TEDxToronto 2010
Brian Goldman: Doctors make mistakes. Can we talk about that?
布莱恩.高德曼：医生们会犯错误，我们能否谈论他们所犯过的错误呢？
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每个医生都会犯错。但是，医师布莱恩高德曼提道，医学界的否认（和耻感）文化让医生们无法诉说他们曾经犯过的错误，以至于无法从错误中学习与进步。从讲述自己的故事开始，他号召医生们开始谈论他们曾经犯过的错误。
Brian Goldman - Physician, broadcaster
Brian Goldman is an emergency-room physician in Toronto, and the host of CBC Radio’s "White Coat, Black Art." Full bio
Brian Goldman is an emergency-room physician in Toronto, and the host of CBC Radio’s "White Coat, Black Art." Full bio
Double-click the English transcript below to play the video.
00:15
I think we have to do something
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我觉得在当今的医学文化中，
00:17
about a piece of the culture of medicine that has to change.
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有一部份文化必须要开始改变。
00:20
And I think it starts with one physician, and that's me.
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而这个改变可以从一个医生开始，那就是我。
00:23
And maybe I've been around long enough
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或许是因为我已经行医多年，
00:25
that I can afford to give away some of my false prestige
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我可以承受放弃一些虚无的名利
00:27
to be able to do that.
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来开始这样的改变。
00:29
Before I actually begin the meat of my talk,
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在进入主题之前，
00:31
let's begin with a bit of baseball.
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让我们先谈谈棒球吧。
00:33
Hey, why not?
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为什么不呢？
00:35
We're near the end, we're getting close to the World Series.
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常规赛季就快结束，世界职业棒球大赛即将开始。
00:38
We all love baseball, don't we?
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我们都喜爱棒球，不是吗？
00:41
(Laughter)
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（笑声）
00:43
Baseball is filled with some amazing statistics.
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棒球的世界中充斥着成千上百种
00:46
And there's hundreds of them.
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让人咋舌的统计数据。
00:49
"Moneyball" is about to come out, and it's all about statistics
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即将上映的电影 “点球成金”，便是完全关于统计数据，
00:52
and using statistics to build a great baseball team.
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以及如何在这些数据的基础上建造一个伟大的球队。
00:54
I'm going to focus on one stat
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我想讲一个
00:57
that I hope a lot of you have heard of.
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我希望大家都听说过的数据，
00:59
It's called batting average.
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叫做击球率。
01:01
So we talk about a 300, a batter who bats 300.
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当我们说一名挥棒球员的击球率为三成的时候，
01:04
That means that ballplayer batted safely, hit safely
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我们是指这位球员的打击非常稳定，
01:08
three times out of 10 at bats.
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每十次种就会有三次安打。
01:11
That means hit the ball into the outfield,
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安打意味着球会被击中并被打入外野，
01:13
it dropped, it didn't get caught,
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而且并不会被立刻接杀，
01:15
and whoever tried to throw it to first base didn't get there in time
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球也不会在跑者成功上到一垒之前
01:18
and the runner was safe.
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被及时的传回。
01:20
Three times out of 10.
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十次中有三次安打。
01:23
Do you know what they call a 300 hitter
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各位知道棒球大联盟如何评论
01:26
in Major League Baseball?
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这些击球率上了三成的球员吗？
01:28
Good, really good,
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很棒，非常棒，
01:31
maybe an all-star.
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明星球员一般的棒。
01:34
Do you know what they call
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各位知道他们又是如何称呼一位
01:36
a 400 baseball hitter?
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击球率有着四成，
01:38
That's somebody who hit, by the way,
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也就是每十次打击
01:40
four times safely out of every 10.
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就会打出四个安打的球员吗。
01:42
Legendary --
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是传奇 --
01:45
as in Ted Williams legendary --
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像泰德. 威廉斯那样的传奇--
01:47
the last Major League Baseball player
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他是棒球大联盟里最后一个在常规赛中
01:49
to hit over 400 during a regular season.
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拥有超过四成击球率的球员。
01:52
Now let's take this back into my world of medicine
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现在让我们回到我的世界 - 医疗领域。
01:54
where I'm a lot more comfortable,
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这个领域我比较熟悉，
01:56
or perhaps a bit less comfortable
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但我接下来要说的
01:58
after what I'm going to talk to you about.
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却让我有些困扰。
02:01
Suppose you have appendicitis
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假设你得了阑尾炎，
02:03
and you're referred to a surgeon
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然后你被推荐给了一位
02:05
who's batting 400 on appendectomies.
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在阑尾移除手术中有着四成“击球率”的外科医生。
02:07
(Laughter)
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（笑声）
02:10
Somehow this isn't working out, is it?
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这听起来怪怪的，对吧？
02:13
Now suppose you live
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又假设你住在
02:15
in a certain part of a certain remote place
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某一个较为偏远的地区，
02:18
and you have a loved one
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而你所爱的人的
02:20
who has blockages in two coronary arteries
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两条冠状动脉都被堵塞。
02:23
and your family doctor refers that loved one to a cardiologist
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你的家庭医生将她推荐给了一位在血管成形手术上
02:26
who's batting 200 on angioplasties.
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有着两成“击球率”的心脏科医师。
02:30
But, but, you know what?
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但是，等等，你知道吗？
02:32
She's doing a lot better this year. She's on the comeback trail.
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她今年的表现有着很大的提高，她的水准也在恢复。
02:34
And she's hitting a 257.
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她的“击球率”达到了两成五。
02:37
Somehow this isn't working.
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但是这样还是不能被接受。
02:39
But I'm going to ask you a question.
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而我现在想问各位一个问题。
02:41
What do you think a batting average
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你们认为，
02:43
for a cardiac surgeon or a nurse practitioner
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一位心脏外科医生，或一位职业护理师，
02:45
or an orthopedic surgeon,
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一位骨科外科医生
02:47
an OBGYN, a paramedic
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妇产科医生或急救人员的 “击球率”
02:49
is supposed to be?
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应该是多少？
02:52
1,000, very good.
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十成？非常好。
02:55
Now truth of the matter is,
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事实上，
02:57
nobody knows in all of medicine
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医学界中没有人知道
02:59
what a good surgeon
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一个好的外科医生，
03:01
or physician or paramedic
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医师或急救人员
03:03
is supposed to bat.
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应该有多少的 “击球率”。
03:05
What we do though is we send each one of them, including myself,
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我们将他们每个人，包括我自己，
03:07
out into the world
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送上职业岗位后
03:09
with the admonition, be perfect.
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便告诫他们以完美来要求自己 --
03:11
Never ever, ever make a mistake,
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绝对，绝对不能作出错误的诊断 --
03:13
but you worry about the details, about how that's going to happen.
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但我们让他们自己考虑细节，考虑如何达到这样的标准。
03:16
And that was the message that I absorbed
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这就是我在医学院时
03:18
when I was in med school.
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得到的信息。
03:20
I was an obsessive compulsive student.
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我是一个有着强迫症倾向的学生。
03:23
In high school, a classmate once said
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在中学时，有个同学曾经说
03:26
that Brian Goldman would study for a blood test.
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布莱恩.高德曼会为了血液测验复习。
03:28
(Laughter)
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（笑声）
03:31
And so I did.
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而我的确这么做了。
03:33
And I studied in my little garret
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我在离这不远处的多伦多总医院里
03:35
at the nurses' residence at Toronto General Hospital,
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护士住宅里的一个小阁楼中，
03:37
not far from here.
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完成了我的学业。
03:39
And I memorized everything.
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我背下了所有东西。
03:41
I memorized in my anatomy class
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我背下了解剖课中
03:43
the origins and exertions of every muscle,
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提到的每一块肌肉的起端和伸展方式，
03:45
every branch of every artery that came off the aorta,
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每一条从主动脉延伸出来的动脉的分支系统，
03:48
differential diagnoses obscure and common.
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以及一切鲜为人知的或者常见的鉴别诊断。
03:51
I even knew the differential diagnosis
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我甚至知道如何鉴别诊断
03:53
in how to classify renal tubular acidosis.
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不同的肾小管性酸中毒症。
03:55
And all the while,
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在这段时间中，
03:57
I was amassing more and more knowledge.
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我积累了越来越多的知识。
03:59
And I did well, I graduated with honors,
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我的表现很好，
04:01
cum laude.
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并以优等的成绩毕业。
04:03
And I came out of medical school
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当我从医学院出来时，
04:06
with the impression
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我觉得
04:08
that if I memorized everything and knew everything,
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我只要记下和明白了所有的东西 –
04:10
or as much as possible,
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或者稍退一步 –
04:12
as close to everything as possible,
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将近所有的东西，
04:14
that it would immunize me against making mistakes.
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那我犯医疗错误的几率就会微乎其微。
04:17
And it worked
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而我在一段时间之内
04:19
for a while,
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的确没有犯错。
04:22
until I met Mrs. Drucker.
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直到我遇到了 Drucker 女士。
04:25
I was a resident at a teaching hospital here in Toronto
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Drucker 女士被带入多伦多的
04:27
when Mrs. Drucker was brought to the emergency department
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一家教学医院的急诊室时，
04:30
of the hospital where I was working.
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我正作为一个实习医生在那里工作。
04:32
At the time I was assigned to the cardiology service
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当时我正因心脏科轮调
04:34
on a cardiology rotation.
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而被指派在心血管诊所。
04:36
And it was my job,
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我的工作是，
04:38
when the emergency staff called for a cardiology consult,
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当紧急救护人员需要有关于心脏的专业会诊时，
04:40
to see that patient in emerg.
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在急症室诊断病人，
04:43
and to report back to my attending.
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并在之后向负责我的主治医生汇报。
04:45
And I saw Mrs. Drucker, and she was breathless.
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当我见到Drucker女士的时候，她的气息已经很微弱。
04:48
And when I listened to her, she was making a wheezy sound.
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在我与她交谈时，我听到她的呼吸有喘息的声音。
04:51
And when I listened to her chest with a stethoscope,
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当我用听诊器聆听她的胸腔时，
04:53
I could hear crackly sounds on both sides
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两边都传来的爆裂的声音告诉我，
04:55
that told me that she was in congestive heart failure.
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这是郁血性心脏衰竭。
04:58
This is a condition in which the heart fails,
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这是由于心脏在衰竭后，
05:01
and instead of being able to pump all the blood forward,
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无法将所有的血液完全的输送出去，
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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而导致部分血液回流入肺脏。肺脏里充满了血液，
05:06
and that's why you have shortness of breath.
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而造成呼吸短促。
05:08
And that wasn't a difficult diagnosis to make.
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这不是一个困难的诊断。
05:11
I made it and I set to work treating her.
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作出诊断后我开始着手帮她治疗。
05:14
I gave her aspirin. I gave her medications to relieve the strain on her heart.
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我开给了她阿司匹林，并给了她一些可以减轻她心脏负担的药物。
05:17
I gave her medications that we call diuretics, water pills,
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我还给了她一些利尿剂，俗称水丸，
05:20
to get her to pee out the access fluid.
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帮助她将体内多余的水分排出。
05:23
And over the course of the next hour and a half or two,
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在接下来的一两个小时里，
05:25
she started to feel better.
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她开始觉得好转，
05:27
And I felt really good.
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我也感到高兴。
05:30
And that's when I made my first mistake;
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而就在此时我犯了第一个错误：
05:33
I sent her home.
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我让她回了家。
05:35
Actually, I made two more mistakes.
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正确的来说，我还犯了两个错误。
05:38
I sent her home
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我在和我的主治汇报之前
05:40
without speaking to my attending.
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便让她回了家。
05:42
I didn't pick up the phone and do what I was supposed to do,
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我没有做我照着我应该做的，
05:45
which was call my attending and run the story by him
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拿起电话打给我的主治并让他看一下这个案例，
05:47
so he would have a chance to see her for himself.
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给他一个亲自见见这名病患的机会。
05:50
And he knew her,
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我的主治认识她，
05:52
he would have been able to furnish additional information about her.
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因此可以提供更详细的病历资料。
05:55
Maybe I did it for a good reason.
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或许我有这么做的理由。
05:57
Maybe I didn't want to be a high-maintenance resident.
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或许我并不想做一个需要经常地指导的实习医生。
06:00
Maybe I wanted to be so successful
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也许我太想
06:02
and so able to take responsibility
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可以独当一面，
06:04
that I would do so
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可以不需要
06:06
and I would be able to take care of my attending's patients
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和我的主治沟通
06:08
without even having to contact him.
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便照顾好他的病患。
06:10
The second mistake that I made was worse.
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而我犯的第二个错误更加严重。
06:14
In sending her home,
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在让她回家时，
06:16
I disregarded a little voice deep down inside
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我忽视了我内心一个微小的声音。
06:18
that was trying to tell me,
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这个声音试图告诉我：
06:20
"Goldman, not a good idea. Don't do this."
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“高德曼，这样不好，不要这么做。”
06:23
In fact, so lacking in confidence was I
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其实，当时的我是如此的没有自信，
06:26
that I actually asked the nurse
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以至于我甚至向照顾Drucker女士
06:28
who was looking after Mrs. Drucker,
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的护士寻求了意见：
06:30
"Do you think it's okay if she goes home?"
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“你觉得让她回家好么？”
06:33
And the nurse thought about it
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那位护士想了想，
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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然后就事论事的说：“嗯，我觉得没有问题。”
06:37
I can remember that like it was yesterday.
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这一切对我来说，都还像是发生在了昨天。
06:40
So I signed the discharge papers,
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我在出院单上签了名，
06:42
and an ambulance came, paramedics came to take her home.
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一辆救护车来后急救人员将她送回了家。
06:45
And I went back to my work on the wards.
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之后我回到了我在诊所的工作。
06:48
All the rest of that day,
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在接下来的一天中，
06:50
that afternoon,
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那天下午，
06:52
I had this kind of gnawing feeling inside my stomach.
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我的肠胃有着一种翻滚的感觉。
06:55
But I carried on with my work.
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但我还是照常的继续工作。
06:58
And at the end of the day, I packed up to leave the hospital
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在工作结束后，我整理了下便离开了医院。
07:00
and walked to the parking lot
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在我走向停车场
07:02
to take my car and drive home
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去取我的车的路程中，
07:04
when I did something that I don't usually do.
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我做了一件我平常不会做的事情。
07:08
I walked through the emergency department on my way home.
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我从急诊室借了道。
07:11
And it was there that another nurse,
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而就在那里，另外一位护士，
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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不是之前照顾Drucker女士的那位，
07:16
said three words to me
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对我说了
07:19
that are the three words
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绝大部分急诊医生
07:21
that most emergency physicians I know dread.
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都害怕听到的三个字。
07:24
Others in medicine dread them as well,
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其他科系的医生也害怕这三个字，
07:26
but there's something particular about emergency medicine
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但因为急诊医生看的病人都来去匆匆，
07:28
because we see patients so fleetingly.
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这三个字对我们有着特别的意义。
07:32
The three words are:
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这三个字是：
07:34
Do you remember?
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记得吗？
07:38
"Do you remember that patient you sent home?"
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“记得吗？你送回家的那个患者？”
07:41
the other nurse asked matter-of-factly.
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那位护士就事论事的问道。
07:43
"Well she's back,"
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“她又回来了。”
07:45
in just that tone of voice.
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她就用了这样平常的语调。
07:47
Well she was back all right.
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她的确回来了。
07:49
She was back and near death.
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回来时已经濒临死亡。
07:52
About an hour after she had arrived home,
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在我让她回家后
07:54
after I'd sent her home,
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大约一个小时后，
07:56
she collapsed and her family called 911
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她昏倒在了地上，她的家人打了911，
07:59
and the paramedics brought her back to the emergency department
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急救人员将她重新带回了急诊室。
08:01
where she had a blood pressure of 50,
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此时的她已严重休克，
08:03
which is in severe shock.
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血压只有 50。
08:05
And she was barely breathing and she was blue.
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她的呼吸极其微弱，面色发青。
08:08
And the emerg. staff pulled out all the stops.
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急救人员们使出了浑身解数。
08:11
They gave her medications to raise her blood pressure.
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他们给了她提升血压的药物，
08:14
They put her on a ventilator.
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并将她连接上了人工呼吸器。
08:16
And I was shocked
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我震惊不已，
08:19
and shaken to the core.
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吓得不得了。
08:21
And I went through this roller coaster,
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之后我的心情便像是做着云霄飞车一般，
08:23
because after they stabilized her,
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因为当他们将她的情况稳定下来后，
08:25
she went to the intensive care unit,
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便将她送进了加护病房，
08:27
and I hoped against hope that she would recover.
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我在绝望中希望她能够醒过来。
08:29
And over the next two or three days,
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但在接下来的两三天中，
08:31
it was clear that she was never going to wake up.
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她再也不会醒来的可能性越来越大。
08:33
She had irreversible brain damage.
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她的脑部已经受到了无法逆转的损伤。
08:36
And the family gathered.
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她的家人聚在了一起。
08:38
And over the course of the next eight or nine days,
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在接下来的八到九天里，
08:41
they resigned themselves to what was happening.
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他们慢慢的接受了这件事实。
08:43
And at about the nine day mark, they let her go --
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在第九天，他们选择让她离开人间 --
08:46
Mrs. Drucker,
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Drucker女士，
08:48
a wife, a mother
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一个家庭的妻子，母亲，
08:50
and a grandmother.
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和祖母。
08:53
They say you never forget the names
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有人说你永远不会忘记那些
08:55
of those who die.
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(因你的疏忽而过世的）人的名字，
08:57
And that was my first time to be acquainted with that.
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而那是我第一次意识到这句话的现实。
09:00
Over the next few weeks,
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在接下来的几个星期内，
09:02
I beat myself up
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我无比的沮丧，
09:05
and I experienced for the first time
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并第一次经历了
09:07
the unhealthy shame that exists
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那种在医学文化中存在的
09:09
in our culture of medicine --
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危险的羞愧感 --
09:11
where I felt alone, isolated,
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我觉得孤单无助。
09:14
not feeling the healthy kind of shame that you feel,
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这不是那种健康的羞愧感，
09:16
because you can't talk about it with your colleagues.
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因为你不能和你的同事提起讨论它。
09:18
You know that healthy kind,
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– 就是那种，
09:20
when you betray a secret that a best friend made you promise never to reveal
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当你背叛了对挚友的承诺而说出了答应要保守的秘密，
09:23
and then you get busted
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并被他知道了以后，
09:25
and then your best friend confronts you
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你的挚友找你算账时，
09:27
and you have terrible discussions,
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虽然你们会争执不休，
09:29
but at the end of it all that sick feeling guides you
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但最后那层罪恶感仍然会主导你，
09:32
and you say, I'll never make that mistake again.
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你告诉自己，我绝对不会再犯同样的错误。
09:34
And you make amends and you never make that mistake again.
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如是，你做了修正的承诺，然后你永不会再犯那样的错。
09:37
That's the kind of shame that is a teacher.
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这种羞愧有着教导的作用。
09:40
The unhealthy shame I'm talking about
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而我所说的那种非良性的羞愧
09:42
is the one that makes you so sick inside.
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会让你愧对于心。
09:45
It's the one that says,
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它会对你说，
09:47
not that what you did was bad,
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并非你做的是错的，
09:49
but that you are bad.
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而是你根本就是坏人。
09:51
And it was what I was feeling.
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这便是我当时的感觉。
09:54
And it wasn't because of my attending; he was a doll.
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而这也不是因为我的主治；他人非常好。
09:57
He talked to the family, and I'm quite sure that he smoothed things over
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他和那家人好好的谈过。我确定他为了确保
10:00
and made sure that I didn't get sued.
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我没有被控告而替我打了圆场。
10:03
And I kept asking myself these questions.
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但我仍然不断问我自己这些问题：
10:06
Why didn't I ask my attending? Why did I send her home?
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为什么当时我没有联系我的主治？为什么我当时会让她回家？
10:09
And then at my worst moments:
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更加沮丧时，我会问：
10:11
Why did I make such a stupid mistake?
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我为什么会犯下如此愚蠢的错误？
10:14
Why did I go into medicine?
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为什么我会选择进入医学界？
10:16
Slowly but surely,
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慢慢的但稳定地，
10:18
it lifted.
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那糟糕的感觉开始淡化了。
10:20
I began to feel a bit better.
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我开始觉得缓和了些。
10:22
And on a cloudy day,
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然后在一个阴云密布的日子里，
10:24
there was a crack in the clouds and the sun started to come out
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当我看到一束阳光从云隙中探出，
10:26
and I wondered,
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我觉得，
10:28
maybe I could feel better again.
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或许我能再次感觉好起来。
10:30
And I made myself a bargain
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然后我和自己做了一个约定：
10:33
that if only I redouble my efforts to be perfect
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如果我加倍努力做到完美，
10:38
and never make another mistake again,
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不再犯错，
10:40
please make the voices stop.
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请就此让那自责的声音消去。
10:42
And they did.
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那个声音的确停止了。
10:44
And I went back to work.
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我回到了工作岗位。
10:46
And then it happened again.
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但错误又发生了。
10:49
Two years later I was an attending in the emergency department
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两年后，当我在一家多伦多北部一间社区医院的
10:52
at a community hospital just north of Toronto,
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急症室做主治医生时，
10:54
and I saw a 25 year-old man with a sore throat.
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我看了一位喉咙酸痛的25岁的男人。
10:57
It was busy, I was in a bit of a hurry.
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当时诊所很忙，所以我也有些急。
10:59
He kept pointing here.
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他不停的指着这里。
11:01
I looked at his throat, it was a little bit pink.
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我看了看，他的喉咙有些红肿。
11:03
And I gave him a prescription for penicillin
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我给他开了盘尼西林的处方后
11:05
and sent him on his way.
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便让他离开了。
11:07
And even as he was walking out the door,
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即便当他走出诊所的大门的时候，
11:09
he was still sort of pointing to his throat.
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他似乎还在指着他的喉咙。
11:12
And two days later I came to do my next emergency shift,
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两天后，又轮到我在急诊室值班。
11:15
and that's when my chief asked to speak to me quietly in her office.
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那时我的主任要我去她的办公室里私下谈谈。
11:18
And she said the three words:
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她说了那三个字：
11:22
Do you remember?
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记得吗？
11:25
"Do you remember that patient you saw with the sore throat?"
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“记得吗？那位你看过的喉咙酸痛的患者？”
11:28
Well it turns out, he didn't have a strep throat.
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原来，他并没有得链球菌性咽喉炎。
11:30
He had a potentially life-threatening condition
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得的是一种有可能威胁到生命的病症，
11:32
called epiglottitis.
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叫会厌炎。
11:34
You can Google it,
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各位可以在谷歌上查询，
11:36
but it's an infection, not of the throat, but of the upper airway,
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但它不是喉咙，而是上呼吸道的感染，
11:39
and it can actually cause the airway to close.
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并有可能造成呼吸道阻塞。
11:42
And fortunately he didn't die.
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幸好，他并没有过世。
11:45
He was placed on intravenous antibiotics
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在被安排做抗生素静脉注射的几天之后，
11:48
and he recovered after a few days.
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他便痊愈了。
11:50
And I went through the same period of shame and recriminations
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而我又回到了那个愧疚和自责的时光中，
11:54
and felt cleansed and went back to work,
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然后等情绪平复后，又回到了工作岗位，
11:58
until it happened again and again and again.
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直到这些错误再度重复的发生。
12:03
Twice in one emergency shift, I missed appendicitis.
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在同一个急诊的值班中，我两次没有发现病患得了盲肠炎。
12:06
Now that takes some doing,
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这是很难想象会发生的事情，
12:09
especially when you work in a hospital
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尤其是当你在一间一个晚上
12:11
that at the time saw but 14 people a night.
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只见十四名病患的医院工作。
12:14
Now in both cases, I didn't send them home
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虽然对这两个病例，我都没有让他们回家，
12:17
and I don't think there was any gap in their care.
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而我也不觉得在治疗照顾过程中有任何空隙和差错。
12:19
One I thought had a kidney stone.
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其中一位我诊断他有肾结石，
12:21
I ordered a kidney X-ray. When it turned out to be normal,
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并安排了肾脏X光，但结果正常。
12:23
my colleague who was doing a reassessment of the patient
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我的同事当时正在对病人的病情做重新的诊断。
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
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在他留意到病人右下腹的地方有些柔软时，便联系了外科医生。
12:29
The other one had a lot of diarrhea.
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另一位病患有严重的腹泻。
12:31
I ordered some fluids to rehydrate him
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我给了他一些液体帮助他补充水分，
12:34
and asked my colleague to reassess him.
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并让我的同事重新看了看。
12:37
And he did
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他照做了。
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
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当他注意到病人右下腹有些柔软时，也联系了外科医生。
12:41
In both cases,
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这两名病患
12:43
they had their operations and they did okay.
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都做了手术并康复了。
12:46
But each time,
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但每当我想到这两起病例，
12:48
they were gnawing at me, eating at me.
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那种感觉都会折磨啃噬我。
12:50
And I'd like to be able to say to you
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而我也希望我可以告诉你
12:52
that my worst mistakes only happened in the first five years of practice
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我造成的最严重的错误只发生在了我开始行医的前五年，
12:55
as many of my colleagues say, which is total B.S.
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像我众多的同事所称一般。但这完全是扯淡。
12:58
(Laughter)
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（笑声）
13:00
Some of my doozies have been in the last five years.
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在最近的五年中，我也犯了一些错误。
13:06
Alone, ashamed and unsupported.
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我依然觉得孤独，羞愧，无助。
13:08
Here's the problem:
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但问题的症结是：
13:10
If I can't come clean
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如果我不能理清
13:12
and talk about my mistakes,
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和谈论我所犯过的错误，
13:16
if I can't find the still-small voice
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如果我无法找到那可以告诉我错误的源头的
13:18
that tells me what really happened,
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那仍然微小的声音，
13:20
how can I share it with my colleagues?
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我又如何能和我的同事分享我的经验？
13:22
How can I teach them about what I did
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我又如何教导他们，
13:25
so that they don't do the same thing?
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让他们不再重蹈我的覆辙？
13:29
If I were to walk into a room --
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当我走入一个场合时 --
13:31
like right now, I have no idea what you think of me.
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就像现在，我完全不知道各位如何看待我。
13:34
When was the last time you heard somebody talk
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你们上一次听到别人谈论自己
13:36
about failure after failure after failure?
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一次又一次的失败是什么时候的事情？
13:38
Oh yeah, you go to a cocktail party
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是的，如果你们去参加一场聚会，
13:40
and you might hear about some other doctor,
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你或许会听到某些关于其他医生的错误的闲聊，
13:42
but you're not going to hear somebody
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但你不会听到有人
13:44
talking about their own mistakes.
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谈论自己所犯的错误。
13:46
If I were to walk into a room filled with my colleages
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如果我现在走入一间坐满我的同事的房间，
13:49
and ask for their support right now
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向他们寻求帮助
13:51
and start to tell what I've just told you right now,
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并开始和他们说我刚才告诉各位的事情，
13:53
I probably wouldn't get through two of those stories
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或许在我还没讲超过两个故事之前，
13:56
before they would start to get really uncomfortable,
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他们就会开始感到非常的不自在。
13:58
somebody would crack a joke,
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有人就会讲个笑话，
14:00
they'd change the subject and we would move on.
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然后他们会改变话题。
14:05
And in fact, if I knew and my colleagues knew
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事实上，如果我，或者我的同事，
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
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知道医院中一位骨科的同事帮病人截错了腿，
14:12
believe me, I'd have trouble
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相信我，当我遇到他时，
14:14
making eye contact with that person.
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我也无法与他有正常眼神的交汇。
14:16
That's the system that we have.
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这就是我们所拥有的体系 --
14:18
It's a complete denial of mistakes.
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一个完完全全的否定错误的体系。
14:21
It's a system
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在这个制度当中
14:23
in which there are two kinds of physicians --
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只有两种人 --
14:27
those who make mistakes
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犯错的
14:29
and those who don't,
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不犯错的，
14:31
those who can't handle sleep deprivation and those who can,
347
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可以调适睡眠不足的和不可以忍受的，
14:34
those who have lousy outcomes
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以及那些有着糟糕的结果
14:36
and those who have great outcomes.
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和有着优秀的结果的。
14:39
And it's almost like an ideological reaction,
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这几乎就像免疫系统的自我反应，
14:41
like the antibodies begin to attack that person.
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像抗体一般开始攻击那个不一样的人。
14:45
And we have this idea
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我们有着一种想法：
14:47
that if we drive the people who make mistakes
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当我们将所有的会犯错的人
14:49
out of medicine,
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赶出医学界后，
14:51
what will we be left with, but a safe system.
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我们便会得到一个安全的系统。
14:55
But there are two problems with that.
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但这种想法会衍生出两个问题。
14:58
In my 20 years or so
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在我二十余年的
15:00
of medical broadcasting and journalism,
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医疗广播和新闻工作中，
15:03
I've made a personal study of medical malpractice and medical errors
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从我为多伦多星报所写的第一篇文章
15:06
to learn everything I can,
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到我的节目《白袍魔艺》，
15:08
from one of the first articles I wrote for the Toronto Star
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我自行研究了我可以接触到的
15:10
to my show "White Coat, Black Art."
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一切医疗疏失和医疗错误。
15:13
And what I've learned
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而我所学到的，
15:15
is that errors are absolutely ubiquitous.
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便是错误绝对是无处不在。
15:18
We work in a system
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我们工作在一个
15:20
where errors happen every day,
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每天都会发生错误的制度中。
15:22
where one in 10 medications
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医院有十分之一的几率
15:24
are either the wrong medication given in hospital
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会给错药
15:26
or at the wrong dosage,
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或者给了错误的剂量，
15:28
where hospital-acquired infections are getting more and more numerous,
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而在医院内被传染的病例正在日渐增多，
15:31
causing havoc and death.
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造成不必要的伤害和死亡。
15:34
In this country,
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在这个国家中，
15:36
as many as 24,000 Canadians die
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有将近2万4千多加拿大人死于
15:38
of preventable medical errors.
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可以避免的医疗错误。
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
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在美国，据医学学院统计，这个人数达到了10万之多。
15:44
In both cases, these are gross underestimates,
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即使如此，这两项数据也还是过于低估了现实，
15:47
because we really aren't ferreting out the problem
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因为我们从未像我们该做的那般
15:49
as we should.
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深入地探究这个问题。
15:51
And here's the thing.
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重点是，
15:54
In a hospital system
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在一个医疗知识
15:57
where medical knowledge is doubling
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以两到三年为单位成倍增长的
15:59
every two or three years, we can't keep up with it.
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医院体系中，我们无法紧跟着这些知识的增长。
16:02
Sleep deprivation is absolutely pervasive.
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睡眠不足的情形绝对是非常普遍的，
16:05
We can't get rid of it.
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而我们也无法摆脱这个问题。
16:07
We have our cognitive biases,
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我们自己的直觉偏差也会直接影响到我们的结论。
16:09
so that I can take a perfect history on a patient with chest pain.
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比如说，我可以为一位胸痛的病人记录下完美的病历。
16:12
Now take the same patient with chest pain,
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但如果这位同样的胸痛的病人
16:14
make them moist and garrulous
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当时胡言乱语
16:16
and put a little bit of alcohol on their breath,
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再加上呼吸带着些许的酒精味的话，
16:18
and suddenly my history is laced with contempt.
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我写下的病历便会挟带着些许的轻蔑。
16:20
I don't take the same history.
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而这份病历便会截然不同。
16:22
I'm not a robot;
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我不是机器人，
16:24
I don't do things the same way each time.
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不会每次都做同样的事情。
16:26
And my patients aren't cars;
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我的病患也不是车子，
16:28
they don't tell me their symptoms in the same way each time.
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他们不会每次都用相同的方式去描述他们的症状。
16:31
Given all of that, mistakes are inevitable.
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因此错误是无可避免的。
16:34
So if you take the system, as I was taught,
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如果真像我被教导的体系那般
16:37
and weed out all the error-prone health professionals,
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赶出所有易出错的医护专业人员，
16:41
well there won't be anybody left.
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那么这个领域便不会有人留下。
16:46
And you know that business
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还有就是关于
16:48
about people not wanting
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人们不愿
16:50
to talk about their worst cases?
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谈论他们所犯的最糟糕的错误一事。
16:53
On my show, on "White Coat, Black Art,"
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在我的节目《白袍魔艺》中，
16:55
I made it a habit of saying, "Here's my worst mistake,"
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我已经会习惯性地说：“这是我最糟糕的错误”。
16:57
I would say to everybody
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我会对从急救医士
16:59
from paramedics to the chief of cardiac surgery,
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到心脏外科首席医师的每个人这么说：
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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“这是我最糟糕的错误，如是，如是。”
17:04
"What about yours?" and I would point the microphone towards them.
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然后我会把麦克风递给他们，问：“你呢？”
17:07
And their pupils would dilate,
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此时他们的瞳孔会放大，
17:09
they would recoil,
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他们会退却。
17:11
then they would look down and swallow hard
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然后他们会看着地上，猛吞着口水
17:14
and start to tell me their stories.
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并开始向我倾诉他们的故事。
17:17
They want to tell their stories. They want to share their stories.
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他们想说他们的故事，他们也想分享他们的故事。
17:20
They want to be able to say,
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他们想能够说：
17:22
"Look, don't make the same mistake I did."
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“听着，别犯和我一样的错。”
17:24
What they need is an environment to be able to do that.
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他们只是需要一个场合来吐露心声。
17:26
What they need is a redefined medical culture.
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他们需要的是一个重新定义的医学文化，
17:30
And it starts with one physician at a time.
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从一位又一位个别的医生开始。
17:33
The redefined physician is human,
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重新定义过的医生也是人类，
17:36
knows she's human,
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明白她自己是人，
17:38
accepts it, isn't proud of making mistakes,
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并接受这个事实。她并不觉得犯错误是光荣的，
17:40
but strives to learn one thing
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却可以
17:42
from what happened
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从其中学习
17:44
that she can teach to somebody else.
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并教于他人。
17:46
She shares her experience with others.
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她会与他人分享她的经验，
17:48
She's supportive when other people talk about their mistakes.
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并在别人谈论自己过错的时候给于支持。
17:51
And she points out other people's mistakes,
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她不会有一种落井下石的心态，
17:53
not in a gotcha way,
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而会以一种
17:55
but in a loving, supportive way
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可以让每个人都从中受惠的关怀，了解的方式
17:58
so that everybody can benefit.
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来指出他人的错误。
18:00
And she works in a culture of medicine
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而她所工作的医学文化
18:02
that acknowledges
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承认
18:04
that human beings run the system,
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整个体系是由人在运作，
18:06
and when human beings run the system, they will make mistakes from time to time.
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而当人在运作一个体系的时候，时不时地错误在所难免。
18:09
So the system is evolving
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这样系统才可以不断地进化改革，
18:13
to create backups
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产生可以让人更加容易察觉
18:17
that make it easier to detect those mistakes
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这些无法避免的错误的
18:20
that humans inevitably make
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补救方案。
18:23
and also fosters in a loving, supportive way
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与此同时，我们可以培养一个热心关怀的工作环境，
18:26
places where everybody who is observing
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鼓励每一位
18:29
in the health care system
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在观察我们的
18:31
can actually point out things that could be potential mistakes
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医疗系统的人
18:34
and is rewarded for doing so,
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随时指出一些潜在的错误。
18:36
and especially people like me, when we do make mistakes,
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尤其是鼓励像我一样的人，当我们犯错后，
18:38
we're rewarded for coming clean.
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我们可以去正面面对并加以改正。
18:42
My name is Brian Goldman.
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我是布莱恩.高德曼，
18:45
I am a redefined physician.
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我是一位重新定义后的医生。
18:48
I'm human. I make mistakes.
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我是一个人类，我也会犯错。
18:50
I'm sorry about that,
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我为此感到抱歉，
18:52
but I strive to learn one thing
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但我会尽力从中学习
18:54
that I can pass on to other people.
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并教于他人。
18:57
I still don't know what you think of me,
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我仍然不知各位如何看待我，
19:00
but I can live with that.
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但我想我对此可以接受。
19:02
And let me close with three words of my own:
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最后让我以我自己的三个字做为结语：
19:05
I do remember.
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我记得。
19:09
(Applause)
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（掌声）
ABOUT THE SPEAKER
Brian Goldman - Physician, broadcasterBrian Goldman is an emergency-room physician in Toronto, and the host of CBC Radio’s "White Coat, Black Art."
Why you should listen
Brian Goldman is an emergency room physician who has worked at Mount Sinai Hospital in downtown Toronto for more than 20 years. He is also a prominent medical journalist and the host of CBC Radio’s White Coat, Black Art. In Dr. Goldman’s first book, The Night Shift, published in 2010, he shares his experiences of working through the witching hours at Mount Sinai, as well as at the other hospitals where he has spent his long career.
Brian Goldman | Speaker | TED.com