TED2012
Atul Gawande: How do we heal medicine?
阿图尔-葛王德：拿什么拯救你，我们的医疗？
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我们的医疗系统破败不堪。医生们开出昂贵无比的诊断书和处方，但他们却忽视了核心问题：真真切切地治疗患者。医生、作家阿图尔-葛王德建议我们退一步思考，换一个角度看待医疗行业——摈弃个人主义，建立团队合作
Atul Gawande - Surgeon, writer, public health innovator
Surgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching. Full bio
Surgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching. Full bio
Double-click the English transcript below to play the video.
00:15
I got my start
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我的职业生涯
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in writing and research
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从写作、研究开始
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as a surgical trainee,
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当时还是个外科实习医生
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as someone who was a long ways away
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像很多人一样，需要经历漫漫长路
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from becoming any kind of an expert at anything.
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才能成为某个领域的专家
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So the natural question you ask then at that point
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因而，在当时那个阶段你自然要问
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is, how do I get good at what I'm trying to do?
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我该如何做好自己所尝试做的这一领域？
00:33
And it became a question of,
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这个问题会演变成
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how do we all get good
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我们怎样才能做好
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at what we're trying to do?
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我们正在努力做的这件事？
00:40
It's hard enough to learn to get the skills,
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要掌握技术着实不易
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try to learn all the material you have to absorb
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需要对所学内容都吸收消化
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at any task you're taking on.
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无论做什么
00:49
I had to think about how I sew and how I cut,
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就拿我来说，我必须学会如何缝合、如何开刀
00:52
but then also how I pick the right person
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还得知道如何选择对的人
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to come to an operating room.
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进入手术室
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And then in the midst of all this
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在以上思考过程中
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came this new context
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还隐藏这一个问题
01:00
for thinking about what it meant to be good.
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那就是：究竟什么才是造福于人？
01:02
In the last few years
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在过去几年中
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we realized we were in the deepest crisis
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我们意识到自己深陷
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of medicine's existence
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医学危机
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due to something you don't normally think about
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原因在于有些事情
01:11
when you're a doctor
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作为医生很难考虑到
01:13
concerned with how you do good for people,
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关于如何造福于人
01:16
which is the cost
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例如，医疗卫生的
01:18
of health care.
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成本问题
01:20
There's not a country in the world
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世界上没有一个国家
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that now is not asking
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不在问
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whether we can afford what doctors do.
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自己是否能支付医疗行为的代价
01:28
The political fight that we've developed
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这也引发了政治上的争论
01:31
has become one around
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争论焦点围绕着
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whether it's the government that's the problem
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究竟是政府
01:36
or is it insurance companies that are the problem.
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还是保险公司才是罪魁祸首
01:41
And the answer is yes and no;
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答案既“是”，也“否”
01:45
it's deeper than all of that.
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还有更深层次的回答
01:47
The cause of our troubles
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造成麻烦的根源
01:49
is actually the complexity that science has given us.
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其实是科学带来的复杂性
01:52
And in order to understand this,
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为了让大家更好地理解这个观点
01:54
I'm going to take you back a couple of generations.
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让我带大家回顾几代人之前的情况
01:58
I want to take you back
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我想带大家回到
02:00
to a time when Lewis Thomas was writing in his book, "The Youngest Science."
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刘易斯-托马斯写下《最年轻的科学》的那个时代
02:03
Lewis Thomas was a physician-writer,
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刘易斯-托马斯是一位医生兼作家
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one of my favorite writers.
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也是我最喜爱的作家之一
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And he wrote this book to explain, among other things,
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他在书中描述了
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what it was like to be a medical intern
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作一名实习医生的生活
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at the Boston City Hospital
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在当时的波士顿市立医院
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in the pre-penicillin year
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在盘尼西林尚未发现的年代
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of 1937.
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那是1937年
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It was a time when medicine was cheap
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当时药物很便宜
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and very ineffective.
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但疗效也不好
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If you were in a hospital, he said,
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他写道：如果你去看病
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it was going to do you good
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医院对你的唯一帮助
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only because it offered you
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就是提供了
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some warmth, some food, shelter,
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给你提供了温暖、食物、住所，
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and maybe the caring attention
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或许还有来自护士的
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of a nurse.
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关怀
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Doctors and medicine
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医生和药物的作用
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made no difference at all.
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无关紧要
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That didn't seem to prevent the doctors
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即使这样
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from being frantically busy in their days,
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当时的医生们还是忙得不可开交
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as he explained.
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对此，他解释道
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What they were trying to do
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他们努力想做的
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was figure out whether you might have one of the diagnoses
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就是弄清楚患者是否适用于某种诊断
03:01
for which they could do something.
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是他们可以治疗的
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And there were a few.
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这样的病症不多
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You might have a lobar pneumonia, for example,
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比如说，你患有大叶性肺炎
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and they could give you an antiserum,
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医生可以对你进行抗血清治疗
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an injection of rabid antibodies
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为你注射狂犬病抗体
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to the bacterium streptococcus,
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以此对抗链球菌
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if the intern sub-typed it correctly.
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前提是实习医生分类正确
03:22
If you had an acute congestive heart failure,
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如果你不幸突发急性充血性心脏衰竭
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they could bleed a pint of blood from you
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医生可以给你放一品脱的血
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by opening up an arm vein,
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从割开的手臂静脉里
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giving you a crude leaf preparation of digitalis
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他们会为你准备一剂粗糙的洋地黄叶制剂
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and then giving you oxygen by tent.
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然后让你在氧幕里吸氧
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If you had early signs of paralysis
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如果你出现瘫痪的前期症状
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and you were really good at asking personal questions,
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如果你很善于问个人问题
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you might figure out
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你或许会发现
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that this paralysis someone has is from syphilis,
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这个病人的瘫痪很有可能是梅毒引发的
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in which case you could give this nice concoction
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因此你可以开出
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of mercury and arsenic --
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汞和砷的混合药剂
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as long as you didn't overdose them and kill them.
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只要不过量使用，不会置他们于死地
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Beyond these sorts of things,
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除此之外
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a medical doctor didn't have a lot that they could do.
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医师能做的事并不多
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This was when the core structure of medicine
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也就在那个时代，医疗的核心
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was created --
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形成了
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what it meant to be good at what we did
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那就是如何做好我们所做的事
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and how we wanted to build medicine to be.
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以及如何建立医疗体系
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It was at a time
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当时
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when what was known you could know,
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医生能知道当时所有的医疗技术
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you could hold it all in your head, and you could do it all.
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一个人就可以记住所有的医疗知识，也能实施所有的医疗行为
04:24
If you had a prescription pad,
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如果你有处方权
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if you had a nurse,
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如果你有一名护士
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if you had a hospital
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如果你有一所医院
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that would give you a place to convalesce, maybe some basic tools,
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或许可以给你一个栖身之所，得到一些基本的工具
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you really could do it all.
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你凭一己之力可以完成所有的事
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You set the fracture, you drew the blood,
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你可以处理骨折，可以抽血
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you spun the blood,
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可以验血
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looked at it under the microscope,
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可以用显微镜观察
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you plated the culture, you injected the antiserum.
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你可以组织切片，可以注射抗血清
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This was a life as a craftsman.
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这是工匠一般的生活
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As a result, we built it around
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最终，我们成功
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a culture and set of values
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建立起了医疗文化和价值体系
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that said what you were good at
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医生最应擅长的事
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was being daring,
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就是行事大胆
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at being courageous,
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充满勇气
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at being independent and self-sufficient.
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并且要独立工作，自给自足
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Autonomy was our highest value.
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自主是至高无上的价值观
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Go a couple generations forward
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往后推几代人
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to where we are, though,
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来看今天
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and it looks like a completely different world.
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世界好像完全变了个样
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We have now found treatments
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我们现在的治疗手段
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for nearly all of the tens of thousands of conditions
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几乎能处理上万种
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that a human being can have.
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人类可能患上的疑难杂症
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We can't cure it all.
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尽管不能治愈所有疾病
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We can't guarantee that everybody will live a long and healthy life.
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我们不能保证每个人都长命百岁、无病无患
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But we can make it possible
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但是我们可以让多数人
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for most.
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过上健康长寿的生活
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But what does it take?
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但是，实现这一结果的代价是什么呢？
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Well, we've now discovered
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如今我们已经发现了
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4,000 medical and surgical procedures.
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4000种药物介入和外科手术
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We've discovered 6,000 drugs
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我们研制了6000种药物
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that I'm now licensed to prescribe.
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这还仅仅是我现在处方权允许的范围
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And we're trying to deploy this capability,
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我们正在尝试把这些治疗手段和药物，推广到更多地方
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town by town,
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挨家挨户地
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to every person alive --
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深入大众
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in our own country,
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覆盖我们国家的每一寸土地
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let alone around the world.
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乃至全球各个角落
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And we've reached the point where we've realized,
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我们已经到了这样的地步
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as doctors,
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作为医生
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we can't know it all.
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我们认识到自己不能知晓一切
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We can't do it all
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也不能一一做到
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by ourselves.
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仅凭一己之力是不行的
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There was a study where they looked
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曾经有一项研究
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at how many clinicians it took to take care of you
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调查了不同时代下，照顾一名患者
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if you came into a hospital,
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在医院里
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as it changed over time.
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需要多少医务人员
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And in the year 1970,
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在1970年
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it took just over two full-time equivalents of clinicians.
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一般需要两名全职临床医务人员
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That is to say,
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也就是说
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it took basically the nursing time
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基本上是护士照料时间
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and then just a little bit of time for a doctor
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加上医生的一点点时间
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who more or less checked in on you
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医生的时间只用来做查房
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once a day.
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一般一天一次
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By the end of the 20th century,
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到了20世纪末年
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it had become more than 15 clinicians
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这一数字上升到15名临床医务人员
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for the same typical hospital patient --
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照顾同样一名典型的住院患者
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specialists, physical therapists,
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包括专科医生、普科医生
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the nurses.
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以及护士
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We're all specialists now,
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如今我们都是专科医生
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even the primary care physicians.
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即便是基本卫生医疗单位的医生
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Everyone just has
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每个人也只
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a piece of the care.
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提供自己专业范围内的一点点关怀
07:03
But holding onto that structure we built
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但是为了坚持我们建立的医疗价值体系
07:05
around the daring, independence,
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针对“勇敢”、“独立”
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self-sufficiency
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“自给自足”
07:09
of each of those people
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对所有这些人而言
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has become a disaster.
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就会变成一场灾难
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We have trained, hired and rewarded people
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我们培训、雇佣、奖励医生
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to be cowboys.
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把他们变成牛仔那样
07:21
But it's pit crews that we need,
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但是我们真正需要的是赛车维修队
07:24
pit crews for patients.
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针对病人的维修队
07:26
There's evidence all around us:
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我们身边就有这样的实例证明
07:28
40 percent of our coronary artery disease patients
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我们社区中40%的
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in our communities
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冠状动脉患者
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receive incomplete or inappropriate care.
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接受的治疗是不全面或不妥当的
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60 percent
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60%
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of our asthma, stroke patients
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哮喘、中风病人
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receive incomplete or inappropriate care.
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接受的治疗是不全面或不妥当的
07:46
Two million people come into hospitals
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200万人在医院的时候
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and pick up an infection
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受到感染
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they didn't have
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这些感染是他们原本所没有的
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because someone failed to follow
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因为有人忽略了
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the basic practices of hygiene.
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最基本的卫生问题
07:59
Our experience
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我们的经验表明
08:01
as people who get sick,
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当人们生病时
08:03
need help from other people,
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需要得到别人的帮助
08:05
is that we have amazing clinicians
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应该是医生们的帮助
08:08
that we can turn to --
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可以让我们找到那些令人放心的医生
08:10
hardworking, incredibly well-trained and very smart --
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勤奋努力、受过良好培训、并且聪明过人
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that we have access to incredible technologies
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还可以得益于尖端技术
08:16
that give us great hope,
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这些都会给我们莫大的希望
08:18
but little sense
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但极少能见到
08:20
that it consistently all comes together for you
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所有这些持续地共同作用于你
08:24
from start to finish
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贯穿整个医疗过程
08:27
in a successful way.
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并且确保成功
08:30
There's another sign
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另外一个征兆
08:32
that we need pit crews,
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我们需要维修队的原因
08:34
and that's the unmanageable cost
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是现有医疗体系高昂到无法控制的
08:37
of our care.
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成本问题
08:40
Now we in medicine, I think,
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我想，在我们的医疗行业
08:42
are baffled by this question of cost.
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百思不得其解的就是这个成本问题
08:44
We want to say, "This is just the way it is.
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我们想说：“这就是现实……
08:48
This is just what medicine requires."
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这就是医药行业必需的“
08:50
When you go from a world
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当你从
08:52
where you treated arthritis with aspirin,
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用阿司匹林治疗关节炎的地方
08:55
that mostly didn't do the job,
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那往往是没有效果的
08:58
to one where, if it gets bad enough,
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到现在，对于严重病患
09:00
we can do a hip replacement, a knee replacement
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我们可以做手术更换人工髋关节或膝盖
09:02
that gives you years, maybe decades,
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那将帮助病人恢复原本可能丧失的功能
09:05
without disability,
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安好地度过几十年
09:07
a dramatic change,
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这是一个多戏剧化的改变啊
09:09
well is it any surprise
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因此，如果说
09:11
that that $40,000 hip replacement
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花4万美元进行个髋关节移植手术
09:14
replacing the 10-cent aspirin
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而不是花10美分买阿司匹林来缓解
09:16
is more expensive?
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哪个更昂贵呢？
09:18
It's just the way it is.
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这就是现实
09:21
But I think we're ignoring certain facts
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但我认为，我们忽略了一些事实
09:23
that tell us something about what we can do.
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这些事实告诉我们，我们能做的其实有很多
09:28
As we've looked at the data
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我们看到一些数据
09:30
about the results that have come
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关于医疗行为的结果
09:33
as the complexity has increased,
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尽管环境日益复杂
09:35
we found
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我们发现
09:37
that the most expensive care
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最昂贵的医疗
09:39
is not necessarily the best care.
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不见得是最好的
09:42
And vice versa,
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反之亦然
09:44
the best care
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最好的医疗
09:46
often turns out to be the least expensive --
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通常花不了几个钱
09:49
has fewer complications,
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而且更简单
09:52
the people get more efficient at what they do.
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人们在那种情况下效率更高
09:55
And what that means
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这一发现的含义在于
09:57
is there's hope.
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我们还有希望
10:00
Because [if] to have the best results,
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因为，假如我们想要获得最好的结果
10:03
you really needed the most expensive care
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要用到最贵的医疗
10:06
in the country, or in the world,
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在一国范围内、或者在世界范围内最贵
10:08
well then we really would be talking about rationing
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那么我们真的要去讨论的就是配额制度
10:11
who we're going to cut off from Medicare.
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决定哪些人不能享受医疗保险
10:15
That would be really our only choice.
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那将会成为唯一的选择
10:19
But when we look at the positive deviants --
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但如果我们看看积极的反面事例
10:21
the ones who are getting the best results
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确实存在以最低的成本
10:24
at the lowest costs --
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获得最佳效果的例子
10:26
we find the ones that look the most like systems
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我们发现最像“系统”的
10:29
are the most successful.
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是最成功的
10:31
That is to say, they found ways
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也就是说，我们发现了
10:34
to get all of the different pieces,
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平衡所有不同部分
10:36
all of the different components,
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不同因素的方法
10:38
to come together into a whole.
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让各个部分变成一个整体
10:41
Having great components is not enough,
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仅有好的组成部分是远远不够的
10:44
and yet we've been obsessed in medicine with components.
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然而我们正是对医药的组成部分太过痴迷了
10:48
We want the best drugs, the best technologies,
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我们想要最好的药物、最好的技术
10:51
the best specialists,
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最好的专科医生
10:54
but we don't think too much
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但我们却不曾想过
10:56
about how it all comes together.
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这些如何组合在一起
10:59
It's a terrible design strategy actually.
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这其实是个很糟糕的战略设计
11:03
There's a famous thought experiment
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有一个很著名的思考实验
11:06
that touches exactly on this
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验证了这个想法
11:08
that said, what if you built a car
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实验是这样的，假如你用最好的汽车零件
11:10
from the very best car parts?
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能造出怎样一辆车？
11:13
Well it would lead you to put in Porsche brakes,
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你可以用保时捷的刹车
11:16
a Ferrari engine,
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法拉利的引擎
11:18
a Volvo body, a BMW chassis.
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沃尔沃的车身，宝马的底盘
11:21
And you put it all together and what do you get?
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你把这些都组装在一起会得到一辆怎样的车呢？
11:24
A very expensive pile of junk that does not go anywhere.
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答案是：一堆很贵的垃圾，一辆完全不能开的车
11:28
And that is what medicine can feel like sometimes.
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有时候医药行业也是这样
11:33
It's not a system.
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它并非一个系统
11:36
Now a system, however,
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然而，为了组建一个体系
11:38
when things start to come together,
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当所有部分都组合到一起
11:41
you realize it has certain skills
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你需要有特定的技巧
11:44
for acting and looking that way.
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来让它运作起来，让它看起来像回事儿
11:47
Skill number one
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首当其冲的是
11:49
is the ability to recognize success
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辨识成功的能力
11:51
and the ability to recognize failure.
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以及辨识失败的能力
11:54
When you are a specialist,
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假如你是一名专科医生
11:56
you can't see the end result very well.
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如果你无法很好地设想最终结果
11:59
You have to become really interested in data,
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你必须认真分析数据
12:02
unsexy as that sounds.
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这听上去非常无趣
12:04
One of my colleagues is a surgeon in Cedar Rapids, Iowa,
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我的一个外科医生同事，在爱荷华州锡达拉皮兹工作
12:07
and he got interested in the question of,
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他对一个问题产生了兴趣
12:11
well how many CT scans did they do
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那就是：他们在锡达拉皮兹
12:13
for their community in Cedar Rapids?
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做了多少个CT扫描？
12:15
He got interested in this
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他对此很感兴趣
12:17
because there had been government reports,
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因为政府报告
12:19
newspaper reports, journal articles
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新闻报道、期刊论文
12:21
saying that there had been too many CT scans done.
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都在说现在做的CT扫描过量了
12:24
He didn't see it in his own patients.
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但他没在自己的病人中看到这个问题
12:28
And so he asked the question, "How many did we do?"
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因此他提出这一疑问：”我们究竟做了多少CT扫描呢？“
12:30
and he wanted to get the data.
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他想得到这一数据
12:32
It took him three months.
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于是他花了3个月时间
12:34
No one had asked this question in his community before.
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此前，在他的社区，没人有过这个疑问
12:37
And what he found was that,
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后来，他发现
12:39
for the 300,000 people in their community,
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在社区的300,000人中
12:41
in the previous year
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过去一年间
12:43
they had done 52,000 CT scans.
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他们曾做了52,000次CT扫描
12:48
They had found a problem.
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于是他们发现了一个问题
12:51
Which brings us to skill number two a system has.
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也就引出了我要说的运作系统的第二项技巧
12:56
Skill one, find where your failures are.
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技巧1是：发现我们错在哪里
12:59
Skill two is devise solutions.
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技巧2是：设计解决方案
13:03
I got interested in this
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我对此也颇感兴趣
13:05
when the World Health Organization came to my team
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世界卫生组织曾来找我的团队
13:07
asking if we could help with a project
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问我们是否能帮他们做一个项目
13:09
to reduce deaths in surgery.
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来降低外科手术的死亡率
13:11
The volume of surgery had spread
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如今外科手术在世界范围内
13:13
around the world,
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数量日益增长
13:15
but the safety of surgery
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但是手术的安全性
13:17
had not.
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却令人担忧
13:19
Now our usual tactics for tackling problems like these
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现在我们普遍的做法是
13:22
are to do more training,
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开展更多培训
13:24
give people more specialization
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让医生更加专业
13:27
or bring in more technology.
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或者提高技术
13:30
Well in surgery, you couldn't have people who are more specialized
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所以，在手术中，我们的医生都是非常专业的
13:33
and you couldn't have people who are better trained.
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受过非常好的教育和培训
13:36
And yet we see unconscionable levels
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然而我们还是看到高得不正常的
13:39
of death, disability
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死亡率和致残率
13:43
that could be avoided.
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这些原本都是可以避免的
13:45
And so we looked at what other high-risk industries do.
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因此我们参考了其他高风险行业的做法
13:47
We looked at skyscraper construction,
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我们观察了摩天大楼的建设
13:49
we looked at the aviation world,
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我们研究了飞机制造业
13:52
and we found
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然后发现
13:54
that they have technology, they have training,
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他们有技术、他们有培训
13:56
and then they have one other thing:
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而且他们还有一样东西
13:59
They have checklists.
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那就是检查表
14:02
I did not expect
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我没有想到自己
14:04
to be spending a significant part
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作为一名哈佛外科医生
14:06
of my time as a Harvard surgeon
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会把大部分时间
14:08
worrying about checklists.
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用来烦恼检查表这个东西
14:11
And yet, what we found
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然而，我们发现
14:13
were that these were tools
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正是这个工具
14:16
to help make experts better.
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帮助专家达到最佳效果
14:19
We got the lead safety engineer for Boeing to help us.
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我们得到了波音公司首席安全工程师的帮助
14:23
Could we design a checklist for surgery?
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我们请教他如何设计一张用于外科手术的清单？
14:26
Not for the lowest people on the totem pole,
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并非为了社会底层人士
14:28
but for the folks
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而是针对
14:30
who were all the way around the chain,
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在这条产业链的每个环节上的人
14:32
the entire team including the surgeons.
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包括外科医生在内的整个团队
14:34
And what they taught us
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他们教我们的是
14:36
was that designing a checklist
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要设计好检查表
14:38
to help people handle complexity
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来帮助人们处理复杂问题
14:40
actually involves more difficulty than I had understood.
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其实比想象的要难
14:43
You have to think about things
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你必须考虑很多问题
14:45
like pause points.
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比如“暂停时点”
14:47
You need to identify the moments in a process
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你需要认识到整个流程中的一些时刻
14:50
when you can actually catch a problem before it's a danger
332
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能够在危险来临前及时发现问题
14:52
and do something about it.
333
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作出处理以免酿成大祸
14:54
You have to identify
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你必须把它当做
14:56
that this is a before-takeoff checklist.
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是一张飞机起飞前的检查表
14:59
And then you need to focus on the killer items.
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你一定要关注一些至关重要的项目
15:02
An aviation checklist,
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在一份飞机制造检查表上
15:04
like this one for a single-engine plane,
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就像这张针对单引擎飞机的检查清单
15:06
isn't a recipe for how to fly a plane,
339
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它可不是驾驶飞机的窍门
15:08
it's a reminder of the key things
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而是对关键问题的提醒
15:10
that get forgotten or missed
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如果他们不去检查
15:13
if they're not checked.
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很可能会遗漏这些问题
15:15
So we did this.
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因此我们也效仿了他们的做法
15:17
We created a 19-item two-minute checklist
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我们设计了一张检查表，19个项目，用时2分钟
15:20
for surgical teams.
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针对手术团队
15:22
We had the pause points
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其中包含“暂停时点”
15:24
immediately before anesthesia is given,
347
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例如，实施麻醉前
15:27
immediately before the knife hits the skin,
348
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手术刀接触病人皮肤之前
15:30
immediately before the patient leaves the room.
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病人离开手术室之前
15:33
And we had a mix of dumb stuff on there --
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检查表上不乏很多看上去很简单的事情
15:36
making sure an antibiotic is given in the right time frame
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例如，确保在正确的时间使用抗生素
15:39
because that cuts the infection rate by half --
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光这一点就让感染率下降了一半
15:41
and then interesting stuff,
353
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还有些有意思的事
15:43
because you can't make a recipe for something as complicated as surgery.
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你无法为手术这样复杂的事情事先开出处方
15:46
Instead, you can make a recipe
355
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然而，你却可以开处方
15:48
for how to have a team that's prepared for the unexpected.
356
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给这个团队，使他们能更好地去面对突发状况
15:51
And we had items like making sure everyone in the room
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我们列出的项目中就包括：确保每个在房间的人
15:54
had introduced themselves by name at the start of the day,
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都在手术开始前互相做了自我介绍
15:57
because you get half a dozen people or more
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因为很多时候，起码有六个人
15:59
who are sometimes coming together as a team
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在这个新组建的团队中
16:02
for the very first time that day that you're coming in.
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都是初次见面
16:05
We implemented this checklist
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后来，我们在世界上8所医院
16:07
in eight hospitals around the world,
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执行、推广了这份检查表
16:10
deliberately in places from rural Tanzania
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其中包括坦桑尼亚的乡村
16:12
to the University of Washington in Seattle.
365
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3000
也包括在西雅图的华盛顿大学
16:15
We found that after they adopted it
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我们发现，当他们使用了这份检查表之后
16:18
the complication rates fell
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复杂程度大大降低
16:20
35 percent.
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2000
降低了35%
16:22
It fell in every hospital it went into.
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每所医院都是如此
16:25
The death rates fell
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死亡率也降低了
16:27
47 percent.
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降低了47%
16:30
This was bigger than a drug.
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这比任何一种药物都管用
16:32
(Applause)
373
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6000
（掌声）
16:38
And that brings us
374
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这将引出
16:40
to skill number three,
375
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第三项技巧
16:43
the ability to implement this,
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执行能力
16:45
to get colleagues across the entire chain
377
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让所有产业链上的同事
16:48
to actually do these things.
378
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都能切实地这样做事
16:51
And it's been slow to spread.
379
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推广这些很花时间
16:53
This is not yet our norm in surgery --
380
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这还不是我们做手术的规范
16:57
let alone making checklists
381
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更别说
16:59
to go onto childbirth and other areas.
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应用于例如分娩等其他紧迫的领域
17:02
There's a deep resistance
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在执行中往往会遇到强大的阻力
17:04
because using these tools
384
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因为使用这些工具
17:06
forces us to confront
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会迫使我们去面对
17:08
that we're not a system,
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我们还未成为“系统”这一事实
17:10
forces us to behave with a different set of values.
387
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会迫使我们不得不用另一套价值观去操作
17:13
Just using a checklist
388
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使用一份检查表
17:15
requires you to embrace different values from the ones we've had,
389
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需要你用与以往不同的价值操守
17:18
like humility,
390
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例如谦虚
17:22
discipline,
391
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纪律
17:25
teamwork.
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团队合作
17:27
This is the opposite of what we were built on:
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这与我们所建立的价值观刚好背道而驰：
17:30
independence, self-sufficiency,
394
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独立、自给自足
17:32
autonomy.
395
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自治
17:35
I met an actual cowboy, by the way.
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说到这儿，我想起来曾经遇到过一个真正的牛仔
17:38
I asked him, what was it like
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我问他：牛仔到底是如何
17:41
to actually herd a thousand cattle
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将上千头牛
17:43
across hundreds of miles?
399
1048000
2000
放牧几百英里
17:45
How did you do that?
400
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你们是怎么做的？
17:47
And he said, "We have the cowboys stationed at distinct places all around."
401
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他回答说：“我们有牛仔驻扎在牧区的几个地点”
17:50
They communicate electronically constantly,
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他们通过电子设备不断交流
17:53
and they have protocols and checklists
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他们有规章制度和各种检查表
17:55
for how they handle everything --
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去处理发生的各种情况
17:57
(Laughter)
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（笑声）
17:59
-- from bad weather
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比如，恶劣天气
18:01
to emergencies or inoculations for the cattle.
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比如，突发事件，或者为牛群接种
18:04
Even the cowboys are pit crews now.
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如今，就连牛仔们也组成了维修队
18:08
And it seemed like time
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似乎是时候
18:10
that we become that way ourselves.
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我们也变成那样了
18:12
Making systems work
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靠“系统”来工作
18:14
is the great task of my generation
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这正是我们这代人
18:17
of physicians and scientists.
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作为医生和科学家的的首要任务
18:19
But I would go further and say
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进一步说
18:21
that making systems work,
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要让“系统”运转起来
18:23
whether in health care, education,
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无论是医疗、教育
18:25
climate change,
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还是气候变化
18:27
making a pathway out of poverty,
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还是消除贫困
18:29
is the great task of our generation as a whole.
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都是我们这代人，作为一个整体需要完成的重要任务
18:33
In every field, knowledge has exploded,
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在各个领域都有知识爆炸
18:36
but it has brought complexity,
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情况更加复杂
18:38
it has brought specialization.
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专业性更强
18:41
And we've come to a place where we have no choice
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我们别无选择
18:43
but to recognize,
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只能去认识到
18:45
as individualistic as we want to be,
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尽管我们都崇尚个人主义
18:48
complexity requires
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但复杂性要求我们
18:51
group success.
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取得集体成功
18:53
We all need to be pit crews now.
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我们全都需要成为维修队
18:57
Thank you.
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谢谢大家
18:59
(Applause)
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（掌声）
ABOUT THE SPEAKER
Atul Gawande - Surgeon, writer, public health innovatorSurgeon and public health professor by day, writer by night, Atul Gawande explores how doctors can dramatically improve their practice using approaches as simple as a checklist – or coaching.
Why you should listen
Atul Gawande is author of several best-selling books, including Complications: A Surgeon's Notes on an Imperfect Science, Better: A Surgeon's Notes on Performance, Being Mortal: Medicine and What Matters in the End and The Checklist Manifesto.
He is also a surgeon at Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker and a professor at Harvard Medical School and the Harvard School of Public Health. He has won the Lewis Thomas Prize for Writing about Science, a MacArthur Fellowship and two National Magazine Awards. In his work in public health, he is Executive Director of Ariadne Labs, a joint center for health systems innovation and chair of Lifebox, a nonprofit organization making surgery safer globally.
In June 2018, Gawande was chosen to lead the new healthcare company set up by Amazon, JPMorgan and Berkshire Hathaway.
Photo: Aubrey Calo
Atul Gawande | Speaker | TED.com