TEDMED 2018
Mitchell Katz: What the US health care system assumes about you
米切尔·卡茨: 美国医疗保健系统假设了我们什么
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美国的医疗保健系统假设了很多关于病人的事情：他们可以在中午离开工作，会说英语，有一个工作电话和稳定的食物供应。美国最大的公共卫生保健系统的首席执行官米切尔·卡茨（Mitchell Katz）说，正因为如此，美国医疗保健系统辜负了许多最需要帮助的人。在这次令人大开眼界的演讲中，他分享了低收入患者面临的挑战，以及我们如何为所有人建立一个更好的系统。
Mitchell Katz - Physician, public health advocate
Mitchell Katz, CEO of NYC Health + Hospitals, works to eliminate the unfair effects of economic disparities in health care, challenging traditional health care systems to find ways to meet all patients on their own terms. Full bio
Mitchell Katz, CEO of NYC Health + Hospitals, works to eliminate the unfair effects of economic disparities in health care, challenging traditional health care systems to find ways to meet all patients on their own terms. Full bio
Double-click the English transcript below to play the video.
00:12
A few years ago,
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几年前，
00:14
I was taking care of a woman
who was a victim of violence.
who was a victim of violence.
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我曾接待过一个
遭受暴力对待的女士。
遭受暴力对待的女士。
00:18
I wanted her to be seen in a clinic
that specialized in trauma survivors.
that specialized in trauma survivors.
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我想让她去专门治疗
创伤幸存者的诊所。
创伤幸存者的诊所。
00:24
I made the appointment myself because,
being the director of the department,
being the director of the department,
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我亲自为她预约，
因为作为这个部门的主管，
因为作为这个部门的主管，
00:29
I knew if I did it,
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我知道如果我去，
00:30
she would get an appointment right away.
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她会立刻得到预约。
00:33
The clinic was about an hour and a half
away from where she lived.
away from where she lived.
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诊所离她住的地方大约
有一个半小时的路程。
有一个半小时的路程。
00:37
But she took down the address
and agreed to go.
and agreed to go.
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她记住了地址并约定了会去。
00:42
Unfortunately, she didn't
make it to the clinic.
make it to the clinic.
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但遗憾的是，她没有出现。
00:47
When I spoke to the psychiatrist,
he explained to me
he explained to me
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当我和精神病医生谈话时，
他向我解释说，
他向我解释说，
00:51
that trauma survivors are often resistant
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创伤幸存者通常拒绝处理
00:55
to dealing with the difficult
issues that they face
issues that they face
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他们遇到的困难，
00:57
and often miss appointments.
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并常常错过预约。
01:00
For this reason,
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因为这个原因，
01:01
they don't generally allow the doctors
to make appointments for the patients.
to make appointments for the patients.
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他们通常不让医生为病人预约。
01:06
They had made a special exception for me.
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他们特地为我开了绿灯。
01:10
When I spoke to my patient,
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当我跟我的病人交谈时，
01:12
she had a much simpler
and less Freudian explanation
and less Freudian explanation
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她对为什么没能赴约
有个简单得多，
有个简单得多，
01:16
of why she didn't go to that appointment:
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而且不那么弗洛伊德式的解释：
01:19
her ride didn't show.
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带她去的车没出现。
01:22
Now, some of you may be thinking,
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现在，你们有些人可能在想，
01:25
"Didn't she have some other way
of getting to that clinic appointment?"
of getting to that clinic appointment?"
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“她没有别的办法去诊所吗？”
01:29
Couldn't she have taken an Uber
or called another friend?
or called another friend?
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她不能打个优步或
叫另一个朋友送她去吗？
叫另一个朋友送她去吗？
01:34
If you're thinking that,
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如果你那样想，
01:35
it's probably because you have resources.
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这可能是因为你有资源。
01:39
But she didn't have
enough money for an Uber,
enough money for an Uber,
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但她并没有足够的钱打优步，
01:42
and she didn't have
another friend to call.
another friend to call.
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也没有另一个朋友可以叫。
01:45
But she did have me,
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但她却有我，
01:47
and I was able to get her
another appointment,
another appointment,
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我能够让她得到另一个预约，
01:50
which she kept without difficulty.
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并且可以毫不费力地保持。
01:53
She wasn't resistant,
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她不是不愿意，
01:55
it's just that her ride didn't show.
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只是她的车没有出现。
01:58
I wish I could say that this
was an isolated incident,
was an isolated incident,
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我希望我能说这是一个孤立的事件，
02:02
but I know from running
the safety net systems
the safety net systems
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但我从旧金山、洛杉矶
和现在的纽约市
和现在的纽约市
02:05
in San Francisco, Los Angeles,
and now New York City,
and now New York City,
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运行的安全网络系统中知道，
02:11
that health care is built
on a middle-class model
on a middle-class model
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医疗保健是建立在
中产阶级模式之上的，
中产阶级模式之上的，
02:14
that often doesn't meet the needs
of low-income patients.
of low-income patients.
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这种模式往往不能满足
低收入患者的需求。
低收入患者的需求。
02:19
That's one of the reasons
why it's been so difficult
why it's been so difficult
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这就是为什么我们很难
02:23
for us to close the disparity
in health care
in health care
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缩小医疗保健方面存在的
02:27
that exists along economic lines,
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经济差距的原因之一，
02:30
despite the expansion of health insurance
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尽管平价医疗法案，也叫奥巴马医改，
02:34
under the ACA, or Obamacare.
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扩大了医疗保险。
02:38
Health care in the United States
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美国的医疗保健假设，
02:41
assumes that, besides getting across
the large land expanse of Los Angeles,
the large land expanse of Los Angeles,
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除了可以跨越广阔的洛杉矶，
02:49
it also assumes that you
can take off from work
can take off from work
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它还假设你可以在中午离开工作
02:52
in the middle of the day to get care.
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去看医生。
02:55
One of the patients who came
to my East Los Angeles clinic
to my East Los Angeles clinic
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有个周四的下午，一位病人来到
02:59
on a Thursday afternoon
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我在东洛杉矶的诊所，
03:01
presented with partial
blindness in both eyes.
blindness in both eyes.
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他的双眼出现了部分失明的症状。
03:07
Very concerned, I said to him,
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我非常担心地对他说，
03:09
"When did this develop?"
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“这种情况是什么时候出现的？”
03:11
He said, "Sunday."
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他说，“星期天。”
03:14
I said, "Sunday?
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我说，“星期天？”
03:15
Did you think of coming sooner to clinic?"
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你想过早点来诊所吗？”
03:19
And he said, "Well, I have to work
in order to pay the rent."
in order to pay the rent."
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他说，“我得工作才能支付租金。”
03:23
A second patient to that same clinic,
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第二病人来到同样的诊所，
03:26
a trucker,
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一个卡车司机，
03:27
drove three days with a raging infection,
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带着严重的感冒开了三天车，
03:31
only coming to see me
after he had delivered his merchandise.
after he had delivered his merchandise.
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只能在他交付完货物后才来见我。
03:36
Both patients' care was jeopardized
by their delays in seeking care.
by their delays in seeking care.
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这两名病人的健康都因
延误求医而受到损害。
延误求医而受到损害。
03:43
Health care in the United States
assumes that you speak English
assumes that you speak English
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美国的医疗保健假设你会说英语，
03:47
or can bring someone with you who can.
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或者你可以带一个会说英语的人。
03:51
In San Francisco, I took care of a patient
on the inpatient service
on the inpatient service
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在旧金山，我在住院部
照顾过一个病人，
照顾过一个病人，
03:56
who was from West Africa
and spoke a dialect so unusual
and spoke a dialect so unusual
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他来自西非，并且说
一种不常见的方言，
一种不常见的方言，
04:01
that we could only find one translator
on the telephonic line
on the telephonic line
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我们只能在电话系统上
找到一个翻译
找到一个翻译
04:06
who could understand him.
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可以听懂他。
04:08
And that translator only worked
one afternoon a week.
one afternoon a week.
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那个翻译一周只工作一个下午。
04:12
Unfortunately, my patient needed
translation services every day.
translation services every day.
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遗憾的是，我的病人
每天都需要翻译服务。
每天都需要翻译服务。
04:18
Health care in the United States
assumes that you are literate.
assumes that you are literate.
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美国的医疗保健假设你有文化。
04:22
I learned that a patient of mine
who spoke English without accent
who spoke English without accent
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我在一个说地道英语的病人
04:27
was illiterate,
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请我马上为他签署一份
04:29
when he asked me to please sign
a social security disability form for him
a social security disability form for him
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社会保障残疾表格时，
04:34
right away.
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才知道他是文盲。
04:36
The form needed to go
to the office that same day,
to the office that same day,
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表格需要在当天交到办公室，
04:39
and I wasn't in clinic,
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而我当时不在诊所，
04:41
so trying to help him out,
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所以为了帮助他解决，
04:43
knowing that he was
the sole caretaker of his son,
the sole caretaker of his son,
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知道他是他儿子的唯一监护人，
04:46
I said, "Well, bring the form
to my administrative office.
to my administrative office.
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我说，“好吧，把表格带到
我的行政办公室。
我的行政办公室。
04:51
I'll sign it and I'll fax it in for you."
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我会签字并传真给你。”
04:54
He took the two buses to my office,
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他坐了两趟公共汽车到我的办公室，
04:56
dropped off the form,
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留下表格，
04:58
went back home to take care of his son ...
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回到家照顾他的小孩…
05:01
I got to the office, and what did I find
next to the big "X" on the form?
next to the big "X" on the form?
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我回到办公室，在表格大大
的“X”旁边我发现了什么？
的“X”旁边我发现了什么？
05:06
The word "applicant."
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写着“申请人”。
05:09
He needed to sign the form.
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他需要在表格上签字。
05:12
And so now I had to have him
take the two buses back to the office
take the two buses back to the office
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所以现在我不得不让他乘坐
两趟公交回到我的办公室，
两趟公交回到我的办公室，
05:15
and sign the form so that
we could then fax it in for him.
we could then fax it in for him.
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再签字，这样我们就可以传真给他。
05:20
It completely changed
how I took care of him.
how I took care of him.
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这完全改变了我关照他的方式。
05:22
I made sure that I always went over
instructions verbally with him.
instructions verbally with him.
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我确保我总是和他一起
仔细口头检查指南。
仔细口头检查指南。
05:29
It also made me think about
all of the patients
all of the patients
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这也让我想起所有的病人，
05:31
who receive reams and reams of paper
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他们会收到我们现代
05:35
spit out by our modern
electronic health record systems,
electronic health record systems,
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电子健康记录系统吐出的大量文件，
05:39
explaining their diagnoses
and their treatments,
and their treatments,
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用于解释他们的诊断和治疗，
05:42
and wondering how many people
actually can understand
actually can understand
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我想知道有多少人能够真正理解
05:44
what's on those pieces of paper.
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这些纸上写的是什么。
05:47
Health care in the United States assumes
that you have a working telephone
that you have a working telephone
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美国的医疗保健假设你
有一部能用的电话
有一部能用的电话
05:52
and an accurate address.
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和一个准确的地址。
05:54
The proliferation
of inexpensive cell phones
of inexpensive cell phones
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廉价手机的普及
05:58
has actually helped quite a lot.
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确实帮了大忙。
06:00
But still, my patients run out of minutes,
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但我的病人手机仍然会欠费，
06:03
and their phones get disconnected.
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然后就联系不上了。
06:06
Low-income people often have
to move around a lot by necessity.
to move around a lot by necessity.
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低收入者经常不得不搬家。
06:11
I remember reviewing a chart of a woman
with an abnormality on her mammogram.
with an abnormality on her mammogram.
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我记得我看过一个乳房X光检查中
出现异常的女性的图表。
出现异常的女性的图表。
06:17
That chart assiduously documents
that three letters were sent to her home,
that three letters were sent to her home,
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那张图表详细记录了
有三封信已经寄到她家，
有三封信已经寄到她家，
06:23
asking her to please
come in for follow-up.
come in for follow-up.
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请她来跟进。
06:27
Of course, if the address isn't accurate,
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当然，如果这个地址不准确，
06:29
it doesn't much matter how many letters
you send to that same address.
you send to that same address.
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你寄多少封信过去
那个地址都不重要。
那个地址都不重要。
06:35
Health care in the United States assumes
that you have a steady supply of food.
that you have a steady supply of food.
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美国的医疗保健假设
你有稳定的食物供应。
你有稳定的食物供应。
06:41
This is particularly
an issue for diabetics.
an issue for diabetics.
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这对糖尿病患者来说尤其是个问题。
06:44
We give them medications
that lower their blood sugar.
that lower their blood sugar.
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我们给他们药物降低他们的血糖。
06:48
On days when they don't have enough food,
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在他们没有足够食物的日子里，
06:51
it puts them at risk
for a life-threatening side effect
for a life-threatening side effect
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这会让他们面临低血糖
06:54
of hypoglycemia, or low blood sugar.
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或低血糖副作用的生命威胁。
06:58
Health care in the United States
assumes that you have a home
assumes that you have a home
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美国医疗保健假设你家里
07:02
with a refrigerator for your insulin,
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有冰箱可以储存你的胰岛素，
07:04
a bathroom where you can wash up,
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有浴室可以洗漱，
07:07
a bed where you can sleep
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有床可以睡觉，
07:09
without worrying about violence
while you're resting.
while you're resting.
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休息时无需担心暴力。
07:14
But what if you don't have that?
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但如果你没有这些呢？
07:16
What if you live on the street,
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如果你住在街上，
07:18
you live under the freeway,
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住在高速公路下面，
07:21
you live in a congregant shelter,
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或者住在集体避难所，
07:23
where every morning
you have to leave at 7 or 8am?
you have to leave at 7 or 8am?
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并且每天早上7点或8点
就必须离开哪里呢？
就必须离开哪里呢？
07:28
Where do you store your medicines?
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你在哪里储存你的药物？
07:32
Where do you use the bathroom?
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你在哪里使用你的浴室？
07:36
How do you put your legs up
if you have congestive heart failure?
if you have congestive heart failure?
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如果你有充血性心力衰竭，
你怎么抬腿？
你怎么抬腿？
07:41
Is it any wonder that providing people
with health insurance who are homeless
with health insurance who are homeless
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为无家可归者提供医疗保险
并没有消除他们
并没有消除他们
07:47
does not erase the huge disparity
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和被安置者之间的巨大差距，
07:50
between the homeless and the housed?
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这有什么奇怪的吗？
07:53
Health care in the United States assumes
that you prioritize your health care.
that you prioritize your health care.
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美国医疗保险假设你以看病为重。
07:59
But what about all of you?
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但你们所有人呢？
08:02
Let me assume for a moment
that you're all taking a medication.
that you're all taking a medication.
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让我假设一个场景，
你们都需要服药。
你们都需要服药。
08:06
Maybe it's for high blood pressure.
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也许是为了治疗高血压。
08:08
Maybe it's for diabetes or depression.
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也许是为了治疗糖尿病和抑郁症。
08:13
What if tonight you had a choice:
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如果你今晚有个选择：
08:16
you could have your medication
but live on the street,
but live on the street,
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你可以服药，但要生活在街上，
08:22
or you could be housed in your home
but not have your medication.
but not have your medication.
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或者你可以住在家中，但不能服药。
08:29
Which would you choose?
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你会怎么选？
08:33
I know which one I would choose.
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我知道我会选择哪个。
08:36
This is just a graphic example
of the kinds of choices
of the kinds of choices
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这就是低收入病人每天
08:40
that low-income patients
have to make every day.
have to make every day.
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面临选择的一个例子。
08:44
So when my doctors
shake their heads and say,
shake their heads and say,
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所以当我的医生摇头并说，
08:47
"I don't know why that patient
didn't keep his follow-up appointments,"
didn't keep his follow-up appointments,"
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“我不知道为什么那个病人
没有遵守他的跟进预约，”
没有遵守他的跟进预约，”
08:52
"I don't know why she didn't go
for that exam that I ordered,"
for that exam that I ordered,"
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“我不知道为什么
他没来参与我预定的检查，”
他没来参与我预定的检查，”
08:57
I think, well, maybe her ride didn't show,
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我想，可能是因为他的车没有出现，
09:01
or maybe he had to work.
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或者他不得不工作。
09:03
But also, maybe there was something
more important that day
more important that day
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但同样，也许那天有
比高血压或结肠镜检查
比高血压或结肠镜检查
09:09
than their high blood pressure
or a screening colonoscopy.
or a screening colonoscopy.
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更重要的事情。
09:13
Maybe that patient was dealing
with an abusive spouse
with an abusive spouse
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也许这个病人面对的是
一个有虐待倾向的配偶，
一个有虐待倾向的配偶，
09:18
or a daughter who is pregnant
and drug-addicted
and drug-addicted
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或者是一个怀孕且吸毒成瘾的女儿，
09:22
or a son who was kicked out of school.
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或者是一个被学校开除的儿子。
09:25
Or even maybe they were riding
their bicycle through an intersection
their bicycle through an intersection
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或者甚至是他们的汽车
经过十字路口时
经过十字路口时
09:31
and got hit by a truck,
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被卡车撞到了，
09:33
and now they're using a wheelchair
and have very limited mobility.
and have very limited mobility.
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现在他们只能坐着轮椅，行动不便。
09:39
Obviously, these things also happen
to middle-class people.
to middle-class people.
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显然，这些事情也会
发生在中产阶级身上。
发生在中产阶级身上。
09:44
But when they do,
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但当它们发生时，
09:45
we have resources that enable us
to deal with these problems.
to deal with these problems.
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我们有资源来应对这些问题。
09:50
We also have the belief that we
will live out our normal lifespans.
will live out our normal lifespans.
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我们也相信我们会活到正常寿命。
09:56
That's not true for low-income people.
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这对于低收入群体则不现实。
09:59
They've seen their friends
and relatives die young
and relatives die young
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他们见过他们的朋友和亲戚
10:03
of accidents,
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因事故，
10:05
of violence,
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暴力，
10:06
of cancers that should have
been diagnosed at an earlier stage.
been diagnosed at an earlier stage.
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或本该在早期就能诊断出来
的癌症而死去。
的癌症而死去。
10:11
It can lead to a sense of hopelessness,
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这会导致无助感，
10:13
that it doesn't really matter what you do.
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这真的跟你怎么做没有关系。
10:18
I know I've painted a bleak picture
of the care of low-income patients.
of the care of low-income patients.
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我知道我描绘了一幅低收入
病人惨淡的画面。
病人惨淡的画面。
10:23
But I want you to know
how rewarding I find it
how rewarding I find it
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但我想让你们知道我认为
在安全的网络系统中
在安全的网络系统中
10:26
to work in a safety net system,
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工作是多么值得，
10:28
and my deep belief is that we can
make the system responsive
make the system responsive
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并且我深信我们
可以让这个系统
可以让这个系统
10:33
to the needs of low-income patients.
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去响应低收入病人的需求。
10:36
The starting point has to be
to meet patients where they are,
to meet patients where they are,
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4116
起点必须是到达病人所在的位置，
10:41
provide services without obstacles
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无障碍地提供服务，
10:44
and provide patients what they need --
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并且提供病人所需要的——
10:48
not what we think they need.
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而非我们认为他们需要的。
10:51
It's impossible for me
to take good care of a patient
to take good care of a patient
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我不可能照料好那些
10:55
who is homeless and living on the street.
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无家可归或流落街头的人。
10:58
The right prescription
for a homeless patient is housing.
for a homeless patient is housing.
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4510
无家可归的病人最好的药方是住房。
11:04
In Los Angeles,
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在洛杉矶，
11:06
we housed 4,700 chronically
homeless persons
homeless persons
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我们收容了4700名患有疾病、
11:12
suffering from medical illness,
mental illness, addiction.
mental illness, addiction.
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精神疾病和毒瘾的长期无家可归者。
11:18
When we housed them, we found
that overall health care costs,
that overall health care costs,
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当我们为他们提供住处时，
我们发现整体的医疗保健成本，
我们发现整体的医疗保健成本，
11:22
including the housing,
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包括住处在内，
11:24
decreased.
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1157
降低了。
11:26
That's because they had
many fewer hospital visits,
many fewer hospital visits,
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那是因为他们去医院的次数少了，
11:30
both in the emergency room
and on the inpatient service.
and on the inpatient service.
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不管是急诊室还是住院部。
11:36
And we gave them back their dignity.
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2604
我们还给他们了尊严，
11:39
No extra charge for that.
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1818
不需要额外的费用。
11:42
For people who do not have
a steady supply of food,
a steady supply of food,
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4621
对没有稳定食物供给的人，
11:47
especially those who are diabetic,
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695297
3663
尤其是那些糖尿病患者，
11:50
safety net systems are experimenting
with a variety of solutions,
with a variety of solutions,
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5409
安全保护网络
正在实验多种解决方案，
正在实验多种解决方案，
11:56
including food pantries
at primary care clinics
at primary care clinics
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包括初级保健诊所的食品分发，
12:00
and distributing maps of community
food banks and soup kitchens.
food banks and soup kitchens.
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4739
以及社区食品银行和
热汤供点的分发地图。
热汤供点的分发地图。
12:05
And in New York City,
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1822
在纽约，
12:07
we've hired a bunch of enrollers
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2559
我们雇用了一群登记者
12:10
to get our patients into
the supplemental nutrition program
the supplemental nutrition program
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5217
来让我们的病人加入
补充营养援助计划，
补充营养援助计划，
12:15
known as "food stamps" to most people.
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3373
即为多数人所知的“食物券”。
12:20
When patients and doctors
don't understand each other,
don't understand each other,
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3637
当病人和医生无法理解彼此时，
12:24
mistakes will occur.
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1769
错误就会出现。
12:26
For non-English-speaking patients,
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734717
1948
对于母语非英语的病人，
12:28
translation is as important
as a prescription pad.
as a prescription pad.
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3839
翻译就如同处方笺一样重要，
12:33
Perhaps more important.
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741208
1490
可能更加重要。
12:35
And, you know, it doesn't
cost anything more
cost anything more
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2869
要知道，将所有的材料
按四年级阅读水品书写
按四年级阅读水品书写
12:38
to put all of the materials
at the level of fourth-grade reading,
at the level of fourth-grade reading,
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4817
并不会增加多少成本，
12:43
so that everybody can understand
what's being said.
what's being said.
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751008
4097
这样每个人都能理解
上面说的是什么。
上面说的是什么。
12:47
But more than anything else,
I think low-income patients
I think low-income patients
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但更重要的，我认为低收入病人
12:51
benefit from having a primary care doctor.
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会受益于初级护理医生。
12:55
Mind you, I think middle-class
people also benefit
people also benefit
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763680
2626
提醒各位一下，我认为
中产阶级也会受益于
中产阶级也会受益于
12:58
from having somebody
to quarterback their care.
to quarterback their care.
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2794
有人管理他们的医疗。
13:01
But when they don't, they have others
who can advocate for them,
who can advocate for them,
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769631
3131
但当他们没有时，
他们有其他人可以为他们争取，
他们有其他人可以为他们争取，
13:04
who can get them that disability placard
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3356
他们可以得到残疾的证明
13:08
or make sure the disability
application is completed.
application is completed.
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4036
或确保残疾申请完成。
13:12
But low-income people really need
a team of people who can help them
a team of people who can help them
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780739
5302
但低收入人群真的需要
一个团队来帮助他们
一个团队来帮助他们
13:18
to access the medical and non-medical
services that they need.
services that they need.
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4670
获取他们所需的医疗
和非医疗资源。
和非医疗资源。
13:23
Also, many low-income people
are disenfranchised
are disenfranchised
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3303
同样，很多低收入人群缺乏
13:26
from other community supports,
214
794553
2392
其他社区的支持，
13:28
and they really benefit from the care
and continuity provided by primary care.
and continuity provided by primary care.
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6014
他们确实会受益于初级护理
及护理的连续性。
及护理的连续性。
13:35
A primary care doctor
I particularly admire
I particularly admire
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一位我尤其欣赏的初级护理医生，
13:38
once told me how she believed
that her relationship with a patient
that her relationship with a patient
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曾经告诉我，她相信她与一个病人
13:43
over a decade
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1487
长达10年的关系
13:45
was the only healthy relationship
that that patient had in her life.
that that patient had in her life.
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是这个病人在她一生中
唯一的健康关系。
唯一的健康关系。
13:50
The good news is, you don't
actually have to be a doctor
actually have to be a doctor
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好消息是，你不必
非得成为一个医生，
非得成为一个医生，
13:54
to provide that special sauce
of care and continuity.
of care and continuity.
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就能提供那种特别的关怀和连续性。
13:59
This was really brought home to me
when one of my own long-term patients
when one of my own long-term patients
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当我的一位长期病人
在一家医院外去世时，
在一家医院外去世时，
14:03
died at an outside hospital.
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我才真正意识到这一点。
14:06
I had to tell the other doctors
and nurses in my clinic
and nurses in my clinic
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3737
我需要告诉诊所里
的其他医生和护士，
的其他医生和护士，
14:10
that he had passed.
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1378
他去世了。
14:12
But I didn't know that
in another part of our clinic,
in another part of our clinic,
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但我不知道的是，
在我们诊所的其他地方，
在我们诊所的其他地方，
14:16
on a different floor,
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2024
在不同的楼层，
14:18
there was a registration clerk
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846546
2523
有一个登记员，
14:21
who had developed a very special
relationship with my patient
relationship with my patient
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4015
他跟这个每次来挂号的病人
14:25
every time he came in for an appointment.
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也发展了一段非常特别的关系。
14:28
When she learned three weeks later
that he had died,
that he had died,
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当她三周后听到他去世的消息时，
14:32
she came and found me
in my examining room,
in my examining room,
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她来到我的检查室找我，
14:35
tears streaming down her cheeks,
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眼泪顺着她的脸颊流下，
14:38
talking about my patient
and the memories that she had of him,
and the memories that she had of him,
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她讲起我的病人和她对他的回忆，
14:43
the kinds of discussions that they had had
about their lives together.
about their lives together.
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4074
他们曾经一起讨论的那些话题。
14:50
My patient had a hard life.
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我的病人生活艰难。
14:52
He was by his own admission a gangbanger.
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3076
他承认自己是个混混。
14:56
He had spent a substantial
amount of time in prison.
amount of time in prison.
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3617
他在监狱里呆了很长一段时间。
15:00
He suffered from a very serious illness.
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2806
他曾遭受一种非常严重疾病的折磨。
15:04
He was a drug addict.
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他是瘾君子。
15:06
But despite all that,
he rarely missed a visit,
he rarely missed a visit,
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3098
尽管如此，他却很少错过
跟医生的预约，
跟医生的预约，
15:10
and I like to believe that was because
he knew at our clinic that he was loved.
he knew at our clinic that he was loved.
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我相信那是因为他知道
他在我们诊所是被爱的。
他在我们诊所是被爱的。
15:17
When our health care systems have the same
commitment to low-income patients
commitment to low-income patients
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905793
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当我们的医疗保健系统
对低收入病人拥有
对低收入病人拥有
15:23
that that man had to us,
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像那个病人对我们同样的承诺时，
15:25
two things will happen.
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1539
两件事会发生。
15:27
First, the system will be responsive
to the needs of low-income people.
to the needs of low-income people.
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4805
首先，医疗系统能够响应
低收入病人的需求。
低收入病人的需求。
15:32
It will speak their language,
it will meet their schedules,
it will meet their schedules,
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它会说他们的语言，
它会顺应他们的日程安排，
它会顺应他们的日程安排，
15:36
it will fulfill their needs.
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它会满足他们的需求。
15:39
Second, we will be providing
the kind of care
the kind of care
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3945
第二，我们会提供
我们进入这个行业
我们进入这个行业
15:43
that we went into this profession to do --
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所要做的护理——
15:45
not just checking the boxes,
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2809
不仅只是检查表格，
15:48
but really taking care of those we serve.
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3355
而是真正照顾这些我们所服务的人。
15:53
Thank you.
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谢谢。
15:54
(Applause)
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（鼓掌）
ABOUT THE SPEAKER
Mitchell Katz - Physician, public health advocateMitchell Katz, CEO of NYC Health + Hospitals, works to eliminate the unfair effects of economic disparities in health care, challenging traditional health care systems to find ways to meet all patients on their own terms.
Why you should listen
Mitchell Katz has spent his career shaping and implementing policies that improve health outcomes for some of the most vulnerable patients in urban settings. As the current leader of NYC Health + Hospitals, the largest public health care system in the United States, Katz ensures that more than one million New Yorkers receive essential inpatient, outpatient and home-based health services every year. Previously, he directed the Los Angeles County Department of Health Services, the country's second largest public safety net system, where he created the ambulatory care network, eliminated the department deficit, updated the city's electronic health system and moved more than 1,000 medically complex patients into independent housing.
Katz is the Deputy Editor of JAMA Internal Medicine, an elected member of the National Academy of Sciences and the recipient of the Los Angeles County Medical Association 2015 Healthcare Champion of the year.
Mitchell Katz | Speaker | TED.com