Rishi Manchanda: What makes us get sick? Look upstream
曼理希: 什麼讓我們生病?看看上游吧!
Rishi Manchanda is an "upstreamist." A physician and public health innovator, he aims to reinvigorate primary care by teaching doctors to think about—and treat—the social and environmental conditions that often underly sickness. Full bio
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live and work in conditions
學習及享樂的地方開始,
approach to healthcare look like,
是什麼樣子?
我跟大家說說小維的故事。
emergency room in Los Angeles.
here's some pain medication,
所以我現在給你開一些止痛藥,
with healthcare professionals,
we tried a different approach.
我們試了一種不同的療法。
洛杉磯南區病人,
妳住的地方的情況?
to three of those things:
the privilege of caring for,
大部分病人一樣,
擱在她的手上。
「過敏性敬禮徵」。
who have chronic allergies.
有慢性過敏的兒童上。
one's nose up and down,
已經是成年婦女,
Veronica some questions,
我想我知道妳得了什麼。
headaches and some sinus congestion,
related to where you live."
talk about your treatment.
現在我們來談一下治療方法。
medications for your symptoms,
a specialist, if that's okay."
如果妳同意。」
「真的?」
the specialist I'm talking about
我認為是這些造成妳的症狀,
call a public interest lawyer,
had improved by 90 percent.
改善了 90%,
the emergency rooms of Los Angeles.
幾個簡單問題,
shattered by the cries of a child,
但有個小孩的哭聲劃破了寧靜,
in need of rescue in the water.
在水裡需要救援。
但願每個人都會做的事。
I'm going to build a raft.
讓我們多領幾個人到安全區,
但也不盡然,
所以他們終於往上游看,
丟這些兒童進水裡。」
加護病房護士、
when you're in dire straits.
所需的資源連結在一起。
a very obvious question
about transportation and housing?
交通及住房的問題?
做手上的工作就好?」
were to use science as our guide,
approach is absolutely necessary.
是絕對必要的。
對我們的健康影響
藥丸及醫療處置總合
of death from heart disease."
space was a powerful influence.
有很大的影響。
at those molecular mechanisms,
our DNA is literally shaped,
我們 DNA 的複雜機制,
should do something about it.
應該為此出力。
我一直難以回答的問題,
all sorts of people in healthcare,
我看過各種醫療照護人員,
for volume and not value.
live and where you work,
these are important issues.
這些是很重要的問題。
of where they live and work,
但有能力在我們工作的系統中
但不一定得是醫師。
then move on to that second step,
他們就進到下一步,
讓我們看一下你的基因,
freeway with major air pollution
空氣很糟的高速公路旁,
mobilize our resources to address,
所有資源來對付的事,
that third part of the process,
步驟的第三部分,
下一步關鍵部分。
以找出解決的方法,
找出合理的解決方法,
actually have clinical problems
nearly enough of them out there.
每 20 至 30 位臨床醫師
in the healthcare system.
需要二萬五千名上游管理人。
out there right now, by all accounts,
幾千名上游管理人,
我與幾位同僚說,
that we use for our success,
評量我們是否成功,
「你不問我不說」的制式心態。
信心增加了二倍。
bouncing you back and forth
that we can all do to get there.
我們能合作達成這件事。
只要他們問問病人的生活背景,
in our data about our patients' lives
發現病人的生活型態,
我們能不能運用資源
next generation of upstreamists.
上游管理人來達成目標。
in the healthcare system
或許也是最重要的一點,
身為病人我們要怎麼做?
有什麼是我該注意的嗎?」
是我從沒注意到的嗎?
我無法採納你的建議
responsibility or phenomenon.
即使不惡劣也很糟的人做這件事。
ABOUT THE SPEAKER
Rishi Manchanda - PhysicianRishi Manchanda is an "upstreamist." A physician and public health innovator, he aims to reinvigorate primary care by teaching doctors to think about—and treat—the social and environmental conditions that often underly sickness.
Why you should listen
For a decade, Rishi Manchanda has worked as a doctor in South Central Los Angeles, treating patients who live and work in harsh conditions. He has worked at the Venice Family Clinic, one of the largest free clinics in the United States. He was the first director of social medicine at the St. John’s Well Child and Family Center in Compton, where he and his team provided high quality primary care to low-income families in the area. Currently, he is the medical director of a veterans’ clinic within the Greater Los Angeles Healthcare System, which he refers to as an “intensive caring unit.” He tells the National Health Corps Services, “The moment when a patient switches from despair to hopefulness is the greatest part of my service.”
Manchanda is the author of the TED Book The Upstream Doctors, in which he looks at how health begins at home and in the workplace, with the social and environmental factors of our everyday lives. He shows how the future of our healthcare system depends on “upstreamists,” the doctors, nurses and other healthcare practitioners who look for the root cause of illness rather than just treating the symptoms.
Manchanda is the president and founder of Health Begins, a social network that teaches and empowers clinicians to improve health where it begins—in patients’ home and work environments. He also founded RxDemocracy, a nonpartisan coalition created to register voters in healthcare clinics. He serves on the board of the National Physicians Alliance, as well as on the board of Physicians for Social Responsibility in Los Angeles.
Rishi Manchanda | Speaker | TED.com