TEDxDesMoines
Timothy Ihrig: What we can do to die well
Timoti Irig (Timothy Ihrig): Šta možemo da učinimo da bismo kvalitetno umrli
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Zdravstvo u Americi je toliko fokusirano na patologiju, hirurgiju i farmakologiju - na ono što lekari „rade“ pacijentima - da se često previđaju vrednosti ljudskih bića do kojih bi trebalo da im bude stalo. Lekar palijativne nege, Timoti Irig, objašnjava prednosti drugačijeg pristupa, onog koji neguje celokupan kvalitet života pacijenta i vodi ozbiljnu bolest od postavljanja dijagnoze do smrti sa dostojanstvom i saosećanjem.
Timothy Ihrig - Palliative care physician
Timothy Ihrig advocates for an approach to healthcare that prioritizes a patient's personal values. Full bio
Timothy Ihrig advocates for an approach to healthcare that prioritizes a patient's personal values. Full bio
Double-click the English transcript below to play the video.
00:13
I am a palliative care physician
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Ja sam lekar palijativne nege
i hteo bih da danas razgovaram sa vama
o zdravstvenoj zaštiti.
o zdravstvenoj zaštiti.
00:14
and I would like to talk to you
today about health care.
today about health care.
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00:18
I'd like to talk to you
about the health and care
about the health and care
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Hteo bih da razgovaram sa vama
o zdravlju i nezi
o zdravlju i nezi
00:22
of the most vulnerable
population in our country --
population in our country --
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najranjivijeg stanovništva naše zemlje -
00:25
those people dealing with the most
complex serious health issues.
complex serious health issues.
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ljudi koji se suočavaju sa najsloženijim
ozbiljnim zdravstvenim problemima.
ozbiljnim zdravstvenim problemima.
00:32
I'd like to talk to you
about economics as well.
about economics as well.
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Takođe bih hteo
da razgovaramo o ekonomiji.
da razgovaramo o ekonomiji.
00:35
And the intersection of these two
should scare the hell out of you --
should scare the hell out of you --
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Ukrštanje ta dva bi trebalo
da vas užasno plaši.
da vas užasno plaši.
00:39
it scares the hell out of me.
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Mene strašno plaši.
00:42
I'd also like to talk to you
about palliative medicine:
about palliative medicine:
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Takođe bih voleo da govorimo
o palijativnoj medicini,
o palijativnoj medicini,
00:45
a paradigm of care for this population,
grounded in what they value.
grounded in what they value.
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o paradigmi nege za ovu populaciju,
utemeljenoj u onome u šta oni veruju,
utemeljenoj u onome u šta oni veruju,
00:52
Patient-centric care based on their values
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o nezi orijentisanoj na pacijenta
zasnovanoj na njegovim vrednostima
zasnovanoj na njegovim vrednostima
00:55
that helps this population
live better and longer.
live better and longer.
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koja pomaže da ova populacija
živi bolje i duže.
živi bolje i duže.
01:00
It's a care model that tells the truth
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To je model nege koji govori istinu,
01:03
and engages one-on-one
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angažuje se jedan na jedan
01:05
and meets people where they're at.
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i izlazi u susret ljudima
tamo gde se nalaze.
tamo gde se nalaze.
01:09
I'd like to start by telling the story
of my very first patient.
of my very first patient.
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Hteo bih da započnem tako što ću ispričati
priču o svom prvom pacijentu.
priču o svom prvom pacijentu.
01:13
It was my first day as a physician,
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Bio je to moj prvi dan kao lekara,
01:15
with the long white coat ...
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sa dugačkim belim mantilom.
01:17
I stumbled into the hospital
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Doteturao sam se u bolnicu
01:19
and right away there's a gentleman,
Harold, 68 years old,
Harold, 68 years old,
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i odmah je tu bio gospodin,
Herold, od 68 godina,
Herold, od 68 godina,
koji je došao u hitnu službu.
01:21
came to the emergency department.
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Imao je glavobolje oko šest nedelja
01:23
He had had headaches for about six weeks
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koje su se sve više pogoršavale.
01:25
that got worse and worse
and worse and worse.
and worse and worse.
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01:28
Evaluation revealed he had cancer
that had spread to his brain.
that had spread to his brain.
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Pregled je otkrio da ima rak
koji se proširio na njegov mozak.
koji se proširio na njegov mozak.
01:33
The attending physician directed me
to go share with Harold and his family
to go share with Harold and his family
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Nadležni lekar me je uputio da sa Haroldom
i njegovom porodicom podelim
i njegovom porodicom podelim
01:39
the diagnosis, the prognosis
and options of care.
and options of care.
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djagnozu, prognozu i opcije za negu.
01:44
Five hours into my new career,
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Pet sati od ulaska u novu karijeru,
01:47
I did the only thing I knew how.
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uradio sam jedino što sam umeo.
01:49
I walked in,
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Ušao sam,
01:51
sat down,
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seo,
01:53
took Harold's hand,
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uzeo Haroldovu ruku,
01:55
took his wife's hand
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uzeo ruku njegove žene
01:58
and just breathed.
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i samo sam disao.
02:00
He said, "It's not good
news is it, sonny?"
news is it, sonny?"
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Rekao je: „Nisu dobre vesti,
zar ne, sine?“
zar ne, sine?“
02:03
I said, "No."
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Odgovorio sam: „Ne.“
02:04
And so we talked
and we listened and we shared.
and we listened and we shared.
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Tako smo pričali, slušali i razmenjivali.
Nakon izvesnog vremena sam upitao:
02:08
And after a while I said,
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02:10
"Harold, what is it
that has meaning to you?
that has meaning to you?
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„Harolde, šta je to
što za tebe ima smisla?
što za tebe ima smisla?
02:13
What is it that you hold sacred?"
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Šta smatraš za svetinju?“
02:15
And he said,
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Odgovorio je:
02:16
"My family."
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„Moju porodicu.“
02:18
I said, "What do you want to do?"
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Upitao sam: „Šta želiš da radiš?“
02:20
He slapped me on the knee
and said, "I want to go fishing."
and said, "I want to go fishing."
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Potapšao me je po kolenu i rekao:
„Želim da idem na pecanje.“
„Želim da idem na pecanje.“
02:23
I said, "That, I know how to do."
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Uzvratio sam: „To znam kako da ostvarim.“
02:26
Harold went fishing the next day.
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Harold je otišao na pecanje narednog dana.
02:29
He died a week later.
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Preminuo je nedelju dana kasnije.
02:32
As I've gone through
my training in my career,
my training in my career,
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Dok sam nastavljao sa obukom
u svojoj karijeri,
u svojoj karijeri,
02:35
I think back to Harold.
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osvrtao sam se na Harolda.
02:36
And I think that this is a conversation
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Mislim da je ovo razgovor
02:40
that happens far too infrequently.
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koji se dešava previše retko.
02:43
And it's a conversation
that had led us to crisis,
that had led us to crisis,
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To je razgovor koji nas je doveo do krize,
02:48
to the biggest threat
to the American way of life today,
to the American way of life today,
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do najveće pretnje
američkom načinu života danas,
američkom načinu života danas,
02:50
which is health care expenditures.
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a to su troškovi zdravstvene zaštite.
02:53
So what do we know?
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Šta je to što znamo?
02:55
We know that
this population, the most ill,
this population, the most ill,
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Znamo da na ovu populaciju najbolesnijih
02:58
takes up 15 percent
of the gross domestic product --
of the gross domestic product --
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odlazi 15 odsto bruto domaćeg proizvoda,
03:00
nearly 2.3 trillion dollars.
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skoro 2,3 biliona dolara.
03:04
So the sickest 15 percent
take up 15 percent of the GDP.
take up 15 percent of the GDP.
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Dakle, na najbolesnijih 15 procenata
odlazi 15 posto BDP.
odlazi 15 posto BDP.
03:07
If we extrapolate this out
over the next two decades
over the next two decades
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Ako to prenesemo na sledeće dve decenije
03:11
with the growth of baby boomers,
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sa porastom bejbi bum generacije,
03:14
at this rate it is 60 percent of the GDP.
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ovom stopom, to je 60 posto BDP-a.
03:20
Sixty percent of the gross
domestic product
domestic product
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Šezdeset odsto bruto domaćeg proizvoda
Sjedinjenih Američkih Država -
03:22
of the United States of America --
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to u tom trenutku ima vrlo malo veze
sa zdravstvenom zaštitom.
sa zdravstvenom zaštitom.
03:24
it has very little to do
with health care at that point.
with health care at that point.
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03:27
It has to do with a gallon of milk,
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Ima veze sa litrom mleka,
03:29
with college tuition.
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sa školarinom za fakultet.
03:31
It has to do with
every thing that we value
every thing that we value
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Ima veze sa svime što cenimo
i svačim za šta trenutno znamo.
03:34
and every thing that we know presently.
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03:38
It has at stake the free-market
economy and capitalism
economy and capitalism
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Stavlja na kocku ekonomiju
slobodnog tržišta i kapitalizam
slobodnog tržišta i kapitalizam
03:42
of the United States of America.
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Sjedinjenih Američkih Država.
03:46
Let's forget all the statistics
for a minute, forget the numbers.
for a minute, forget the numbers.
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Zaboravimo sve statističke podatke
na trenutak, zaboravimo brojeve.
na trenutak, zaboravimo brojeve.
Hajde da razgovaramo o vrednosti
koju dobijamo za dolare koje potrošimo.
koju dobijamo za dolare koje potrošimo.
03:50
Let's talk about the value we get
for all these dollars we spend.
for all these dollars we spend.
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03:54
Well, the Dartmouth Atlas,
about six years ago,
about six years ago,
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Pa, projekat Darmut Atlas je,
pre oko šest godina,
pre oko šest godina,
razmotrio svaki dolar
koji je potrošilo osiguranje Mediker
koji je potrošilo osiguranje Mediker
03:57
looked at every dollar
spent by Medicare --
spent by Medicare --
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04:00
generally this population.
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uopšte na ovu populaciju.
04:01
We found that those patients who have
the highest per capita expenditures
the highest per capita expenditures
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Otkrili smo da su ti pacijenti koji imaju
najveće izdatke po glavi stanovnika
najveće izdatke po glavi stanovnika
04:08
had the highest suffering,
pain, depression.
pain, depression.
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prolaze kroz najviše patnje,
bolova i depresije.
bolova i depresije.
04:12
And, more often than not, they die sooner.
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Takođe, u većem broju slučajeva,
oni umiru ranije.
oni umiru ranije.
04:15
How can this be?
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Kako je to moguće?
Živimo u Sjedinjenim Državama
04:17
We live in the United States,
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koje imaju najbolji sistem
zdravstvene zaštite na planeti.
zdravstvene zaštite na planeti.
04:19
it has the greatest health care
system on the planet.
system on the planet.
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04:21
We spend 10 times more on these patients
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Trošimo 10 puta više na te pacijente
04:24
than the second-leading
country in the world.
country in the world.
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od druge po redu vodeće zemlje sveta.
04:27
That doesn't make sense.
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To nema nikakvog smisla.
Međutim, ono što znamo je da,
04:29
But what we know is,
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04:31
out of the top 50 countries on the planet
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od 50 zemalja na planeti koje su u vrhu
04:34
with organized health care systems,
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po organizovanim sistemima
zdravstvene zaštite,
zdravstvene zaštite,
04:37
we rank 37th.
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nalazimo se na 37. mestu.
Zemlje bivšeg Istočnog bloka
i zemlje podsaharske Afrike
i zemlje podsaharske Afrike
04:42
Former Eastern Bloc countries
and sub-Saharan African countries
and sub-Saharan African countries
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04:46
rank higher than us
as far as quality and value.
as far as quality and value.
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imaju bolji rang od nas
u pogledu kvaliteta i vrednosti.
u pogledu kvaliteta i vrednosti.
04:52
Something I experience
every day in my practice,
every day in my practice,
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Nešto što doživljavam
svakog dana u svojoj praksi,
svakog dana u svojoj praksi,
04:55
and I'm sure, something many of you
on your own journeys have experienced:
on your own journeys have experienced:
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a siguran sam da su to mnogi od vas
iskusili na svojim putovanjima -
iskusili na svojim putovanjima -
04:59
more is not more.
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dodatno ne znači više.
05:04
Those individuals who had more tests,
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Ti pojedinci koji su imali
dodatne testove,
dodatne testove,
05:06
more bells, more whistles,
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dodatne skupe naprave,
05:07
more chemotherapy,
more surgery, more whatever --
more surgery, more whatever --
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dodatne hemoterapije, operacije, šta god -
što više uradimo nekome,
05:09
the more that we do to someone,
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05:13
it decreases the quality of their life.
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to umanjuje kvalitet njegovog života
05:17
And it shortens it, most often.
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i najčešće ga skraćuje.
Pa, šta ćemo preduzeti po tom pitanju?
05:21
So what are we going to do about this?
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Šta radimo u vezi sa ovim?
05:23
What are we doing about this?
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05:25
And why is this so?
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Zašto je to tako?
05:27
The grim reality, ladies and gentlemen,
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Surova realnost, dame i gospodo,
je da mi, industrija zdravstvene zaštite -
lekari u dugim belim mantilima -
lekari u dugim belim mantilima -
05:29
is that we, the health care industry --
long white-coat physicians --
long white-coat physicians --
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05:32
are stealing from you.
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krademo od vas.
05:34
Stealing from you the opportunity
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Krademo od vas mogućnost
05:37
to choose how you want to live your lives
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da odaberete kako želite
da provedete svoje živote
da provedete svoje živote
05:40
in the context of whatever disease it is.
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u kontekstu bolesti koja je u pitanju.
05:42
We focus on disease
and pathology and surgery
and pathology and surgery
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Usmereni smo na bolest,
patologiju, hirurgiju
patologiju, hirurgiju
05:45
and pharmacology.
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i farmakologiju.
05:49
We miss the human being.
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Propuštamo ljudsko biće.
05:53
How can we treat this
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Kako možemo lečiti ovo
05:54
without understanding this?
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bez razumevanja ovoga?
05:59
We do things to this;
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Radimo stvari ovome;
06:02
we need to do things for this.
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treba da radimo stvari za ovo.
06:08
The triple aim of healthcare:
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Trostruki cilj zdravstvene zaštite -
06:09
one, improve patient experience.
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prvo, poboljšati iskustvo pacijenta.
06:13
Two, improve the population health.
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Drugo, poboljšati zdravlje populacije.
06:17
Three, decrease per capita expenditure
across a continuum.
across a continuum.
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Treće, smanjiti potrošnju
po glavi stanovnika duž kontinuuma.
po glavi stanovnika duž kontinuuma.
06:23
Our group, palliative care,
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Naša grupa, palijativna nega,
06:25
in 2012, working with
the sickest of the sick --
the sickest of the sick --
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2012. godine, kroz rad
sa najbolesnijima među bolesnicima -
sa najbolesnijima među bolesnicima -
06:31
cancer,
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rak,
06:32
heart disease, lung disease,
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bolesti srca i pluća,
06:34
renal disease,
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bubrežne bolesti,
06:35
dementia --
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demencija -
06:37
how did we improve patient experience?
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kako smo poboljšali iskustvo pacijenta?
„Želim da budem kod kuće, doktore.“
06:41
"I want to be at home, Doc."
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06:42
"OK, we'll bring the care to you."
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„U redu, dovešćemo negu kod vas.“
06:44
Quality of life, enhanced.
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Kvalitet života je poboljšan.
06:47
Think about the human being.
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Razmislite o ljudskom biću.
06:49
Two: population health.
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Pod dva - zdravlje populacije.
06:51
How did we look
at this population differently,
at this population differently,
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Kako smo drugačije sagledavali
ovu populaciju,
ovu populaciju,
06:53
and engage with them
at a different level, a deeper level,
at a different level, a deeper level,
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angažovali se oko njih
na drugačijem, dubljem nivou,
na drugačijem, dubljem nivou,
i povezali se u širem smislu
ljudskog stanja od sopstvenog?
ljudskog stanja od sopstvenog?
06:56
and connect to a broader sense
of the human condition than my own?
of the human condition than my own?
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07:01
How do we manage this group,
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Kako rukovodimo ovom grupom,
pa od naše populacije
na vanbolničkom lečenju
na vanbolničkom lečenju
07:04
so that of our outpatient population,
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07:06
94 percent, in 2012,
never had to go to the hospital?
never had to go to the hospital?
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94 posto njih 2012. godine
uopšte nije moralo da ide u bolnicu?
uopšte nije moralo da ide u bolnicu?
07:11
Not because they couldn't.
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Ne zato što nisu mogli,
07:15
But they didn't have to.
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već nisu morali da idu.
07:17
We brought the care to them.
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Doveli smo negu kod njih.
07:19
We maintained their value, their quality.
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Sačuvali smo njihove vrednosti,
njihov kvalitet.
njihov kvalitet.
07:25
Number three: per capita expenditures.
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Broj tri - izdaci po glavi stanovnika.
07:28
For this population,
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Kod ove populacije
07:30
that today is 2.3 trillion dollars
and in 20 years is 60 percent of the GDP,
and in 20 years is 60 percent of the GDP,
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na koju danas odlazi 2,3 biliona dolara,
a za 20 godina 60 odsto BDP-a,
a za 20 godina 60 odsto BDP-a,
07:35
we reduced health care expenditures
by nearly 70 percent.
by nearly 70 percent.
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umanjili smo troškove zdravstvene zaštite
za gotovo 70 procenata.
za gotovo 70 procenata.
07:40
They got more of what they wanted
based on their values,
based on their values,
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Dobili su više od onoga što su hteli
na osnovu svojih vrednosti,
na osnovu svojih vrednosti,
07:44
lived better and are living longer,
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živeli su bolje i duže,
07:47
for two-thirds less money.
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za dve trećine manje novca.
07:54
While Harold's time was limited,
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Dok je Haroldovo vreme bilo ograničeno,
07:57
palliative care's is not.
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vreme palijativne nege to nije.
08:00
Palliative care is a paradigm
from diagnosis through the end of life.
from diagnosis through the end of life.
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Palijativna nega je paradigma
od postavljanja dijagnoze do kraja života.
od postavljanja dijagnoze do kraja života.
08:06
The hours,
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Sati,
08:08
weeks, months, years,
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nedelje, meseci, godine,
08:11
across a continuum --
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duž kontinuuma -
08:13
with treatment, without treatment.
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sa lečenjem, bez lečenja.
08:15
Meet Christine.
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Upoznajte Kristinu.
08:17
Stage III cervical cancer,
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Treći stadijum raka grlića materice
08:19
so, metastatic cancer
that started in her cervix,
that started in her cervix,
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dakle, metastatski rak
koji je otpočeo u grliću materice
koji je otpočeo u grliću materice
08:22
spread throughout her body.
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proširio se kroz njeno telo.
08:24
She's in her 50s and she is living.
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U pedesetim je godinama i živi.
08:28
This is not about end of life,
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Ovde se ne radi o kraju života,
08:30
this is about life.
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već o životu.
08:33
This is not just about the elderly,
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Ne radi se samo o starijima,
08:35
this is about people.
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radi se o ljudima.
08:37
This is Richard.
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Ovo je Ričard.
08:39
End-stage lung disease.
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Krajnji stadijum bolesti pluća.
08:42
"Richard, what is it
that you hold sacred?"
that you hold sacred?"
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„Ričarde, šta je to
što smatraš svetinjom?“
što smatraš svetinjom?“
08:45
"My kids, my wife and my Harley."
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„Moja deca, žena i moj Harli.“
08:49
(Laughter)
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(Smeh)
08:50
"Alright!
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„U redu!
Ne mogu da vas vozim unaokolo na njemu
jer jedva da umem da vozim bicikl,
jer jedva da umem da vozim bicikl,
08:52
I can't drive you around on it
because I can barely pedal a bicycle,
because I can barely pedal a bicycle,
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08:55
but let's see what we can do."
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ali hajde da vidimo šta možemo.“
08:58
Richard came to me,
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Ričard je došao kod mene
09:00
and he was in rough shape.
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i bio je u teškom stanju.
Mali glas u njemu mu je govorio
09:04
He had this little voice telling him
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da možda njegovo vreme dolazi
za nekoliko nedelja ili meseci.
za nekoliko nedelja ili meseci.
09:06
that maybe his time was weeks to months.
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09:09
And then we just talked.
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Zatim smo samo pričali.
09:10
And I listened and tried to hear --
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Ja sam slušao i pokušavao da čujem;
09:14
big difference.
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velika razlika.
09:16
Use these in proportion to this.
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Koristite ovo srazmerno ovome.
Rekao sam: „U redu,
hajde da se bavimo ovim dan za danom“,
hajde da se bavimo ovim dan za danom“,
09:20
I said, "Alright, let's take it
one day at a time,"
one day at a time,"
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09:23
like we do in every
other chapter of our life.
other chapter of our life.
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kao što to radimo
u svakom drugoj oblasti života.
u svakom drugoj oblasti života.
09:26
And we have met Richard
where Richard's at day-to-day.
where Richard's at day-to-day.
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Izlazili smo u susret Ričardu
tamo gde se on nalazio iz dana u dan.
tamo gde se on nalazio iz dana u dan.
09:31
And it's a phone call or two a week,
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U pitanju je jedan
ili dva telefonska poziva nedeljno,
ili dva telefonska poziva nedeljno,
09:35
but he's thriving in the context
of end-stage lung disease.
of end-stage lung disease.
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ali on napreduje u kontekstu
krajnjeg stadijuma bolesti pluća.
krajnjeg stadijuma bolesti pluća.
09:43
Now, palliative medicine is not
just for the elderly,
just for the elderly,
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Palijativna medicina
nije samo za starije osobe,
nije samo za starije osobe,
09:45
it is not just for the middle-aged.
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niti je samo za osobe srednjih godina.
Ona je za svakog.
09:49
It is for everyone.
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09:51
Meet my friend Jonathan.
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Upoznajte mog prijatelja Džonatana.
Imamo čast i zadovoljstvo
09:53
We have the honor and pleasure
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da su nam se Džonatan i njegov otac
danas pridružili ovde.
danas pridružili ovde.
09:55
of Jonathan and his father
joining us here today.
joining us here today.
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Džonatan je u svojim dvadesetim
i upoznao sam ga pre nekoliko godina.
i upoznao sam ga pre nekoliko godina.
09:57
Jonathan is in his 20s,
and I met him several years ago.
and I met him several years ago.
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10:00
He was dealing with
metastatic testicular cancer,
metastatic testicular cancer,
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Borio se sa metastatskim rakom testisa
koji se proširio na njegov mozak.
10:04
spread to his brain.
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10:06
He had a stroke,
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Doživeo je šlog,
10:08
he had brain surgery,
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imao je operaciju na mozgu,
10:09
radiation, chemotherapy.
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radijaciju, hemoterapiju.
Po mom upoznavanju sa njim
i njegovom porodicom,
i njegovom porodicom,
10:13
Upon meeting him and his family,
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10:15
he was a couple of weeks away
from a bone marrow transplant,
from a bone marrow transplant,
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imao je par nedelja
do transplantacije koštane srži,
do transplantacije koštane srži,
a tokom slušanja i uključenosti,
10:18
and in listening and engaging,
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10:20
they said, "Help us
understand -- what is cancer?"
understand -- what is cancer?"
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rekli su: „Pomozite nam
da razumemo - šta je to rak?“
da razumemo - šta je to rak?“
Kako smo dospeli tako daleko
10:27
How did we get this far
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bez razumevanja o tome sa čim imamo posla?
10:30
without understanding
what we're dealing with?
what we're dealing with?
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Kako smo dospeli toliko daleko
bez osnaživanja osobe
bez osnaživanja osobe
10:33
How did we get this far
without empowering somebody
without empowering somebody
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10:35
to know what it is they're dealing with,
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da zna sa čime se suočava,
a zatim preduzimanja sledećeg koraka
i bavljenja time ko je kao ljudsko biće
i bavljenja time ko je kao ljudsko biće
10:37
and then taking the next step and engaging
in who they are as human beings
in who they are as human beings
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tako da znamo da li je to
ono što treba da radimo?
ono što treba da radimo?
10:41
to know if that is what we should do?
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10:43
Lord knows we can do
any kind of thing to you.
any kind of thing to you.
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Sam bog zna da možemo
da vam svašta uradimo.
da vam svašta uradimo.
10:49
But should we?
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Ipak, da li bi trebalo?
10:53
And don't take my word for it.
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Nemojte mi verovati na reč.
10:55
All the evidence that is related
to palliative care these days
to palliative care these days
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Svi dokazi u poslednje vreme
vezani za palijativnu negu
vezani za palijativnu negu
11:00
demonstrates with absolute certainty
people live better and live longer.
people live better and live longer.
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pokazuju sa apsolutnom sigurnošću
da ljudi žive bolje i duže.
da ljudi žive bolje i duže.
Bio je jedan plodonosni članak
u Medicinskom časopisu Nove Engleske
u Medicinskom časopisu Nove Engleske
11:04
There was a seminal article
out of the New England Journal of Medicine
out of the New England Journal of Medicine
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iz 2010. godine.
11:07
in 2010.
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Studija koju su na Harvardu sproveli
moji prijatelji, kolege.
moji prijatelji, kolege.
11:09
A study done at Harvard
by friends of mine, colleagues.
by friends of mine, colleagues.
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11:12
End-stage lung cancer:
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Krajnji stadijum raka pluća -
11:13
one group with palliative care,
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jedna grupa sa palijativnom negom,
11:16
a similar group without.
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slična grupa bez nje.
11:19
The group with palliative care
reported less pain,
reported less pain,
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Grupa sa palijativnom negom
je saopštavala da ima manje bolova,
je saopštavala da ima manje bolova,
11:23
less depression.
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manje depresije.
11:25
They needed fewer hospitalizations.
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Ređe im je bila potrebna hospitalizacija.
11:28
And, ladies and gentlemen,
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Takođe, dame i gospodo,
11:30
they lived three to six months longer.
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živeli su tri do šest meseci duže.
Kada bi palijativna nega
bila lek protiv raka,
bila lek protiv raka,
11:35
If palliative care were a cancer drug,
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11:39
every cancer doctor on the planet
would write a prescription for it.
would write a prescription for it.
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svaki doktor za rak na planeti
bi propisivao recepte za nju.
bi propisivao recepte za nju.
Zašto to ne rade?
11:44
Why don't they?
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11:47
Again, because we goofy,
long white-coat physicians
long white-coat physicians
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Još jednom, zato što smo mi,
smešni lekari u dugim belim mantilima,
smešni lekari u dugim belim mantilima,
11:50
are trained and of the mantra
of dealing with this,
of dealing with this,
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obrazovani i imamo mantru
za bavljenje ovim,
za bavljenje ovim,
a ne ovim.
11:56
not with this.
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12:02
This is a space that we will
all come to at some point.
all come to at some point.
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Ovo je mesto na koje ćemo svi doći
u nekom trenutku.
u nekom trenutku.
12:07
But this conversation today
is not about dying,
is not about dying,
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Međutim, ovaj razgovor danas
nije o umiranju,
nije o umiranju,
12:10
it is about living.
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već o življenju.
O življenju na osnovu naših vrednosti,
12:12
Living based on our values,
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12:13
what we find sacred
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onome što smatramo svetim
i načinu na koji želimo
da ispišemo poglavlja svog života,
da ispišemo poglavlja svog života,
12:15
and how we want to write
the chapters of our lives,
the chapters of our lives,
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12:17
whether it's the last
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bilo da je u pitanju poslednje
12:19
or the last five.
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ili poslednjih pet.
12:22
What we know,
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Ono što znamo,
ono što smo dokazali,
12:24
what we have proven,
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jeste da ovaj razgovor
mora da se dogodi danas -
mora da se dogodi danas -
12:26
is that this conversation
needs to happen today --
needs to happen today --
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12:29
not next week, not next year.
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ne naredne nedelje, ne naredne godine.
12:32
What is at stake is our lives today
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U pitanju je naš život danas,
12:34
and the lives of us as we get older
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naši životi kada ostarimo,
12:36
and the lives of our children
and our grandchildren.
and our grandchildren.
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životi naše dece i naših unuka.
12:40
Not just in that hospital room
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Ne samo u toj bolničkoj sobi
12:42
or on the couch at home,
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ili na kauču kod kuće,
12:44
but everywhere we go
and everything we see.
and everything we see.
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već gde god da odemo i šta god da vidimo.
12:48
Palliative medicine is the answer
to engage with human beings,
to engage with human beings,
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Palijativna medicina je odgovor
za bavljenje ljudskim bićima,
za bavljenje ljudskim bićima,
12:53
to change the journey
that we will all face,
that we will all face,
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za promenu putovanja
sa kojim ćemo se svi suočiti,
sa kojim ćemo se svi suočiti,
12:58
and change it for the better.
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i to promenu nabolje.
13:02
To my colleagues,
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Od svojih kolega,
13:04
to my patients,
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od svojih pacijenata,
13:06
to my government,
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od svoje vlade,
13:08
to all human beings,
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od svih ljudskih bića,
13:10
I ask that we stand and we
shout and we demand
shout and we demand
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tražim da ustanemo, uzviknemo i zahtevamo
13:14
the best care possible,
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najbolju moguću negu,
tako da možemo da živimo bolje danas
13:17
so that we can live better today
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13:19
and ensure a better life tomorrow.
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i obezbedimo bolji život sutra.
13:21
We need to shift today
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Moramo da napravimo preokret danas
13:24
so that we can live tomorrow.
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da bismo mogli da živimo sutra.
Hvala vam mnogo.
13:28
Thank you very much.
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(Aplauz)
13:30
(Applause)
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ABOUT THE SPEAKER
Timothy Ihrig - Palliative care physicianTimothy Ihrig advocates for an approach to healthcare that prioritizes a patient's personal values.
Why you should listen
Dr. Timothy Ihrig, MD practices palliative medicine, caring for the most vulnerable and sickest people, and helps other providers improve the quality and value of the care they provide to this population. His work has shown how patient-centered care improves quality and length of life, and that it has significant economic benefits to patients, healthcare systems and the economy.
Ihrig is nationally recognized for his expertise in continuum population health and community-based palliative care. He holds appointments as content expert to the Accountable Care Learning Collaborative, an industry-leading healthcare innovation collaborative co-chaired by former Health and Human Services Secretary and Utah Governor Mike Leavitt and former Food and Drug Administration Commissioner Dr. Mark McClellan. Ihrig is a member of the Advisory Council of the Iowa Healthcare Collaborative, a think-tank for strategies in health care quality, safety and value for the state of Iowa. He also serves as an Iowa Alternate-Delegate to the American Medical Association.
Ihrig has been an expert source for palliative care development for the Brookings Institution, and he was the sole practicing physician assisting the Iowa General Assembly in raising minimum standard requirements for Iowa physicians with respect to end-of-life care and oversight of prescriptive narcotics. He also acted as an expert clinician in support of Iowa Physician Orders for Life-Sustaining Treatment bill. He holds appointments as Clinical Adjunct Professor in the Department of Medicine at the University of Iowa Carver School of Medicine and acts as Palliative Care clinical instructor. He is on the board of the Hospice and Palliative Care Association of Iowa, is the former chair of the Advocacy Committee and sits on the Palliative Care Advisory Committee.
Ihrig's other interests include sexuality at the end of life and global health. He served as the Medical Chair of the Health Services Committee for Empower Tanzania Incorporated, whose mission is the development of sustainable healthcare solutions in sub-Saharan Africa for individuals suffering with HIV/AIDS, cancer and other life-limited illnesses.
Timothy Ihrig | Speaker | TED.com