TEDxToronto 2010
Brian Goldman: Doctors make mistakes. Can we talk about that?
Brian Goldman: Lekári robia chyby. Pohovoríme si o tom?
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Všetci lekári robia chyby. Podľa slov doktora Briana Goldmana však vypestované zvyklosti v medicíne založené na zapieraní (a pocite hanby) znemožňujú lekárom, aby o svojich pochybeniach hovorili, alebo aby im umožnili poučiť a zlepšiť sa. Príkladmi zo svojej dlhoročnej praxe apeluje na lekárov, aby prehovorili o tom, že aj oni sa vedia mýliť.
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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Myslím, že je potrebné niečo podniknúť
00:17
about a piece of the culture of medicine that has to change.
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v oblasti medicínskej praxe, ktorá si vyžaduje zmenu.
00:20
And I think it starts with one physician, and that's me.
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Stojím tu pre vami ako zdravotník, ktorý sa na to podujal.
00:23
And maybe I've been around long enough
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Snáď som v tejto branži dosť dlho na to,
00:25
that I can afford to give away some of my false prestige
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že si môžem dovoliť
00:27
to be able to do that.
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prísť o kus svojej falošnej prestíže.
00:29
Before I actually begin the meat of my talk,
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Prv než prejdem k veci,
00:31
let's begin with a bit of baseball.
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načriem z iného súdka...baseballového.
00:33
Hey, why not?
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Prečo nie?
00:35
We're near the end, we're getting close to the World Series.
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Sezóna je u konca, pred nami je čoskoro finálová Svetová séria.
00:38
We all love baseball, don't we?
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Baseball máme radi všetci, či nie?
00:41
(Laughter)
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(Smiech)
00:43
Baseball is filled with some amazing statistics.
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Baseball je plný fascinujúcich štatistík.
00:46
And there's hundreds of them.
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Sú ich celé stovky.
00:49
"Moneyball" is about to come out, and it's all about statistics
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Do kín prichádza film Moneyball, ktorý sa venuje
00:52
and using statistics to build a great baseball team.
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využitiu štatistík na vyskladanie skvelého baseballového družstva.
00:54
I'm going to focus on one stat
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Jedným štatistickým údajom,
00:57
that I hope a lot of you have heard of.
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ktorý asi veľa z vás pozná
00:59
It's called batting average.
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je priemerná úspešnosť odpalu.
01:01
So we talk about a 300, a batter who bats 300.
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Pri skóre 300 pálkar odpáli 300 nadhodov.
01:04
That means that ballplayer batted safely, hit safely
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Inak povedané, hráč bezpečne odpálil
01:08
three times out of 10 at bats.
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trikrát z 10 nadhodov.
01:11
That means hit the ball into the outfield,
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Znamená to, že odpálil loptičku do zadného poľa,
01:13
it dropped, it didn't get caught,
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spadla do poľa, nikto ju v lete nechytil,
01:15
and whoever tried to throw it to first base didn't get there in time
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a k prvej méte sa nedostala skôr než bežec - útočník,
01:18
and the runner was safe.
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ktorý si tým zaistil bezpečnú pozíciu.
01:20
Three times out of 10.
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Tri z desiatich.
01:23
Do you know what they call a 300 hitter
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Viete, ako hodnotia 300 bodového pálkara
01:26
in Major League Baseball?
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v Hlavnej baseballovej lige?
01:28
Good, really good,
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Ten je dobrý, vážne dobrý,
01:31
maybe an all-star.
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možno dokonca hráč hviezdneho výberu.
01:34
Do you know what they call
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Čo potom
01:36
a 400 baseball hitter?
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400-bodový pálkar?
01:38
That's somebody who hit, by the way,
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Len pre objasnenie, ide o pálkara,
01:40
four times safely out of every 10.
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ktorý bezpečne odpálil štyrikrát z 10 nadhodov.
01:42
Legendary --
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Ten je legendárny...
01:45
as in Ted Williams legendary --
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ako napríklad Ted Williams...
01:47
the last Major League Baseball player
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posledný hráč Hlavnej baseballovej ligy,
01:49
to hit over 400 during a regular season.
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ktorý odpálil 400 nadhodov v riadnej hracej sezóne.
01:52
Now let's take this back into my world of medicine
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Prenesme si to do sveta medicíny,
01:54
where I'm a lot more comfortable,
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kde sa cítim viac vo svojej koži.
01:56
or perhaps a bit less comfortable
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Teda až doposiaľ, kedže potom,
01:58
after what I'm going to talk to you about.
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čo vám dnes poviem sa to môže zmeniť.
02:01
Suppose you have appendicitis
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Dajme tomu, že máte zápal slepého čreva
02:03
and you're referred to a surgeon
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a odporučia vás k chirurgovi,
02:05
who's batting 400 on appendectomies.
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ktorý operuje slepé črevo so 400 bodovou úspešnosťou.
02:07
(Laughter)
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(Smiech)
02:10
Somehow this isn't working out, is it?
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Akosi to nepasuje, však?
02:13
Now suppose you live
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A čo ak žijete
02:15
in a certain part of a certain remote place
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niekde na odľahnom vidieku
02:18
and you have a loved one
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a niekto z vašich blízkych
02:20
who has blockages in two coronary arteries
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trpí nepriechodnosťou dvoch srdcových tepien?
02:23
and your family doctor refers that loved one to a cardiologist
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Váš praktický lekár ho odporučí ku kardiologičke,
02:26
who's batting 200 on angioplasties.
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ktorá v angioplastike odpaľuje na 200 bodovej úrovni.
02:30
But, but, you know what?
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Ale viete vy čo?
02:32
She's doing a lot better this year. She's on the comeback trail.
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Tento rok jej to ide omnoho lepšie. Je na vzostupe.
02:34
And she's hitting a 257.
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Teraz odpaľuje až na úrovni 257 bodov!
02:37
Somehow this isn't working.
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Táto analógia akosi nefunguje.
02:39
But I'm going to ask you a question.
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Chcem sa vás teraz niečo spýtať.
02:41
What do you think a batting average
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Aká by podľa vás mala byť priemerná úspešnosť odpalu
02:43
for a cardiac surgeon or a nurse practitioner
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u kardiochirurga alebo diplomovaného zdravotníka,
02:45
or an orthopedic surgeon,
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ortopedickej chirurgičky,
02:47
an OBGYN, a paramedic
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u pôrodníka
02:49
is supposed to be?
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či záchranárky?
02:52
1,000, very good.
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1 000, správne.
02:55
Now truth of the matter is,
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Pravdou však je, že
02:57
nobody knows in all of medicine
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nikto v medicínskom odbore nevie,
02:59
what a good surgeon
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akú priemernú úspešnosť by
03:01
or physician or paramedic
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lekár alebo záchranárka
03:03
is supposed to bat.
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mali mať.
03:05
What we do though is we send each one of them, including myself,
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Každého z nich však, mňa nevynímajúc,
03:07
out into the world
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posielame do sveta
03:09
with the admonition, be perfect.
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s požiadavkou, aby boli dokonalí.
03:11
Never ever, ever make a mistake,
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Ani nech Ti nenapadne, aby si pochybil,
03:13
but you worry about the details, about how that's going to happen.
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ale to, ako sa s tým vysporiadaš, je na Tvojich pleciach.
03:16
And that was the message that I absorbed
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Týmto odkazom som nasiakol,
03:18
when I was in med school.
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keď som študoval medicínu.
03:20
I was an obsessive compulsive student.
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Ako študent som bol obsesívne kompulzívny.
03:23
In high school, a classmate once said
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Na strednej škole jeden spolužiak o mne raz povedal,
03:26
that Brian Goldman would study for a blood test.
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že by som študoval aj na krvnú skúšku.
03:28
(Laughter)
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(Smiech)
03:31
And so I did.
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A aj som študoval.
03:33
And I studied in my little garret
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Študoval som v svojej malej mandzardke
03:35
at the nurses' residence at Toronto General Hospital,
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v komplexe pre stredný zdravotnícky personál v Torontskej všeobecnej nemocnici
03:37
not far from here.
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neďaleko odtiaľto.
03:39
And I memorized everything.
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A neustále som sa bifľoval.
03:41
I memorized in my anatomy class
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Na hodinách anatómie som sa učil naspamäť
03:43
the origins and exertions of every muscle,
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pôvod a námahu všetkých svalov,
03:45
every branch of every artery that came off the aorta,
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všetkých vetiev každej artérie, ktoré vystupuju z aorty,
03:48
differential diagnoses obscure and common.
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diferenciálne diagnózy, či už obskúrne alebo bežné.
03:51
I even knew the differential diagnosis
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Dokonca som poznal aj diferenciálnu diagnózu
03:53
in how to classify renal tubular acidosis.
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ako klasifikovať renálnu tubulárnu acidózu.
03:55
And all the while,
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Postupom času
03:57
I was amassing more and more knowledge.
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som zberal viac a viac vedomostí.
03:59
And I did well, I graduated with honors,
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A počínal som si veľmi dobre, vysokú školu som skončil
04:01
cum laude.
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s vyznamením.
04:03
And I came out of medical school
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Z lekárskej fakulty som vyšiel
04:06
with the impression
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v domnení,
04:08
that if I memorized everything and knew everything,
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že pokiaľ by som dokázal zapamäť si a vedieť všecičko,
04:10
or as much as possible,
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alebo aspoň toľko koľko je možné,
04:12
as close to everything as possible,
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tak blízko k dokonalosti ako sa dá,
04:14
that it would immunize me against making mistakes.
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že sa zaočkujem voči pochybeniu.
04:17
And it worked
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Chvíľu to dokonca
04:19
for a while,
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aj fungovalo.
04:22
until I met Mrs. Drucker.
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Až kým som nestretol pani Druckerovú.
04:25
I was a resident at a teaching hospital here in Toronto
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Pôsobil som ako asistujúci lekár
04:27
when Mrs. Drucker was brought to the emergency department
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v univerzitnej nemocnici tu v Toronte,
04:30
of the hospital where I was working.
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keď na pohotovosť doviezli pani Druckerovú.
04:32
At the time I was assigned to the cardiology service
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V tom čase som slúžil
04:34
on a cardiology rotation.
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na kardiológii.
04:36
And it was my job,
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Ak z pohotovosti
04:38
when the emergency staff called for a cardiology consult,
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zavolali so žiadosťou o kardiologické konziliárne vyšetrenie,
04:40
to see that patient in emerg.
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mal som pacienta vyšetriť a následne
04:43
and to report back to my attending.
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referovať svojmu nadriadenému sekundárnemu lekárovi.
04:45
And I saw Mrs. Drucker, and she was breathless.
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Pri vyšetrení bola pani Druckerová dýchavičná.
04:48
And when I listened to her, she was making a wheezy sound.
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Voľným uchom bolo u nej počuť sipot.
04:51
And when I listened to her chest with a stethoscope,
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Keď som ju popočúval stetoskopom,
04:53
I could hear crackly sounds on both sides
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na oboch stranách som počul praskavý zvuk,
04:55
that told me that she was in congestive heart failure.
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ktorý naznačoval, že išlo o kongestívne zlyhanie srdca.
04:58
This is a condition in which the heart fails,
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Je to stav, pri ktorom srdce zlyháva,
05:01
and instead of being able to pump all the blood forward,
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keďže nedokáže prečerpávať všetku krv smerom vpred,
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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namiesto čoho istý objem krvi zostáva v pľúcach, ktoré sa ňou postupne napĺňajú.
05:06
and that's why you have shortness of breath.
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Preto tá dýchavičnosť.
05:08
And that wasn't a difficult diagnosis to make.
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Nebolo obtiažne dopracovať sa k tejto diagnóze.
05:11
I made it and I set to work treating her.
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Čo sa aj stalo, a nasadil som liečbu.
05:14
I gave her aspirin. I gave her medications to relieve the strain on her heart.
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Podal som jej aspirín a lieky na zmiernenie záťaže na srdce.
05:17
I gave her medications that we call diuretics, water pills,
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Podal som jej diuretiká,
05:20
to get her to pee out the access fluid.
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a teda tablety na vymočenie nadbytočnej tekutiny.
05:23
And over the course of the next hour and a half or two,
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A počas ďalšej jeden a pol hodiny až dvoch hodín
05:25
she started to feel better.
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sa začala cítiť lepšie.
05:27
And I felt really good.
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A ja s ňou.
05:30
And that's when I made my first mistake;
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Vtedy som urobil prvú chybu -
05:33
I sent her home.
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poslal som ju domov.
05:35
Actually, I made two more mistakes.
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Vlastne som urobil hneď dve.
05:38
I sent her home
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Poslal som ju domov
05:40
without speaking to my attending.
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bez toho, aby som o nej referoval svojmu nadriadenému.
05:42
I didn't pick up the phone and do what I was supposed to do,
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Nezdvihol som telefón, aj keď som mal,
05:45
which was call my attending and run the story by him
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nezreferoval mu, a nedal mu šancu
05:47
so he would have a chance to see her for himself.
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aby ju mohol prezrieť aj on.
05:50
And he knew her,
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On ju dokonca poznal,
05:52
he would have been able to furnish additional information about her.
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a bol by vedel o nej ďalšie informácie.
05:55
Maybe I did it for a good reason.
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Možno som na to mal dobrý dôvod.
05:57
Maybe I didn't want to be a high-maintenance resident.
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Možno som mu nechcel byť na obtiaž.
06:00
Maybe I wanted to be so successful
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Možno som si chcel byť tak dobrý
06:02
and so able to take responsibility
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v preberaní zodpovednosti,
06:04
that I would do so
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že som to chcel dokázať
06:06
and I would be able to take care of my attending's patients
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starostlivosťou o pacientov svojho nadriadeného,
06:08
without even having to contact him.
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a to dokonca bez toho, aby som ho kontaktoval.
06:10
The second mistake that I made was worse.
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Druhá chyba, ktorej som sa dopustil, bola horšia.
06:14
In sending her home,
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Tým, že som ju poslal domov
06:16
I disregarded a little voice deep down inside
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nedbal som na svoj vnútorný hlas,
06:18
that was trying to tell me,
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ktorý sa ma snažil upozorniť slovami
06:20
"Goldman, not a good idea. Don't do this."
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„Goldman, to nie je dobrý nápad. Nerob to."
06:23
In fact, so lacking in confidence was I
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Neveril som si až natoľko,
06:26
that I actually asked the nurse
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že som sa dokonca opýtal sestry,
06:28
who was looking after Mrs. Drucker,
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ktorá sa o ňu starala:
06:30
"Do you think it's okay if she goes home?"
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„Myslíte, že bude v poriadku, ak pôjde domov?"
06:33
And the nurse thought about it
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Sestra sa zamyslela
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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a veľmi vecne odvetila, Hej, myslím, že bude v poriadku."
06:37
I can remember that like it was yesterday.
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Pamätám si to, akoby to bolo včera.
06:40
So I signed the discharge papers,
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A tak som podpísal prepúšťaciu správu,
06:42
and an ambulance came, paramedics came to take her home.
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došla sanitka a odviezla ju domov.
06:45
And I went back to my work on the wards.
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Ja som sa vrátil k práci na oddeleniach.
06:48
All the rest of that day,
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Po zvyšok dňa,
06:50
that afternoon,
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celé popoludnie,
06:52
I had this kind of gnawing feeling inside my stomach.
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mi žalúdok zvieral ťaživý pocit.
06:55
But I carried on with my work.
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Pokračoval som však v práci.
06:58
And at the end of the day, I packed up to leave the hospital
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Na konci dňa som sa zbalil a kráčal som z nemocnice
07:00
and walked to the parking lot
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k parkovisku,
07:02
to take my car and drive home
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kde som chcel nastúpiť do auta a odísť domov,
07:04
when I did something that I don't usually do.
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keď som zrazu urobil niečo, čo som zvyčajne nerobil.
07:08
I walked through the emergency department on my way home.
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Na ceste domov som sa prešiel cez pohotovosť.
07:11
And it was there that another nurse,
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Sestra, ktorá tam slúžila,
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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a nebola to sestra, ktorá sa starala o pani Druckerovú,
07:16
said three words to me
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mi položila otázku,
07:19
that are the three words
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presne tú otázku,
07:21
that most emergency physicians I know dread.
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ktorej sa väčšina pohotovostných lekárov desí.
07:24
Others in medicine dread them as well,
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Aj iní v medicíne pri nej tuhnú hrôzou,
07:26
but there's something particular about emergency medicine
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ale pri pohotovostnej medicíne má trochu inú váhu,
07:28
because we see patients so fleetingly.
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lebo tu sa stretávame s pacientmi len na kratučkú chvíľu.
07:32
The three words are:
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Tá otázka znie:
07:34
Do you remember?
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„Pamätáte si?"
07:38
"Do you remember that patient you sent home?"
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„Pamätáte si tú pacientku, ktorú ste poslali domov?,"
07:41
the other nurse asked matter-of-factly.
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spýtala sa táto sestra akoby mimochodom.
07:43
"Well she's back,"
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"Nuž, je späť,"
07:45
in just that tone of voice.
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presne týmto tónom hlasu.
07:47
Well she was back all right.
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Nielenže bola späť,
07:49
She was back and near death.
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ale bola tiež na pokraji smrti.
07:52
About an hour after she had arrived home,
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Asi po hodine na to, ako došla domov,
07:54
after I'd sent her home,
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po tom, čo som ju tam poslal,
07:56
she collapsed and her family called 911
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skolabovala a jej rodina zavolala záchranku,
07:59
and the paramedics brought her back to the emergency department
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ktorá ju dopravila späť na pohotovosť.
08:01
where she had a blood pressure of 50,
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Jej krvný tlak bol na 50-tke,
08:03
which is in severe shock.
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čo znamená, že bola vo vážnom šoku.
08:05
And she was barely breathing and she was blue.
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Ledva dýchala a bola namodralá.
08:08
And the emerg. staff pulled out all the stops.
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Pohotovostný personál urobil všetko, čo sa dalo.
08:11
They gave her medications to raise her blood pressure.
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Podali jej liečivá na zvýšenie krvného tlaku.
08:14
They put her on a ventilator.
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Dali ju na ventilátor.
08:16
And I was shocked
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Ja som zostal v šoku
08:19
and shaken to the core.
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a hlboko otrasený.
08:21
And I went through this roller coaster,
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Bol som citovo rozorvaný,
08:23
because after they stabilized her,
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kedže po tom ako ju stabilizovali,
08:25
she went to the intensive care unit,
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presunuli ju do jednotky intenzívnej starostlivosti
08:27
and I hoped against hope that she would recover.
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a ja som si nadovšetko prial, aby sa zotavila.
08:29
And over the next two or three days,
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O dva alebo tri dni
08:31
it was clear that she was never going to wake up.
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bolo zjavné, že sa už neprebudí.
08:33
She had irreversible brain damage.
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Mala totiž nezvratné poškodenie mozgu.
08:36
And the family gathered.
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Zišla sa jej rodina.
08:38
And over the course of the next eight or nine days,
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V priebehu osmi alebo deviatich dní
08:41
they resigned themselves to what was happening.
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sa zmierili s tým, čo sa deje.
08:43
And at about the nine day mark, they let her go --
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Zhruba na deviaty deň ju nechali v pokoji odísť.
08:46
Mrs. Drucker,
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Pani Druckerová,
08:48
a wife, a mother
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manželka, matka,
08:50
and a grandmother.
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a stará mama.
08:53
They say you never forget the names
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Vraví sa, že nikdy nezabudnete na mená tých,
08:55
of those who die.
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ktorí zomrú.
08:57
And that was my first time to be acquainted with that.
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Vtedy som to okúsil po prvý raz.
09:00
Over the next few weeks,
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Ďalších niekoľko týždňov
09:02
I beat myself up
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som sa obviňoval
09:05
and I experienced for the first time
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a po prvý raz okúsil
09:07
the unhealthy shame that exists
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škodlivý pocit hanby, ktorá pretrváva
09:09
in our culture of medicine --
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v našej medicínskej kultúre -
09:11
where I felt alone, isolated,
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cítil som sa tu osamotený a izolovaný.
09:14
not feeling the healthy kind of shame that you feel,
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Nebol to pocit zdravej hanby,
09:16
because you can't talk about it with your colleagues.
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o ktorej sa človek môže porozprávať s kolegami,
09:18
You know that healthy kind,
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tak ako keď vytárate tajomstvo,
09:20
when you betray a secret that a best friend made you promise never to reveal
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pri ktorom Vás najlepší priateľ zaprisahal, aby ste ho neprezradili
09:23
and then you get busted
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a vyjde to najavo.
09:25
and then your best friend confronts you
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Zídete sa zoči-voči,
09:27
and you have terrible discussions,
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prebehnú strašlivé debaty,
09:29
but at the end of it all that sick feeling guides you
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a na konci celej tejto peripetie Vás ten žieravý pocit privedie k tomu,
09:32
and you say, I'll never make that mistake again.
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že si poviete - „ Tak túto chybu už nikdy neurobím."
09:34
And you make amends and you never make that mistake again.
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Urobíte nápravu a danú chybu už nikdy nezopakujete.
09:37
That's the kind of shame that is a teacher.
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Tento druh pocitu hanby pôsobí v roli učiteľa.
09:40
The unhealthy shame I'm talking about
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Ja mám však namysli hanbu, ktorá
09:42
is the one that makes you so sick inside.
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Vás zviera vo vnútri.
09:45
It's the one that says,
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Tú hanbu, pri ktorej sa nepresvedčite o tom,
09:47
not that what you did was bad,
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že to, čo ste urobili, bolo zlé,
09:49
but that you are bad.
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ale že ste zlý Vy.
09:51
And it was what I was feeling.
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Presne tak som sa cítil.
09:54
And it wasn't because of my attending; he was a doll.
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Nebolo to mojím nadriadením, ten bol skvelý.
09:57
He talked to the family, and I'm quite sure that he smoothed things over
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Pohovoril si s dotknutou rodinou. Iste sa mu podarilo veci utriasť
10:00
and made sure that I didn't get sued.
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a ja sa vyhol žalobe.
10:03
And I kept asking myself these questions.
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Dokola som sa sám seba spytoval:
10:06
Why didn't I ask my attending? Why did I send her home?
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„Prečo som sa nespýtal svojho nadriadeného? Prečo som ju len poslal domov?"
10:09
And then at my worst moments:
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A v najhorších chvíľach dokonca:
10:11
Why did I make such a stupid mistake?
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„Prečo som urobil tak hlúpu chybu?"
10:14
Why did I go into medicine?
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„Prečo som sa dal na medicínu?"
10:16
Slowly but surely,
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Pomaly ale isto
10:18
it lifted.
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tento stav pominul.
10:20
I began to feel a bit better.
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Začal som sa cítiť lepšie.
10:22
And on a cloudy day,
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V deň, keď bolo nebo zamračené,
10:24
there was a crack in the clouds and the sun started to come out
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sa zrazu mraky pohli a keď ich preťal lúč slnka
10:26
and I wondered,
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a ja som si pripustil,
10:28
maybe I could feel better again.
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že sa možno opäť raz budem cítiť dobre.
10:30
And I made myself a bargain
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Urobil som dohodu sám so sebou.
10:33
that if only I redouble my efforts to be perfect
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Znásobím svoju snahu zdokonaliť sa
10:38
and never make another mistake again,
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a už nikdy neurobím žiadnu chybu.
10:40
please make the voices stop.
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Len nech tie vnútorné hlasy stíchnu.
10:42
And they did.
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A oni stíchli
10:44
And I went back to work.
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a ja som sa vrátil k práci.
10:46
And then it happened again.
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Lenže jedného dňa sa to stalo opäť.
10:49
Two years later I was an attending in the emergency department
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O dva roky neskôr som ako sekundárny lekár slúžil na pohotovosti
10:52
at a community hospital just north of Toronto,
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v komunitnej nemocnici severne od Toronta,
10:54
and I saw a 25 year-old man with a sore throat.
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kde som vyšetroval 25-ročného muža s bolesťami hrdla.
10:57
It was busy, I was in a bit of a hurry.
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Mal som nabitý deň a trochu som sa ponáhľal.
10:59
He kept pointing here.
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Stále mi ukazoval prstom sem.
11:01
I looked at his throat, it was a little bit pink.
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Prezrel som mu hrdlo. Bolo trochu naružovelé.
11:03
And I gave him a prescription for penicillin
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Dal som mu recept na penicilín
11:05
and sent him on his way.
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a vyprevadil som ho.
11:07
And even as he was walking out the door,
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Ešte aj keď kráčal k dverám
11:09
he was still sort of pointing to his throat.
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mimovoľne poukazoval na to hrdlo.
11:12
And two days later I came to do my next emergency shift,
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O dva dni na to som došiel do ďalšej pohovostnej zmeny,
11:15
and that's when my chief asked to speak to me quietly in her office.
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kedy si ma môja šéfka zavolala na rozhovor medzi štyrmi očami.
11:18
And she said the three words:
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Z jej úst zazneli opäť tie známe slová:
11:22
Do you remember?
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„Pamätáte sa?"
11:25
"Do you remember that patient you saw with the sore throat?"
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„Pamätáte sa na pacienta, ktorý k Vám prišiel s boľavým hrdlom?"
11:28
Well it turns out, he didn't have a strep throat.
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Ukázalo sa, že nemal streptokovovú angínu.
11:30
He had a potentially life-threatening condition
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Trpel na potenciálne smrteľné ochorenie
11:32
called epiglottitis.
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zvané epiglotitída.
11:34
You can Google it,
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Vygooglite si to ak chcete.
11:36
but it's an infection, not of the throat, but of the upper airway,
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Každopádne ide o infekciu horných dýchacích ciest, nie hrdla,
11:39
and it can actually cause the airway to close.
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ktorá môže spôsobiť uzáver dýchacej cesty.
11:42
And fortunately he didn't die.
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Našťastie nezomrel.
11:45
He was placed on intravenous antibiotics
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Nasadili mu infúzne antibiotiká
11:48
and he recovered after a few days.
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a v priebehu pár dní sa zotavil.
11:50
And I went through the same period of shame and recriminations
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Ja som si opäť prešiel obdobím plným hanby a sebaobviňovania,
11:54
and felt cleansed and went back to work,
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čo ma očistilo a vrátilo späť k práci.
11:58
until it happened again and again and again.
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Ale stalo sa to opäť a znovu..
12:03
Twice in one emergency shift, I missed appendicitis.
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Dvakrát v priebehu jednej zmeny som nezaregistroval apendicídu.
12:06
Now that takes some doing,
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To už je čo povedať,
12:09
especially when you work in a hospital
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najmä ak pracujete v nemocnici,
12:11
that at the time saw but 14 people a night.
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kde sme vtedy vyšetrili celkom 14 pacientov za noc.
12:14
Now in both cases, I didn't send them home
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Ani v jednom z týchto dvoch prípadov som ich neposlal domov
12:17
and I don't think there was any gap in their care.
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a nemyslím, že pri ich starostlivosti došlo k akémukoľvek zanedbaniu.
12:19
One I thought had a kidney stone.
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V prvom prípade som sa domnieval, že ide o obličkový kameň.
12:21
I ordered a kidney X-ray. When it turned out to be normal,
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Požiadal som o RTG. Keď sa vrátili výsledky a boli v norme,
12:23
my colleague who was doing a reassessment of the patient
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môj kolega, ktorý robil druhé vyšetrenie pacienta,
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
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si všimol niečo v pravom dolnom kvadrante a zavolal chirurgov.
12:29
The other one had a lot of diarrhea.
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V druhom prípade pacient trpel úpornou hnačkou
12:31
I ordered some fluids to rehydrate him
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a tak som nasadil tekutiny na rehydratáciu
12:34
and asked my colleague to reassess him.
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a požiadal som kolegu o druhé vyšetrenie.
12:37
And he did
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Keď ho robil,
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
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všimol si istú mieru citlivosti v pravom dolnom kvadrante a prizval k nemu chirurgov.
12:41
In both cases,
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V oboch prípadoch
12:43
they had their operations and they did okay.
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sa im dostalo operácie a boli v poriadku.
12:46
But each time,
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Ale v oboch prípadoch
12:48
they were gnawing at me, eating at me.
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ma tieto prípady gniavili, zožierali ma.
12:50
And I'd like to be able to say to you
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Najradšej by som vám povedal,
12:52
that my worst mistakes only happened in the first five years of practice
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že k mojim najvážnejším chybám došlo v prvých piatich rokoch praxe,
12:55
as many of my colleagues say, which is total B.S.
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podobne ako to tvrdia o sebe aj moji kolegovia, ale to je úplná sprosťosť.
12:58
(Laughter)
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(Smiech)
13:00
Some of my doozies have been in the last five years.
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K poniektorým z mojich prešľapov došlo v uplynulých piatich rokoch.
13:06
Alone, ashamed and unsupported.
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V osamotení, zahanbení a bez opory.
13:08
Here's the problem:
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V tom je koreň problému.
13:10
If I can't come clean
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Ak nemôžem vyjsť s pravdou von
13:12
and talk about my mistakes,
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a hovoriť o svojich omyloch,
13:16
if I can't find the still-small voice
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ak nemôžem nasledovať ten zatiaľ nerozvinutý vnútorný hlas,
13:18
that tells me what really happened,
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ktorý svedčí o tom, čo sa skutočne stalo,
13:20
how can I share it with my colleagues?
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ako potom môžem ísť za svojimi kolegami a podeliť sa s nimi o to?
13:22
How can I teach them about what I did
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Ako ich môžem poučiť o tom, čo som urobil ja,
13:25
so that they don't do the same thing?
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aby nevstúpili do tej istej rieky?
13:29
If I were to walk into a room --
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Ak by som práve vstúpil do miestnosti,
13:31
like right now, I have no idea what you think of me.
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práve v tej chvíli, vôbec netuším, čo by ste si o mne pomysleli.
13:34
When was the last time you heard somebody talk
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Kedy naposledy ste počuli hovoriť niekoho
13:36
about failure after failure after failure?
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o jednom zlyhaní za druhým?
13:38
Oh yeah, you go to a cocktail party
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Jasné, počujete o tom napríklad na večierku,
13:40
and you might hear about some other doctor,
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kde ktosi rozpráva historky o akomsi druhom lekárovi,
13:42
but you're not going to hear somebody
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ale určite nezačujete nikoho hovoriť
13:44
talking about their own mistakes.
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o svojich vlastných chybách.
13:46
If I were to walk into a room filled with my colleages
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Ak by som medzi svojími kolegami
13:49
and ask for their support right now
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začal vykladať to, o čom som práve rozprával vám,
13:51
and start to tell what I've just told you right now,
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dúfajúc, že ma pochopia,
13:53
I probably wouldn't get through two of those stories
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už pri druhom príbehu by sa
13:56
before they would start to get really uncomfortable,
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prestali cítiť vo svojej koži,
13:58
somebody would crack a joke,
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niekto by nadhodil vtip
14:00
they'd change the subject and we would move on.
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a prešlo by sa na inú tému.
14:05
And in fact, if I knew and my colleagues knew
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Vlastne, ak by sme s kolegami vedeli,
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
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že jeden náš kolega na ortopédii odoperoval nesprávnu nohu,
14:12
believe me, I'd have trouble
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verte mi, robilo by mi problém
14:14
making eye contact with that person.
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pozrieť sa mu do očí.
14:16
That's the system that we have.
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V takomto systéme žijeme.
14:18
It's a complete denial of mistakes.
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V úplnom popieraní omylov.
14:21
It's a system
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V systéme,
14:23
in which there are two kinds of physicians --
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ktorý sa delí na dva svety -
14:27
those who make mistakes
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na tých, ktorí chybujú
14:29
and those who don't,
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a na tých, ktorí sú neomylní;
14:31
those who can't handle sleep deprivation and those who can,
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na tých, ktorí zvládnu nedostatok spánku a tých, ktorí to nedokážu;
14:34
those who have lousy outcomes
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na tých, ktorí majú mizerné výsledky
14:36
and those who have great outcomes.
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a na tých, ktorých oslňujú.
14:39
And it's almost like an ideological reaction,
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Akoby išlo o ideologickú reakciu,
14:41
like the antibodies begin to attack that person.
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pri ktorej protilátky začnú takéhoto človeka napádať.
14:45
And we have this idea
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Trpíme tiež predstavou,
14:47
that if we drive the people who make mistakes
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že ak z lekárskej paxe vytlačíme ľudí
14:49
out of medicine,
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ktorí robia chyby,
14:51
what will we be left with, but a safe system.
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dopracujeme sa k bezpečnému systému.
14:55
But there are two problems with that.
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Tu vnimam dva základné problémy.
14:58
In my 20 years or so
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Za 20 rokov v
15:00
of medical broadcasting and journalism,
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lekárskej mediálnej oblasti,
15:03
I've made a personal study of medical malpractice and medical errors
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som skúmal fenomén zanedbania pochybeniav rámci lekárskej starostlivosti.
15:06
to learn everything I can,
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v rámci osobnej prípravy
15:08
from one of the first articles I wrote for the Toronto Star
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na základe článku, ktorý som napísal pre Toronto Star
15:10
to my show "White Coat, Black Art."
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pre reláciu pod názvom „Biely plášť, čierne umenie."
15:13
And what I've learned
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Zistil som,
15:15
is that errors are absolutely ubiquitous.
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že omyly sú všadeprítomné.
15:18
We work in a system
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Pracujeme v systéme,
15:20
where errors happen every day,
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kde k pochybeniam dochádza každý deň.
15:22
where one in 10 medications
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V 10 percentách prípadov je výber
15:24
are either the wrong medication given in hospital
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lieku alebo dávky v nemocnici
15:26
or at the wrong dosage,
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nesprávny.
15:28
where hospital-acquired infections are getting more and more numerous,
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Stále častejšie dochádza k prenosu infekciíí práve v nemocnici
15:31
causing havoc and death.
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a šíria skazu a smrť.
15:34
In this country,
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Podľa odhadov ročne
15:36
as many as 24,000 Canadians die
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zomrie na pochybenie, ktorému bolo možné predísť
15:38
of preventable medical errors.
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až 24 tisíc Kanaďanov.
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
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V USA, Inštitút Medicíny hovorí o čísle 100 tisíc.
15:44
In both cases, these are gross underestimates,
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V oboch prípadoch sú odhady hlboko podhodnotené,
15:47
because we really aren't ferreting out the problem
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pretože nejdeme dôsledne po koreni problému.
15:49
as we should.
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Ale mali by sme.
15:51
And here's the thing.
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Akoby toho nebolo dosť,
15:54
In a hospital system
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v systéme nemocničnej starostivosti,
15:57
where medical knowledge is doubling
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sa medicínske vedomosti znásobujú
15:59
every two or three years, we can't keep up with it.
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každé dva alebo tri roky, čo je nemysliteľné.
16:02
Sleep deprivation is absolutely pervasive.
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O nedostatku spánku ani nehovorím.
16:05
We can't get rid of it.
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Nevieme sa ho zbaviť.
16:07
We have our cognitive biases,
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Ďalej, každý z nás má sklon k predpojatosti.
16:09
so that I can take a perfect history on a patient with chest pain.
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ale urobiť anamnézu u pacienta s bolesťami na hrudi zvládnem dokonale.
16:12
Now take the same patient with chest pain,
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Ak by sme ale vzali obdobného pacienta s bolesťami na hrudi,
16:14
make them moist and garrulous
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ktorý by bol záreoveň spotený a utáraný
16:16
and put a little bit of alcohol on their breath,
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a mierne by ho bolo cítiť po alkohole,
16:18
and suddenly my history is laced with contempt.
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moja anamnéza by zrazu nasiakla pohŕdaním.
16:20
I don't take the same history.
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Anamnézy nerobím podľa šablóny.
16:22
I'm not a robot;
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Nie som robot;
16:24
I don't do things the same way each time.
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nerobím veci zakaždým rovnako.
16:26
And my patients aren't cars;
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Moji pacienti nie sú autá;
16:28
they don't tell me their symptoms in the same way each time.
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ani oni mi nehovoria o svojich symptómoch zakaždým rovnako.
16:31
Given all of that, mistakes are inevitable.
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Spočítané a zrátané, chybám sa nedá vyhnúť.
16:34
So if you take the system, as I was taught,
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Ak použijem logiku, ktorú ma naučili,
16:37
and weed out all the error-prone health professionals,
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a chystám sa odstrániť zo systému všetkých zdravotníkov so sklonom k pochybeniu,
16:41
well there won't be anybody left.
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nikto by v ňom potom nezostal.
16:46
And you know that business
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Poznáte to,
16:48
about people not wanting
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ako nikto nechce hovoriť
16:50
to talk about their worst cases?
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o svojich najhorších pochybeniach?
16:53
On my show, on "White Coat, Black Art,"
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Vo svojej relácii „Biely plášť, čierne umenie",
16:55
I made it a habit of saying, "Here's my worst mistake,"
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som si zaužíval hovoriť o najhoršej chybe svojej praxe.
16:57
I would say to everybody
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Počnúc záchranármi
16:59
from paramedics to the chief of cardiac surgery,
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až po primára kardiochirurgie, všetkým som povedal
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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"Najhoršou chybou,ktorú som kedy urobil bolo x, y,
17:04
"What about yours?" and I would point the microphone towards them.
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aká bola tá Vaša?" a posunul som pred nich mikrofón.
17:07
And their pupils would dilate,
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Zreničky sa mi rozšírili,
17:09
they would recoil,
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myklo nimi,
17:11
then they would look down and swallow hard
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oči spustili nadol, ťažko prehltli,
17:14
and start to tell me their stories.
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a začali rozprávať.
17:17
They want to tell their stories. They want to share their stories.
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Oni o tom chcú prehovoriť. Podeliť sa o to.
17:20
They want to be able to say,
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Radi by povedali,
17:22
"Look, don't make the same mistake I did."
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„Len prosím neurob rovnakú chybu, akú som urobil ja."
17:24
What they need is an environment to be able to do that.
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Potrebujú prostredie, ktoré im to umožní.
17:26
What they need is a redefined medical culture.
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Potrebujú medicínsku kultúru, ktorá sa predefinuje.
17:30
And it starts with one physician at a time.
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Tá vznikne jedným zdravotníkom po druhom.
17:33
The redefined physician is human,
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Predefinovaný zdravotník alebo zdravotníčka je len človek,
17:36
knows she's human,
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vie, že len človekom,
17:38
accepts it, isn't proud of making mistakes,
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prijíma tento fakt a nie je hrdá na svoje chyby,
17:40
but strives to learn one thing
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ale usiluje sa o to.
17:42
from what happened
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aby na základe toho, čo sa stalo,
17:44
that she can teach to somebody else.
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mohla naučiť niekoho iného, ako sa tomu vyvarovať.
17:46
She shares her experience with others.
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Delí sa o svoju skúsenosť s inými.
17:48
She's supportive when other people talk about their mistakes.
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Chápavo pristupuje k tým, ktorí hovoria o svojich chybách.
17:51
And she points out other people's mistakes,
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Upovedomí na chyby iných,
17:53
not in a gotcha way,
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bez zbytočného chytráctva,
17:55
but in a loving, supportive way
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láskavým, chápavým spôsobom,
17:58
so that everybody can benefit.
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tak aby mal z toho prospech každý.
18:00
And she works in a culture of medicine
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Funguje v kultúre medicíny,
18:02
that acknowledges
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ktorá priznáva skutočnosť,
18:04
that human beings run the system,
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že ho spravujú ľudské bytosti,
18:06
and when human beings run the system, they will make mistakes from time to time.
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a tak z času nas čas robia chyby.
18:09
So the system is evolving
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Aby sa systém vyvíjal
18:13
to create backups
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tvorbou zálohových mechanizmov,
18:17
that make it easier to detect those mistakes
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ktoré uľahčia registráciu chýb,
18:20
that humans inevitably make
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ktoré sa ľudia nezvratne vo svojej podstate dopúšťajú,
18:23
and also fosters in a loving, supportive way
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a závoreň láskavo a chápavo vytváral
18:26
places where everybody who is observing
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priestor na to, aby každý kto
18:29
in the health care system
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systém zdravotnej starostlivosti pozoruje
18:31
can actually point out things that could be potential mistakes
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mohol na potenciálne chyby nielen poukázať
18:34
and is rewarded for doing so,
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ale mohol byť za to aj ocenený.
18:36
and especially people like me, when we do make mistakes,
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A pre ľudí mne podobných by bolo obzvlášť podstatné, že ak pochybíme,
18:38
we're rewarded for coming clean.
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a chybu si priznáme, systém to bude vedieť oceniť.
18:42
My name is Brian Goldman.
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Volám sa Brian Goldman.
18:45
I am a redefined physician.
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Som predefinovaný zdravotník.
18:48
I'm human. I make mistakes.
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Som len človek. Robím chyby.
18:50
I'm sorry about that,
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Mrzí ma to,
18:52
but I strive to learn one thing
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ale usilujem sa,
18:54
that I can pass on to other people.
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aby som svoje ponaučenie odovzdal iným.
18:57
I still don't know what you think of me,
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Ani v tejto chvíli neviem, čo si o mne myslíte
19:00
but I can live with that.
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ale svet sa mi nezrúti.
19:02
And let me close with three words of my own:
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Dovoľte mi uzavrieť tromi vlastnými slovami:
19:05
I do remember.
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Áno, pamätám si.
19:09
(Applause)
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(Potlesk)
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