TEDxToronto 2010
Brian Goldman: Doctors make mistakes. Can we talk about that?
Brian Goldman: 醫生犯錯了，我們能說嗎？
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每位醫生都會犯錯。但是醫生Brian Goldman說，醫界的文化拒絕(或羞於)談論那些錯誤，或是從錯誤中學習和改正。從他個人長期的經驗中，他呼籲醫生們開始從錯誤中學習。
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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我想我們該做些事
00:17
about a piece of the culture of medicine that has to change.
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去改變醫界一部份的文化
00:20
And I think it starts with one physician, and that's me.
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我想該從一位醫生開始，就是我。
00:23
And maybe I've been around long enough
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我想我在這一行夠久了
00:25
that I can afford to give away some of my false prestige
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我承受得了失去一些虛名
00:27
to be able to do that.
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來做這樣的改變。
00:29
Before I actually begin the meat of my talk,
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在我開始進入主題之前
00:31
let's begin with a bit of baseball.
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我們來談點棒球。
00:33
Hey, why not?
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嗯! 有何不可?
00:35
We're near the end, we're getting close to the World Series.
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球季就快結束，就要打到世界大賽了。
00:38
We all love baseball, don't we?
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我們都愛棒球，不是嗎？
00:41
(Laughter)
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(笑聲)
00:43
Baseball is filled with some amazing statistics.
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棒球有許多驚人的統計數據
00:46
And there's hundreds of them.
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有上百個
00:49
"Moneyball" is about to come out, and it's all about statistics
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電影《魔球》就要上映，裡頭都在講統計數據
00:52
and using statistics to build a great baseball team.
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和如何用統計數據來組成一隊棒球隊。
00:54
I'm going to focus on one stat
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我要來談其中一項數據
00:57
that I hope a lot of you have heard of.
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我希望在座有許多人聽過。
00:59
It's called batting average.
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叫做打擊率。
01:01
So we talk about a 300, a batter who bats 300.
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我們說打擊率有三成的打者。
01:04
That means that ballplayer batted safely, hit safely
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是指這位打者,打擊很穩定
01:08
three times out of 10 at bats.
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每十次就有三次會打安打。
01:11
That means hit the ball into the outfield,
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能把球打去外野
01:13
it dropped, it didn't get caught,
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球會落在外野，不會被接殺
01:15
and whoever tried to throw it to first base didn't get there in time
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不管誰試著要把球傳往一壘也來不及刺殺
01:18
and the runner was safe.
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跑者會安全上壘。
01:20
Three times out of 10.
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每十次中有三次可以打安打。
01:23
Do you know what they call a 300 hitter
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各位知道在大聯盟裡
01:26
in Major League Baseball?
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怎麼說這些打擊率三成的打者
01:28
Good, really good,
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好，真的很好。
01:31
maybe an all-star.
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可以說是明星球員。
01:34
Do you know what they call
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各位知道他們又是如何稱呼
01:36
a 400 baseball hitter?
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一位打擊率四成的打者嗎？
01:38
That's somebody who hit, by the way,
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也就是一位每十次打擊
01:40
four times safely out of every 10.
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就有四次打出安打的打者。
01:42
Legendary --
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是傳奇
01:45
as in Ted Williams legendary --
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是像Ted Williams那樣的傳奇
01:47
the last Major League Baseball player
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他是在球季大聯盟賽中最新傳奇球員,
01:49
to hit over 400 during a regular season.
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擁有超過四成打擊率的打者
01:52
Now let's take this back into my world of medicine
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現在回來談我的世界--醫療領域。
01:54
where I'm a lot more comfortable,
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這個主題我比較在行,
01:56
or perhaps a bit less comfortable
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但可能也有點困擾
01:58
after what I'm going to talk to you about.
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特別是在我的演說之後。
02:01
Suppose you have appendicitis
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假設各位得了盲腸炎
02:03
and you're referred to a surgeon
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而且交由一位執行盲腸炎手術
02:05
who's batting 400 on appendectomies.
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有四成成功率的外科醫生。
02:07
(Laughter)
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(笑聲)
02:10
Somehow this isn't working out, is it?
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這聽起來不太行，對吧?
02:13
Now suppose you live
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現在假設你住在
02:15
in a certain part of a certain remote place
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一個特定的偏遠地區
02:18
and you have a loved one
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你所鍾愛的人
02:20
who has blockages in two coronary arteries
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她的兩條冠狀動脈都有堵塞
02:23
and your family doctor refers that loved one to a cardiologist
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你的家庭醫師將你所鐘愛的人引介給一位心臟科醫師
02:26
who's batting 200 on angioplasties.
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該醫師在心血管手術上有兩成的成功率。
02:30
But, but, you know what?
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但是，等等 你知道嗎?
02:32
She's doing a lot better this year. She's on the comeback trail.
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她今年的成功率提高，她的水準又回來了。
02:34
And she's hitting a 257.
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她有兩成五七的成功率。
02:37
Somehow this isn't working.
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但是這樣還是不能被接受。
02:39
But I'm going to ask you a question.
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我現在要問各位一個問題
02:41
What do you think a batting average
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各位認為所謂的"成功率"
02:43
for a cardiac surgeon or a nurse practitioner
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對一位心臟外科醫生或是職業護士
02:45
or an orthopedic surgeon,
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或是整形外科醫生
02:47
an OBGYN, a paramedic
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一位婦產科醫生，或一位合格的醫護人員
02:49
is supposed to be?
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應該是多少?
02:52
1,000, very good.
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十成，很好.。
02:55
Now truth of the matter is,
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但事實上,
02:57
nobody knows in all of medicine
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沒有人知道在醫界
02:59
what a good surgeon
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一位好的外科醫生
03:01
or physician or paramedic
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一位醫生，或護理人員
03:03
is supposed to bat.
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應該"成功率"是多少.。
03:05
What we do though is we send each one of them, including myself,
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而我們所做的是，讓他們每一位，包括我自己
03:07
out into the world
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在世人眼前
03:09
with the admonition, be perfect.
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是訓練有素的，是完美的。
03:11
Never ever, ever make a mistake,
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從不會犯錯的.。
03:13
but you worry about the details, about how that's going to happen.
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但你還是會擔心，這是如何達成。
03:16
And that was the message that I absorbed
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這是我在醫學院時
03:18
when I was in med school.
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所得到的訊息。
03:20
I was an obsessive compulsive student.
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我是一位有學習強迫症的學生
03:23
In high school, a classmate once said
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在高中時，曾有同學說
03:26
that Brian Goldman would study for a blood test.
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我會去學習血液檢驗學
03:28
(Laughter)
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(笑聲)
03:31
And so I did.
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我的確去學了。
03:33
And I studied in my little garret
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我在多倫多總醫院
03:35
at the nurses' residence at Toronto General Hospital,
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護士宿舍的小閣樓學習
03:37
not far from here.
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離這裡不遠。
03:39
And I memorized everything.
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我強記每一件事
03:41
I memorized in my anatomy class
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我背下解剖課時
03:43
the origins and exertions of every muscle,
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每一塊肌肉的來源，伸展方式
03:45
every branch of every artery that came off the aorta,
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每一條從主動脈延伸出來的小動脈和分支系統
03:48
differential diagnoses obscure and common.
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細分診斷上的隱蔽症狀，和通常症狀。
03:51
I even knew the differential diagnosis
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我甚至知道鑑別診斷上
03:53
in how to classify renal tubular acidosis.
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要如何區分不同的腎小管酸中毒症
03:55
And all the while,
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這段時間
03:57
I was amassing more and more knowledge.
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我累積越來越多知識。
03:59
And I did well, I graduated with honors,
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我表現良好，高分畢業
04:01
cum laude.
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拿到優等。
04:03
And I came out of medical school
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我從醫學院畢業
04:06
with the impression
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以為如果
04:08
that if I memorized everything and knew everything,
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我記得每件事，知道每件事
04:10
or as much as possible,
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或幾乎記得所有全部的事,
04:12
as close to everything as possible,
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還有跟每件事情有關的也都記得,
04:14
that it would immunize me against making mistakes.
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那我犯醫療錯誤機會就微乎其微。
04:17
And it worked
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有好一段時間
04:19
for a while,
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我的確沒有犯任何錯
04:22
until I met Mrs. Drucker.
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直到我遇見Drucker女士。
04:25
I was a resident at a teaching hospital here in Toronto
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我當時是多倫多一間教學醫院的住院醫生
04:27
when Mrs. Drucker was brought to the emergency department
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當Drucker女士被送來
04:30
of the hospital where I was working.
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我所工作醫院的急診室時。
04:32
At the time I was assigned to the cardiology service
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當時我在心臟科的輪調時
04:34
on a cardiology rotation.
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被分配到心臟門診
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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當急診室人員尋求心臟科的諮詢時
04:40
to see that patient in emerg.
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去急診室診斷病人
04:43
and to report back to my attending.
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再回來報告給我的主治。
04:45
And I saw Mrs. Drucker, and she was breathless.
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我見到Drucker女士，她當時呼吸困難
04:48
And when I listened to her, she was making a wheezy sound.
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當我跟她交談時,聽到她有喘息的聲音。
04:51
And when I listened to her chest with a stethoscope,
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當我用聽診器聽她的胸腔時
04:53
I could hear crackly sounds on both sides
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我可以聽到兩邊都傳來爆裂的聲音
04:55
that told me that she was in congestive heart failure.
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這告訴我, 這是充血性心臟衰竭。
04:58
This is a condition in which the heart fails,
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這是造成心臟衰竭的原因之一
05:01
and instead of being able to pump all the blood forward,
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心臟不能將血液往前輸送
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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有部分的血液流回肺臟，肺裡充滿的血液,
05:06
and that's why you have shortness of breath.
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這也是造成呼吸短促的原因。
05:08
And that wasn't a difficult diagnosis to make.
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這在診斷上並不困難。
05:11
I made it and I set to work treating her.
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我做了診斷，安排治療。
05:14
I gave her aspirin. I gave her medications to relieve the strain on her heart.
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我開了阿斯匹靈和一些藥物來減輕她心臟的收縮。
05:17
I gave her medications that we call diuretics, water pills,
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我給她的藥物，是我們稱之為利尿劑，水丸
05:20
to get her to pee out the access fluid.
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幫助她將多餘的水分排出。
05:23
And over the course of the next hour and a half or two,
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接下來的一個半小時或兩小時
05:25
she started to feel better.
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她開始覺得好轉。
05:27
And I felt really good.
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我也感到高興。
05:30
And that's when I made my first mistake;
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但那時我開始犯第一個錯
05:33
I sent her home.
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我讓她回家。
05:35
Actually, I made two more mistakes.
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事實上，我犯了兩個錯。
05:38
I sent her home
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我讓她回家前
05:40
without speaking to my attending.
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沒有告知我的上級主治醫生。
05:42
I didn't pick up the phone and do what I was supposed to do,
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我甚至沒有把電話機拿起，做我應該做的事
05:45
which was call my attending and run the story by him
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就是打電話給主治醫生，報告整件事情。
05:47
so he would have a chance to see her for himself.
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他原本有機會親自前來診斷。
05:50
And he knew her,
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主治認識她,
05:52
he would have been able to furnish additional information about her.
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他可以提供更詳細的病情資料。
05:55
Maybe I did it for a good reason.
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也許我有我的理由。
05:57
Maybe I didn't want to be a high-maintenance resident.
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也許我不想成為一位老是被指導的住院醫生。
06:00
Maybe I wanted to be so successful
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也許我太想成功
06:02
and so able to take responsibility
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想證明我是可以獨當一面的
06:04
that I would do so
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我可以做,
06:06
and I would be able to take care of my attending's patients
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我有能力照護主治醫生的病人,
06:08
without even having to contact him.
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而且不需要聯繫他。
06:10
The second mistake that I made was worse.
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但第二個錯誤是更嚴重的。
06:14
In sending her home,
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讓她出院回家,
06:16
I disregarded a little voice deep down inside
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我忽視心裡一個很小的聲音
06:18
that was trying to tell me,
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這個聲音試圖告訴我,
06:20
"Goldman, not a good idea. Don't do this."
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「Goldman，這樣不對，別這麼做」。
06:23
In fact, so lacking in confidence was I
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事實上，我當時沒什麼自信,
06:26
that I actually asked the nurse
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所以我詢問了
06:28
who was looking after Mrs. Drucker,
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看顧Drucker女士的護士。
06:30
"Do you think it's okay if she goes home?"
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「你覺得她回家好嗎？」
06:33
And the nurse thought about it
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然後護士想了一下,
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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就事論事地說「嗯，我想她可以的。」
06:37
I can remember that like it was yesterday.
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在我記憶裡, 那就像是昨天發生的事。
06:40
So I signed the discharge papers,
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所以我簽了出院文件
06:42
and an ambulance came, paramedics came to take her home.
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救護車來了，醫務人員帶她回家。
06:45
And I went back to my work on the wards.
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我回到我的工作崗位。
06:48
All the rest of that day,
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之後的那一整天。
06:50
that afternoon,
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那個下午
06:52
I had this kind of gnawing feeling inside my stomach.
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我一直被惱人的情緒干擾。
06:55
But I carried on with my work.
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但我還是繼續工作。
06:58
And at the end of the day, I packed up to leave the hospital
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那天結束，我收拾東西離開醫院
07:00
and walked to the parking lot
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然後走到停車場
07:02
to take my car and drive home
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取車回家
07:04
when I did something that I don't usually do.
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當時我做了一件我平常不會做的事。
07:08
I walked through the emergency department on my way home.
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我穿越急診室去停車場
07:11
And it was there that another nurse,
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那裡有另一位護士,
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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不是原先那位看顧Druker女士的那位，是另一位
07:16
said three words to me
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她告訴我三個字
07:19
that are the three words
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就這三個字
07:21
that most emergency physicians I know dread.
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大部分我認識的急診室醫生都害怕。
07:24
Others in medicine dread them as well,
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其他醫界的人也害怕,
07:26
but there's something particular about emergency medicine
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但對急診醫學來說這件事比較特別
07:28
because we see patients so fleetingly.
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因為我們看診的病人來去匆匆。
07:32
The three words are:
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那三個字是
07:34
Do you remember?
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"記得嗎？"
07:38
"Do you remember that patient you sent home?"
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"你記得你讓她出院的那病人嗎？"
07:41
the other nurse asked matter-of-factly.
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那位護士就事論事地說
07:43
"Well she's back,"
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「她又回來了」
07:45
in just that tone of voice.
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用那種就事論事的聲調。
07:47
Well she was back all right.
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好吧，她回來了
07:49
She was back and near death.
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她回來，而且差點過世
07:52
About an hour after she had arrived home,
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我讓她回家後
07:54
after I'd sent her home,
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到家後的一小時
07:56
she collapsed and her family called 911
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她昏倒了，她家人打緊急電話求救
07:59
and the paramedics brought her back to the emergency department
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然後救護人員把她送回急診室
08:01
where she had a blood pressure of 50,
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當時她的血壓只有50
08:03
which is in severe shock.
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嚴重休克
08:05
And she was barely breathing and she was blue.
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她幾乎沒有呼吸，臉色發青。
08:08
And the emerg. staff pulled out all the stops.
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然後急診室人員使出渾身解數
08:11
They gave her medications to raise her blood pressure.
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要使她血壓恢復。
08:14
They put her on a ventilator.
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他們讓她戴上呼吸器。
08:16
And I was shocked
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我震驚不已
08:19
and shaken to the core.
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我嚇得不得了。
08:21
And I went through this roller coaster,
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我像坐上雲霄飛車
08:23
because after they stabilized her,
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因為後來他們穩住了她的病情
08:25
she went to the intensive care unit,
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她被送到加護病房
08:27
and I hoped against hope that she would recover.
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但我希望她有機會好轉。
08:29
And over the next two or three days,
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在接下來的兩三天
08:31
it was clear that she was never going to wake up.
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很明顯地她再也不會醒來。
08:33
She had irreversible brain damage.
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她的腦部受損已經不會好轉。
08:36
And the family gathered.
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她的家人聚在一起
08:38
And over the course of the next eight or nine days,
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在之後八九天的治療期間
08:41
they resigned themselves to what was happening.
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他們接受了這件事實。
08:43
And at about the nine day mark, they let her go --
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九天後，他們放棄治療，讓她離開人間
08:46
Mrs. Drucker,
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Druker女士,
08:48
a wife, a mother
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一位妻子，一位母親
08:50
and a grandmother.
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也是一位祖母。
08:53
They say you never forget the names
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他們說你會永遠忘不了
08:55
of those who die.
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那些(因你疏忽而死的)名字
08:57
And that was my first time to be acquainted with that.
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那是我第一次意識到。
09:00
Over the next few weeks,
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在接下來的幾週,
09:02
I beat myself up
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我非常自責。
09:05
and I experienced for the first time
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我也第一次經歷了
09:07
the unhealthy shame that exists
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那種不健康的羞愧
09:09
in our culture of medicine --
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存在於我們醫界的文化中--
09:11
where I felt alone, isolated,
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在那兒我感到孤單無助
09:14
not feeling the healthy kind of shame that you feel,
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不是像各位會感受到的那種的羞愧
09:16
because you can't talk about it with your colleagues.
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因為你沒辦法和你的同事訴說。
09:18
You know that healthy kind,
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有一種健康的羞愧是
09:20
when you betray a secret that a best friend made you promise never to reveal
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當你背叛了對摯友的承諾
09:23
and then you get busted
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你說出了原先答應要保守的秘密
09:25
and then your best friend confronts you
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而當你的摯友找你算帳時
09:27
and you have terrible discussions,
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你們爭執不休
09:29
but at the end of it all that sick feeling guides you
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但最後罪感主導著你
09:32
and you say, I'll never make that mistake again.
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然後你說，我絕對不會再犯相同的錯。
09:34
And you make amends and you never make that mistake again.
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你做了修正承諾，然後你永不再犯同樣的錯。
09:37
That's the kind of shame that is a teacher.
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這種羞愧可以教導我們
09:40
The unhealthy shame I'm talking about
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而我所說那種非良性的羞愧
09:42
is the one that makes you so sick inside.
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是那種會讓人愧對於心的
09:45
It's the one that says,
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是那種
09:47
not that what you did was bad,
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不是你做了壞事
09:49
but that you are bad.
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而是你根本就是壞人。
09:51
And it was what I was feeling.
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這是我當時候的感受。
09:54
And it wasn't because of my attending; he was a doll.
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由於我跟隨的主治樂心助人
09:57
He talked to the family, and I'm quite sure that he smoothed things over
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和他的家人好好談過，我確定他替我打了圓場
10:00
and made sure that I didn't get sued.
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才能確保我不會被控告。
10:03
And I kept asking myself these questions.
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我不斷問自己這些問題。
10:06
Why didn't I ask my attending? Why did I send her home?
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為什麼當時我沒有聯繫主治醫生？為什麼我讓她回家？
10:09
And then at my worst moments:
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我最糟的回憶是:
10:11
Why did I make such a stupid mistake?
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我為什麼犯了這麼愚蠢的錯？
10:14
Why did I go into medicine?
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為什麼我選擇進入醫界?
10:16
Slowly but surely,
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慢慢地，但穩定地
10:18
it lifted.
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糟糕的感覺漸淡了。
10:20
I began to feel a bit better.
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我的感覺緩和了些。
10:22
And on a cloudy day,
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然後在一個天氣陰陰的日子裡
10:24
there was a crack in the clouds and the sun started to come out
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陽光開始從雲隙間探出
10:26
and I wondered,
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我思考著
10:28
maybe I could feel better again.
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也許我能讓自己再次快樂起來。
10:30
And I made myself a bargain
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我告訴自己
10:33
that if only I redouble my efforts to be perfect
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我要加倍努力，做到完美
10:38
and never make another mistake again,
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不要再犯錯了
10:40
please make the voices stop.
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請就讓那個(自責)聲音停止。
10:42
And they did.
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那個聲音的確停止了。
10:44
And I went back to work.
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我回到工作崗位
10:46
And then it happened again.
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但錯誤又發生了。
10:49
Two years later I was an attending in the emergency department
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兩年後，我在多倫多北部
10:52
at a community hospital just north of Toronto,
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一間社區醫院擔任急診室的主治醫生。
10:54
and I saw a 25 year-old man with a sore throat.
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我看了一位二十五歲的病人，他有喉嚨痛
10:57
It was busy, I was in a bit of a hurry.
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那天很忙，我也有點手忙腳亂
10:59
He kept pointing here.
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他不斷指著這裡
11:01
I looked at his throat, it was a little bit pink.
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我看了他的喉嚨，有點紅色。
11:03
And I gave him a prescription for penicillin
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我開給他盤尼西林的處方籤,
11:05
and sent him on his way.
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就讓他離開。
11:07
And even as he was walking out the door,
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即便他要走出大門時
11:09
he was still sort of pointing to his throat.
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他仍然指著他的喉嚨。
11:12
And two days later I came to do my next emergency shift,
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兩天後，我又輪到在急診室值班
11:15
and that's when my chief asked to speak to me quietly in her office.
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那時候我的主任要我過去她的辦公室私下談談
11:18
And she said the three words:
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她說了那三個字:
11:22
Do you remember?
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"記得嗎？"
11:25
"Do you remember that patient you saw with the sore throat?"
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"你記得你看過的那位喉嚨痛的病人嗎？"
11:28
Well it turns out, he didn't have a strep throat.
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原來，他並沒有鍊球菌性咽喉炎。
11:30
He had a potentially life-threatening condition
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他得到的是一種會嚴重威脅生命的病症
11:32
called epiglottitis.
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叫做急性會厭炎。
11:34
You can Google it,
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各位可以上網查詢
11:36
but it's an infection, not of the throat, but of the upper airway,
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不是喉嚨感染，而是上呼吸道感染,
11:39
and it can actually cause the airway to close.
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會造成呼吸道阻塞。
11:42
And fortunately he didn't die.
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幸好他沒過世。
11:45
He was placed on intravenous antibiotics
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他被安排去做抗生素靜脈注射
11:48
and he recovered after a few days.
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幾天之後，他痊癒了。
11:50
And I went through the same period of shame and recriminations
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我又回到那個愧疚和責難的時光中
11:54
and felt cleansed and went back to work,
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然後情緒平復後，回到工作崗位
11:58
until it happened again and again and again.
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直到這些錯誤再發生, 歷史一直重複。
12:03
Twice in one emergency shift, I missed appendicitis.
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一個急診的輪班裡發生兩次，我沒發現病人得了盲腸炎。
12:06
Now that takes some doing,
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這是很難想像會發生的事
12:09
especially when you work in a hospital
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特別是當你在醫院工作
12:11
that at the time saw but 14 people a night.
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整個晚上你只有十四名病患。
12:14
Now in both cases, I didn't send them home
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對這兩個病人，我沒有讓他們回家
12:17
and I don't think there was any gap in their care.
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我也不覺得在治療過程中有任何差錯。
12:19
One I thought had a kidney stone.
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其中一位我判斷他有腎結石。
12:21
I ordered a kidney X-ray. When it turned out to be normal,
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我安排照了腎臟X光，但結果正常。
12:23
my colleague who was doing a reassessment of the patient
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我同事當時正在對病人病情重新診斷
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
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注意到病人右下腹的地方按壓會痛，就聯繫了外科醫生。
12:29
The other one had a lot of diarrhea.
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另一個病人有嚴重的腹瀉
12:31
I ordered some fluids to rehydrate him
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我開了一些藥水幫助他補充水分
12:34
and asked my colleague to reassess him.
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也要求我同事重新診斷。
12:37
And he did
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他做了
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
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他注意到病人右下腹的地方按壓會痛，也聯繫了外科醫生。
12:41
In both cases,
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這兩個病例
12:43
they had their operations and they did okay.
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他們都動了手術，狀況良好。
12:46
But each time,
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但每次想到這兩例子
12:48
they were gnawing at me, eating at me.
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那種感覺折磨啃噬我。
12:50
And I'd like to be able to say to you
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我非常想要告訴各位
12:52
that my worst mistakes only happened in the first five years of practice
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我最嚴重的錯誤只發生在頭五年的行醫歷史中
12:55
as many of my colleagues say, which is total B.S.
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像我眾多同事們所說的一樣，但是這是鬼扯。
12:58
(Laughter)
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(笑聲)
13:00
Some of my doozies have been in the last five years.
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在最近的五年內, 我也發生一些糗事。
13:06
Alone, ashamed and unsupported.
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孤單，羞愧，無助。
13:08
Here's the problem:
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問題的癥結是:
13:10
If I can't come clean
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如果我不能理清楚
13:12
and talk about my mistakes,
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談論我犯的錯,
13:16
if I can't find the still-small voice
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如果我不能找到那微小的聲音
13:18
that tells me what really happened,
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告訴著我事實是如何。
13:20
how can I share it with my colleagues?
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我該如何跟我的同事分享經驗？
13:22
How can I teach them about what I did
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我該如何教導他們, 我犯的錯誤。
13:25
so that they don't do the same thing?
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讓他們不再重蹈覆轍呢？
13:29
If I were to walk into a room --
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如果我進入一個場合 --
13:31
like right now, I have no idea what you think of me.
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就像現在，我不知道各位會如何看待我。
13:34
When was the last time you heard somebody talk
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上一次各位聽到別人談論
13:36
about failure after failure after failure?
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有關自己一次又一次的失敗是什麼時候？
13:38
Oh yeah, you go to a cocktail party
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是的，如果各位去參加一場宴會
13:40
and you might hear about some other doctor,
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你或許會聽到某些醫生的閒聊,
13:42
but you're not going to hear somebody
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但各位不會聽到有人
13:44
talking about their own mistakes.
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談論自己的過錯。
13:46
If I were to walk into a room filled with my colleages
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如果我走進一個場合，裡頭坐滿我的同事
13:49
and ask for their support right now
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我向他們尋求認同
13:51
and start to tell what I've just told you right now,
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然後開始跟他們說，我剛告訴各位的事情
13:53
I probably wouldn't get through two of those stories
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在我還沒講超過兩個故事前
13:56
before they would start to get really uncomfortable,
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他們就會感到非常不自在。
13:58
somebody would crack a joke,
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有人就會開始說笑話,
14:00
they'd change the subject and we would move on.
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想要改變話題，然後拋棄前個話題。
14:05
And in fact, if I knew and my colleagues knew
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事實上，如果我知道或我同事知道
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
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我們其中一位骨科同事在醫院裡幫病人截錯肢
14:12
believe me, I'd have trouble
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相信我，我會有困難
14:14
making eye contact with that person.
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跟他有任何正面的交會。
14:16
That's the system that we have.
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這就是我們的制度。
14:18
It's a complete denial of mistakes.
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完全否認錯誤的系統。
14:21
It's a system
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這個制度下
14:23
in which there are two kinds of physicians --
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只有兩種情況--
14:27
those who make mistakes
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一邊是犯錯的
14:29
and those who don't,
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一邊是沒犯錯的
14:31
those who can't handle sleep deprivation and those who can,
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一邊是不能調適眠眠被剝削，一邊則可以
14:34
those who have lousy outcomes
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一邊是糟糕的結果
14:36
and those who have great outcomes.
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一邊則有優秀的結果
14:39
And it's almost like an ideological reaction,
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這幾乎像是意識形態的反應
14:41
like the antibodies begin to attack that person.
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像抗體一樣，開始攻擊那個人
14:45
And we have this idea
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我們有這個想法:
14:47
that if we drive the people who make mistakes
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如果我們趕走那些犯錯的人
14:49
out of medicine,
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讓他們離開醫界,
14:51
what will we be left with, but a safe system.
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我們就會留下一個安全的制度。
14:55
But there are two problems with that.
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但這樣做會衍生兩個問題。
14:58
In my 20 years or so
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這二十多年來
15:00
of medical broadcasting and journalism,
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我從事醫療報導和新聞工作
15:03
I've made a personal study of medical malpractice and medical errors
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我自行探討了醫療疏失和醫療錯誤
15:06
to learn everything I can,
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所有相關的事。
15:08
from one of the first articles I wrote for the Toronto Star
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從我為多倫多星報所寫的第一則新聞
15:10
to my show "White Coat, Black Art."
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到我的節目《白袍與黑色藝術》。
15:13
And what I've learned
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我所學到的是
15:15
is that errors are absolutely ubiquitous.
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錯誤絕對無所不在。
15:18
We work in a system
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我們在一個
15:20
where errors happen every day,
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每天都會發生錯誤的制度下工作。
15:22
where one in 10 medications
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有十分之一的機會,
15:24
are either the wrong medication given in hospital
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醫院會給錯藥
15:26
or at the wrong dosage,
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或是給了錯誤的劑量。
15:28
where hospital-acquired infections are getting more and more numerous,
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而在醫院內的感染越來越多
15:31
causing havoc and death.
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造成傷害和死亡。
15:34
In this country,
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在這個國家
15:36
as many as 24,000 Canadians die
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有24,000加拿大人
15:38
of preventable medical errors.
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死於可避免的醫療疏失。
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
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在美國, 醫學統計則有100,000人。
15:44
In both cases, these are gross underestimates,
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這兩項數據都是低估了
15:47
because we really aren't ferreting out the problem
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因為我們未曾深入探究問題
15:49
as we should.
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而這是我們應該這麼做的。
15:51
And here's the thing.
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事實是這樣
15:54
In a hospital system
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在醫療體系裡
15:57
where medical knowledge is doubling
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醫療知識是每二到三年就倍數成長
15:59
every two or three years, we can't keep up with it.
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我們跟不上這樣的速度。
16:02
Sleep deprivation is absolutely pervasive.
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睡眠不足絕對是普遍的。
16:05
We can't get rid of it.
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我們擺脫不了這問題。
16:07
We have our cognitive biases,
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而我們有自己的直覺偏差,
16:09
so that I can take a perfect history on a patient with chest pain.
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對相同病歷史完整的胸痛病人,會有不同診斷結果。
16:12
Now take the same patient with chest pain,
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拿一個有胸痛病症的病人來說
16:14
make them moist and garrulous
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如果當時他胡言亂語,再加上他的呼吸
16:16
and put a little bit of alcohol on their breath,
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有酒精味,那我們會認為他其實是喝醉了。
16:18
and suddenly my history is laced with contempt.
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因為這樣誤診, 然後我的醫療生涯突然蒙羞。
16:20
I don't take the same history.
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我不會做同樣的事
16:22
I'm not a robot;
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我不是機器人;
16:24
I don't do things the same way each time.
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我不會每次都做同樣的動作。
16:26
And my patients aren't cars;
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我的病人不是車子;
16:28
they don't tell me their symptoms in the same way each time.
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他們不會每次都用相同的方式描述他們的病症。
16:31
Given all of that, mistakes are inevitable.
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有鑑於此，錯誤是無可避免的。
16:34
So if you take the system, as I was taught,
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如果是在我所被教導的制度下
16:37
and weed out all the error-prone health professionals,
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趕出所有易出錯的醫療專業人員,
16:41
well there won't be anybody left.
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那麼這個領域會無人留下。
16:46
And you know that business
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你知道嗎? 在那領域
16:48
about people not wanting
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人們不願意談論
16:50
to talk about their worst cases?
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有關他們所犯糟糕的過往。
16:53
On my show, on "White Coat, Black Art,"
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在我的節目《白袍與黑色藝術》中,
16:55
I made it a habit of saying, "Here's my worst mistake,"
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我習慣會說「這是我最糟糕的錯誤」。
16:57
I would say to everybody
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我可以對每個人這麼說
16:59
from paramedics to the chief of cardiac surgery,
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從一般的醫務人員到心臟外科的首席外科醫生
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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「我最糟糕的錯誤，是什麼，什麼，什麼諸如此類的」
17:04
"What about yours?" and I would point the microphone towards them.
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然後我會把麥克風遞給他們，問說「你呢？」
17:07
And their pupils would dilate,
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他們的瞳孔會放大,
17:09
they would recoil,
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他們會退卻,
17:11
then they would look down and swallow hard
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他們會看著地上，猛吞口水。
17:14
and start to tell me their stories.
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然後開始告訴我他們的故事。
17:17
They want to tell their stories. They want to share their stories.
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他們想說他們的故事，他們想分享他們的故事。
17:20
They want to be able to say,
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他們想要說,
17:22
"Look, don't make the same mistake I did."
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「聽著，別犯跟我一樣的錯」。
17:24
What they need is an environment to be able to do that.
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他們需要的是一個場合讓他們吐露心聲。
17:26
What they need is a redefined medical culture.
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他們需要的是重新定義醫界文化。
17:30
And it starts with one physician at a time.
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從一位醫生接另一位醫生開始,
17:33
The redefined physician is human,
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重新定義醫生是人類,
17:36
knows she's human,
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知道自己是人類。
17:38
accepts it, isn't proud of making mistakes,
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接受了事實，我不是說犯錯是光榮的,
17:40
but strives to learn one thing
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但努力學習一件事:
17:42
from what happened
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從錯誤中學習。
17:44
that she can teach to somebody else.
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讓醫師能教導別人發生過的事
17:46
She shares her experience with others.
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分享了她的經驗
17:48
She's supportive when other people talk about their mistakes.
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當別人談論自己的過錯時，她能給予諒解。
17:51
And she points out other people's mistakes,
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然後她也能指出別人所犯的錯
17:53
not in a gotcha way,
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不是用落井下石的方式。
17:55
but in a loving, supportive way
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而是關懷體諒的方式
17:58
so that everybody can benefit.
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所以每一個人都能受惠。
18:00
And she works in a culture of medicine
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醫師在醫界工作
18:02
that acknowledges
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能瞭解
18:04
that human beings run the system,
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這是由人所掌控的制度
18:06
and when human beings run the system, they will make mistakes from time to time.
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當人們執行制度時，錯誤就是免不了要會發生的。
18:09
So the system is evolving
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所以制度可以會改革
18:13
to create backups
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來產生補救方案
18:17
that make it easier to detect those mistakes
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能夠更簡單檢查出那些錯誤
18:20
that humans inevitably make
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那些人類無可避免的錯誤。
18:23
and also fosters in a loving, supportive way
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同時培養一種關懷扶持的方式
18:26
places where everybody who is observing
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建構一個讓每一個人
18:29
in the health care system
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都能觀察的健康保障的制度
18:31
can actually point out things that could be potential mistakes
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可以真正檢查出那些潛在的錯誤
18:34
and is rewarded for doing so,
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並獲得鼓勵。
18:36
and especially people like me, when we do make mistakes,
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特別是像我一樣的人，當我們犯了錯
18:38
we're rewarded for coming clean.
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我們可以被鼓勵面對錯誤並改正。
18:42
My name is Brian Goldman.
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我是Brian Goldman。
18:45
I am a redefined physician.
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我是位有新定義的醫療人員。
18:48
I'm human. I make mistakes.
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我是一個人類，我會犯錯。
18:50
I'm sorry about that,
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我對此感到抱歉,
18:52
but I strive to learn one thing
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但我努力學習某件事
18:54
that I can pass on to other people.
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讓它可以薪傳下去。
18:57
I still don't know what you think of me,
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我仍然不知道大家會如何看我,
19:00
but I can live with that.
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但我想我能接受。
19:02
And let me close with three words of my own:
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讓我用三個字來總結
19:05
I do remember.
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我記得。
19:09
(Applause)
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(掌聲)
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