TEDxToronto 2010
Brian Goldman: Doctors make mistakes. Can we talk about that?
Brajan Goldman (Brian Goldman): Doktori greše. Možemo li da pričamo o tome?
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Svaki doktor greši, ali je lekar Brajan Godlman ubeđen da medicinska kultura koja promoviše poricanje (i sramotu) onemogućava lekare da pričaju o tim greškama kao i da ih koriste kako bi na tome učili i napredovali. Pripovedajući o događajima iz njegove dugogodišnje prakse, on poziva lekare da podele svoje greške sa svima.
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 je neophodno da promenimo
00:17
about a piece of the culture of medicine that has to change.
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jedan aspekt medicinske kulture.
00:20
And I think it starts with one physician, and that's me.
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Mislim da jedan lekar može da pokrene to, to sam ja.
00:23
And maybe I've been around long enough
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Mislim da sam već dovoljno dugo u tome
00:25
that I can afford to give away some of my false prestige
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da mogu da priuštim da se odreknem dela lažnog prestiža
00:27
to be able to do that.
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da bih to uradio.
00:29
Before I actually begin the meat of my talk,
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Pre nego što zadrem u suštinu mog predavanja,
00:31
let's begin with a bit of baseball.
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počeo bih sa pričom o bejzbolu.
00:33
Hey, why not?
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Ha, a što da ne?
00:35
We're near the end, we're getting close to the World Series.
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Sezona se uskoro završava, uskoro će i veliko finale.
00:38
We all love baseball, don't we?
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Svi volimo bejzbol, zar ne?
00:41
(Laughter)
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(smeh)
00:43
Baseball is filled with some amazing statistics.
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U bejzbolu nailazite na neverovatne statističke podatke.
00:46
And there's hundreds of them.
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Ima ih na hiljade.
00:49
"Moneyball" is about to come out, and it's all about statistics
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Uskoro će izaći i film "Moneyball", tu se radi o statistici,
00:52
and using statistics to build a great baseball team.
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upotreba statistike kako biste napravili odličan bejzbol tim.
00:54
I'm going to focus on one stat
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Fokusiraću se na jedan podatak,
00:57
that I hope a lot of you have heard of.
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a nadam se da ste svi čuli o tome.
00:59
It's called batting average.
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To nazivamo prosečan uspeh.
01:01
So we talk about a 300, a batter who bats 300.
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Ako pričamo o broju 300, o udaraču koji udara 300.
01:04
That means that ballplayer batted safely, hit safely
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To znači da je igrač sigurno udario loptu
01:08
three times out of 10 at bats.
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3 puta od 10 pokušaja.
01:11
That means hit the ball into the outfield,
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To znači da je plasirao loptu van terena,
01:13
it dropped, it didn't get caught,
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pala je, niko je nije uhvatio,
01:15
and whoever tried to throw it to first base didn't get there in time
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i ko god da je pokušao da dobaci loptu do prve baze nije to na vreme uradio
01:18
and the runner was safe.
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i trkač je osvojio bazu.
01:20
Three times out of 10.
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U 3 od 10 pokušaja.
01:23
Do you know what they call a 300 hitter
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Znate li kako zovu udarača koji ima prosek 300
01:26
in Major League Baseball?
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u glavnoj bejzbol ligi?
01:28
Good, really good,
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Dobar, veoma dobar,
01:31
maybe an all-star.
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možda super zvezda.
01:34
Do you know what they call
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Da li znate kako zovu onoga
01:36
a 400 baseball hitter?
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ko ima prosek udaraca 400?
01:38
That's somebody who hit, by the way,
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To je neko ko udari lopticu, uzgred budi rečeno,
01:40
four times safely out of every 10.
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4 puta u 10 pokušaja.
01:42
Legendary --
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Legendarni,
01:45
as in Ted Williams legendary --
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kao legendarni Ted Vilijams,
01:47
the last Major League Baseball player
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poslednji igrač glavne bejzbol lige
01:49
to hit over 400 during a regular season.
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koji je premašio prosek od 400 tokom redovne sezone.
01:52
Now let's take this back into my world of medicine
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Sada bih ove podatke preslikao u svet medicine,
01:54
where I'm a lot more comfortable,
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o tome mnogo više znam,
01:56
or perhaps a bit less comfortable
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a možda će mi biti manje prijatno
01:58
after what I'm going to talk to you about.
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kada vam ispričam ono što želim da kažem.
02:01
Suppose you have appendicitis
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Zamislite da imate upalu slepog creva
02:03
and you're referred to a surgeon
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i da su vas uputili na hirurga
02:05
who's batting 400 on appendectomies.
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čiji je prosek uspešnosti 400 u apendiktomijama.
02:07
(Laughter)
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(smeh)
02:10
Somehow this isn't working out, is it?
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Nekako ovo baš i ne funkcioniše, zar ne?
02:13
Now suppose you live
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Zamisilite sada da živite
02:15
in a certain part of a certain remote place
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u veoma udaljenom delu sveta,
02:18
and you have a loved one
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a vaša voljena osoba
02:20
who has blockages in two coronary arteries
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pati od zakrčenja dve koronarne arterije,
02:23
and your family doctor refers that loved one to a cardiologist
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a vaš porodični lekar preporuči vašoj voljenoj osobi kardiologa
02:26
who's batting 200 on angioplasties.
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čiji je prosek oko 200 u angioplastičnoj hirurgiji.
02:30
But, but, you know what?
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Ali, ali, znate šta?
02:32
She's doing a lot better this year. She's on the comeback trail.
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Mnogo je bolja ove godine. Vraća se u formu.
02:34
And she's hitting a 257.
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Tako da je njen prosek sada 257.
02:37
Somehow this isn't working.
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To nekako ne funkcioniše.
02:39
But I'm going to ask you a question.
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Pitaću vas sada nešto.
02:41
What do you think a batting average
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Šta vi mislite kolika treba da bude
02:43
for a cardiac surgeon or a nurse practitioner
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prosečna uspešnost kardiologa
02:45
or an orthopedic surgeon,
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ili medicinske sestre,
02:47
an OBGYN, a paramedic
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ortopeda, ginekologa,
02:49
is supposed to be?
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hitne službe?
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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Istina je da niko u svetu
02:57
nobody knows in all of medicine
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medicine ne zna
02:59
what a good surgeon
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koliki prosek treba da ima
03:01
or physician or paramedic
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dobar hirurg
03:03
is supposed to bat.
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ili lekar ili služba za spašavanje.
03:05
What we do though is we send each one of them, including myself,
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Ono što mi ustvari sistemski radimo lekarima, pa i meni,
03:07
out into the world
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mi im ugraviramo zahtev da budu perfektni
03:09
with the admonition, be perfect.
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u svom poslu.
03:11
Never ever, ever make a mistake,
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Nikada, nikada nemoj napraviti grešku,
03:13
but you worry about the details, about how that's going to happen.
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ali ti se brini o detaljima kako da to sprovedeš u delo.
03:16
And that was the message that I absorbed
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To je poruka koju sam poneo sa sobom
03:18
when I was in med school.
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sa studija medicine.
03:20
I was an obsessive compulsive student.
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Bio sam opsesivno kompulsivan student.
03:23
In high school, a classmate once said
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U srednjoj školi je moj drugar iz razreda
03:26
that Brian Goldman would study for a blood test.
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govorio kako Brajan Goldman uči za test analize krvi.
03:28
(Laughter)
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(smeh)
03:31
And so I did.
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I to je tačno.
03:33
And I studied in my little garret
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Učio sam u mom malom potkrovlju
03:35
at the nurses' residence at Toronto General Hospital,
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u rezidenciji za medicinske sestre Opšte bolnice u Torontu,
03:37
not far from here.
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nedaleko odavde.
03:39
And I memorized everything.
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Sve sam pamtio.
03:41
I memorized in my anatomy class
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Na časovima anatomije sam pamtio
03:43
the origins and exertions of every muscle,
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početak i kraj svakog mišića,
03:45
every branch of every artery that came off the aorta,
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granu svake arterije koja se račva od aorte,
03:48
differential diagnoses obscure and common.
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čudne i uobičajene diferencijalne dijagnoze.
03:51
I even knew the differential diagnosis
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Znao sam čak i diferencijalnu dijagnozu
03:53
in how to classify renal tubular acidosis.
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po kojoj se klasifikuju tipovi acidoze bubrežnih kanala.
03:55
And all the while,
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Sve to vreme,
03:57
I was amassing more and more knowledge.
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skladištio sam sve više i više znanja.
03:59
And I did well, I graduated with honors,
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Dobro mi je išlo, diplomirao sam sa posebnim pohvalama,
04:01
cum laude.
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sa desetkom.
04:03
And I came out of medical school
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Završio sam medicinski fakulet
04:06
with the impression
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i imao sam utisak
04:08
that if I memorized everything and knew everything,
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da ukoliko zapamtim sve i znam sve,
04:10
or as much as possible,
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ili barem što je moguće više,
04:12
as close to everything as possible,
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što bliže sveobuhvatnom znanju,
04:14
that it would immunize me against making mistakes.
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da će me to znanje osposobiti da ne pravim greške.
04:17
And it worked
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To je i bilo tako
04:19
for a while,
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neko vreme,
04:22
until I met Mrs. Drucker.
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dok nisam upoznao gospođu Druker.
04:25
I was a resident at a teaching hospital here in Toronto
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Bio sam na specijalizaciji u bolnici ovde u Torontu,
04:27
when Mrs. Drucker was brought to the emergency department
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kada su gospođu Druker doveli u urgentni centar
04:30
of the hospital where I was working.
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bolnice u kojoj sam radio.
04:32
At the time I was assigned to the cardiology service
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U tom periodu sam vršio dužnosti kardiologa,
04:34
on a cardiology rotation.
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bio sam na specijalizaciji iz kardiologije.
04:36
And it was my job,
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Moj zadatak je bio da pomognem
04:38
when the emergency staff called for a cardiology consult,
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u urgentnom centru kada im je potreban savet kardiologa,
04:40
to see that patient in emerg.
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da obiđem pacijenta u urgentnom centru,
04:43
and to report back to my attending.
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i da podnesem izveštaj svom nadređenom.
04:45
And I saw Mrs. Drucker, and she was breathless.
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Obišao sam g-đu Druker, bila je bez daha.
04:48
And when I listened to her, she was making a wheezy sound.
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Kada sam je oslušnuo, pravila je zviždukav zvuk.
04:51
And when I listened to her chest with a stethoscope,
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Kada sam joj poslušao pluća stetoskopom,
04:53
I could hear crackly sounds on both sides
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čuo sam razarajući zvuk sa obe strane
04:55
that told me that she was in congestive heart failure.
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što mi je ukazalo da je u pitanju srčani napad.
04:58
This is a condition in which the heart fails,
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U tom stanju srce prestane da radi,
05:01
and instead of being able to pump all the blood forward,
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i umesto da ispumpava krv u sistemski krvotok,
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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deo krvi se vraća u pluća koja se pune krvlju,
05:06
and that's why you have shortness of breath.
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i zato imate kratak udisaj.
05:08
And that wasn't a difficult diagnosis to make.
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To nije bilo teško dijganostifikovati.
05:11
I made it and I set to work treating her.
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Učinio sam to i počeo sa terapijom.
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 i lekove koji smanjuju pritisak u srcu.
05:17
I gave her medications that we call diuretics, water pills,
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Dao sam joj lekove koje nazivamo dijureticima, vodene pilule,
05:20
to get her to pee out the access fluid.
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kako bi ispiškila višak tečnosti.
05:23
And over the course of the next hour and a half or two,
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U toku narednih sat i po ili dva vremena,
05:25
she started to feel better.
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počela je da se oporavlja.
05:27
And I felt really good.
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Dobro sam se osećao.
05:30
And that's when I made my first mistake;
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Tada sam učinio prvu grešku:
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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U stvari, napravio sam još dve 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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a nisam razgovarao sa nadređenim lekarem.
05:42
I didn't pick up the phone and do what I was supposed to do,
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Nisam telefonirao i nisam uradio ono što je trebalo da uradim,
05:45
which was call my attending and run the story by him
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a to je da pozovem dežurnog i prepričam mu detalje
05:47
so he would have a chance to see her for himself.
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kako bi on bio u prilici da je i sam pregleda.
05:50
And he knew her,
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On ju je poznavao,
05:52
he would have been able to furnish additional information about her.
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bio bi u stanju da dođe do dodatnih informacija o njoj.
05:55
Maybe I did it for a good reason.
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Možda sam to uradio iz dobrog razloga.
05:57
Maybe I didn't want to be a high-maintenance resident.
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Možda nisam želeo da budem neko kome treba puno supervizije.
06:00
Maybe I wanted to be so successful
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Možda sam želeo da budem toliko uspešan
06:02
and so able to take responsibility
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i sposoban da preuzmem odgovornost,
06:04
that I would do so
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a da bih to uradio
06:06
and I would be able to take care of my attending's patients
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trebalo je da se postaram o pacijentima nadređenog,
06:08
without even having to contact him.
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a da ga uopšte ne kontaktiram.
06:10
The second mistake that I made was worse.
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Druga greška je bila još gora.
06:14
In sending her home,
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Kada sam je poslao kući,
06:16
I disregarded a little voice deep down inside
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zanemario sam glasić u sebi
06:18
that was trying to tell me,
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koji je pokušavao da mi kaže:
06:20
"Goldman, not a good idea. Don't do this."
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"Goldmane, to nije dobra ideja. Ne čini to."
06:23
In fact, so lacking in confidence was I
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Toliko sam bio nesiguran
06:26
that I actually asked the nurse
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da sam na kraju pitao sestru
06:28
who was looking after Mrs. Drucker,
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koja je pazila g-đu Druker:
06:30
"Do you think it's okay if she goes home?"
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"Da li je OK da je pustimo kući?"
06:33
And the nurse thought about it
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Sestra se zamislila,
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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a onda odlučno rekla: "Da, mislim da će biti okej."
06:37
I can remember that like it was yesterday.
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Sećam se toga kao da je juče bilo.
06:40
So I signed the discharge papers,
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Potpisao sam otpusnu listu,
06:42
and an ambulance came, paramedics came to take her home.
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došla su kola hitne pomoći i odvela je kući.
06:45
And I went back to my work on the wards.
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Vratio sam se svojim dužnostima.
06:48
All the rest of that day,
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Tokom celog dana,
06:50
that afternoon,
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tog popodeva,
06:52
I had this kind of gnawing feeling inside my stomach.
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sam osećao grčeve u stomaku.
06:55
But I carried on with my work.
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Ali sam nastavio sa poslom.
06:58
And at the end of the day, I packed up to leave the hospital
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Na kraju dana, spremio sam se da napustim bolnicu,
07:00
and walked to the parking lot
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i otišao sam do parkinga
07:02
to take my car and drive home
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kako bih se odvezao kući,
07:04
when I did something that I don't usually do.
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ali sam tada uradio nešto što inače ne radim.
07:08
I walked through the emergency department on my way home.
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Prošao sam kroz urgentni centar na svom putu ka kući.
07:11
And it was there that another nurse,
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Tamo mi je druga sestra,
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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ne ona sestra koja je negovala g-đu Druker, već druga sestra,
07:16
said three words to me
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rekla tri reči,
07:19
that are the three words
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to su tri reči kojih se
07:21
that most emergency physicians I know dread.
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svi lekari u uregentnom plaše.
07:24
Others in medicine dread them as well,
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Ostali medicinari ih se takođe plaše,
07:26
but there's something particular about emergency medicine
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ali urgentni centar karakteriše nešto posebno
07:28
because we see patients so fleetingly.
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jer sa pacijentima provodimo kratko vreme.
07:32
The three words are:
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Te tri reči su"
07:34
Do you remember?
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"Sećaš li se?"
07:38
"Do you remember that patient you sent home?"
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"Sećaš li se onog pacijenta kog si poslao kući?",
07:41
the other nurse asked matter-of-factly.
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ta druga sestra me je odvažno pitala.
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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baš tim tonom glasa.
07:47
Well she was back all right.
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Pa, ona se vratila, u redu.
07:49
She was back and near death.
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Ona se vratila i gotovo da je mrtva.
07:52
About an hour after she had arrived home,
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Sat vremena nakon što je stigla kući,
07:54
after I'd sent her home,
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nakon što sam je ja poslao kući
07:56
she collapsed and her family called 911
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ona je kolabirala i njena porodica je pozvala 94,
07:59
and the paramedics brought her back to the emergency department
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i ekipa paramedika ju je vratila u urgentni centar
08:01
where she had a blood pressure of 50,
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imala je krvni pritisak 50,
08:03
which is in severe shock.
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što znači da je u teškom šoku.
08:05
And she was barely breathing and she was blue.
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Jedva je disala i bila je plava.
08:08
And the emerg. staff pulled out all the stops.
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Osoblje iz urgentnog centra je uradilo sve što je moglo.
08:11
They gave her medications to raise her blood pressure.
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Dobila je lekove za povišenje krvnog pritiska.
08:14
They put her on a ventilator.
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Prikačili su je na veštačka pluća.
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 potpuno potresen.
08:21
And I went through this roller coaster,
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Sve se u mojoj glavi vrtelo,
08:23
because after they stabilized her,
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kada su stabilizovali njeno stanje
08:25
she went to the intensive care unit,
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poslali su je na intezivnu negu,
08:27
and I hoped against hope that she would recover.
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i suludo sam se nadao da će se oporaviti.
08:29
And over the next two or three days,
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Nakon dva, tri dana
08:31
it was clear that she was never going to wake up.
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bilo je jasno da se nikada neće probuditi.
08:33
She had irreversible brain damage.
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Došlo je do nepovratnog oštećenja mozga.
08:36
And the family gathered.
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Porodica se okupila.
08:38
And over the course of the next eight or nine days,
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U narednih osam ili devet dana
08:41
they resigned themselves to what was happening.
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su prihvatili neminovnost koja je pred njima.
08:43
And at about the nine day mark, they let her go --
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Devetog dana su se oprostili od nje,
08:46
Mrs. Drucker,
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g-đa Druker,
08:48
a wife, a mother
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žena, majka
08:50
and a grandmother.
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i baka.
08:53
They say you never forget the names
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Kažu da se imena onih koji umru
08:55
of those who die.
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nikada ne zaborave.
08:57
And that was my first time to be acquainted with that.
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A tada sam se ja prvi put suočio sa tim.
09:00
Over the next few weeks,
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U toku narednih nekoliko nedelja
09:02
I beat myself up
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sam mučio samog sebe,
09:05
and I experienced for the first time
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i po prvi put doživeo
09:07
the unhealthy shame that exists
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tu nezdravu sramotu koja
09:09
in our culture of medicine --
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karakteriše kulturu medicine.
09:11
where I felt alone, isolated,
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Osećao sam se usamljeno, izolovano,
09:14
not feeling the healthy kind of shame that you feel,
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nisam doživljavao kao vi zdravu sramotu,
09:16
because you can't talk about it with your colleagues.
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jer nisam mogao da pričam o tome sa kolegama.
09:18
You know that healthy kind,
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Znate onaj zdrav tip sramote,
09:20
when you betray a secret that a best friend made you promise never to reveal
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otkriješ tajnu za koju si najboljem prijatelju obećao da je nikome nećeš reći,
09:23
and then you get busted
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a onda budeš provaljen,
09:25
and then your best friend confronts you
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pa te tvoj najbolji prijatelj suoči sa tim
09:27
and you have terrible discussions,
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i obavite žučnu diskusiju,
09:29
but at the end of it all that sick feeling guides you
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ali na kraju svega toga taj nezdrav osećaj te usmerava
09:32
and you say, I'll never make that mistake again.
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i kažeš kako nikada nećeš ponoviti tu grešku.
09:34
And you make amends and you never make that mistake again.
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Iskupiš se i nikada ne ponoviš tu grešku.
09:37
That's the kind of shame that is a teacher.
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Ovakav vid sramote je učitelj.
09:40
The unhealthy shame I'm talking about
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Nezdrav osećaj sramote o kom pričam
09:42
is the one that makes you so sick inside.
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je onaj tip koji te čini bolesnim iznutra.
09:45
It's the one that says,
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Taj tip prosto kaže
09:47
not that what you did was bad,
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ne da je loše to što si uradio,
09:49
but that you are bad.
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već da si ti sam loš.
09:51
And it was what I was feeling.
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Upravo sam to osećao.
09:54
And it wasn't because of my attending; he was a doll.
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To nije uzrokovao moj mentor, on je bio odličan.
09:57
He talked to the family, and I'm quite sure that he smoothed things over
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Razgovarao je sa familijom i siguran sam da je izgladio stvari
10:00
and made sure that I didn't get sued.
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i pobrinuo se da me ne sude.
10:03
And I kept asking myself these questions.
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Ponavljao sam sebi ova pitanja.
10:06
Why didn't I ask my attending? Why did I send her home?
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Zašto nisam pitao ništa svog mentora? Zašto sam je otpustio?
10:09
And then at my worst moments:
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A u najgorim momentima:
10:11
Why did I make such a stupid mistake?
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Zašto sam napravio tako glupavu grešku?
10:14
Why did I go into medicine?
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Zašto sam studirao medicinu?
10:16
Slowly but surely,
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Polako, ali sigurno
10:18
it lifted.
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osećaj je nestao.
10:20
I began to feel a bit better.
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Osećao sam se bolje.
10:22
And on a cloudy day,
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Jednog oblačnog dana
10:24
there was a crack in the clouds and the sun started to come out
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je sunce počelo da se pomalja između oblaka
10:26
and I wondered,
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i ja sam se pitao
10:28
maybe I could feel better again.
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da li ću se osećati bolje ponovo.
10:30
And I made myself a bargain
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Napravio sam dogovor da ako
10:33
that if only I redouble my efforts to be perfect
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udvostručim svoje napore da dosegnem savršenstvo
10:38
and never make another mistake again,
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i nikada ne napravim novu grešku,
10:40
please make the voices stop.
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ti glasovi nestanu.
10:42
And they did.
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Nestali su.
10:44
And I went back to work.
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Vratio sam se poslu.
10:46
And then it happened again.
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A onda se ponovo desilo.
10:49
Two years later I was an attending in the emergency department
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Dve godine kasnije bio sam dežurni u urgentnom centru,
10:52
at a community hospital just north of Toronto,
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u državnoj bolnici severno od Toronta,
10:54
and I saw a 25 year-old man with a sore throat.
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i pregledao sam 25-ogodišnjaka sa upaljenim grlom.
10:57
It was busy, I was in a bit of a hurry.
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Bila je gužva, ja sam bio u žurbi.
10:59
He kept pointing here.
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Non-stop je pokazivao ovde.
11:01
I looked at his throat, it was a little bit pink.
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Pogledao sam mu grlo, bilo je ružičasto.
11:03
And I gave him a prescription for penicillin
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Prepisao sam mu penicilin,
11:05
and sent him on his way.
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i poslao ga kući.
11:07
And even as he was walking out the door,
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Čak i dok je izlazio kroz vrata,
11:09
he was still sort of pointing to his throat.
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pokazivao je ka svom grlu.
11:12
And two days later I came to do my next emergency shift,
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Nakon dva dana, došao sam da odradim novu smenu na urgentnom,
11:15
and that's when my chief asked to speak to me quietly in her office.
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i tada me je šefica pozvala da porazgovaramo u kancelariji.
11:18
And she said the three words:
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Izgovorili je tri reči:
11:22
Do you remember?
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Sećaš li se?
11:25
"Do you remember that patient you saw with the sore throat?"
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"Sećaš li se tog pacijenta koji boluje od upale grla?"
11:28
Well it turns out, he didn't have a strep throat.
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Pa, ispostavilo se da nije patio od upale grla.
11:30
He had a potentially life-threatening condition
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Bolovao je od veoma ozbiljnog problema
11:32
called epiglottitis.
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koji nazivamo epiglotitis.
11:34
You can Google it,
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Možete proveriti na Guglu,
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 disajnih puteva,
11:39
and it can actually cause the airway to close.
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i može dovesti do zatvaranja disajnih 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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Nakon intravenozne terapije antibioticima,
11:48
and he recovered after a few days.
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oporavio se nakon dva dana.
11:50
And I went through the same period of shame and recriminations
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Prošao sam kroz isti period osećaja srama, osude,
11:54
and felt cleansed and went back to work,
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onda sam se pročistio i vratio poslu,
11:58
until it happened again and again and again.
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i ponovilo se opet, i opet, i opet.
12:03
Twice in one emergency shift, I missed appendicitis.
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Dva puta sam u jednoj smeni promašio upalu slepog creva.
12:06
Now that takes some doing,
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E pa, to nije lako uraditi,
12:09
especially when you work in a hospital
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a naročito kada radite u bolnici koja
12:11
that at the time saw but 14 people a night.
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je tada primala četrnaest ljudi u noćnoj smeni.
12:14
Now in both cases, I didn't send them home
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Nisam poslao ljude kući u oba slučaja,
12:17
and I don't think there was any gap in their care.
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i smatram da nije došlo do propusta u lečenju.
12:19
One I thought had a kidney stone.
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U prvom slučaju sam pomislio da je u pitanju kamen u bubregu.
12:21
I ordered a kidney X-ray. When it turned out to be normal,
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Snimili smo mu bubrege. Ničega čudnog nije bilo,
12:23
my colleague who was doing a reassessment of the patient
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moj kolega koji je nakon toga pregledao pacijenta
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
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je osetio meko tkivo u donjem desnom delu abdomena i pozvao je hirurge.
12:29
The other one had a lot of diarrhea.
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Drugi je patio od dijareje.
12:31
I ordered some fluids to rehydrate him
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Pokušao sam da ga rehidriram,
12:34
and asked my colleague to reassess him.
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i zamolio kolegu da ga i on pregleda.
12:37
And he did
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Kada je osetio
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
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meko tkivo u donjem desnom delu adbomena, pozvao je hirurge.
12:41
In both cases,
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U oba slučaja,
12:43
they had their operations and they did okay.
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pacijenti su operisni i sve je prošlo dobro.
12:46
But each time,
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Ali svaki put bi me
12:48
they were gnawing at me, eating at me.
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oni proždirali, izjedali.
12:50
And I'd like to be able to say to you
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Voleo bih da mogu da vam kažem
12:52
that my worst mistakes only happened in the first five years of practice
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kako sam najgore greške napravio u toku prvih pet godina rada
12:55
as many of my colleagues say, which is total B.S.
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kao što to kažu mnoge moje kolege, a to je potpuna laž.
12:58
(Laughter)
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(smeh)
13:00
Some of my doozies have been in the last five years.
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Neki od mojih bisera su se desili u poslednjih pet godina.
13:06
Alone, ashamed and unsupported.
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Usamljen, osramoćen i bez podrške.
13:08
Here's the problem:
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U ovome je problem:
13:10
If I can't come clean
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Ukoliko ne mogu otvoreno
13:12
and talk about my mistakes,
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da pričam o svojim greškama,
13:16
if I can't find the still-small voice
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ukoliko ne mogu da čujem glas razuma
13:18
that tells me what really happened,
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koji mi govori šta se zaista desilo,
13:20
how can I share it with my colleagues?
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kako onda mogu to da podelim sa kolegama?
13:22
How can I teach them about what I did
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Kako mogu da im prenesem to znanje
13:25
so that they don't do the same thing?
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kako oni ne bi napravili istu grešku?
13:29
If I were to walk into a room --
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Kada bih ušetao u sobu,
13:31
like right now, I have no idea what you think of me.
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kao sada, ja nemam predstavu šta mislite o meni.
13:34
When was the last time you heard somebody talk
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Kada ste poslednji put slušali nekog ko priča
13:36
about failure after failure after failure?
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o neuspehu, za neuspehom, za neuspehom?
13:38
Oh yeah, you go to a cocktail party
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A da, odete na koktel prijem
13:40
and you might hear about some other doctor,
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verovatno biste čuli o nekom drugom lekaru,
13:42
but you're not going to hear somebody
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ali nećete čuti nikoga
13:44
talking about their own mistakes.
329
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ko priča o sopstvenim greškama.
13:46
If I were to walk into a room filled with my colleages
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Ukoliko bih ušetao u sobu gde su moje kolege,
13:49
and ask for their support right now
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i zamolio ih baš sada za podršku
13:51
and start to tell what I've just told you right now,
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i kada bih im ispričao ovo što sam vama upravo rekao,
13:53
I probably wouldn't get through two of those stories
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verovatno bi počeli da se osećaju nelagodno
13:56
before they would start to get really uncomfortable,
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pre završetka druge priče
13:58
somebody would crack a joke,
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neko bi se našalio,
14:00
they'd change the subject and we would move on.
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promenili bi temu i nastavili.
14:05
And in fact, if I knew and my colleagues knew
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Ukoliko bih znao i ukoliko bi moje kolege znale
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
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da je jedan od mojih kolega ortopeda uklonio pogrešnu nogu u bolnici,
14:12
believe me, I'd have trouble
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verujte mi, bilo bi mi teško
14:14
making eye contact with that person.
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da uspostavim kontakt sa tom osobom.
14:16
That's the system that we have.
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To je naš sistem.
14:18
It's a complete denial of mistakes.
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Potpuno nepriznavanje grešaka.
14:21
It's a system
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To je sistem
14:23
in which there are two kinds of physicians --
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koji priznaje dva tipa doktora:
14:27
those who make mistakes
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oni koji prave greške
14:29
and those who don't,
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i oni koji ne prave,
14:31
those who can't handle sleep deprivation and those who can,
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oni koji ne mogu da podnesu nespavanje i oni koji mogu,
14:34
those who have lousy outcomes
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oni koji imaju loše rezultate
14:36
and those who have great outcomes.
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i oni koji imaju odlične.
14:39
And it's almost like an ideological reaction,
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To je skoro kao ideološka reakcija,
14:41
like the antibodies begin to attack that person.
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kao da antitela počnu da napadaju tu osobu.
14:45
And we have this idea
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Nosimo se idejom
14:47
that if we drive the people who make mistakes
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da ukoliko bismo izbacili ljude koji čine greške
14:49
out of medicine,
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iz medicine,
14:51
what will we be left with, but a safe system.
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dobili bismo siguran sistem.
14:55
But there are two problems with that.
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Ali susrećemo se tu sa dva problema.
14:58
In my 20 years or so
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Izveo sam studiju o greškama u medicini i lošoj praksi
15:00
of medical broadcasting and journalism,
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koja obuhvata moj dvadesetogodišnji rad
15:03
I've made a personal study of medical malpractice and medical errors
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izučavanja loše prakse i medicinskog žurnalizma,
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 prvog članka koji sam napisao za "Toronto Star"
15:10
to my show "White Coat, Black Art."
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do moje emisije "Beli mantil, crna umetnost".
15:13
And what I've learned
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Shvatio sam da su
15:15
is that errors are absolutely ubiquitous.
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greške široko rasprostranjene.
15:18
We work in a system
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Radimo u sistemu gde
15:20
where errors happen every day,
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se greške dešavaju svakog dana,
15:22
where one in 10 medications
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u kom je jedan od 10 prepisanih lekova
15:24
are either the wrong medication given in hospital
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ili pogrešan lek
15:26
or at the wrong dosage,
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ili je primenjen u pogrešnoj dozi,
15:28
where hospital-acquired infections are getting more and more numerous,
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u sistemu gde su sve češće dešavaju zaraze u bolnicama,
15:31
causing havoc and death.
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i dovode do opšte propasti i smrti.
15:34
In this country,
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U ovoj zemlji umre
15:36
as many as 24,000 Canadians die
373
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24.000 Kanađana usled grešaka medicinara
15:38
of preventable medical errors.
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koje se mogu sprečiti.
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
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U Sjedinjenim Državama je Institut za medicinu procenio taj broj na 100.000.
15:44
In both cases, these are gross underestimates,
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U oba slučaju su to podcenjene procene,
15:47
because we really aren't ferreting out the problem
377
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obzirom da se ne bavimo problemom onako
15:49
as we should.
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kako bi trebalo.
15:51
And here's the thing.
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U ovome je stvar.
15:54
In a hospital system
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U bolničkom sistemu u kom
15:57
where medical knowledge is doubling
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se znanja iz medicine udvostručavaju
15:59
every two or three years, we can't keep up with it.
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svake dve ili tri godine, ne možemo sve da znamo.
16:02
Sleep deprivation is absolutely pervasive.
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Nedostatak sna je sveprisutan.
16:05
We can't get rid of it.
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Ne možemo ga se otarasiti.
16:07
We have our cognitive biases,
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Zatim pravimo greške u rasuđivanju,
16:09
so that I can take a perfect history on a patient with chest pain.
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da bih došao do odlične medicinske istorije pacijenta koji oseća bol u grudima.
16:12
Now take the same patient with chest pain,
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Ukoliko biste pregledali istog pacijenta,
16:14
make them moist and garrulous
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a da je sada mokar i pričljiv,
16:16
and put a little bit of alcohol on their breath,
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i oseća se na alkohol,
16:18
and suddenly my history is laced with contempt.
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tada bi istorija bolesti bila povezana sa predrasudom.
16:20
I don't take the same history.
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Ne dođem do iste istorije bolesti,
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 ponavljam svaki put stvari na isti način.
16:26
And my patients aren't cars;
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Moji pacijenti nisu kola,
16:28
they don't tell me their symptoms in the same way each time.
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ne izlažu mi svoje simptome na isti način svaki put.
16:31
Given all of that, mistakes are inevitable.
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Uzimajući sve to u obzir, greške su neizbežne.
16:34
So if you take the system, as I was taught,
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Ukoliko prihvatite sistem na način koji je meni predstavljen
16:37
and weed out all the error-prone health professionals,
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i uklonite sve medicinare koji prave greške,
16:41
well there won't be anybody left.
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pa niko u njemu ne bi ostao.
16:46
And you know that business
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Znate čitavu tu ujdurmu
16:48
about people not wanting
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o tome kako ljudi ne žele
16:50
to talk about their worst cases?
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da pričaju o svojim najgorim slučajevima?
16:53
On my show, on "White Coat, Black Art,"
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U svojoj emisiji "Beli mantil, crna umetnost",
16:55
I made it a habit of saying, "Here's my worst mistake,"
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imam običaj da kažem: "Ovo je moja najgora greška",
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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ljudima iz hitne službe i šefu kardiologije:
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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"Ovo je moja najveća greška", bla,bla,bla.
17:04
"What about yours?" and I would point the microphone towards them.
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"A koja je tvoja?", usmerio bi mikrofon ka njima.
17:07
And their pupils would dilate,
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Zenice bi im se raširile,
17:09
they would recoil,
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trgli bi se,
17:11
then they would look down and swallow hard
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a potom bi spustili pogled, zagrcnuli bi se
17:14
and start to tell me their stories.
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i počeli bi da pričaju svoje priče.
17:17
They want to tell their stories. They want to share their stories.
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Oni žele da ispričaju svoje priče. Oni to žele.
17:20
They want to be able to say,
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Žele priliku da kažu:
17:22
"Look, don't make the same mistake I did."
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"Slušaj, ne ponavljaj moju grešku."
17:24
What they need is an environment to be able to do that.
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Neophodna im je sredina koja bi to omogućila.
17:26
What they need is a redefined medical culture.
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Neophodna im je promena u kulturi medicine.
17:30
And it starts with one physician at a time.
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To počinje sa jednim lekarom.
17:33
The redefined physician is human,
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Novodefinisani lekar je ljudsko biće,
17:36
knows she's human,
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zna da je ljudsko biće,
17:38
accepts it, isn't proud of making mistakes,
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prihvata to, ne ponosi se greškama,
17:40
but strives to learn one thing
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ali se trudi da nauči nešto
17:42
from what happened
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iz onoga što se desilo
17:44
that she can teach to somebody else.
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i poduči kolegu.
17:46
She shares her experience with others.
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Ona deli svoje iskustvo sa drugima.
17:48
She's supportive when other people talk about their mistakes.
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Pruža podršku ljudima koji pričaju o svojim greškama.
17:51
And she points out other people's mistakes,
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Ukazuje na greške drugih ljudi,
17:53
not in a gotcha way,
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ne u pogrdnom smislu,
17:55
but in a loving, supportive way
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već sa puno ljubavi i poštovanja,
17:58
so that everybody can benefit.
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kako bi svi imali koristi od toga.
18:00
And she works in a culture of medicine
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Radi u takvoj kulturi
18:02
that acknowledges
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koja prihvata činjenicu
18:04
that human beings run the system,
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da su ljudi zaposleni u tom sistemu,
18:06
and when human beings run the system, they will make mistakes from time to time.
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i kada je takav slučaj, s vremena na vreme će se dešavati greške.
18:09
So the system is evolving
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Sistem evoluira na način
18:13
to create backups
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da stvara podršku
18:17
that make it easier to detect those mistakes
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koja omogućava lakše uočavanje tih grešaka
18:20
that humans inevitably make
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koje ljudi bespogovorno čine,
18:23
and also fosters in a loving, supportive way
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i takođe razvija na način pun ljubavi i podrške
18:26
places where everybody who is observing
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mesta gde svako ko se bavi analizom
18:29
in the health care system
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sistema zdravstva
18:31
can actually point out things that could be potential mistakes
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može da dođe i ukaže na moguće greške i
18:34
and is rewarded for doing so,
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biva nagrađen za to,
18:36
and especially people like me, when we do make mistakes,
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a naročito kada ljudi kao ja prave greške,
18:38
we're rewarded for coming clean.
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mi treba da dobijemo nagradu kada ih priznamo.
18:42
My name is Brian Goldman.
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Zovem se Brajan Goldman.
18:45
I am a redefined physician.
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Ja sam nova vrsta lekara.
18:48
I'm human. I make mistakes.
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Ja sam ljudsko biće. Grešim.
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 trudim se da naučim nešto
18:54
that I can pass on to other people.
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što mogu da prenesem drugim ljudima.
18:57
I still don't know what you think of me,
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Ja i dalje ne znam šta mislite o meni,
19:00
but I can live with that.
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ali mogu da živim sa tim.
19:02
And let me close with three words of my own:
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Zaključio bih sa svoje tri reči:
19:05
I do remember.
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Da, sećam se.
19:09
(Applause)
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(aplauz)
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