TEDxToronto 2010
Brian Goldman: Doctors make mistakes. Can we talk about that?
Brian Goldman: Liječnici griješe. Možemo li razgovarati o tome?
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Svaki liječnik griješi. Ali, liječnik Brian Goldman kaže, medicinska kultura poricanja (i srama) sprječava liječnike da ikada govore o tim pogreškama ili da ih koriste kako bi iz njih učili i usavršavali se. Pričajući priče iz svoje duge prakse, poziva liječnike da krenu govoriti o tome kako su griješli.
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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Mislim da moramo učiniti nešto
00:17
about a piece of the culture of medicine that has to change.
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s dijelom medicinske kulture koji se mora promijeniti.
00:20
And I think it starts with one physician, and that's me.
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I smatram kako to počinje s jednim liječnikom, a to sam ja.
00:23
And maybe I've been around long enough
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Možda sam dovoljno dugo tu negdje
00:25
that I can afford to give away some of my false prestige
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da si mogu priuštiti odricanje od lažnog ugleda
00:27
to be able to do that.
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kako bih to mogao učiniti.
00:29
Before I actually begin the meat of my talk,
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Prije no što zapravo dođem do poante svog govora,
00:31
let's begin with a bit of baseball.
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počnimo s malo bejzbola.
00:33
Hey, why not?
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Hej, zašto ne?
00:35
We're near the end, we're getting close to the World Series.
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Pri kraju smo, bližimo se World Series-u.
00:38
We all love baseball, don't we?
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Svi mi volimo bejzbol, zar ne?
00:41
(Laughter)
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(Smijeh)
00:43
Baseball is filled with some amazing statistics.
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Bejzbol je pun nevjerojatne statistike.
00:46
And there's hundreds of them.
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I ima ih na stotine.
00:49
"Moneyball" is about to come out, and it's all about statistics
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"Igra pobjednika" (film) samo što nije izašla i cijeli je povezan sa statistikom
00:52
and using statistics to build a great baseball team.
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i korištenjem statistike kako bi se napravila odlična bejzbolska momčad.
00:54
I'm going to focus on one stat
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Usredotočit ću se na jednu statistiku
00:57
that I hope a lot of you have heard of.
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za koju se nadam kako su mnogi čuli za nju.
00:59
It's called batting average.
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Zove se prosjek udaranja.
01:01
So we talk about a 300, a batter who bats 300.
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Govorimo o 300, o igraču koji udara 300.
01:04
That means that ballplayer batted safely, hit safely
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To znači da je igrač udarao sigurno, pogodio sigurno
01:08
three times out of 10 at bats.
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tri puta od 10 udaraca.
01:11
That means hit the ball into the outfield,
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To znači pogoditi teren loptom,
01:13
it dropped, it didn't get caught,
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ona pada, nije uhvaćena
01:15
and whoever tried to throw it to first base didn't get there in time
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i tko god ju je pokušao baciti do prve baze nije stigao tamo na vrijeme
01:18
and the runner was safe.
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i trkač je siguran.
01:20
Three times out of 10.
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Tri puta od mogućih 10.
01:23
Do you know what they call a 300 hitter
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Znate li kako zovu udarača koji udara 300
01:26
in Major League Baseball?
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u Velikoj bejzbolskoj ligi?
01:28
Good, really good,
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Dobrim, jako dobrim,
01:31
maybe an all-star.
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možda čak zvijezdom.
01:34
Do you know what they call
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Znate li kako zovu udarača
01:36
a 400 baseball hitter?
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koji udara 400?
01:38
That's somebody who hit, by the way,
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To je netko tko je udario, usput,
01:40
four times safely out of every 10.
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četiri puta sigurno od svakih 10.
01:42
Legendary --
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Legendarnim –
01:45
as in Ted Williams legendary --
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poput legendarnog Teda Williamsa –
01:47
the last Major League Baseball player
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posljednjeg igrača Velike bejzbolske lige
01:49
to hit over 400 during a regular season.
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koji je udario 400 tijekom redovne sezone.
01:52
Now let's take this back into my world of medicine
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Vratimo se sad u moj svijet medicine
01:54
where I'm a lot more comfortable,
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u kojem se osjećam ugodnije
01:56
or perhaps a bit less comfortable
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ili možda malo manje ugodno
01:58
after what I'm going to talk to you about.
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nakon onoga što ću vam ispričati.
02:01
Suppose you have appendicitis
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Pretpostavimo da imate upalu slijepog crijeva
02:03
and you're referred to a surgeon
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i uputili su vas kirurgu
02:05
who's batting 400 on appendectomies.
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koji udara 400 na operacijama slijepog crijeva.
02:07
(Laughter)
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(Smijeh)
02:10
Somehow this isn't working out, is it?
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To nekako ne funkcionira, zar ne?
02:13
Now suppose you live
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Zamislite sad da živite
02:15
in a certain part of a certain remote place
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u određenom dijelu određenog udaljenog mjesta
02:18
and you have a loved one
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i imate voljenu osobu
02:20
who has blockages in two coronary arteries
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kojoj su zakrčene dvije koronarne arterije
02:23
and your family doctor refers that loved one to a cardiologist
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i vaš obiteljski liječnik upućuje tog voljenog kardiologu
02:26
who's batting 200 on angioplasties.
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koju udara 200 na angioplastici.
02:30
But, but, you know what?
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Ali, ali, znate što?
02:32
She's doing a lot better this year. She's on the comeback trail.
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Ona je mnogo bolja ove godine. Na povratnoj je stazi.
02:34
And she's hitting a 257.
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I udara 257.
02:37
Somehow this isn't working.
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To opet nekako ne funkcionira.
02:39
But I'm going to ask you a question.
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Ali postavit ću vam pitanje.
02:41
What do you think a batting average
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Što mislite,
02:43
for a cardiac surgeon or a nurse practitioner
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za kardiokirurga ili medicinsku sestru
02:45
or an orthopedic surgeon,
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ili kirurga ortopeda,
02:47
an OBGYN, a paramedic
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ginekologa ili bolničara;
02:49
is supposed to be?
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koliki bi trebao biti prosjek udaranja?
02:52
1,000, very good.
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1.000, vrlo dobro.
02:55
Now truth of the matter is,
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Istini za volju,
02:57
nobody knows in all of medicine
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u cijeloj medicini
02:59
what a good surgeon
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nitko ne zna koliko bi
03:01
or physician or paramedic
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trebao udarati dobar kirurg
03:03
is supposed to bat.
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ili liječnik ili bolničar.
03:05
What we do though is we send each one of them, including myself,
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Ono što radimo jest da pošaljemo svakog od njih, uključujući i sebe,
03:07
out into the world
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van u svijet sa savjetom,
03:09
with the admonition, be perfect.
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budi savršen.
03:11
Never ever, ever make a mistake,
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Nikada, ali nikada nemoj napraviti grešku,
03:13
but you worry about the details, about how that's going to happen.
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ali brini o detaljima, o tome kako će se to dogoditi.
03:16
And that was the message that I absorbed
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To je bila poruka koju sam upijao
03:18
when I was in med school.
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tijekom medicinskog fakulteta.
03:20
I was an obsessive compulsive student.
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Bio sam opsesivno kompulzivni student.
03:23
In high school, a classmate once said
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U srednjoj školi, prijatelj iz razreda jednom je rekao
03:26
that Brian Goldman would study for a blood test.
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da će Brian Goldman studirati za testiranje krvi.
03:28
(Laughter)
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(Smijeh)
03:31
And so I did.
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I jesam.
03:33
And I studied in my little garret
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I studirao sam na svom malom tavanu
03:35
at the nurses' residence at Toronto General Hospital,
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u prebivalištu medicinskih sestara u bolnici Toronto General,
03:37
not far from here.
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ne tako daleko odavde.
03:39
And I memorized everything.
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I upamtio sam sve.
03:41
I memorized in my anatomy class
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Na satovima anatomije
03:43
the origins and exertions of every muscle,
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pamtio sam početak i naprezanje svakog mišića,
03:45
every branch of every artery that came off the aorta,
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svake grane bilo koje arterije koja je došla iz aorte,
03:48
differential diagnoses obscure and common.
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diferencijalne dijagnoze – neuobičajene i uobičajene.
03:51
I even knew the differential diagnosis
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Čak sam znao diferencijalnu dijagnozu
03:53
in how to classify renal tubular acidosis.
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toga kako klasificirati bubrežnu tubularnu acidozu.
03:55
And all the while,
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I svo to vrijeme
03:57
I was amassing more and more knowledge.
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sam skupljao sve više i više znanja.
03:59
And I did well, I graduated with honors,
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I uspio sam, diplomirao sam s počastima,
04:01
cum laude.
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s pohvalom.
04:03
And I came out of medical school
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I izašao sam iz medicinskog fakulteta
04:06
with the impression
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s dojmom
04:08
that if I memorized everything and knew everything,
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da ako sam sve zapamtio i sve znao
04:10
or as much as possible,
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ili bar što je više moguće,
04:12
as close to everything as possible,
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gotovo blizu toga da je sve moguće,
04:14
that it would immunize me against making mistakes.
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da će me to cijepiti protiv pravljenja grešaka.
04:17
And it worked
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I to je djelovalo
04:19
for a while,
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neko vrijeme,
04:22
until I met Mrs. Drucker.
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sve dok nisam upoznao gđu. Drucker.
04:25
I was a resident at a teaching hospital here in Toronto
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Bio sam specijalizant u sveučilišnoj bolnici ovdje u Torontu
04:27
when Mrs. Drucker was brought to the emergency department
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kad je gđa. Drucker dovezena na odjel hitne
04:30
of the hospital where I was working.
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u bolnicu u kojoj sam radio.
04:32
At the time I was assigned to the cardiology service
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U to sam vrijeme bio dodijeljen kardiološkoj službi
04:34
on a cardiology rotation.
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kao kardiološka zamjena.
04:36
And it was my job,
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Moj je posao bio,
04:38
when the emergency staff called for a cardiology consult,
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kad je osoblje hitne pozvalo nekog na kardiološko savjetovanje,
04:40
to see that patient in emerg.
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da dođem vidjeti pacijenta na hitnu
04:43
and to report back to my attending.
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i da izvjestim o tome svog nadređenog.
04:45
And I saw Mrs. Drucker, and she was breathless.
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Vidio sam gđu. Drucker, bila je bez zraka.
04:48
And when I listened to her, she was making a wheezy sound.
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Kada sam je poslušao, ispuštala je šišteći zvuk.
04:51
And when I listened to her chest with a stethoscope,
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A kada sam poslušao njena prsa stetoskopom,
04:53
I could hear crackly sounds on both sides
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mogao sam čuti pucketajuće zvukove na obje strane
04:55
that told me that she was in congestive heart failure.
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što mi je govorilo da je imala kongestivno zatajenje srca.
04:58
This is a condition in which the heart fails,
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To je stanje u kojem srce zakazuje
05:01
and instead of being able to pump all the blood forward,
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i umjesto da je u mogućnosti da tjera svu krv naprijed,
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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krv se vraća natrag u pluća, pluća se pune krvlju
05:06
and that's why you have shortness of breath.
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i zato ostajete bez zraka.
05:08
And that wasn't a difficult diagnosis to make.
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To nije bila dijagnoza koju je bilo teško donijeti.
05:11
I made it and I set to work treating her.
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Donio sam je i krenuo je liječiti.
05:14
I gave her aspirin. I gave her medications to relieve the strain on her heart.
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Dao sam joj aspirin. Dao sam joj lijekove koji olakšavaju naprezanje njenog srca.
05:17
I gave her medications that we call diuretics, water pills,
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Dao sam joj lijekove koje zovemo diureticima, vodene pilule,
05:20
to get her to pee out the access fluid.
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kako bi izmokrila tekućinu.
05:23
And over the course of the next hour and a half or two,
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I tijekom sljedećih sat i pol ili dva,
05:25
she started to feel better.
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počela se bolje osjećati.
05:27
And I felt really good.
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I ja sam se osjećao stvarno dobro.
05:30
And that's when I made my first mistake;
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A tada sam učinio svoju prvu pogrešku;
05:33
I sent her home.
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poslao sam je kući.
05:35
Actually, I made two more mistakes.
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Zapravo, učinio sam još dvije greške.
05:38
I sent her home
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Poslao sam je kući
05:40
without speaking to my attending.
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bez da sam razgovarao sa svojim nadređenim.
05:42
I didn't pick up the phone and do what I was supposed to do,
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Nisam podigao telefonsku slušalicu i učinio što sam trebao,
05:45
which was call my attending and run the story by him
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a to je nazvati svog nadređenog, ispričati mu priču
05:47
so he would have a chance to see her for himself.
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kako bi on imao priliku otići je vidjeti sam.
05:50
And he knew her,
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A poznavao ju je,
05:52
he would have been able to furnish additional information about her.
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bio bi u stanju opskrbiti nas dodatnim informacijama o njoj.
05:55
Maybe I did it for a good reason.
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Možda sam to učinio s dobrim razlogom.
05:57
Maybe I didn't want to be a high-maintenance resident.
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Možda nisam želio biti specijalizant koji će privlačiti puno pozornosti.
06:00
Maybe I wanted to be so successful
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Možda sam želio biti toliko uspješan
06:02
and so able to take responsibility
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i toliko sposoban preuzeti odgovornost
06:04
that I would do so
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da sam to i učinio
06:06
and I would be able to take care of my attending's patients
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i bio bih u stanju pobrinuti se za pacijente svog nadređenog
06:08
without even having to contact him.
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bez da ga uopće kontaktiram.
06:10
The second mistake that I made was worse.
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Druga greška koju sam učinio je bila gora.
06:14
In sending her home,
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Šaljući je kući,
06:16
I disregarded a little voice deep down inside
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ignorirao sam mali glas duboko u sebi
06:18
that was trying to tell me,
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koji mi je pokušavao reći,
06:20
"Goldman, not a good idea. Don't do this."
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"Goldman, to nije dobra ideja. Nemoj to raditi."
06:23
In fact, so lacking in confidence was I
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Zapravo, toliko mi je nedostajalo povjerenja
06:26
that I actually asked the nurse
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da sam pitao sestru
06:28
who was looking after Mrs. Drucker,
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koja se brinula o gđi. Drucker,
06:30
"Do you think it's okay if she goes home?"
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"Mislite li kako je u redu da ide kući?"
06:33
And the nurse thought about it
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Sestra je razmislila o tome
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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i rekla veoma odvažno, "Da, mislim kako će biti dobro."
06:37
I can remember that like it was yesterday.
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Sjećam se toga kao da je bilo jučer.
06:40
So I signed the discharge papers,
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I tako sam potpisao otpusno pismo,
06:42
and an ambulance came, paramedics came to take her home.
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kola hitne pomoći su došla, bolničari su je odveli kući.
06:45
And I went back to my work on the wards.
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A ja sam se vratio svom poslu na odjelima.
06:48
All the rest of that day,
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Ostatak tog dana,
06:50
that afternoon,
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tog popodneva,
06:52
I had this kind of gnawing feeling inside my stomach.
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imao sam neki mučan osjećaj u želucu.
06:55
But I carried on with my work.
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Ali nastavio sam s poslom.
06:58
And at the end of the day, I packed up to leave the hospital
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Na kraju dana, spremao sam se otići iz bolnice
07:00
and walked to the parking lot
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i hodao sam prema parkiralištu
07:02
to take my car and drive home
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kako bih došao do svog auta i odvezao se kući,
07:04
when I did something that I don't usually do.
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no tada sam učinio nešto što inače ne radim.
07:08
I walked through the emergency department on my way home.
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Prošao sam kroz odjel hitne pomoći na svom putu kući.
07:11
And it was there that another nurse,
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A tamo je bila jedna druga sestra,
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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ne ona koja je brinula o gđi. Drucker ranije, već druga,
07:16
said three words to me
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rekla mi je tri riječi,
07:19
that are the three words
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a to su tri riječi
07:21
that most emergency physicians I know dread.
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kojih se većina liječnika hitne pomoći koje ja znam užasavaju.
07:24
Others in medicine dread them as well,
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I drugi u medicini ih se također užasavaju,
07:26
but there's something particular about emergency medicine
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ali nešto je posebno s hitnom pomoći
07:28
because we see patients so fleetingly.
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jer vidimo pacijente tako prolazno.
07:32
The three words are:
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Te tri riječi su:
07:34
Do you remember?
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Sjećate li se?
07:38
"Do you remember that patient you sent home?"
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"Sjećate li se te pacijentice koju ste poslali kući?"
07:41
the other nurse asked matter-of-factly.
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pitala je ta druga sestra odmah.
07:43
"Well she's back,"
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"Pa, vratila se,"
07:45
in just that tone of voice.
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tim tonom glasa.
07:47
Well she was back all right.
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Itekako se vratila.
07:49
She was back and near death.
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Vratila se i bila je blizu smrti.
07:52
About an hour after she had arrived home,
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Otprilike sat vremena nakon što je stigla kući,
07:54
after I'd sent her home,
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nakon što sam je poslao kući,
07:56
she collapsed and her family called 911
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pala je u nesvijesti i njena obitelj je nazvala 911
07:59
and the paramedics brought her back to the emergency department
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pa su je bolničari doveli natrag na odjel hitne pomoći
08:01
where she had a blood pressure of 50,
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gdje je imala krvni tlak 50,
08:03
which is in severe shock.
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što je težak šok.
08:05
And she was barely breathing and she was blue.
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Jedva je disala i poplavila je.
08:08
And the emerg. staff pulled out all the stops.
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Osoblje hitne pomoći učinilo je sve što je moglo.
08:11
They gave her medications to raise her blood pressure.
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Dali su joj lijekove za podizanje krvnog tlaka.
08:14
They put her on a ventilator.
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Stavili su je na ventilator.
08:16
And I was shocked
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Bio sam šokiran
08:19
and shaken to the core.
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i potresen do srži.
08:21
And I went through this roller coaster,
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Prolazio sam kroz taj 'vlak smrti'
08:23
because after they stabilized her,
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jer nakon što su je stabilizirali,
08:25
she went to the intensive care unit,
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prebačena je u jedinicu intenzivne njege
08:27
and I hoped against hope that she would recover.
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i nadao sam se protiv nade da će se oporaviti.
08:29
And over the next two or three days,
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Tijekom sljedeća dva ili tri dana,
08:31
it was clear that she was never going to wake up.
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postalo je jasno kako se nikada neće probuditi.
08:33
She had irreversible brain damage.
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Imala je nepopravljivo oštećenje mozga.
08:36
And the family gathered.
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Obitelj se okupila.
08:38
And over the course of the next eight or nine days,
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Tijekom sljedećih osam ili devet dana
08:41
they resigned themselves to what was happening.
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pomirili su se s onim što se događalo.
08:43
And at about the nine day mark, they let her go --
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Negdje tijekom devetog dana, pustili su je –
08:46
Mrs. Drucker,
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gđu. Drucker,
08:48
a wife, a mother
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ženu, majku
08:50
and a grandmother.
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i baku.
08:53
They say you never forget the names
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Kažu da nikada ne zaboravljate imena
08:55
of those who die.
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onih koji umru.
08:57
And that was my first time to be acquainted with that.
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I to je bio moj prvi put da sam se upoznao s time.
09:00
Over the next few weeks,
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Tijekom sljedećih nekoliko tjedana
09:02
I beat myself up
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grizao sam se
09:05
and I experienced for the first time
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i po prvi puta sam iskusio
09:07
the unhealthy shame that exists
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nezdravi sram koji postoji
09:09
in our culture of medicine --
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u našoj kulturi medicine –
09:11
where I felt alone, isolated,
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gdje sam se osjećao usamljeno, izolirano,
09:14
not feeling the healthy kind of shame that you feel,
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nisam osjećao zdravu vrstu srama koju osjećate,
09:16
because you can't talk about it with your colleagues.
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jer ne možete o tome razgovarati s kolegama.
09:18
You know that healthy kind,
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Znate zdravu vrstu,
09:20
when you betray a secret that a best friend made you promise never to reveal
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kad odate tajnu za koju ste najboljem prijatelju obećali da je nikada nećete otkriti
09:23
and then you get busted
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i onda ste uhvaćeni
09:25
and then your best friend confronts you
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i onda vam se vaš najbolji prijatelj suprotstavi
09:27
and you have terrible discussions,
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i obavite groznu diskusiju,
09:29
but at the end of it all that sick feeling guides you
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ali na kraju svega taj vas bolestan osjećaj vodi
09:32
and you say, I'll never make that mistake again.
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i kažete, "Više nikada neću ponoviti tu grešku."
09:34
And you make amends and you never make that mistake again.
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Popravite to i više nikada tako ne pogriješite.
09:37
That's the kind of shame that is a teacher.
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To je vrsta srama koja vas uči.
09:40
The unhealthy shame I'm talking about
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Nezdravi sram o kojem ja pričam
09:42
is the one that makes you so sick inside.
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je onaj od kojeg vam je zlo unutra.
09:45
It's the one that says,
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To je onaj koji,
09:47
not that what you did was bad,
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ne samo da kaže da je ono što ste učinili loše,
09:49
but that you are bad.
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već da ste vi loši.
09:51
And it was what I was feeling.
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I to je ono što sam osjećao.
09:54
And it wasn't because of my attending; he was a doll.
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I to nije bilo zbog mog nadređenog; on je bio ljubazan.
09:57
He talked to the family, and I'm quite sure that he smoothed things over
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Razgovarao je s obitelji i prilično sam siguran da je izgladio stvari
10:00
and made sure that I didn't get sued.
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i osigurao da me ne tuže.
10:03
And I kept asking myself these questions.
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A ja sam si nastavio postavljati ova pitanja.
10:06
Why didn't I ask my attending? Why did I send her home?
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Zašto nisam pitao nadređenog? Zašto sam je poslao kući?
10:09
And then at my worst moments:
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I u najgorim trenucima:
10:11
Why did I make such a stupid mistake?
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Zašto sam učinio tako glupu grešku?
10:14
Why did I go into medicine?
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Zašto sam išao na medicinu?
10:16
Slowly but surely,
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Polako, ali sigurno
10:18
it lifted.
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dizao sam se natrag.
10:20
I began to feel a bit better.
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Počeo sam se osjećati malo bolje.
10:22
And on a cloudy day,
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A za vrijeme oblačnog dana,
10:24
there was a crack in the clouds and the sun started to come out
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postojala je rupa u oblacima i sunce je počelo izlaziti
10:26
and I wondered,
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pa sam se zapitao,
10:28
maybe I could feel better again.
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možda bih se mogao ponovo bolje osjećati.
10:30
And I made myself a bargain
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Napravio sam pogodbu sam sa sobom
10:33
that if only I redouble my efforts to be perfect
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da samo ako udvostručim svoj napor da budem savršen
10:38
and never make another mistake again,
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i nikada više ne učinim nijednu grešku,
10:40
please make the voices stop.
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neka glasovi utihnu.
10:42
And they did.
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I utihnuli su.
10:44
And I went back to work.
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I krenuo sam natrag na posao.
10:46
And then it happened again.
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I onda se opet dogodilo.
10:49
Two years later I was an attending in the emergency department
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Dvije godine kasnije bio sam nadređeni u odjelu hitne
10:52
at a community hospital just north of Toronto,
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u općoj bolnici, sjeverno od Toronta
10:54
and I saw a 25 year-old man with a sore throat.
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i primio sam 25-ogodišnjeg mladića s upalom grla.
10:57
It was busy, I was in a bit of a hurry.
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Bilo je posla, bio sam u žurbi.
10:59
He kept pointing here.
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On je opetovano pokazivao ovdje.
11:01
I looked at his throat, it was a little bit pink.
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Pogledao sam njegovo grlo, bilo je malkice ružičasto.
11:03
And I gave him a prescription for penicillin
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Dao sam mu recept za penicilin
11:05
and sent him on his way.
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i poslao ga dalje.
11:07
And even as he was walking out the door,
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Čak i kad je izlazio kroz vrata,
11:09
he was still sort of pointing to his throat.
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još je uvijek na neki način pokazivao na svoje grlo.
11:12
And two days later I came to do my next emergency shift,
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Dva dana kasnije, došao sam odraditi svoju sljedeću smjenu u hitnoj,
11:15
and that's when my chief asked to speak to me quietly in her office.
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a onda me moja šefica zamolila da popričamo u njenom uredu.
11:18
And she said the three words:
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Rekla je tri riječi:
11:22
Do you remember?
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Sjećaš li se?
11:25
"Do you remember that patient you saw with the sore throat?"
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"Sjećaš li se pacijenta kojeg si vidio s upaljenim grlom?"
11:28
Well it turns out, he didn't have a strep throat.
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Ispalo je da nije imao streptokok u grlu.
11:30
He had a potentially life-threatening condition
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Imao je stanje koje potencijalno može ugroziti život
11:32
called epiglottitis.
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pod nazivom epiglotitis.
11:34
You can Google it,
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Možete potražiti na Google-u,
11:36
but it's an infection, not of the throat, but of the upper airway,
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to je infekcija, ali ne grla, već gornjih dišnih puteva
11:39
and it can actually cause the airway to close.
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i može prouzročiti zatvaranje dišnih puteva.
11:42
And fortunately he didn't die.
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Srećom, nije umro.
11:45
He was placed on intravenous antibiotics
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Stavljen je na intravenozne antibiotike
11:48
and he recovered after a few days.
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i oporavio se nakon nekoliko dana.
11:50
And I went through the same period of shame and recriminations
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A ja sam prošao isti period srama i uzajamnih optužbi
11:54
and felt cleansed and went back to work,
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i osjećao se očišćeno i vratio se natrag na posao
11:58
until it happened again and again and again.
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dok se nije dogodilo opet i opet i opet.
12:03
Twice in one emergency shift, I missed appendicitis.
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Dva sam puta u hitnoj službi propustio upalu slijepog crijeva.
12:06
Now that takes some doing,
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To treba znati,
12:09
especially when you work in a hospital
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pogotovo kad radite u bolnici
12:11
that at the time saw but 14 people a night.
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u kojoj istovremeno vidite 14 ljudi na noć.
12:14
Now in both cases, I didn't send them home
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U oba slučaja nisam ih poslao kući
12:17
and I don't think there was any gap in their care.
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i smatram kako nije bilo propusta u njihovoj njezi.
12:19
One I thought had a kidney stone.
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Za jednog sam mislio da ima bubrežni kamenac.
12:21
I ordered a kidney X-ray. When it turned out to be normal,
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Zatražio sam rendgen bubrega. Kad je ispalo da je rendgen normalan,
12:23
my colleague who was doing a reassessment of the patient
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moj kolega koji je radio revidiranje pacijenta
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
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primijetio je mekoću u donjem desnom kvadrantu i pozvao je kirurge.
12:29
The other one had a lot of diarrhea.
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Drugi je imao obilan proljev.
12:31
I ordered some fluids to rehydrate him
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Naručio sam mnogo tekućine kako bi se rehidrirao
12:34
and asked my colleague to reassess him.
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i zamolio kolegu da revidira.
12:37
And he did
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Revidirao je
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
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i kad je osjetio mekoću u donjem desnom kvadrantu, pozvao je kirurge.
12:41
In both cases,
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U oba su slučaja pacijenti
12:43
they had their operations and they did okay.
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operirani i bili su dobro.
12:46
But each time,
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Ali svaki put
12:48
they were gnawing at me, eating at me.
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su me mučili, proždirali me.
12:50
And I'd like to be able to say to you
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Volio bih da vam mogu reći
12:52
that my worst mistakes only happened in the first five years of practice
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kako su se moje najgore greške dogodile u prvih pet godina moje prakse
12:55
as many of my colleagues say, which is total B.S.
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kao što mnogo mojih kolega kaže, što je totalno sr...e.
12:58
(Laughter)
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(Smijeh)
13:00
Some of my doozies have been in the last five years.
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Neki od mojih bisera su se dogodili u posljednjih pet godina.
13:06
Alone, ashamed and unsupported.
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Sami, posramljeni i bez podrške.
13:08
Here's the problem:
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Evo u čemu je problem:
13:10
If I can't come clean
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Ako ne mogu priznati
13:12
and talk about my mistakes,
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i pričati o svojim greškama,
13:16
if I can't find the still-small voice
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ako ne mogu pronaći tišinu – mali glas
13:18
that tells me what really happened,
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koji mi govori što se zaista dogodilo,
13:20
how can I share it with my colleagues?
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kako to mogu podijeliti s kolegama?
13:22
How can I teach them about what I did
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Kako ih mogu naučiti o tome što sam ja učinio
13:25
so that they don't do the same thing?
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kako oni ne bi ponovili istu grešku?
13:29
If I were to walk into a room --
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Kad bih ja ušetao u prostoriju –
13:31
like right now, I have no idea what you think of me.
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poput ove sada, ne bih imao pojma što mislite o meni.
13:34
When was the last time you heard somebody talk
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Kada ste posljednji put čuli nekog da priča
13:36
about failure after failure after failure?
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o neuspjehu neuspjeha nakon neuspjeha?
13:38
Oh yeah, you go to a cocktail party
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O da, odete na koktel zabavu
13:40
and you might hear about some other doctor,
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i možda ćete čuti o nekim drugim liječnicima,
13:42
but you're not going to hear somebody
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ali nećete nikog čuti kako
13:44
talking about their own mistakes.
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govori o vlastitim pogreškama.
13:46
If I were to walk into a room filled with my colleages
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Da sam ušetao u prostoriju punu mojih kolega
13:49
and ask for their support right now
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i zatražio ih potporu sada
13:51
and start to tell what I've just told you right now,
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i počeo pričati ono što sam upravo vama ispričao,
13:53
I probably wouldn't get through two of those stories
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vjerojatno ne bih došao ni do druge priče
13:56
before they would start to get really uncomfortable,
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prije no što bi im postalo vrlo neugodno,
13:58
somebody would crack a joke,
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netko bi izvalio šalu,
14:00
they'd change the subject and we would move on.
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promijenili bi temu i nastavili dalje.
14:05
And in fact, if I knew and my colleagues knew
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I zapravo, kad bih znao i kad bi moji kolege znali
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
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kako je jedan od mojih kolega s ortopedije odrezao krivu nogu u mojoj bolnici,
14:12
believe me, I'd have trouble
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vjerujte mi, imao bih problema
14:14
making eye contact with that person.
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s uspostavljanjem kontakta oči u oči s tom osobom.
14:16
That's the system that we have.
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To je sustav koji imamo.
14:18
It's a complete denial of mistakes.
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To je potpuno poricanje grešaka.
14:21
It's a system
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To je sustav
14:23
in which there are two kinds of physicians --
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u kojem postoje dvije vrste pozicija –
14:27
those who make mistakes
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oni koji griješe
14:29
and those who don't,
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i oni koji ne griješe,
14:31
those who can't handle sleep deprivation and those who can,
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oni koji ne mogu podnijeti gubitak sna i oni koji mogu,
14:34
those who have lousy outcomes
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oni koji imaju traljave ishode
14:36
and those who have great outcomes.
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i oni koji imaju odlične ishode.
14:39
And it's almost like an ideological reaction,
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To je poput ideološke reakcije,
14:41
like the antibodies begin to attack that person.
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poput antitijela koja počinju napadati tu osobu.
14:45
And we have this idea
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Imamo tu ideju da
14:47
that if we drive the people who make mistakes
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ako povučemo iz medicine one
14:49
out of medicine,
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ljude koji rade greške,
14:51
what will we be left with, but a safe system.
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što će nam ostati, nego siguran sustav.
14:55
But there are two problems with that.
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Ali evo problema s takvom percepcijom.
14:58
In my 20 years or so
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U mojih 20-ak godina
15:00
of medical broadcasting and journalism,
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medicinskog emitiranja i novinarstva,
15:03
I've made a personal study of medical malpractice and medical errors
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napravio sam privatnu studiju o pogrešnom liječenju i medicinskim greškama
15:06
to learn everything I can,
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kako bih naučio sve što mogu,
15:08
from one of the first articles I wrote for the Toronto Star
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od jednog od prvih članaka koje sam napisao za Toronto Star
15:10
to my show "White Coat, Black Art."
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do mog showa 'Bijela kuta, crna umjetnost'.
15:13
And what I've learned
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Ono što sam naučio je
15:15
is that errors are absolutely ubiquitous.
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da su greške apsolutno sveprisutne.
15:18
We work in a system
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Radimo u sustavu
15:20
where errors happen every day,
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gdje se greške događaju svakog dana,
15:22
where one in 10 medications
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gdje je jedan od 10 lijekova
15:24
are either the wrong medication given in hospital
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ili pogrešan lijek koji su vam dali u bolnici
15:26
or at the wrong dosage,
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ili je pogrešna doza,
15:28
where hospital-acquired infections are getting more and more numerous,
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gdje su bolničke infekcije sve brojnije i brojnije,
15:31
causing havoc and death.
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uzrokuju rasulo i smrt.
15:34
In this country,
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U ovoj zemlji,
15:36
as many as 24,000 Canadians die
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čak 24.000 Kanađana umire
15:38
of preventable medical errors.
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od medicinskih grešaka koje se mogu spriječiti.
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
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U Sjedinjenim Američkim Državama, Institut Medicine procijenio je to na 100.000.
15:44
In both cases, these are gross underestimates,
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U oba slučaja, to su podcijenjeni ukupni iznosi
15:47
because we really aren't ferreting out the problem
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jer se ne odnosimo prema problemu
15:49
as we should.
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kako bismo trebali.
15:51
And here's the thing.
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Evo u čemu je stvar.
15:54
In a hospital system
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U bolničkom sustavu
15:57
where medical knowledge is doubling
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gdje se medicinsko znanje udvostručuje
15:59
every two or three years, we can't keep up with it.
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svake dvije ili tri godine, ne možemo to sustići.
16:02
Sleep deprivation is absolutely pervasive.
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Nedostatak sna potpuno prožima.
16:05
We can't get rid of it.
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Ne možemo ga se riješiti.
16:07
We have our cognitive biases,
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Imamo svoje kognitivne sklonosti
16:09
so that I can take a perfect history on a patient with chest pain.
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tako što mogu uzeti odličnu anamnezu pacijenta s bolom u prsima.
16:12
Now take the same patient with chest pain,
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Uzmite sad istog pacijenta s bolom u prsima,
16:14
make them moist and garrulous
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učinite ga vlažnim i govorljivim,
16:16
and put a little bit of alcohol on their breath,
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stavite malo alkohola u njihov zadah
16:18
and suddenly my history is laced with contempt.
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i odjednom je moja anamneza okovana prezirom.
16:20
I don't take the same history.
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Ne uzimam istu anamnezu.
16:22
I'm not a robot;
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Nisam robot;
16:24
I don't do things the same way each time.
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ne radim stvari na isti način svaki put.
16:26
And my patients aren't cars;
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I moji pacijenti nisu automobili;
16:28
they don't tell me their symptoms in the same way each time.
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ne govore mi svoje simptome na isti način svaki put.
16:31
Given all of that, mistakes are inevitable.
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S obzirom na sve to, pogreške su neizbježne.
16:34
So if you take the system, as I was taught,
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Ako uzmete sustav, kao što su mene učili,
16:37
and weed out all the error-prone health professionals,
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i maknete sve medicinske profesionalce sklone greškama,
16:41
well there won't be anybody left.
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pa neće nitko ostati.
16:46
And you know that business
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A znate ono kako ljudi
16:48
about people not wanting
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ne žele govoriti
16:50
to talk about their worst cases?
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o svojim najgorim slučajevima?
16:53
On my show, on "White Coat, Black Art,"
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U mojoj emisiji, "Bijela kuta, crna umjetnost'
16:55
I made it a habit of saying, "Here's my worst mistake,"
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imam naviku govoriti, "Evo moje najgore greške,"
16:57
I would say to everybody
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rekao bih to svima
16:59
from paramedics to the chief of cardiac surgery,
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od bolničara do šefova kardiokirurgije,
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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"Evo moje najgore greške", bla, bla, bla, bla, bla,
17:04
"What about yours?" and I would point the microphone towards them.
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"Koja je vaša?" i uperio bih mikrofon prema njima.
17:07
And their pupils would dilate,
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Zjenice bi im se raširile,
17:09
they would recoil,
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ustuknuli bi,
17:11
then they would look down and swallow hard
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pogledali prema dolje, progutali knedlu
17:14
and start to tell me their stories.
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i počeli mi pričati svoje priče.
17:17
They want to tell their stories. They want to share their stories.
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Žele pričati svoje priče. Žele podijeliti svoje priče.
17:20
They want to be able to say,
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Žele biti u mogućnosti da kažu,
17:22
"Look, don't make the same mistake I did."
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"Gledaj, nemojte učiniti istu pogrešku koju sam ja učinio."
17:24
What they need is an environment to be able to do that.
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Ono što im treba je okruženje u kojem to mogu učiniti.
17:26
What they need is a redefined medical culture.
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Ono što im treba jest redefinirana medicinska kultura.
17:30
And it starts with one physician at a time.
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I počinje s jednim liječnikom.
17:33
The redefined physician is human,
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Redefinirani liječnik je čovjek,
17:36
knows she's human,
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zna kako je čovjek,
17:38
accepts it, isn't proud of making mistakes,
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prihvaća to, nije ponosan na pravljenje grešaka,
17:40
but strives to learn one thing
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ali teži tome da nauči jednu stvar
17:42
from what happened
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iz toga što se dogodilo
17:44
that she can teach to somebody else.
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kako bi mogao naučiti nekog drugog.
17:46
She shares her experience with others.
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Dijeli svoje iskustvo s drugima.
17:48
She's supportive when other people talk about their mistakes.
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Podupire kada ostali ljudi pričaju o svojim greškama.
17:51
And she points out other people's mistakes,
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Ističe greške drugih ljudi,
17:53
not in a gotcha way,
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ne na način – uhvatio sam te,
17:55
but in a loving, supportive way
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već na drag i podržavajući način
17:58
so that everybody can benefit.
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kako bi svi mogli imati korist od toga.
18:00
And she works in a culture of medicine
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I radi u kulturi medicine
18:02
that acknowledges
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koja priznaje da
18:04
that human beings run the system,
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ljudska bića vode sustav,
18:06
and when human beings run the system, they will make mistakes from time to time.
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a kada ljudska bića vode sustav, rade greške s vremena na vrijeme.
18:09
So the system is evolving
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Sustav se razvija
18:13
to create backups
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kako bi stvorio rezerve
18:17
that make it easier to detect those mistakes
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kako bi bilo lakše detektirati te greške
18:20
that humans inevitably make
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koje ljudi neizbježno rade
18:23
and also fosters in a loving, supportive way
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i također potiče na nježan, podupirući način
18:26
places where everybody who is observing
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mjesta gdje svi koji promatraju
18:29
in the health care system
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u sustavu zdravstvene njege
18:31
can actually point out things that could be potential mistakes
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mogu zapravo izraziti stvari koje bi mogle biti potencijalne greške
18:34
and is rewarded for doing so,
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i nagrađeni su za to,
18:36
and especially people like me, when we do make mistakes,
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i pogotovo za ljude poput mene, kada napravimo greške,
18:38
we're rewarded for coming clean.
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nagrađeni smo što smo priznali.
18:42
My name is Brian Goldman.
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Moje ime je Brian Goldman.
18:45
I am a redefined physician.
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Redefinirani sam liječnik.
18:48
I'm human. I make mistakes.
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Čovjek sam. Griješim.
18:50
I'm sorry about that,
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Žao mi je zbog toga,
18:52
but I strive to learn one thing
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ali nastojim naučiti jednu stvar
18:54
that I can pass on to other people.
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koju mogu proslijediti drugim ljudima.
18:57
I still don't know what you think of me,
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Još uvijek ne znam što mislite o meni,
19:00
but I can live with that.
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ali mogu živjeti s tim.
19:02
And let me close with three words of my own:
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Dopustite mi da završim sa svoje tri riječi:
19:05
I do remember.
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"Da, sjećam se."
19:09
(Applause)
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(Pljesak)
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