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Daniel Levitin: How to stay calm when you know you'll be stressed
Daniel Levitin: Como manter a calma cando sabes que te vas estresar
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Cando estamos estresados, non rendimos ao noso máximo nivel. De feito, o noso cerebro evolucionou durante milenios para liberar cortisol en situacións de estrés, o que inhibe o pensamento lóxico e racional aínda que pode axudarnos a sobrevivir no caso de sermos atacados, por exemplo, por un león. O neurocientífico Daniel Levitin pensa que hai un modo de evitar os erros graves en situacións de estrés, cando a nosa mente se nubra: o pensamento a posteriori anticipado ou "pre mortem". Como explica el mesmo: "Todos imos cometer algún erro antes ou despois. A idea é pensar con antelación en cales poden ser eses erros."
Daniel Levitin - Neuroscientist
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Double-click the English transcript below to play the video.
00:13
A few years ago,
I broke into my own house.
I broke into my own house.
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Hai uns anos,
quedei fóra da casa sen chaves.
quedei fóra da casa sen chaves.
00:16
I had just driven home,
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Acababa de chegar á casa
00:18
it was around midnight
in the dead of Montreal winter,
in the dead of Montreal winter,
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era sobre media noite,
en pleno inverno en Montreal.
en pleno inverno en Montreal.
00:20
I had been visiting my friend,
Jeff, across town,
Jeff, across town,
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Fora visitar un amigo
ó outro lado da cidade
ó outro lado da cidade
00:23
and the thermometer on the front porch
read minus 40 degrees --
read minus 40 degrees --
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e o termómetro do soportal
sinalaba 40 graos baixo cero.
sinalaba 40 graos baixo cero.
E non preguntedes
se eran graos Celsius ou Fahrenheit
se eran graos Celsius ou Fahrenheit
00:27
and don't bother asking
if that's Celsius or Fahrenheit,
if that's Celsius or Fahrenheit,
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00:30
minus 40 is where the two scales meet --
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porque a esa temperatura
coinciden as dúas escalas.
coinciden as dúas escalas.
00:33
it was very cold.
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Ía moito frío.
00:34
And as I stood on the front porch
fumbling in my pockets,
fumbling in my pockets,
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E eu estaba no soportal,
buscando nos petos
buscando nos petos
00:37
I found I didn't have my keys.
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e deime conta
de que non tiña as chaves.
de que non tiña as chaves.
00:40
In fact, I could see them
through the window,
through the window,
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De feito, podía velas pola fiestra
00:42
lying on the dining room table
where I had left them.
where I had left them.
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enriba da mesa do comedor,
onde as deixara.
onde as deixara.
00:45
So I quickly ran around
and tried all the other doors and windows,
and tried all the other doors and windows,
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Corrín arredor da casa,
comprobando tódalas portas e fiestras
comprobando tódalas portas e fiestras
00:48
and they were locked tight.
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pero estaban todas pechadas.
00:50
I thought about calling a locksmith --
at least I had my cellphone,
at least I had my cellphone,
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Pensei en chamar un cerralleiro,
xa que tiña o móbil comigo
xa que tiña o móbil comigo
00:53
but at midnight, it could take a while
for a locksmith to show up,
for a locksmith to show up,
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pero coa hora que era,
podía tardar moito en chegar
podía tardar moito en chegar
00:56
and it was cold.
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e ía moito frío.
01:00
I couldn't go back to my friend
Jeff's house for the night
Jeff's house for the night
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Non podía pasa-la noite
na casa do meu amigo
na casa do meu amigo
01:03
because I had an early flight
to Europe the next morning,
to Europe the next morning,
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porque pola mañá cedo
tiña un voo a Europa
tiña un voo a Europa
01:05
and I needed to get
my passport and my suitcase.
my passport and my suitcase.
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e necesitaba coller
o pasaporte e a maleta.
o pasaporte e a maleta.
01:08
So, desperate and freezing cold,
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Así que, desesperado e morrendo de frío
01:10
I found a large rock and I broke
through the basement window,
through the basement window,
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collín unha pedra
e rompín a fiestra do soto
e rompín a fiestra do soto
01:14
cleared out the shards of glass,
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limpei ben os cristais e entrei por ela.
01:16
I crawled through,
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01:17
I found a piece of cardboard
and taped it up over the opening,
and taped it up over the opening,
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Collín un cacho de cartón
e pegueino na fiestra para cubrila.
e pegueino na fiestra para cubrila.
01:21
figuring that in the morning,
on the way to the airport,
on the way to the airport,
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Díxenme que pola mañá,
de camiño ó aeroporto
de camiño ó aeroporto
01:24
I could call my contractor
and ask him to fix it.
and ask him to fix it.
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podía chama-lo contratista
e pedirlle que o arranxase.
e pedirlle que o arranxase.
01:26
This was going to be expensive,
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Íame custar moitos cartos
01:28
but probably no more expensive
than a middle-of-the-night locksmith,
than a middle-of-the-night locksmith,
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pero tampouco máis
que un cerralleiro no medio da noite.
que un cerralleiro no medio da noite.
01:31
so I figured, under the circumstances,
I was coming out even.
I was coming out even.
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Dadas as circunstancias,
pareceume que tanto tiña.
pareceume que tanto tiña.
01:36
Now, I'm a neuroscientist by training
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Ben, dedícome á neurociencia
01:39
and I know a little bit
about how the brain performs under stress.
about how the brain performs under stress.
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e sei bastante sobre como o cerebro
se comporta baixo estrés.
se comporta baixo estrés.
01:43
It releases cortisol
that raises your heart rate,
that raises your heart rate,
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Emite cortisol,
que eleva o ritmo cardíaco
que eleva o ritmo cardíaco
01:46
it modulates adrenaline levels
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modula os niveis de adrenalina
01:49
and it clouds your thinking.
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e nubra a mente.
01:51
So the next morning,
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Así que, á mañá seguinte
01:53
when I woke up on too little sleep,
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cando me levantei
despois de durmir pouco,
despois de durmir pouco,
01:55
worrying about the hole in the window,
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preocupado pola fiestra rota
01:58
and a mental note
that I had to call my contractor,
that I had to call my contractor,
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e por lembrarme de chama-lo contratista
e polo frío que ía
e polo frío que ía
02:01
and the freezing temperatures,
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02:02
and the meetings I had upcoming in Europe,
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e polas reunións que ía ter en Europa
02:05
and, you know, with all
the cortisol in my brain,
the cortisol in my brain,
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e, vaia, con todo o cortisol
que tiña no cerebro
que tiña no cerebro
02:08
my thinking was cloudy,
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tiña a mente nubrada
02:10
but I didn't know it was cloudy
because my thinking was cloudy.
because my thinking was cloudy.
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pero non sabía que tiña a mente nubrada
porque tiña a mente nubrada.
porque tiña a mente nubrada.
02:13
(Laughter)
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(Risas)
02:15
And it wasn't until I got
to the airport check-in counter,
to the airport check-in counter,
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E ata chegar ó mostrador do aeroporto
02:18
that I realized I didn't have my passport.
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non me dei conta
de que esquecera o pasaporte.
de que esquecera o pasaporte.
02:20
(Laughter)
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(Risas)
02:22
So I raced home in the snow
and ice, 40 minutes,
and ice, 40 minutes,
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Así que volvín rapidamente á casa,
con neve e xeo, en 40 minutos
con neve e xeo, en 40 minutos
02:26
got my passport,
raced back to the airport,
raced back to the airport,
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collín o pasaporte, volvín ó aeroporto
02:28
I made it just in time,
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e cheguei xusto a tempo,
02:30
but they had given away
my seat to someone else,
my seat to someone else,
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pero déranlle o meu asento
a outra persoa
a outra persoa
02:32
so I got stuck in the back of the plane,
next to the bathrooms,
next to the bathrooms,
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así que tiven que sentarme ó fondo,
ó lado dos aseos
ó lado dos aseos
02:35
in a seat that wouldn't recline,
on an eight-hour flight.
on an eight-hour flight.
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nun asento que non se podía reclinar
nun voo de 8 horas.
nun voo de 8 horas.
E tiven bastante tempo para pensar
sen durmir durante esas 8 horas.
sen durmir durante esas 8 horas.
02:39
Well, I had a lot of time to think
during those eight hours and no sleep.
during those eight hours and no sleep.
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(Risas)
02:43
(Laughter)
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E empecei a pensar se sería posible
facer algo
facer algo
02:44
And I started wondering,
are there things that I can do,
are there things that I can do,
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establecer sistemas
para evitar que pasasen cousas malas.
para evitar que pasasen cousas malas.
02:47
systems that I can put into place,
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02:49
that will prevent bad things
from happening?
from happening?
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02:51
Or at least if bad things happen,
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Ou, no caso de que pasasen cousas malas,
02:53
will minimize the likelihood
of it being a total catastrophe.
of it being a total catastrophe.
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para minimizar a probabilidade
de que fosen unha catástrofe.
de que fosen unha catástrofe.
02:59
So I started thinking about that,
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Pero non cheguei a ningures
ata un mes despois.
ata un mes despois.
03:00
but my thoughts didn't crystallize
until about a month later.
until about a month later.
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Estaba ceando cun colega,
o premio Nobel Danny Kahneman,
o premio Nobel Danny Kahneman,
03:03
I was having dinner with my colleague,
Danny Kahneman, the Nobel Prize winner,
Danny Kahneman, the Nobel Prize winner,
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e conteille, avergoñado,
o que me pasara coa fiestra
o que me pasara coa fiestra
03:07
and I somewhat embarrassedly told him
about having broken my window,
about having broken my window,
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03:10
and, you know, forgotten my passport,
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e co pasaporte
03:13
and Danny shared with me
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e Danny contoume
03:14
that he'd been practicing
something called prospective hindsight.
something called prospective hindsight.
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que estivera practicando o que chamaba
pensamento a posteriori anticipado.
pensamento a posteriori anticipado.
03:19
(Laughter)
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(Risas)
03:20
It's something that he had gotten
from the psychologist Gary Klein,
from the psychologist Gary Klein,
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Foi algo que sacara
do psicólogo Gary Klein
do psicólogo Gary Klein
03:24
who had written about it
a few years before,
a few years before,
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que escribira sobre isto había uns anos
e que tamén se chama pre mortem.
e que tamén se chama pre mortem.
03:26
also called the pre-mortem.
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03:28
Now, you all know what the postmortem is.
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Todos sabedes qué é o post mortem.
Cando ocorre un desastre
Cando ocorre un desastre
03:30
Whenever there's a disaster,
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03:31
a team of experts come in and they try
to figure out what went wrong, right?
to figure out what went wrong, right?
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chega un equipo de expertos
que intenta determinar qué pasou, non?
que intenta determinar qué pasou, non?
03:36
Well, in the pre-mortem, Danny explained,
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Pois no pre mortem, como explicou Danny,
03:38
you look ahead and you try to figure out
all the things that could go wrong,
all the things that could go wrong,
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miras cara ó futuro e intentas determinar
qué pode saír mal
qué pode saír mal
03:42
and then you try to figure out
what you can do
what you can do
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e logo intentas determinar
qué podes facer
qué podes facer
03:45
to prevent those things from happening,
or to minimize the damage.
or to minimize the damage.
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para evitar que pasen esas cousas,
ou para minimizar os seus efectos.
ou para minimizar os seus efectos.
03:48
So what I want to talk to you about today
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Do que vos quero falar hoxe
é do que podemos facer
é do que podemos facer
03:51
are some of the things we can do
in the form of a pre-mortem.
in the form of a pre-mortem.
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no referido ó pre mortem.
03:55
Some of them are obvious,
some of them are not so obvious.
some of them are not so obvious.
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Algunhas cousas son evidentes,
outras non o son tanto.
outras non o son tanto.
03:58
I'll start with the obvious ones.
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Vou empezar polas evidentes.
03:59
Around the home, designate a place
for things that are easily lost.
for things that are easily lost.
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Designar lugares por toda a casa
para as cousas que se perden facilmente.
para as cousas que se perden facilmente.
04:05
Now, this sounds
like common sense, and it is,
like common sense, and it is,
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Ben, isto parece de sentido común,
e é así
e é así
04:09
but there's a lot of science
to back this up,
to back this up,
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pero a ciencia apoia isto
baseándose en como funciona
a memoria espacial.
a memoria espacial.
04:12
based on the way our spatial memory works.
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04:15
There's a structure in the brain
called the hippocampus,
called the hippocampus,
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Hai unha estrutura do cerebro,
chamada hipocampo
chamada hipocampo
04:18
that evolved over tens
of thousands of years,
of thousands of years,
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que evolucionou
durante centos de miles de anos
durante centos de miles de anos
04:21
to keep track of the locations
of important things --
of important things --
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para lembrar
a localización de cousas importantes.
a localización de cousas importantes.
04:25
where the well is,
where fish can be found,
where fish can be found,
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Onde está o pozo, onde se pode pescar,
04:27
that stand of fruit trees,
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onde están as árbores froiteiras
04:30
where the friendly and enemy tribes live.
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onde viven as tribos aliadas e inimigas.
04:32
The hippocampus is the part of the brain
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O hipocampo é a parte do cerebro
04:34
that in London taxicab drivers
becomes enlarged.
becomes enlarged.
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que se atopa aumentada
nos condutores de taxis de Londres.
nos condutores de taxis de Londres.
04:38
It's the part of the brain
that allows squirrels to find their nuts.
that allows squirrels to find their nuts.
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É a parte do cerebro
que lles permite ós esquíos
atopar as súas noces.
atopar as súas noces.
04:41
And if you're wondering,
somebody actually did the experiment
somebody actually did the experiment
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De feito, houbo alguén
que fixo o experimento
que fixo o experimento
04:44
where they cut off
the olfactory sense of the squirrels,
the olfactory sense of the squirrels,
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de corta-lo sentido do olfacto dos esquíos
e seguían atopando as noces.
04:47
and they could still find their nuts.
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Non usaban o olfacto, senón o hipocampo,
04:49
They weren't using smell,
they were using the hippocampus,
they were using the hippocampus,
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un mecanismo do cerebro
04:52
this exquisitely evolved mechanism
in the brain for finding things.
in the brain for finding things.
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exquisitamente evolucionado
para atopar cousas.
para atopar cousas.
04:57
But it's really good for things
that don't move around much,
that don't move around much,
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Pero funciona ben
con cousas que non se moven demasiado
con cousas que non se moven demasiado
05:01
not so good for things that move around.
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e non con cousas que se moven.
05:03
So this is why we lose car keys
and reading glasses and passports.
and reading glasses and passports.
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Por iso perdémo-las chaves do coche,
as gafas de ler ou o pasaporte.
as gafas de ler ou o pasaporte.
05:07
So in the home,
designate a spot for your keys --
designate a spot for your keys --
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Por iso hai que designar algún sitio
para as chaves.
para as chaves.
05:10
a hook by the door,
maybe a decorative bowl.
maybe a decorative bowl.
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Un gancho ó lado da porta
ou un prato decorativo.
ou un prato decorativo.
05:13
For your passport, a particular drawer.
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Para o pasaporte, un caixón específico.
As gafas de ler, nunha mesa específica.
As gafas de ler, nunha mesa específica.
05:15
For your reading glasses,
a particular table.
a particular table.
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05:18
If you designate a spot
and you're scrupulous about it,
and you're scrupulous about it,
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Se se designa un lugar e se é escrupuloso
05:21
your things will always be there
when you look for them.
when you look for them.
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as cousas van estar no seu sitio
cando as busquemos.
cando as busquemos.
05:24
What about travel?
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E cando viaxemos?
Saca unha foto co móbil
Saca unha foto co móbil
05:25
Take a cell phone picture
of your credit cards,
of your credit cards,
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das tarxetas de crédito,
do carné de conducir e do pasaporte.
do carné de conducir e do pasaporte.
05:28
your driver's license, your passport,
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05:30
mail it to yourself so it's in the cloud.
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Mándate un correo coa foto
para subila á nube.
para subila á nube.
05:32
If these things are lost or stolen,
you can facilitate replacement.
you can facilitate replacement.
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Se perdes ou che rouban estas cousas,
pódelas substituír máis facilmente.
pódelas substituír máis facilmente.
05:37
Now these are some rather obvious things.
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Estas parecen cousas evidentes.
05:39
Remember, when you're under stress,
the brain releases cortisol.
the brain releases cortisol.
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Recordade que cando estamos baixo estrés,
o cerebro emite cortisol.
o cerebro emite cortisol.
05:43
Cortisol is toxic,
and it causes cloudy thinking.
and it causes cloudy thinking.
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O cortisol é tóxico e nubra a mente.
05:46
So part of the practice of the pre-mortem
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Parte da práctica do pre mortem
05:49
is to recognize that under stress
you're not going to be at your best,
you're not going to be at your best,
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consiste en recoñecer que baixo estrés
non vas poder dar o mellor de ti mesmo
non vas poder dar o mellor de ti mesmo
05:53
and you should put systems in place.
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e que deberías establecer algún sistema.
05:55
And there's perhaps
no more stressful a situation
no more stressful a situation
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E quizais non haxa
una situación de máis estrés
una situación de máis estrés
05:58
than when you're confronted
with a medical decision to make.
with a medical decision to make.
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que cando te enfrontas
a unha decisión médica.
a unha decisión médica.
06:02
And at some point, all of us
are going to be in that position,
are going to be in that position,
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Todos estaremos nalgún momento
nunha situación
nunha situación
06:05
where we have to make
a very important decision
a very important decision
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na que teñamos que tomar
unha decisión importante
unha decisión importante
06:07
about the future of our medical care
or that of a loved one,
or that of a loved one,
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sobre a nosa saúde ou a dun ser querido
ou axudalos a tomar unha decisión.
ou axudalos a tomar unha decisión.
06:11
to help them with a decision.
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06:12
And so I want to talk about that.
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E sobre iso quero falar.
06:14
And I'm going to talk about
a very particular medical condition.
a very particular medical condition.
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E vou falar dun problema médico
moi particular,
moi particular,
06:17
But this stands as a proxy for all kinds
of medical decision-making,
of medical decision-making,
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pero isto pode aplicarse
a calquera tipo de decisión médica
a calquera tipo de decisión médica
06:21
and indeed for financial decision-making,
and social decision-making --
and social decision-making --
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e incluso a decisións financeiras
ou sociais
ou sociais
06:25
any kind of decision you have to make
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ou calquera decisión que teñamos que facer
06:27
that would benefit from a rational
assessment of the facts.
assessment of the facts.
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na que sexa beneficioso realizar
unha análise racional de datos.
unha análise racional de datos.
06:31
So suppose you go to your doctor
and the doctor says,
and the doctor says,
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Supoñamos que ides ó médico e este di
06:34
"I just got your lab work back,
your cholesterol's a little high."
your cholesterol's a little high."
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"Teño os resultados das probas
e ten o colesterol un pouco alto".
e ten o colesterol un pouco alto".
06:39
Now, you all know that high cholesterol
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Sabedes que o colesterol alto
06:42
is associated with an increased risk
of cardiovascular disease,
of cardiovascular disease,
136
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está asociado a unha elevación
do risco de enfermidades cardiovasculares,
do risco de enfermidades cardiovasculares,
ataque ó corazón ou apoplexía.
06:46
heart attack, stroke.
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06:47
And so you're thinking
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E dades en pensar
que ter o colesterol alto non é moi bo.
que ter o colesterol alto non é moi bo.
06:49
having high cholesterol
isn't the best thing,
isn't the best thing,
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06:51
and so the doctor says,
"You know, I'd like to give you a drug
"You know, I'd like to give you a drug
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E o doutor di:
"Quero receitarlle un medicamento
"Quero receitarlle un medicamento
que lle vai axudar a baixa-lo colesterol:
unha estatina".
unha estatina".
06:54
that will help you
lower your cholesterol, a statin."
lower your cholesterol, a statin."
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06:57
And you've probably heard of statins,
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É probable que coñezáde-las estatinas
e saibades que son un dos medicamentos
e saibades que son un dos medicamentos
06:59
you know that they're among
the most widely prescribed drugs
the most widely prescribed drugs
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máis receitados hoxe en día.
Quizas ata coñecedes
Quizas ata coñecedes
07:01
in the world today,
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07:03
you probably even know
people who take them.
people who take them.
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a alguén que as toma.
E dicides "Si, déame a estatina!"
E dicides "Si, déame a estatina!"
07:05
And so you're thinking,
"Yeah! Give me the statin."
"Yeah! Give me the statin."
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413135
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Pero deberiades preguntar algo
neste momento.
neste momento.
07:07
But there's a question
you should ask at this point,
you should ask at this point,
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2435
07:10
a statistic you should ask for
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Deberiades pedir unha estatística
da que moitos doutores non queren falar
e as compañías farmacéuticas
e as compañías farmacéuticas
07:11
that most doctors
don't like talking about,
don't like talking about,
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07:14
and pharmaceutical companies
like talking about even less.
like talking about even less.
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aínda menos.
07:18
It's for the number needed to treat.
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É o número necesario a tratar (NNT).
E que é o NNT?
E que é o NNT?
07:21
Now, what is this, the NNT?
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1976
07:23
It's the number of people
that need to take a drug
that need to take a drug
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É o número de persoas
que teñen que toma-lo medicamento
que teñen que toma-lo medicamento
ou recibir calquera outro tratamento
ou procedemento
ou procedemento
07:26
or undergo a surgery
or any medical procedure
or any medical procedure
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07:29
before one person is helped.
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antes de que axude unha persoa.
07:31
And you're thinking,
what kind of crazy statistic is that?
what kind of crazy statistic is that?
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E pensaredes
"que demo de estatística é esa?
"que demo de estatística é esa?
07:34
The number should be one.
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O número debería ser un. O meu médico
non me receitaría algo que non axuda".
non me receitaría algo que non axuda".
07:35
My doctor wouldn't prescribe
something to me
something to me
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07:37
if it's not going to help.
159
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1285
07:39
But actually, medical practice
doesn't work that way.
doesn't work that way.
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2484
Pero a medicina non funciona así.
07:41
And it's not the doctor's fault,
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1531
E non é culpa do doutor. Se alguén
é culpable sómo-los científicos coma min.
é culpable sómo-los científicos coma min.
07:43
if it's anybody's fault,
it's the fault of scientists like me.
it's the fault of scientists like me.
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2919
07:46
We haven't figured out
the underlying mechanisms well enough.
the underlying mechanisms well enough.
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Aínda non coñecemos ben
os mecanismos subxacentes.
os mecanismos subxacentes.
07:48
But GlaxoSmithKline estimates
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2410
GlaxoSmithKline estima
07:51
that 90 percent of the drugs work
in only 30 to 50 percent of the people.
in only 30 to 50 percent of the people.
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4976
que o 90 % dos medicamentos funcionan
entre un 30 % e un 50 % dos casos.
entre un 30 % e un 50 % dos casos.
07:56
So the number needed to treat
for the most widely prescribed statin,
for the most widely prescribed statin,
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3816
Polo que o NNT
no caso da estatina máis receitada
no caso da estatina máis receitada
08:00
what do you suppose it is?
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2136
cal pensades que é?
08:02
How many people have to take it
before one person is helped?
before one person is helped?
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2816
Cantas persoas teñen que tomala
antes de que axude a alguén?
antes de que axude a alguén?
08:05
300.
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1200
300.
08:07
This is according to research
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1381
Isto segundo os resultados
08:08
by research practitioners
Jerome Groopman and Pamela Hartzband,
Jerome Groopman and Pamela Hartzband,
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dos investigadores
Jerome Groopman e Pamela Hartzband
Jerome Groopman e Pamela Hartzband
confirmados de forma independente
por Bloomberg.com.
por Bloomberg.com.
08:12
independently confirmed by Bloomberg.com.
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2776
08:14
I ran through the numbers myself.
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2400
Eu mesmo comprobei os datos.
300 persoas deben toma-la estatina
durante un ano
durante un ano
08:17
300 people have to
take the drug for a year
take the drug for a year
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2376
08:20
before one heart attack, stroke
or other adverse event is prevented.
or other adverse event is prevented.
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antes de que evite un ataque ó corazón,
unha apoplexía ou outro caso adverso.
unha apoplexía ou outro caso adverso.
08:24
Now you're probably thinking,
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1381
E pensaredes
08:25
"Well, OK, one in 300 chance
of lowering my cholesterol.
of lowering my cholesterol.
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493725
2811
"Teño unha posibilidade entre 300
de baixa-lo colesterol.
de baixa-lo colesterol.
08:28
Why not, doc? Give me
the prescription anyway."
the prescription anyway."
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2216
Por que non? Déame o medicamento, doutor".
08:30
But you should ask at this point
for another statistic,
for another statistic,
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2856
Pero neste momento
deberiades pedir outra estatística
deberiades pedir outra estatística
08:33
and that is, "Tell me
about the side effects." Right?
about the side effects." Right?
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2576
que é: "Fáleme
dos efectos secundarios", non?
dos efectos secundarios", non?
08:36
So for this particular drug,
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1656
No caso deste medicamento
08:37
the side effects occur
in five percent of the patients.
in five percent of the patients.
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3656
os efectos secundarios danse
no 5 % dos pacientes.
no 5 % dos pacientes.
08:41
And they include terrible things --
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1667
E inclúen cousas terribles.
08:43
debilitating muscle and joint pain,
gastrointestinal distress --
gastrointestinal distress --
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511331
4444
Dor aguda en músculos e articulacións,
malestar gastrointestinal...
malestar gastrointestinal...
08:47
but now you're thinking, "Five percent,
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515799
1859
Pero pensaredes, "Un 5 %.
Non creo que me pase a min.
Non creo que me pase a min.
08:49
not very likely
it's going to happen to me,
it's going to happen to me,
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517682
2014
Sigo querendo tomalo".
Pero esperade un momento.
Pero esperade un momento.
08:51
I'll still take the drug."
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1238
08:52
But wait a minute.
188
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1194
Recordade: baixo estrés
non pensades claramente.
non pensades claramente.
08:54
Remember under stress
you're not thinking clearly.
you're not thinking clearly.
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2336
Pensade en como ides procesar isto
antes de tempo
antes de tempo
08:56
So think about how you're going
to work through this ahead of time,
to work through this ahead of time,
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524560
3165
para non ter que
crea-lo razoamento no momento.
crea-lo razoamento no momento.
08:59
so you don't have to manufacture
the chain of reasoning on the spot.
the chain of reasoning on the spot.
191
527750
3198
Ben, 300 persoas toman o medicamento.
Unha cura,
Unha cura,
09:02
300 people take the drug, right?
One person's helped,
One person's helped,
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2492
e o 5 % desas 300
sofre efectos secundarios
sofre efectos secundarios
09:05
five percent of those 300
have side effects,
have side effects,
193
533489
2407
é dicir, 15 persoas.
09:07
that's 15 people.
194
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1480
09:09
You're 15 times more likely
to be harmed by the drug
to be harmed by the drug
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3896
Tes 15 veces máis posibilidades
de que o medicamento te dane
de que o medicamento te dane
que de que te axude.
09:13
than you are to be helped by the drug.
196
541720
2816
09:16
Now, I'm not saying whether you
should take the statin or not.
should take the statin or not.
197
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2905
Non estou dicindo
se debedes toma-la estatina ou non
se debedes toma-la estatina ou non
09:19
I'm just saying you should have
this conversation with your doctor.
this conversation with your doctor.
198
547489
3143
só que deberiades
ter esta conversación co voso médico.
ter esta conversación co voso médico.
Por ética médica, é parte do principio
de consentimento informado.
de consentimento informado.
09:22
Medical ethics requires it,
199
550656
1320
09:24
it's part of the principle
of informed consent.
of informed consent.
200
552000
2296
09:26
You have the right to have access
to this kind of information
to this kind of information
201
554320
3216
Tedes dereito a ter acceso
a esta información para poder falar
a esta información para poder falar
09:29
to begin the conversation about whether
you want to take the risks or not.
you want to take the risks or not.
202
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3896
sobre se aceptade-los riscos.
Quizais pensedes
Quizais pensedes
09:33
Now you might be thinking
203
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1216
09:34
I've pulled this number
out of the air for shock value,
out of the air for shock value,
204
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2696
que falo deste número
para sorprender
para sorprender
09:37
but in fact it's rather typical,
this number needed to treat.
this number needed to treat.
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3256
pero en realidade o NNT
é bastante habitual.
09:40
For the most widely performed surgery
on men over the age of 50,
on men over the age of 50,
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4616
No caso da cirurxía máis estendida
entre os homes de máis de 50 anos,
entre os homes de máis de 50 anos,
09:45
removal of the prostate for cancer,
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2216
a extracción da próstata por cancro,
o NNT é 49.
o NNT é 49.
09:47
the number needed to treat is 49.
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2576
09:50
That's right, 49 surgeries are done
for every one person who's helped.
for every one person who's helped.
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4176
Si: hai que realizar 49 cirurxías
por cada persoa que se axuda.
por cada persoa que se axuda.
09:54
And the side effects in that case
occur in 50 percent of the patients.
occur in 50 percent of the patients.
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4656
E os efectos secundarios neste caso
danse no 50 % dos pacientes.
danse no 50 % dos pacientes.
09:59
They include impotence,
erectile dysfunction,
erectile dysfunction,
211
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2856
Inclúen impotencia, disfunción eréctil,
10:01
urinary incontinence, rectal tearing,
212
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2776
incontinencia urinaria, fisuras anais,
10:04
fecal incontinence.
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1456
incontinencia fecal.
10:06
And if you're lucky, and you're one
of the 50 percent who has these,
of the 50 percent who has these,
214
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3496
Se tes sorte, se pertences
a este 50 % que sofre isto
a este 50 % que sofre isto
10:09
they'll only last for a year or two.
215
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2040
só durará un ou dous anos.
10:12
So the idea of the pre-mortem
is to think ahead of time
is to think ahead of time
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3616
Entón, a idea do pre mortem
é pensar antes do momento
nas preguntas que podes facer
nas preguntas que podes facer
10:16
to the questions
that you might be able to ask
that you might be able to ask
217
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2536
10:19
that will push the conversation forward.
218
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2376
para que a conversación avance.
10:21
You don't want to have to manufacture
all of this on the spot.
all of this on the spot.
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3096
O ideal é non ter que crear todo isto
no momento.
no momento.
10:24
And you also want to think
about things like quality of life.
about things like quality of life.
220
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2896
Tamén hai que pensar en temas
como a calidade de vida.
como a calidade de vida.
10:27
Because you have a choice oftentimes,
221
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1776
Porque a miúdo temos opcións.
10:29
do you I want a shorter life
that's pain-free,
that's pain-free,
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2296
Quero vivir unha vida máis corta
pero sen dor
pero sen dor
10:31
or a longer life that might have
a great deal of pain towards the end?
a great deal of pain towards the end?
223
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3776
ou unha vida máis longa
quizais con moita dor cara ó final?
quizais con moita dor cara ó final?
10:35
These are things to talk about
and think about now,
and think about now,
224
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2416
Son cousas nas que debemos pensar agora
e falalas coa familia e seres queridos.
e falalas coa familia e seres queridos.
10:37
with your family and your loved ones.
225
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1816
Pode que cambiemos de idea
coa presión do momento
coa presión do momento
10:39
You might change your mind
in the heat of the moment,
in the heat of the moment,
226
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2496
pero é bo practicar
este tipo de razoamento.
este tipo de razoamento.
10:42
but at least you're practiced
with this kind of thinking.
with this kind of thinking.
227
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10:45
Remember, our brain under stress
releases cortisol,
releases cortisol,
228
633320
4616
Recordade: baixo estrés
o cerebro emite cortisol
o cerebro emite cortisol
10:49
and one of the things
that happens at that moment
that happens at that moment
229
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2336
e unha das cousas que pasa nese momento
é que se apagan un montón de sistemas.
é que se apagan un montón de sistemas.
10:52
is a whole bunch on systems shut down.
230
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1936
10:54
There's an evolutionary reason for this.
231
642280
1905
A evolución dáno-la explicación.
Cando nos enfrontamos a un predador,
non precisamos do sistema dixestivo
non precisamos do sistema dixestivo
10:56
Face-to-face with a predator,
you don't need your digestive system,
you don't need your digestive system,
232
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3407
10:59
or your libido, or your immune system,
233
647640
2456
ou da libido ou do sistema inmunolóxico
11:02
because if you're body is expending
metabolism on those things
metabolism on those things
234
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3656
porque se o corpo inviste metabolismo
nestas cousas
nestas cousas
11:05
and you don't react quickly,
235
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1656
e non reaccionamos rapidamente
11:07
you might become the lion's lunch,
and then none of those things matter.
and then none of those things matter.
236
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3976
podemos se-la comida do león,
e todas esas cousas deixan de importar.
e todas esas cousas deixan de importar.
11:11
Unfortunately,
237
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1416
Desafortunadamente,
unha das cousas que se apaga
unha das cousas que se apaga
11:12
one of the things that goes out the window
during those times of stress
during those times of stress
238
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3616
neses momentos de estrés
é o pensamento lóxico e racional,
é o pensamento lóxico e racional,
11:16
is rational, logical thinking,
239
664560
1976
11:18
as Danny Kahneman
and his colleagues have shown.
and his colleagues have shown.
240
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3416
como demostraron Danny Kahneman
e os seus colegas.
e os seus colegas.
11:22
So we need to train ourselves
to think ahead
to think ahead
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3176
Por iso necesitamos adestrarnos
para pensar anticipadamente
para pensar anticipadamente
11:25
to these kinds of situations.
242
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2256
neste tipo de situacións.
11:27
I think the important point here
is recognizing that all of us are flawed.
is recognizing that all of us are flawed.
243
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Creo que o máis importante
é recoñecer que todos temos defectos.
é recoñecer que todos temos defectos.
11:33
We all are going to fail now and then.
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2856
Nalgún momento imos equivocarnos.
11:36
The idea is to think ahead
to what those failures might be,
to what those failures might be,
245
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3616
A idea é pensar anticipadamente
no que poden ser estas equivocacións,
no que poden ser estas equivocacións,
11:40
to put systems in place
that will help minimize the damage,
that will help minimize the damage,
246
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3896
establecer sistemas
que poidan minimizar os danos
que poidan minimizar os danos
11:44
or to prevent the bad things
from happening in the first place.
from happening in the first place.
247
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3520
ou simplemente evitar
que estas cousas malas pasen.
que estas cousas malas pasen.
11:48
Getting back to that
snowy night in Montreal,
snowy night in Montreal,
248
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2656
Volvendo a aquela noite con neve
en Montreal.
en Montreal.
11:50
when I got back from my trip,
249
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1736
Cando volvín da viaxe
11:52
I had my contractor install
a combination lock next to the door,
a combination lock next to the door,
250
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3856
o meu contratista instaloume
unha pechadura con código ó lado da porta
unha pechadura con código ó lado da porta
11:56
with a key to the front door in it,
an easy to remember combination.
an easy to remember combination.
251
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3536
coa chave da porta da casa dentro
e un código fácil de recordar.
e un código fácil de recordar.
12:00
And I have to admit,
252
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1216
E recoñezo que teño montóns de correo
que aínda teño que ordenar
que aínda teño que ordenar
12:01
I still have piles of mail
that haven't been sorted,
that haven't been sorted,
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3416
e montóns de correos electrónicos
que teño que ler.
que teño que ler.
12:04
and piles of emails
that I haven't gone through.
that I haven't gone through.
254
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2576
12:07
So I'm not completely organized,
255
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1776
Non son totalmente organizado
12:09
but I see organization
as a gradual process,
as a gradual process,
256
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3136
pero creo que a organización
é un proceso gradual
é un proceso gradual
e estou traballando niso.
12:12
and I'm getting there.
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12:13
Thank you very much.
258
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Moitas grazas.
12:14
(Applause)
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ABOUT THE SPEAKER
Daniel Levitin - NeuroscientistDaniel Levitin incorporates findings from neuroscience into everyday life.
Why you should listen
Dr. Daniel Levitin is a neuroscientist at McGill University in Montreal, dean at Minerva Schools in San Francisco and a musician. His research focuses on pattern processing in the brain.
His three books This Is Your Brain on Music, The World in Six Songs, and the recent The Organized Mind are all bestsellers. A polymath at heart, he has performed with top musicians and holds a few gold and platinum records.
Levitin earned his B.A. in Cognitive Psychology and Cognitive Science at Stanford University, and went on to earn his Ph.D. in Psychology from the University of Oregon, researching complex auditory patterns and pattern processing in expert and non-expert populations. He completed post-doctoral training at Stanford University Medical School (in Neuroimaging) and at UC Berkeley (in Cognitive Psychology). He has consulted on audio sound source separation for the U.S. Navy, and on audio quality for several rock bands and record labels (including the Grateful Dead and Steely Dan), and served as one of the “Golden Ears” expert listeners in the original Dolby AC3 compression tests. He worked for two years at the Silicon Valley think tank Interval Research Corporation.
He taught at Stanford University in the Department of Computer Science, the Program in Human-Computer Interaction, and the Departments of Psychology, Anthropology, Computer Music, and History of Science.
Daniel Levitin | Speaker | TED.com