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