士帶著一個孩子進來
03:07
and Conan柯南 Doyle多伊爾 describes介紹 the following以下 exchange交換.
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柯南‧道爾描寫下述的交談
03:10
The woman女人 says, "Good Morning早上."
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那女人說:「早安」
03:14
Bell says, "What sort分類 of crossing路口 did you have
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貝爾問:「從奔提斯蘭(Burntisland)
03:17
on the ferry渡船 from Burntisland泰蘭?"
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搭渡輪過海行程怎樣啊?」
03:20
She says, "It was good."
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她回答:「一切平順。」
03:22
And he says, "What did you do with the other child兒童?"
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他接著問:「你的另一個小孩呢?」
03:25
She says, "I left him with my sister妹妹 at Leith利思."
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她回答:「我留他在里斯(Leith)我姊姊家。」
03:28
And he says,
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他接著問:
03:30
"And did you take the shortcut捷徑 down InverleithInverleith酒店 Row
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「你走捷徑往印佛里斯(Inverleith Row)
03:32
to get here to the infirmary醫務室?"
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來到醫院這兒的嗎?」
03:34
She says, "I did."
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她回應:「是的。」
03:36
And he says, "Would you still be working加工 at the linoleum油布 factory?"
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他接著問:「你仍是在油蠟地板工廠工作嗎?」
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And she says, "I am."
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她回應:「是的。」
03:42
And Bell then goes on to explain說明 to the students學生們.
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貝爾接著轉向學生解說
03:44
He says, "You see, when she said, 'Good'好 morning早上,'
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他說:「你們瞧,在她說『早安』時
03:47
I picked採摘的 up her Fife accent口音.
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我學起她的Fife(位於蘇格蘭東方)口音
03:49
And the nearest最近的 ferry渡船 crossing路口 from Fife is from Burntisland泰蘭.
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從Fife來最近的渡輪旅程是由奔提斯蘭(Burntisland)
03:52
And so she must必須 have taken採取 the ferry渡船 over.
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因而,她必定乘渡輪而來。
03:55
You notice注意 that the coat塗層 she's carrying攜帶
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你們有注意到她拿著的那件外套
03:57
is too small for the child兒童 who is with her,
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對和她一道來的那孩子而言,太小了
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and therefore因此, she started開始 out the journey旅程 with two children孩子,
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因此,她開始是和兩個孩童同行
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but dropped下降 one off along沿 the way.
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但在途中放下一個小孩
04:06
You notice注意 the clay粘土 on the soles鞋底 of her feet.
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你們注意看她雙腳底下的土
04:08
Such這樣 red clay粘土 is not found發現 within a hundred miles英里 of Edinburgh愛丁堡,
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這樣的紅土在愛丁堡方圓一百英里內看不到
04:12
except in the botanical植物 gardens花園.
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除了在植物園
04:14
And therefore因此, she took a short cut down InverleithInverleith酒店 Row
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由此可知,她走捷徑往印佛里斯(Inverleith Row)
04:17
to arrive到達 here.
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來到這兒的
04:19
And finally最後, she has a dermatitis皮炎
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最後一點,她有皮膚炎
04:21
on the fingers手指 of her right hand,
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在她右手的手指
04:23
a dermatitis皮炎 that is unique獨特
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該皮膚炎是好發於
04:25
to the linoleum油布 factory workers工人 in Burntisland泰蘭."
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奔提斯蘭(Burntisland)油蠟地板工廠的工人。」
04:28
And when Bell actually其實 strips帶子 the patient患者,
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而其實,當貝爾讓病人脫去衣物
04:30
begins開始 to examine檢查 the patient患者,
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開始檢查病人,
04:32
you can only imagine想像 how much more he would discern辨別.
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你能想像到,他會覺察出的又更多
04:35
And as a teacher老師 of medicine醫學, as a student學生 myself,
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身為一位醫學老師,也身為一位學生
04:38
I was so inspired啟發 by that story故事.
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這故事激發我的靈感
04:40
But you might威力 not realize實現
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但你可能不了解
04:42
that our ability能力 to look into the body身體
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我們以這樣簡單的方式
04:44
in this simple簡單 way, using運用 our senses感官,
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使用我們的感官,來檢查身體
04:46
is quite相當 recent最近.
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是相當近代的方法
04:48
The picture圖片 I'm showing展示 you is of Leopold利奧波德 AuenbruggerAuenbrugger
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我讓你們看的這張圖像是李奧波得‧奧恩布魯格(Leopold Auenbrugger)
04:51
who, in the late晚了 1700s,
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在18世紀末
04:53
discovered發現 percussion打擊樂器.
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他發現「叩診法」
04:55
And the story故事 is that Leopold利奧波德 AuenbruggerAuenbrugger
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故事是李奧波得‧奧恩布魯格(Leopold Auenbrugger)
04:58
was the son兒子 of an innkeeper店主.
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是一位旅館老闆的兒子
05:01
And his father父親 used to go down into the basement地下室
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他的父親過去常會到地下室
05:04
to tap龍頭 on the sides雙方 of casks木桶 of wine紅酒
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輕敲酒桶側面
05:06
to determine確定 how much wine紅酒 was left
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以判定還剩多少酒
05:08
and whether是否 to reorder重新排序.
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決定是否要再訂酒
05:10
And so when AuenbruggerAuenbrugger became成為 a physician醫師,
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因此當李奧波得(Auenbrugger)成為一名醫生
05:12
he began開始 to do the same相同 thing.
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他開始效法其父之舉
05:14
He began開始 to tap龍頭 on the chests箱子 of his patients耐心,
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他開始輕敲病患的胸膛
05:17
on their abdomens腹部.
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他們的腹部
05:19
And basically基本上 everything we know about percussion打擊樂器,
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基本上,我們對叩診的了解
05:21
which哪一個 you can think of as an ultrasound超聲 of its day --
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你可以想成是那個時代的超音波 --
05:25
organ器官 enlargement放大, fluid流體 around the heart, fluid流體 in the lungs,
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器官腫大、心臟周圍的流體、肺中流體
05:28
abdominal腹部的 changes變化 --
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腹部變化 --
05:30
all of this he described描述 in this wonderful精彩 manuscript手稿
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所有叩診法門他都敍述在這本精采的手冊
05:32
"InventumInventum NovumNovum酒店," "New Invention發明,"
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《創新發明(Inventum Novum拉丁文)》
05:35
which哪一個 would have disappeared消失 into obscurity朦朧,
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這本書本會如石沈大海,無人聞問
05:37
except for the fact事實 that this physician醫師, CorvisartCorvisart,
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要不是這名醫生柯比沙特(Corvisart)
05:40
a famous著名 French法國 physician醫師 --
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他是位有名的法國醫生 --
05:42
famous著名 only because he was physician醫師 to this gentleman紳士 --
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出名只因為他是這位男士的醫生 --
05:45
CorvisartCorvisart repopularizedrepopularized and reintroduced重新 the work.
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柯比沙特(Corvisart)重新宣揚並採用這法門
05:49
And it was followed其次 a year or two later後來
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約一、兩年後,接著
05:51
by Laennec拉埃內克 discovering發現 the stethoscope聽筒.
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雷涅克(Laennec)發明了聽診器
05:54
Laennec拉埃內克, it is said, was walking步行 in the streets街道 of Paris巴黎
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據說,雷涅克(Laennec)當時走在巴黎的街道
05:57
and saw two children孩子 playing播放 with a stick.
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看到二個小孩玩著一根棍子
05:59
One was scratching搔抓 at the end結束 of the stick,
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一個小孩在一端刮著
06:02
another另一個 child兒童 listened聽了 at the other end結束.
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另一個小孩在另一頭聽著
06:04
And Laennec拉埃內克 thought this would be a wonderful精彩 way
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雷涅克(Laennec)認為這會是一種妙法
06:06
to listen to the chest胸部 or listen to the abdomen腹部
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來聽診胸部或腹部
06:08
using運用 what he called "the cylinder圓筒."
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用他稱之為「圓筒」的東西
06:10
Later後來 he renamed改名 it the stethoscope聽筒.
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稍後他為其重新命名為聽診器(stethoscope)
06:12
And that is how stethoscope聽筒 and auscultation聽診 was born天生.
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這就是聽診器和聽診問世的原由
06:16
So within a few少數 years年份,
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所以在幾年內
06:18
in the late晚了 1800s, early 1900s,
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在十九世紀末、二十世紀初
06:20
all of a sudden突然,
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倏然
06:22
the barber理髮師 surgeon外科醫生 had given特定 way
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「理髮師兼外科手術師」已被
06:25
to the physician醫師 who was trying to make a diagnosis診斷.
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試圖作診斷的醫生取代
06:28
If you'll你會 recall召回, prior to that time,
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如果回想在那以前
06:30
no matter what ailedailed you, you went to see the barber理髮師 surgeon外科醫生
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無論什麼讓你不適、痛苦,你向「理髮師兼外科手術師」求助
06:33
who wound傷口 up cupping拔罐 you,
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他們到頭來對你拔罐
06:35
bleeding流血的 you, purging清洗 you.
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放血、通腸
06:37
And, oh yes, if you wanted,
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當然,若你想的話
06:39
he would give you a haircut理髮 -- short on the sides雙方, long in the back --
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他會幫你理髮 -- 兩旁短,後面長 --
06:42
and pull your tooth while he was at it.
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順便拔掉你的牙
06:44
He made製作 no attempt嘗試 at diagnosis診斷.
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他無心診斷
06:46
In fact事實, some of you might威力 well know
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事實上,你們某些人也很可能知道
06:48
that the barber理髮師 pole, the red and white白色 stripes條紋,
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理髮師的紅白相間圓筒招牌
06:51
represents代表 the blood血液 bandages繃帶 of the barber理髮師 surgeon外科醫生,
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代表「理髮師兼外科手術師」的血液繃帶
06:54
and the receptacles插座 on either end結束
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而底座的托盆
06:56
represent代表 the pots in which哪一個 the blood血液 was collected.
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則相當於承接血液的鍋盆
06:59
But the arrival到達 of auscultation聽診 and percussion打擊樂器
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但聽診和叩診的問世
07:02
represented代表 a sea change更改,
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意味著瞬息巨大的轉變
07:04
a moment時刻 when physicians醫師 were beginning開始 to look inside the body身體.
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醫生開始檢察人體內部的時期開始
07:07
And this particular特定 painting繪畫, I think,
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而我認為這張獨特的畫作
07:10
represents代表 the pinnacle巔峰, the peak, of that clinical臨床 era時代.
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象徵著臨床時代的巔峰高點
07:13
This is a very famous著名 painting繪畫:
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這是一幅很有名的彩畫
07:15
"The Doctor醫生" by Luke盧克 Fildes菲爾德斯.
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《醫生》由路克‧菲爾德茲(Luke Fildes)
07:18
Luke盧克 Fildes菲爾德斯 was commissioned委託 to paint塗料 this by Tate泰特,
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路克‧菲爾德茲受塔特(Tate)所託
07:21
who then established既定 the Tate泰特 Gallery畫廊.
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此人當時創立英國塔特美術館(Tate Gallery)
07:23
And Tate泰特 asked Fildes菲爾德斯 to paint塗料 a painting繪畫
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塔特要求菲爾德茲繪出
07:25
of social社會 importance重要性.
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「社會的重要性」的畫
07:27
And it's interesting有趣 that Fildes菲爾德斯 picked採摘的 this topic話題.
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而有趣的是,菲爾德茲選擇了這個主題
07:30
Fildes'菲爾德斯“ oldest最老的 son兒子, Philip菲利普,
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菲爾德茲之長子菲力普(Philip)
07:33
died死亡 at the age年齡 of nine on Christmas聖誕 Eve前夕
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在九歲時的聖誕節前夕
07:36
after a brief簡要 illness疾病.
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在一場短暫的病後歸天
07:38
And Fildes菲爾德斯 was so taken採取 by the physician醫師
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而菲爾德茲深深感念醫師的舉措 --
07:41
who held保持 vigil守夜 at the bedside床頭 for two, three nights,
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這位醫生在一旁守護兩、三夜
07:45
that he decided決定 that he would try and depict描繪
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他便決定嘗試描繪
07:47
the physician醫師 in our time --
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美國那時代的醫生 --
07:49
almost幾乎 a tribute to this physician醫師.
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可說是對該醫生致敬意
07:51
And hence於是 the painting繪畫 "The Doctor醫生," a very famous著名 painting繪畫.
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因而此畫作《醫生》頗負盛名
07:54
It's been on calendars日曆, postage郵資 stamps郵票 in many許多 different不同 countries國家.
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在很多國家的日曆或月曆和郵票上都可以看到
07:57
I've often經常 wondered想知道, what would Fildes菲爾德斯 have doneDONE
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我常在想,菲爾德茲會怎麼做
08:00
had he been asked to paint塗料 this painting繪畫
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要是他被要求畫這幅畫
08:02
in the modern現代 era時代,
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在現代?
08:04
in the year 2011?
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在2011年?
08:07
Would he have substituted取代 a computer電腦 screen屏幕
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他會改繪畫「電腦銀幕」
08:11
for where he had the patient患者?
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在「病人」的位置嗎?
08:13
I've gotten得到 into some trouble麻煩 in Silicon Valley
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在矽谷(Silicon Valley)我已惹上一些麻煩
08:15
for saying that the patient患者 in the bed
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因我說在病榻的病人
08:17
has almost幾乎 become成為 an icon圖標
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已幾乎成了雕像
08:20
for the real真實 patient患者 who's誰是 in the computer電腦.
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在電腦內的是真正的病人
08:23
I've actually其實 coined創造 a term術語 for that entity實體 in the computer電腦.
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事實上,我給電腦內的實體造了個詞
08:26
I call it the iPatientiPatient.
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我稱其為「iPatient」
08:28
The iPatientiPatient is getting得到 wonderful精彩 care關心 all across橫過 America美國.
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全美「iPatient」得到無微不至的看照
08:31
The real真實 patient患者 often經常 wonders奇蹟,
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真正的病人常奇怪
08:33
where is everyone大家?
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人都上哪去了?
08:35
When are they going to come by and explain說明 things to me?
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他們何時才會來向我說明我的情況?
08:38
Who's誰是 in charge收費?
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誰負責的?
08:40
There's a real真實 disjunction脫節 between之間 the patient's耐心 perception知覺
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確實有分歧存在於病人的觀感
08:43
and our own擁有 perceptions看法 as physicians醫師 of the best最好 medical care關心.
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和身為最佳醫療保健醫師的我們自己的觀感
08:46
I want to show顯示 you a picture圖片
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我要讓你們看張照片
08:48
of what rounds looked看著 like
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關於巡診是怎麼一回事
08:50
when I was in training訓練.
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當我還在受訓時
08:52
The focus焦點 was around the patient患者.
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焦點是投注在病人身上
08:54
We went from bed to bed. The attending出席 physician醫師 was in charge收費.
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我們一張病床巡過一張病床,由主治醫生負責
08:57
Too often經常 these days,
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這些日子大多數
08:59
rounds look very much like this,
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巡診八九不離十看起來就像這樣
09:01
where the discussion討論 is taking服用 place地點
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病情討論的地點
09:03
in a room房間 far away from the patient患者.
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就在遠離病人的小會議室
09:06
The discussion討論 is all about images圖片 on the computer電腦, data數據.
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討論的內容不外乎是電腦影像、數據資料
09:09
And the one critical危急 piece missing失踪
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而遺漏了關鍵的那部分
09:11
is that of the patient患者.
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就是病人
09:13
Now I've been influenced影響 in this thinking思維
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現在我有這種想法,而且我已經受兩件
09:16
by two anecdotes軼事 that I want to share分享 with you.
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發生在我周遭的事所影響,我要跟你們分享。
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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一件是與我的那位曾罹患胸癌的友人有關
09:22
had a small breast乳房 cancer癌症 detected檢測 --
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其被偵察到有小型胸癌
09:25
had her lumpectomy乳房腫瘤切除術 in the town in which哪一個 I lived生活.
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在我過去居住的城市中,進行她的乳房腫瘤切除
09:27
This is when I was in Texas德州.
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這是當我還在德州時發生的事
09:29
And she then spent花費 a lot of time researching研究
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而且她那時花了好多時間研究
09:32
to find the best最好 cancer癌症 center中央 in the world世界
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為了找出世界最佳癌症中心
09:35
to get her subsequent隨後 care關心.
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獲得後續照護
09:37
And she found發現 the place地點 and decided決定 to go there, went there.
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她找到那個地方、決定去那並到了那裡。
09:40
Which哪一個 is why I was surprised詫異 a few少數 months個月 later後來
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那是為何我會訝異,在幾個月後
09:43
to see her back in our own擁有 town,
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看到她重返我們自己的城市
09:46
getting得到 her subsequent隨後 care關心 with her private私人的 oncologist腫瘤科醫生.
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接受私人腫瘤專家的後續照護
09:49
And I pressed壓制 her, and I asked her,
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我打破砂鍋似的追問她:
09:51
"Why did you come back and get your care關心 here?"
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「為何你回來這兒接受照護?」
09:54
And she was reluctant不情願 to tell me.
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而她不情不願的告訴我。
09:56
She said, "The cancer癌症 center中央 was wonderful精彩.
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她說:「那間癌症中心是好極了
09:59
It had a beautiful美麗 facility設施,
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有完備的設施
10:01
giant巨人 atrium中庭, valet代客 parking停車處,
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有寬敞的中庭、代客泊車
10:03
a piano鋼琴 that played發揮 itself本身,
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自動彈奏的鋼琴
10:05
a concierge門房 that took you around from here to there.
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領著你四處逛的接待
10:08
But," she said,
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但......」,她說:
10:10
"but they did not touch觸摸 my breasts乳房."
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「但他們不觸碰我的胸部。」
10:14
Now you and I could argue爭論
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此時你和我會爭論
10:16
that they probably大概 did not need to touch觸摸 her breasts乳房.
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他們大可能不用觸碰她的胸部
10:18
They had her scanned掃描 inside out.
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他們將她由裡到外掃瞄
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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他們了解她胸癌的分子狀態
10:23
they had no need to touch觸摸 her breasts乳房.
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他們不需觸碰她的胸部
10:25
But to her, it mattered要緊 deeply.
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但對她而言,卻是很重要
10:28
It was enough足夠 for her to make the decision決定
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足以讓她作出決定
10:32
to get her subsequent隨後 care關心 with her private私人的 oncologist腫瘤科醫生
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聘用她私人的腫瘤專家作後續照護
10:35
who, every一切 time she went,
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每次那腫瘤專家看診
10:37
examined檢查 both breasts乳房 including包含 the axillary tail尾巴,
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檢查兩邊胸部,包括腋窩尾部
10:40
examined檢查 her axilla腋下 carefully小心,
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仔細地檢查她的腋窩
10:42
examined檢查 her cervical頸椎 region地區, her inguinal腹股溝 region地區,
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檢查她的頸部、她的腹股溝區域
10:44
did a thorough徹底 exam考試.
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作全面徹底的檢查
10:46
And to her, that spoke of a kind of attentiveness注意力 that she needed需要.
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而且對她而言,這表明了她需要的關注
10:50
I was very influenced影響 by that anecdote軼事.
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我深受那件事影響
10:52
I was also influenced影響 by another另一個 experience經驗 that I had,
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另一個經歷也讓我心有所感
10:55
again, when I was in Texas德州, before I moved移動 to Stanford斯坦福.
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同樣,我還在德州,未搬到史丹佛時
10:58
I had a reputation聲譽
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眾所周知
11:00
as being存在 interested有興趣 in patients耐心
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我關注於
11:02
with chronic慢性 fatigue疲勞.
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慢性疲勞症的病患
11:05
This is not a reputation聲譽 you would wish希望 on your worst最差 enemy敵人.
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就是你最難纏的敵人,你也不願其被冠上這樣的名號
11:09
I say that because these are difficult patients耐心.
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我這麼說,是因為這些是棘手的病人
11:12
They have often經常 been rejected拒絕 by their families家庭,
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他們往往無法得到家人的體諒
11:15
have had bad experiences經驗 with medical care關心
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他們歷經不佳的醫療對待
11:17
and they come to you fully充分 prepared準備
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他們來到你這兒已作好打算
11:20
for you to join加入 the long list名單 of people
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把你列入那長串名單中
11:22
who's誰是 about to disappoint辜負 them.
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會讓他們失望的人之一
11:24
And I learned學到了 very early on with my first patient患者
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我在很早時就由我的首位病人了解
11:27
that I could not do justice正義
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我無法充分審視
11:29
to this very complicated複雜 patient患者
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這位經歷曲折複雜的病人
11:31
with all the records記錄 they were bringing使
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憑著隨著他們走的病歷記錄
11:33
in a new patient患者 visit訪問 of 45 minutes分鐘.
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以及由和一位新病人45分鐘的門診知道的
11:35
There was just no way.
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真的沒辦法
11:37
And if I tried試著, I'd disappoint辜負 them.
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若我這麼做,我會令他們失望
11:40
And so I hit擊中 on this method方法
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所以我想到了這個方法
11:42
where I invited邀請 the patient患者
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我鼓勵病人
11:44
to tell me the story故事 for their entire整個 first visit訪問,
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在他們首次到診時,告訴我他們的病史
11:47
and I tried試著 not to interrupt打斷 them.
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我試著不去打斷他們
11:50
We know the average平均 American美國 physician醫師
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我們曉得美國醫師
11:52
interrupts中斷 their patient患者 in 14 seconds.
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平均14秒打斷他們的病人的話
11:55
And if I ever get to heaven天堂,
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而若我真到了天堂
11:57
it will be because I held保持 my piece for 45 minutes分鐘
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那是因為我靜候不語45分鐘
12:00
and did not interrupt打斷 my patient患者.
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且不打斷病人說話
12:02
I then scheduled計劃 the physical物理 exam考試 for two weeks hence於是,
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然後我排定兩週後的身體檢查
12:05
and when the patient患者 came來了 for the physical物理,
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當那病人到診檢查身體
12:07
I was able能夠 to do a thorough徹底 physical物理,
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我能執行一個徹底的身體檢查
12:09
because I had nothing else其他 to do.
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因為那是我能做的
12:11
I like to think that I do a thorough徹底 physical物理 exam考試,
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我喜歡認為自己執行一個徹底的身體檢查
12:14
but because the whole整個 visit訪問 was now about the physical物理,
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但因此時這整個回診是有關身體檢查
12:17
I could do an extraordinarily異常 thorough徹底 exam考試.
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我可以執行徹徹底底的檢查
12:20
And I remember記得 my very first patient患者 in that series系列
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我記得我那首位病人在一聯串檢查中
12:24
continued繼續 to tell me more history歷史
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繼續告訴我更多的病史
12:26
during what was meant意味著 to be the physical物理 exam考試 visit訪問.
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在安排用來作身體檢查的看診時間
12:29
And I began開始 my ritual儀式.
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我開始診斷儀式
12:31
I always begin開始 with the pulse脈衝,
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我總是由把脈開始
12:33
then I examine檢查 the hands, then I look at the nail beds,
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然後我檢查其雙手,接著我檢視其指甲肉床
12:36
then I slide滑動 my hand up to the epitrochlearepitrochlear node節點,
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然後我的手上移去觸診上滑車淋巴結
12:38
and I was into my ritual儀式.
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我熱衷於診斷的儀式
12:40
And when my ritual儀式 began開始,
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我的診斷儀式開始時
12:42
this very voluble能言善辯 patient患者
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這位滔滔不絶的病人
12:44
began開始 to quiet安靜 down.
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開始安靜無聲
12:46
And I remember記得 having a very eerie怪異 sense
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我記得有種奇異的氛圍
12:49
that the patient患者 and I
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我和病人
12:52
had slipped下滑 back into a primitive原始 ritual儀式
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不知不覺地進入原始的儀式
12:54
in which哪一個 I had a role角色
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在儀式中我有個任務
12:56
and the patient患者 had a role角色.
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病人有一個任務
12:58
And when I was doneDONE,
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我完成儀式時
13:00
the patient患者 said to me with some awe威嚴,
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病人語帶敬畏的對我說:
13:02
"I have never been examined檢查 like this before."
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「我之前從未被像這樣子檢查過。」
13:05
Now if that were true真正,
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若那真是如此
13:07
it's a true真正 condemnation非難 of our health健康 care關心 system系統,
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我們的醫療照護體制就責無旁貸
13:09
because they had been seen看到 in other places地方.
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因為他們已在其他地方就診過
13:12
I then proceeded繼續 to tell the patient患者,
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我接著告訴病人
13:14
once一旦 the patient患者 was dressed連衣裙的,
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待他穿好衣衫時
13:16
the standard標準 things that the person must必須 have heard聽說 in other institutions機構,
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所謂的「制式標準」──那人必定在其他醫療機構已有所聞
13:19
which哪一個 is, "This is not in your head.
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就是:「這不是你腦袋想的;
13:21
This is real真實.
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這是真的。
13:23
The good news新聞, it's not cancer癌症, it's not tuberculosis結核,
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好消息是,這不是癌症;這不是結核病
13:26
it's not coccidioidomycosis球孢子菌病 or some obscure朦朧 fungal真菌 infection感染.
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不是球黴菌症或某種不知名的黴菌感染。
13:29
The bad news新聞 is we don't know exactly究竟 what's causing造成 this,
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壞消息是,我們不曉得究竟是什麼導致的
13:32
but here's這裡的 what you should do, here's這裡的 what we should do."
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但這兒是你應做的;這兒是我們該做的。」
13:35
And I would lay鋪設 out all the standard標準 treatment治療 options選項
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我會列出所有的標準治療供選擇
13:38
that the patient患者 had heard聽說 elsewhere別處.
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病人在別處已有所聞
13:41
And I always felt
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我總認為
13:43
that if my patient患者 gave up the quest尋求
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若我的病人放棄尋求
13:45
for the magic魔法 doctor醫生, the magic魔法 treatment治療
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巫醫、巫術治療
13:48
and began開始 with me on a course課程 towards wellness健康,
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並開始與我進行一項創造健康的療程
13:51
it was because I had earned the right
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是因為我已得其精髓
13:53
to tell them these things
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藉著檢查的過程
13:55
by virtue美德 of the examination檢查.
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告知他們這些事情
13:57
Something of importance重要性 had transpired蒸騰 in the exchange交換.
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某個東西的重要性在交流中已昭然若揭
14:01
I took this to my colleagues同事
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我把這與我在
14:03
at Stanford斯坦福 in anthropology人類學
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史丹佛人類學的同事分享
14:05
and told them the same相同 story故事.
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並告訴他們同樣的故事
14:07
And they immediately立即 said to me,
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他們立刻對我說:
14:09
"Well you are describing說明 a classic經典 ritual儀式."
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「嗯,你說的是一種古典的儀式。」
14:11
And they helped幫助 me understand理解
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且他們幫助我了解
14:13
that rituals儀式 are all about transformation轉型.
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儀式是關於徹底改觀或轉變
14:16
We marry結婚, for example,
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舉例來說,人們結婚
14:18
with great pomp盛況 and ceremony儀式 and expense費用
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由場面壯觀、儀式隆重及大手筆的花費
14:21
to signal信號 our departure離開
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以宣告脫離
14:23
from a life of solitude孤獨 and misery苦難 and loneliness孤單
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寂寞、悲慘和孤單的生活
14:25
to one of eternal永恆 bliss.
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投身永恆美滿幸福人生
14:28
I'm not sure why you're laughing.
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我不知道為何你們在笑
14:30
That was the original原版的 intent意圖, was it not?
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這是初始的意圖對吧?
14:32
We signal信號 transitions過渡 of power功率
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我們發出權力交接的訊號
14:34
with rituals儀式.
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透過儀式
14:36
We signal信號 the passage通道 of a life with rituals儀式.
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我們發出人生邁入新階段的訊號,透過儀式
14:38
Rituals儀式 are terribly可怕 important重要.
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儀式非常的重要
14:40
They're all about transformation轉型.
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關乎徹底轉變
14:42
Well I would submit提交 to you
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我向你們主張
14:44
that the ritual儀式
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這個儀式
14:46
of one individual個人 coming未來 to another另一個
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一個人來到另一人面前
14:48
and telling告訴 them things
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告訴他們事情
14:50
that they would not tell their preacher牧師 or rabbi拉比,
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那是他們不會對牧師或拉比(rabbi)吐露的話
14:53
and then, incredibly令人難以置信 on top最佳 of that,
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難以置信尤勝之的是
14:55
disrobing脫衣 and allowing允許 touch觸摸 --
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脫去衣物和允許觸碰 --
14:58
I would submit提交 to you that that is a ritual儀式 of exceeding超額 importance重要性.
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我向你們主張,那是一項極為重要的儀式
15:02
And if you shortchange奸商 that ritual儀式
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若你跳過儀式,當為而不為
15:04
by not undressing脫衣 the patient患者,
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不脫去病人衣物
15:06
by listening with your stethoscope聽筒 on top最佳 of the nightgown睡衣,
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而用你的聽診器在睡袍上聽診
15:09
by not doing a complete完成 exam考試,
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不執行全套的檢查
15:11
you have bypassed繞過 on the opportunity機會
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你已錯過機會
15:13
to seal密封 the patient-physician醫患 relationship關係.
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建立醫生與病人之間聯結
15:17
I am a writer作家,
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我是一個作家
15:19
and I want to close by reading you a short passage通道 that I wrote
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我要念一段我寫的文章來結束今天演說
15:23
that has to do very much with this scene現場.
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與這場景大為相關
15:25
I'm an infectious傳染病 disease疾病 physician醫師,
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我是一名傳染性疾病的醫師
15:27
and in the early days of HIVHIV, before we had our medications藥物治療,
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在愛滋病的早期,在有醫療資源前
15:30
I presided主持 over so many許多 scenes場景 like this.
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我負責很多諸如此類的場合
15:34
I remember記得, every一切 time I went to a patient's耐心 deathbed臨終,
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我記得,每次我走到病人的床榻
15:37
whether是否 in the hospital醫院 or at home,
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無論是在醫院或在家中
15:39
I remember記得 my sense of failure失敗 --
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我記得我的挫折感 --
15:43
the feeling感覺 of I don't know what I have to say;
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我不知道我必須說些什麼的那種感覺
15:45
I don't know what I can say;
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我不曉得我能說什麼
15:47
I don't know what I'm supposed應該 to do.
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我不清楚我應該要做些什麼
15:49
And out of that sense of failure失敗,
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擺脫那種挫敗感
15:51
I remember記得, I would always examine檢查 the patient患者.
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我記得,我總會檢查病人
15:54
I would pull down the eyelids眼皮.
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我會下拉其眼瞼
15:56
I would look at the tongue.
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我會檢視其舌頭
15:58
I would percuss叩診 the chest胸部. I would listen to the heart.
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我會輕叩其胸膛,我會聆聽其心臟
16:01
I would feel the abdomen腹部.
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我會觸摸其腹部
16:03
I remember記得 so many許多 patients耐心,
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我記得諸多的病人
16:06
their names still vivid生動 on my tongue,
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他們的名字我仍然叫得出來
16:08
their faces面孔 still so clear明確.
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他們的臉龐依然如此清晰
16:10
I remember記得 so many許多 huge巨大, hollowed挖空 out, haunted鬧鬼 eyes眼睛
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我記得一雙雙斗大、凹陷、愁困的眼睛
16:14
staring凝視 up at me as I performed執行 this ritual儀式.
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當我執行這項儀式盯著我
16:17
And then the next下一個 day,
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接著,第二天
16:19
I would come, and I would do it again.
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我會再來並重覆執行這項儀式
16:21
And I wanted to read you this one closing關閉 passage通道
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我要向你們朗讀這篇尾聲的小節
16:24
about one patient患者.
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與某個病患有關
16:26
"I recall召回 one patient患者
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「我回想起某個病人
16:28
who was at that point
393
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在那一刻
16:30
no more than a skeleton骨架
394
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他瘦骨嶙峋
16:32
encased封閉式 in shrinking萎縮 skin皮膚,
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被一層萎縮的皮包覆著
16:34
unable無法 to speak說話,
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無法說話
16:36
his mouth crusted結痂 with candida念珠菌
397
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2000
他的嘴覆蓋著念珠菌
16:38
that was resistant to the usual通常 medications藥物治療.
398
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那對一般的醫療藥品有抗藥力
16:41
When he saw me
399
986000
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當他看到我時
16:43
on what turned轉身 out to be his last hours小時 on this earth地球,
400
988000
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正是他在這個地球停滯的最後幾小時
16:45
his hands moved移動 as if in slow motion運動.
401
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他的雙手彷彿是以慢速在移動
16:48
And as I wondered想知道 what he was up to,
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當我奇怪他正想做什麼時
16:50
his stick fingers手指 made製作 their way
403
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他如枝條般的手指慢慢地
16:52
up to his pajama睡衣 shirt襯衫,
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移向他的睡衣
16:54
fumbling摸索 with his buttons鈕扣.
405
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摸索著衣扣
16:57
I realized實現 that he was wanting希望
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我了解他正想要
16:59
to expose暴露 his wicker-basket柳條筐 chest胸部 to me.
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讓我看他那如柳條所編織出的胸膛。
17:02
It was an offering, an invitation請帖.
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這是一項提供、一項邀約
17:05
I did not decline下降.
409
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我沒拒絶
17:07
I percussed叩痛. I palpated觸診. I listened聽了 to the chest胸部.
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我輕敲、觸摸、耹聽其胸膛
17:10
I think he surely一定 must必須 have known已知 by then
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我想他那時想必已知曉
17:12
that it was vital重要 for me
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這對我而言是極為重要的
17:14
just as it was necessary必要 for him.
413
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正如對他而言是必要的
17:16
Neither也不 of us could skip跳躍 this ritual儀式,
414
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我倆皆不會略過這項儀式
17:19
which哪一個 had nothing to do with detecting檢測 rales羅音 in the lung,
415
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這無關乎診察肺中的羅音(rale)
17:22
or finding發現 the gallop馳騁 rhythm韻律 of heart failure失敗.
416
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也無關於發現心臟衰竭的馬奔律動(gallop rhythm)
17:25
No, this ritual儀式 was about the one message信息
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不,這儀式是關於一個訊息
17:28
that physicians醫師 have needed需要 to convey傳達 to their patients耐心.
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醫師有必要傳達給他們的病人
17:31
Although雖然, God knows知道, of late晚了, in our hubris傲慢,
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雖然,天知道,近來,在我們的傲慢驕盈中
17:33
we seem似乎 to have drifted漂流 away.
420
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我們似乎已漸行漸遠
17:35
We seem似乎 to have forgotten忘記了 --
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我們似乎已忘卻 --
17:37
as though雖然, with the explosion爆炸 of knowledge知識,
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彷彿,隨著知識的爆炸
17:39
the whole整個 human人的 genome基因組 mapped映射 out at our feet,
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整個人類基因體攤開在我們的腳前
17:42
we are lulled哄騙 into inattention注意力不集中,
424
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我們漫不經心
17:44
forgetting遺忘 that the ritual儀式 is cathartic瀉藥 to the physician醫師,
425
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忘了對醫師而言,這項儀式是淨化導引
17:47
necessary必要 for the patient患者 --
426
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對病人是種需要 --
17:49
forgetting遺忘 that the ritual儀式 has meaning含義
427
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忘了儀式的意義
17:51
and a singular單數 message信息 to convey傳達 to the patient患者.
428
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有微妙的訊息要傳遞給病人
17:55
And the message信息, which哪一個 I didn't fully充分 understand理解 then,
429
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那時,我尚不完全明白訊息的含意
17:58
even as I delivered交付 it,
430
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當在我傳達它時
18:00
and which哪一個 I understand理解 better now is this:
431
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而現在我對它有較佳理解:
18:03
I will always, always, always be there.
432
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「我將永遠、永遠、永遠在那裡,
18:06
I will see you through通過 this.
433
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我將助你渡過此關;
18:08
I will never abandon放棄 you.
434
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我將永不離棄你,
18:10
I will be with you through通過 the end結束."
435
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我會伴著你直到穿越終點。」
18:12
Thank you very much.
436
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非常感謝你們
18:14
(Applause掌聲)
437
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(掌聲)
Translated by Resa CC
Reviewed by Joyce Chou

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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