ABOUT THE SPEAKER
Leana Wen - Emergency physician, public health advocate
Dr. Leana Wen is Baltimore City's Health Commissioner.

Why you should listen

Dr. Leana Wen is the Baltimore City Health Commissioner. A physician and public health advocate, she has traveled the world listening to patients’ stories. Born in Shanghai, she was a Rhodes Scholar at Oxford, a reporter with The New York Times’ Nick Kristof, a fellow at the World Health Organization and the Director of Patient-Centered Care Research in the Department of Emergency Medicine at George Washington University.

Inspired by struggles during her mother’s long illness, she wrote When Doctors Don't Listen, a book about empowering patients to avoid misdiagnoses and unnecessary tests.

As an outspoken leader among a new generation of physicians, she served as President of the American Medical Student Association and as Chair of the International Young Professionals Commission. She also helped create Who’s My Doctor, a campaign for radical transparency in medicine. Read her own transparency statement, and find more resources on TEDMED.

In October 2015, she wrote a blanket prescription, or "standing order," in Baltimore City which covers anyone trained to administer naloxone, a medication that reverses the effects of drug overdoses. Under the order, medication will be available on demand to everyone with the proper training to use it, potentially saving many lifes that might have been lost to overdoses.

More profile about the speaker
Leana Wen | Speaker | TED.com
TEDMED 2014

Leana Wen: What your doctor won’t disclose

溫麟衍: 你的醫生不願透露的是什麼?

Filmed:
2,030,830 views

你不想知道你的醫生是否是一間醫療公司的收費代言人嗎?或者他的個人理念是否與你想要的醫療方式不同?目前,至少在美國,你的醫生不需要告訴你這些訊息,當醫師溫麟衍呼籲同行公開這些訊息,她得到的反應......令人忐忑不安。
- Emergency physician, public health advocate
Dr. Leana Wen is Baltimore City's Health Commissioner. Full bio

Double-click the English transcript below to play the video.

00:13
They told me that I'm a traitor叛徒
to my own擁有 profession職業,
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人們說我背叛了自己的職業,
00:17
that I should be fired解僱,
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我應該被炒魷魚,
00:19
have my medical license執照 taken採取 away,
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我的醫師執照應被吊銷,
00:21
that I should go back to my own擁有 country國家.
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甚至要我回到我自己的國家去。
00:26
My email電子郵件 got hacked砍死.
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我的電子信箱被駭。
00:28
In a discussion討論 forum論壇 for other doctors醫生,
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在另一個醫生論壇裡,
00:31
someone有人 took credit信用
for "Twitter-bombingTwitter的轟炸" my account帳戶.
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有人聲稱他「推特轟炸」我的帳號。
00:35
Now, I didn't know if this
was a good or bad thing,
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我不知道那究竟是好還是壞,
00:38
but then came來了 the response響應:
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後來卻看到回覆說:
00:40
"Too bad it wasn't a real真實 bomb炸彈."
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「真可惜那不是真的炸彈」。
00:44
I never thought that I would do something
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我從來沒想到
我做的事會激起其他醫生
00:46
that would provoke this level水平 of anger憤怒
among其中 other doctors醫生.
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這種程度的仇恨。
00:50
Becoming變得 a doctor醫生 was my dream夢想.
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成為醫生是我的夢想。
00:52
I grew成長 up in China中國,
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我在中國大陸長大,
00:53
and my earliest最早 memories回憶
are of being存在 rushed to the hospital醫院
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我最早的兒時記憶就是被緊急送醫,
00:57
because I had such這樣 bad asthma哮喘
that I was there nearly幾乎 every一切 week.
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因為我有很嚴重的氣喘,
幾乎每週都去醫院。
01:01
I had this one doctor醫生, Dr博士. Sam山姆,
who always took care關心 of me.
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當時一直照顧我的是山姆醫生,
01:04
She was about the same相同 age年齡 as my mother母親.
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她大概和我的母親一樣大。
01:06
She had this wild野生, curly捲曲 hair頭髮,
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披著一頭很亂的捲髮,
01:08
and she always wore穿著
these bright yellow黃色 flowery如花 dresses禮服.
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她總是穿著鮮黃印花的洋裝。
01:12
She was one of those doctors醫生 who,
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她這種醫生就是
01:13
if you fell下跌 and you broke打破 your arm,
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如果你摔倒斷了手臂,
01:16
she would ask you why you weren't laughing
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她會問你為何不笑呢?
因為那是你的肱骨(英文與幽默同音)。
明白嗎?
01:18
because it's your humerus. Get it?
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你在痛苦呻吟,
01:22
See, you'd groan呻吟,
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01:24
but she'd always make you feel better
after having seen看到 her.
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但她總能讓你見到她之後
覺得舒服一點。
我們都有兒時崇拜的英雄,
01:27
Well, we all have that childhood童年 hero英雄
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01:29
that we want to grow增長 up
to be just like, right?
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希望長大後成為那樣的人,對吧?
01:32
Well, I wanted to be just like Dr博士. Sam山姆.
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我從小就想成為山姆醫生那樣。
01:35
When I was eight,
my parents父母 and I moved移動 to the U.S.,
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八歲時我隨父母搬到美國,
我們的生活和典型的移民一樣。
01:39
and ours我們的 became成為
the typical典型 immigrant移民 narrative敘述.
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父母靠打掃飯店房間、
做洗碗工和為人加油賺錢,
01:41
My parents父母 cleaned清洗 hotel旅館 rooms客房
and washed dishes碗碟 and pumped gas加油站
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讓我可以追求我的夢想。
01:46
so that I could pursue追求 my dream夢想.
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01:49
Well, eventually終於 I learned學到了 enough足夠 English英語,
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後來我學了夠多的英語,
01:51
and my parents父母 were so happy快樂
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在我進入醫學院
為治療和服務宣誓那天,
01:53
the day that I got into medical school學校
and took my oath誓言 of healing復原 and service服務.
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我的父母非常開心。
但有一天,一切都改變了。
01:58
But then one day, everything changed.
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媽媽打電話告訴我她覺得很不舒服,
02:01
My mother母親 called me to tell me
that she wasn't feeling感覺 well,
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咳嗽咳很久都不會好,
而且呼吸困難又疲憊。
02:04
she had a cough咳嗽 that wouldn't不會 go away,
she was short of breath呼吸 and tired.
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02:07
Well, I knew知道 that my mother母親 was someone有人
who never complained抱怨 about anything.
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我知道媽媽是那種
從不抱怨任何事的人。
當她告訴我這些身體的不適時,
02:11
For her to tell me
that something was the matter,
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我就覺得這件事很不妙。
02:14
I knew知道 something had to be really wrong錯誤.
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02:16
And it was:
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結果也是如此:
我們發現她是乳癌第四期,
02:17
We found發現 out that she had
stage階段 IVIV breast乳房 cancer癌症,
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那時癌細胞已經擴散到
她的肺、骨頭和腦部。
02:20
cancer癌症 that by then had spread傳播
to her lungs, her bones骨頭, and her brain.
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我媽媽當時還是很勇敢並懷抱希望。
02:26
My mother母親 was brave勇敢,
though雖然, and she had hope希望.
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她經歷了手術和放射治療,
02:28
She went through通過 surgery手術 and radiation輻射,
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然後在做第三階段的化療時,
02:30
and was on her third第三 round回合 of chemotherapy化療
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02:32
when she lost丟失 her address地址 book.
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她找不到她的通訊錄。
她試著在網路上找腫瘤醫生的電話,
02:34
She tried試著 to look up her oncologist's腫瘤學家的
phone電話 number on the Internet互聯網
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她找到了,但她也找到了其他東西。
02:37
and she found發現 it,
but she found發現 something else其他 too.
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02:40
On several一些 websites網站,
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在一些網站上,
02:41
he was listed上市 as a highly高度 paid支付
speaker揚聲器 to a drug藥物 company公司,
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她的醫生被列為
一家製藥公司的高薪發言人,
02:45
and in fact事實 often經常 spoke on behalf代表
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而且他其實常代言
02:47
of the same相同 chemo化療 regimen方案
that he had prescribed規定 her.
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他開給她的化療方案。
她驚慌地打電話給我,
02:50
She called me in a panic恐慌,
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02:52
and I didn't know what to believe.
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我不知道該相信什麼。
02:54
Maybe this was the right
chemo化療 regimen方案 for her,
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也許這個化療方案對她來說是對的,
02:56
but maybe it wasn't.
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但也可能不是對的。
02:58
It made製作 her scared害怕 and it made製作 her doubt懷疑.
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這讓她感到恐懼和懷疑。
03:01
When it comes to medicine醫學,
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當涉及到藥物時,
03:03
having that trust相信 is a must必須,
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信任是必須的,
03:06
and when that trust相信 is gone走了,
then all that's left is fear恐懼.
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但當信任消失後,剩下的只有恐懼。
03:11
There's another另一個 side to this fear恐懼.
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這個恐懼還有另外一面。
當我還是醫學院學生的時候,
03:13
As a medical student學生, I was taking服用 care關心
of this 19-year-old-歲
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我照顧一位 19 歲的年輕人,
03:17
who was biking騎自行車 back to his dorm宿舍
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他在騎腳踏車回宿舍時
03:18
when he got struck來襲 and hit擊中,
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被一輛休旅車撞倒,
03:20
run over by an SUVSUV.
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並輾了過去。
03:23
He had seven broken破碎 ribs肋骨,
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他的七根肋骨骨折,
03:24
shattered破滅 hip臀部 bones骨頭,
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臀骨粉碎,
03:26
and he was bleeding流血的 inside
his belly肚皮 and inside his brain.
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他當時腹部和顱內都在出血。
現在,你想像他的父母
03:29
Now, imagine想像 being存在 his parents父母
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從兩千多英里外的西雅圖坐飛機過來,
03:31
who flew in from Seattle西雅圖,
2,000 miles英里 away,
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看到他們的兒子仍然昏迷。
03:33
to find their son兒子 in a coma昏迷.
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你一定想知道他現在是什麼狀況吧?
03:35
I mean, you'd want to find out
what's going on with him, right?
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他們請求參與我們的病房巡視,
03:38
They asked to attend出席 our bedside床頭 rounds
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03:40
where we discussed討論
his condition條件 and his plan計劃,
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那時我們會討論
病人的現況和處理方案,
03:42
which哪一個 I thought was a reasonable合理 request請求,
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我認為這是很合理的請求,
並且也給我們機會
03:44
and also would give us
a chance機會 to show顯示 them
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展示我們是多麼努力和關心。
03:46
how much we were trying
and how much we cared照顧.
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03:49
The head doctor醫生, though雖然, said no.
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然而主治醫生卻拒絕了,
03:52
He gave all kinds of reasons原因.
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他列出了各種理由,
03:53
Maybe they'll他們會 get in the nurse's護士 way.
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例如他們會妨礙護士工作、
03:55
Maybe they'll他們會 stop students學生們
from asking questions問題.
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或許他們會阻止實習醫師提問。
他甚至說:
03:59
He even said,
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04:01
"What if they see mistakes錯誤 and sue起訴 us?"
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「如果他們看到我們出差錯,
起訴我們怎麼辦?」
04:05
What I saw behind背後 every一切 excuse藉口
was deep fear恐懼,
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我看到在每個藉口背後
是深深的恐懼,
04:08
and what I learned學到了
was that to become成為 a doctor醫生,
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因此我學到:要成為醫生,
04:11
we have to put on our white白色 coats大衣,
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我們要穿上白袍,
04:13
put up a wall, and hide隱藏 behind背後 it.
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築起一道牆,把自己藏在牆後。
04:17
There's a hidden epidemic疫情 in medicine醫學.
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其實在醫療界有一個隱藏的 「傳染病」。
04:20
Of course課程, patients耐心 are scared害怕
when they come to the doctor醫生.
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當然,病人就醫時總是心存恐懼。
04:23
Imagine想像 you wake喚醒 up
with this terrible可怕 bellyache腹痛,
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想像你因腹部劇痛而醒來,
04:25
you go to the hospital醫院,
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你去醫院看病,
04:26
you're lying說謊 in this strange奇怪 place地點,
you're on this hospital醫院 gurney格尼,
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你躺在這個奇怪的地方,
你在醫院的病床上,
04:29
you're wearing穿著 this flimsy單薄 gown,
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你穿著單薄的病服,
04:31
strangers陌生人 are coming未來
to poke and prod at you.
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陌生人們過來對你又戳又刺。
04:33
You don't know what's going to happen發生.
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你不知道接下來會發生什麼事。
04:35
You don't even know if you're going to get
the blanket you asked for 30 minutes分鐘 ago.
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你甚至不知道會不會拿到
30 分鐘前要的毛毯。
04:39
But it's not just patients耐心 who are scared害怕;
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然而害怕的不只是病人;
04:41
doctors醫生 are scared害怕 too.
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醫生其實也害怕。
04:43
We're scared害怕 of patients耐心
finding發現 out who we are
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我們害怕病人發現我們的真面目,
04:46
and what medicine醫學 is all about.
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並且洞悉醫療的真相。
04:48
And so what do we do?
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所以我們怎麼辦呢?
04:50
We put on our white白色 coats大衣
and we hide隱藏 behind背後 them.
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我們穿上白袍,將自己藏在後面。
04:53
Of course課程, the more we hide隱藏,
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當然,我們藏得越多,
04:54
the more people want to know
what it is that we're hiding.
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就越多人好奇我們究竟在隱藏什麼。
過多的恐懼演變為
不信任和不良的醫療處置。
04:57
The more fear恐懼 then spirals螺旋
into mistrust不信任 and poor較差的 medical care關心.
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我們現在不只是害怕生病,
05:01
We don't just have a fear恐懼 of sickness疾病,
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05:03
we have a sickness疾病 of fear恐懼.
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我們也患了恐懼症。
05:07
Can we bridge this disconnect斷開
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我們能在病人所需和醫生所為之間的斷層
搭起橋樑嗎?
05:09
between之間 what patients耐心 need
and what doctors醫生 do?
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05:13
Can we overcome克服 the sickness疾病 of fear恐懼?
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我們能克服恐懼症嗎?
05:15
Let me ask you differently不同:
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讓我換個方式提問:
05:17
If hiding isn't the answer回答,
what if we did the opposite對面?
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如果隱藏不是正確的答案時,
假如我們反其道而行,會怎麼樣呢?
05:21
What if doctors醫生 were to become成為
totally完全 transparent透明 with their patients耐心?
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如果醫生變成必須對病人完全透明,
會怎麼樣呢?
05:26
Last fall秋季, I conducted進行
a research研究 study研究 to find out
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去年秋天,我做了一項實地調查,
為了了解關於醫療
大家最想知道的是什麼。
05:29
what it is that people want
to know about their healthcare衛生保健.
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05:32
I didn't just want to study研究
patients耐心 in a hospital醫院,
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我不想只研究醫院裡病人的想法,
05:34
but everyday每天 people.
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而是一般常人的想法。
05:35
So my two medical students學生們,
SuhaviSuhavi Tucker塔克 and Laura勞拉 Johns約翰斯,
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所以我的兩個學生──
蘇哈維.塔克和勞拉.約翰,
05:39
literally按照字面 took their research研究
to the streets街道.
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直接到街上做調查,
05:41
They went to banks銀行,
coffee咖啡 shops商店, senior前輩 centers中心,
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他們去了銀行、咖啡館、老人活動中心、
05:45
Chinese中文 restaurants餐館 and train培養 stations.
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中餐館和火車站。
05:49
What did they find?
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你猜他們發現了什麼?
05:50
Well, when we asked people,
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當我們問民眾:
05:51
"What do you want to know
about your healthcare衛生保健?"
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「對於你的醫療,
你最想知道的是什麼?」
05:54
people responded回應 with what they want
to know about their doctors醫生,
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民眾回應說,
他們想了解的是他們的醫生,
05:58
because people understand理解 health健康 care關心
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因為人們所了解的醫療
05:59
to be the individual個人 interaction相互作用
between之間 them and their doctors醫生.
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是他們自己與醫生之間的個別互動。
那我們就問:
「你想知道關於你醫生的什麼呢?」
06:03
When we asked, "What do you
want to know about your doctors醫生?"
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他們給了三種不同的答案。
06:06
people gave three different不同 answers答案.
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06:08
Some want to know
that their doctor醫生 is competent勝任
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有些人想知道他們的醫生是否稱職,
06:11
and certified認證 to practice實踐 medicine醫學.
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是否有從事醫療工作的認證。
06:13
Some want to be sure
that their doctor醫生 is unbiased不偏不倚
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有些人想確定他們的醫生是公正的,
06:16
and is making製造 decisions決定
based基於 on evidence證據 and science科學,
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會依靠證據和科學做出決定,
而不是根據誰付錢。
06:19
not on who pays支付 them.
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讓我們感到驚訝的是,
06:21
Surprisingly出奇 to us,
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06:23
many許多 people want to know
something else其他 about their doctors醫生.
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很多人想知道醫生其他的事情。
喬納森,28 歲的法學院學生,
06:26
Jonathan喬納森, a 28-year-old-歲 law student學生,
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06:29
says he wants to find someone有人
who is comfortable自在 with LGBTQLGBTQ patients耐心
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表示他在找能夠接受 「非異性戀患者」,
並且專長於「非異性戀疾病」治療的醫生。
06:34
and specializes專業 in LGBTLGBT health健康.
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賽琳娜,32 歲的會計師,
06:36
Serena小威, a 32-year-old-歲 accountant會計,
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06:38
says that it's important重要 to her
for her doctor醫生 to share分享 her values
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表示醫生認同她的價值觀
對她而言很重要,
06:41
when it comes to reproductive生殖 choice選擇
and women's女士的 rights權利.
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尤其是涉及生育選擇和女性權利時。
06:45
Frank坦率, a 59-year-old-歲
hardware硬件 store商店 owner所有者,
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弗蘭克,59 歲的五金行老闆,
06:47
doesn't even like going to the doctor醫生
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甚至不喜歡去看醫生,
06:50
and wants to find someone有人
who believes相信 in prevention預防 first,
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他想找的是相信預防優先,
06:53
but who is comfortable自在
with alternative替代 treatments治療.
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並且能接受另類療法的醫生。
06:56
One after another另一個,
our respondents受訪者 told us
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一個接一個的受訪者告訴我們
06:59
that that doctor-patient醫患 relationship關係
is a deeply intimate親密 one —
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醫生和病人之間的關係
其實是非常親密的,
在讓他們的醫生看到自己的身體
07:02
that to show顯示 their doctors醫生 their bodies身體
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07:04
and tell them their deepest最深 secrets秘密,
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並告訴他們自己最深層的秘密之前,
07:06
they want to first understand理解
their doctor's醫生 values.
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他們想先了解醫生的價值準則。
07:09
Just because doctors醫生
have to see every一切 patient患者
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僅僅因為醫生需要看他們所有的病人,
07:12
doesn't mean that patients耐心
have to see every一切 doctor醫生.
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並不意味著病人需要去看所有的醫生。
07:15
People want to know
about their doctors醫生 first
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人們想先了解醫生,
07:17
so that they can make an informed通知 choice選擇.
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他們才可以做出有根據的選擇。
根據這個調查結果,我發起了一個活動,
07:20
As a result結果 of this, I formed形成 a campaign運動,
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07:22
Who's誰是 My Doctor醫生?
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「我的醫生是誰?」
07:24
that calls電話 for total
transparency透明度 in medicine醫學.
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呼籲醫學界完全透明化。
07:27
Participating參與 doctors醫生 voluntarily自行 disclose透露
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參與的醫生
自願在一個公共網站上公開,
07:29
on a public上市 website網站
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07:30
not just information信息
about where we went to medical school學校
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不僅是關於我們讀哪所醫學院
07:33
and what specialty專業 we're in,
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和我們的醫療專長,
07:35
but also our conflicts衝突 of interest利益.
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並且公開我們的利益衝突。
07:36
We go beyond
the Government政府 in the Sunshine陽光 Act法案
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我們超越政府在陽光法案中
07:39
about drug藥物 company公司 affiliations隸屬關係,
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醫生和藥廠的關係要公開的規定,
07:41
and we talk about how we're paid支付.
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我們公布自己的收入來源。
07:44
Incentives激勵 matter.
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金錢誘因是很重要的。
07:46
If you go to your doctor醫生
because of back pain疼痛,
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如果你因為背痛去看醫生,
07:48
you might威力 want to know he's getting得到 paid支付
5,000 dollars美元 to perform演出 spine脊柱 surgery手術
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你也許想知道
他幫你做脊椎手術會賺到五千美元,
07:52
versus 25 dollars美元 to refer參考 you
to see a physical物理 therapist治療師,
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而推薦你去看復健師只能賺到 25 美元,
07:56
or if he's getting得到 paid支付 the same相同 thing
no matter what he recommends建議.
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或者不管他推薦哪一種,收入都一樣。
08:00
Then, we go one step further進一步.
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然後,我們再進一步。
08:03
We add our values
when it comes to women's女士的 health健康,
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我們在談到婦女健康、
08:05
LGBTLGBT health健康, alternative替代 medicine醫學,
176
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非異性戀者的健康、另類醫療、
預防保健和臨終決定時
會提出自己的價值觀。
08:08
preventive預防 health健康,
and end-of-life生命盡頭 decisions決定.
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08:11
We pledge保證 to our patients耐心
that we are here to serve服務 you,
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我們對病人宣誓要服務你們,
08:14
so you have a right to know who we are.
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所以你們有權了解我們。
08:17
We believe that transparency透明度
can be the cure治愈 for fear恐懼.
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我們相信這種透明可以治療恐懼症。
我原以為有些醫生會加入我們,有些不會,
08:21
I thought some doctors醫生 would sign標誌 on
and others其他 wouldn't不會,
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08:24
but I had no idea理念 of the huge巨大 backlash反彈
that would ensue接踵而至.
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但我從沒想到會因此引起強烈反彈。
08:29
Within one week of starting開始
Who's誰是 My Doctor醫生?
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在「我的醫生是誰」發起的一周內,
08:31
Medscape'sMedscape表示的 public上市 forum論壇
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醫景 (Medscape) 公共論壇
08:33
and several一些 online線上 doctors'醫生 communities社區
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和一些醫生社團網站
08:35
had thousands數千 of posts帖子 about this topic話題.
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出現上千則關於這個話題的貼文。
這裡有一些例子。
08:39
Here are a few少數.
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波特蘭的腸胃科醫生說:
08:40
From a gastroenterologist腸胃病 in Portland波特蘭:
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08:42
"I devoted忠誠 12 years年份 of my life
to being存在 a slave奴隸.
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「我奉獻了 12 年的生命做奴隸。
08:45
I have loans貸款 and mortgages抵押貸款.
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我有一些貸款和房貸。
08:47
I depend依靠 on lunches午餐 from
drug藥物 companies公司 to serve服務 patients耐心."
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我得靠製藥公司提供午餐
才能服務患者。」
08:51
Well, times may可能 be hard for everyone大家,
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生活在這個時代每個人都很困難,
但是你可以試試告訴那些
08:54
but try telling告訴 your patient患者
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每年賺三萬五千美元養活一家四口的病人
08:55
making製造 35,000 dollars美元 a year
to serve服務 a family家庭 of four
194
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08:58
that you need the free自由 lunch午餐.
195
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你需要免費的午餐。
來自夏洛特的一名整形外科醫生說:
09:02
From an orthopedic骨科 surgeon外科醫生 in Charlotte夏洛特:
196
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09:05
"I find it an invasion侵入 of my privacy隱私
to disclose透露 where my income收入 comes from.
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「我認為公開收入來源
是侵犯我的隱私。」
「我的病人也不向我公開他們的收入。」
09:09
My patients耐心 don't disclose透露
their incomes收入 to me."
198
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但是病人的收入來源不影響你的健康。
09:13
But your patients'耐心' sources來源 of income收入
don't affect影響 your health健康.
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來自紐約市的一名精神科醫生寫道:
09:17
From a psychiatrist心理醫生 in New York紐約 City:
200
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09:19
"Pretty漂亮 soon不久 we will have to disclose透露
whether是否 we prefer比較喜歡 cats to dogs小狗,
201
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3419
「不久後我們就必須公開
我們喜歡貓還是狗、
09:23
what model模型 of car汽車 we drive駕駛,
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開哪種車、
09:24
and what toilet廁所 paper we use."
203
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1648
用哪種衛生紙。」
你對豐田汽車或者綿柔衛生紙的看法
09:27
Well, how you feel
about Toyotas豐田 or CottonelleCottonelle
204
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09:30
won't慣於 affect影響 your patients'耐心' health健康,
205
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不會影響病人的健康,
09:32
but your views意見
on a woman's女人的 right to choose選擇
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560204
2001
但是你對於婦女選擇權、預防醫學
09:34
and preventive預防 medicine醫學
and end-of-life生命盡頭 decisions決定 just might威力.
207
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和臨終決定的觀點,就可能會影響。
我最喜歡的一則是
來自堪薩斯市的心臟科醫生說:
09:38
And my favorite喜愛,
from a Kansas堪薩斯 City cardiologist心髒病:
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09:41
"More government-mandated政府規定 stuff東東?
209
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「更多政府強制管理的鳥事?
09:44
Dr博士. Wen溫家寶 needs需求 to move移動
back to her own擁有 country國家."
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溫醫生可以回自己的國家去​​了。」
09:48
Well, two pieces of good news新聞.
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好的,我有兩個好消息。
09:50
First of all, this is meant意味著 to be
voluntary自主性 and not mandatory強制性,
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首先,這是自願而不是強制的,
09:53
and second第二 of all, I'm American美國
and I'm already已經 here.
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其次,我是美國人,我已經在這裡了。
09:57
(Laughter笑聲) (Applause掌聲)
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(笑聲)(掌聲)
10:05
Within a month, my employers雇主
were getting得到 calls電話
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在一個月之內,我的僱主接到很多來電
10:08
asking for me to be fired解僱.
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要求解僱我。
10:10
I received收到 mail郵件
at my undisclosed未公開 home address地址
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我在從未公開的住家地址收到
10:13
with threats威脅 to contact聯繫
the medical board to sanction制裁 me.
218
601806
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威脅要聯繫醫務委員制裁我的郵件。
10:17
My friends朋友 and family家庭 urged敦促 me
to quit放棄 this campaign運動.
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我的朋友和家人力勸我放棄這個活動。
在收到炸彈威脅後,我停止了活動。
10:21
After the bomb炸彈 threat威脅, I was doneDONE.
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10:24
But then I heard聽說 from patients耐心.
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後來我卻收到來自病人的訊息。
10:26
Over social社會 media媒體, a TweetChatTweetChat,
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在社交媒體推特聊天室上,
10:29
which哪一個 I'd learned學到了 what that was by then,
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當時我才知道那個網站,
10:31
generated產生 4.3 million百萬 impressions印象,
224
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這件事出現在 430 萬人次的版上,
10:34
and thousands數千 of people wrote
to encourage鼓勵 me to continue繼續.
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有數千人留言鼓勵我堅持下去。
他們留言說:
10:38
They wrote with things like,
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「如果醫生在做他們自己都
感到羞恥的事情,
10:40
"If doctors醫生 are doing something
they're that ashamed羞愧 of,
227
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10:43
they shouldn't不能 be doing it."
228
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他們就不該繼續做。」
10:46
"Elected當選 officials官員 have to disclose透露
campaign運動 contributions捐款.
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「民選官員必須公開選舉經費明細。
10:49
Lawyers律師 have to disclose透露
conflicts衝突 of interests利益.
230
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律師必須要公開是否有利益衝突,
10:51
Why shouldn't不能 doctors醫生?"
231
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為什麼醫生就不行?」
10:53
And finally最後, many許多 people wrote and said,
232
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最後,還有很多人留言:
10:56
"Let us patients耐心 decide決定
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「讓我們這些病人來決定
10:58
what's important重要
when we're choosing選擇 a doctor醫生."
234
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2313
選醫生要看什麼才重要。」
11:02
In our initial初始 trial審訊,
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我們初次嘗試的時候,
11:03
over 300 doctors醫生 have taken採取
the total transparency透明度 pledge保證.
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超過三百位醫生參與了這項
完全透明的承諾。
11:08
What a crazy new idea理念, right?
237
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很瘋狂的想法,對吧?
11:10
But actually其實, this is not
that new of a concept概念 at all.
238
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其實這個概念根本沒那麼新。
11:13
Remember記得 Dr博士. Sam山姆, my doctor醫生 in China中國,
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記得山姆醫生嗎?我在中國的醫生,
11:15
with the goofy高飛 jokes笑話 and the wild野生 hair頭髮?
240
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2799
會說些傻笑話、頭髮很亂的那位。
11:18
Well, she was my doctor醫生,
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她是我的醫生,
11:19
but she was also our neighbor鄰居
242
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也是我們的鄰居,
11:21
who lived生活 in the building建造
across橫過 the street.
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就住在對面。
11:23
I went to the same相同 school學校 as her daughter女兒.
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我和她的女兒上同一所學校。
11:26
My parents父母 and I trusted信任 her
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我和爸媽都很信任她,
11:28
because we knew知道 who she was
and what she stood站在 for,
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2396
因為我們都知道她是誰,
還有她的價值觀點,
11:30
and she had no need to hide隱藏 from us.
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她也沒必要向我們隱瞞。
11:33
Just one generation ago,
this was the norm規範 in the U.S. as well.
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這在上一代的美國也很常見。
11:37
You knew知道 that your family家庭 doctor醫生
was the father父親 of two teenage青少年 boys男孩,
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3476
你知道你的家庭醫生
有兩個十幾歲的兒子,
11:40
that he quit放棄 smoking抽煙 a few少數 years年份 ago,
250
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1845
他在幾年前戒了煙,
11:42
that he says he's a regular定期 churchgoer禮拜的,
251
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1991
他說他常上教堂做禮拜,
11:44
but you see him twice兩次 a year:
once一旦 at Easter復活節
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2317
但是你一年才會見到他兩次,
一次在復活節,
11:46
and once一旦 when his mother-in-law岳母
comes to town.
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2234
一次在他的岳母來探望他時。
11:50
You knew知道 what he was about,
254
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你知道他的事情,
11:51
and he had no need to hide隱藏 from you.
255
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1777
他也沒必要向你隱瞞。
11:54
But the sickness疾病 of fear恐懼 has taken採取 over,
256
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2331
但是恐懼症席捲了這一切,
11:57
and patients耐心 suffer遭受 the consequences後果.
257
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而病人承擔後果。
11:59
I know this firsthand第一手.
258
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1380
我也親自體會過。
12:02
My mother母親 fought戰鬥
her cancer癌症 for eight years年份.
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2293
我媽媽和癌症抗爭了八年。
12:05
She was a planner規劃人員,
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1143
她是善於計劃的人,
12:06
and she thought a lot
about how she wanted to live生活
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她思考了她要如何活
12:08
and how she wanted to die.
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以及她要如何死。
12:10
Not only did she sign標誌 advance提前 directives指令,
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她不僅簽了臨終醫療指示,
12:13
she wrote a 12-page-頁 document文件
about how she had suffered遭遇 enough足夠,
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還寫了一份 12 頁的文章敘述
她已經受夠了痛苦,
12:16
how it was time for her to go.
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是她該離開的時候了。
12:19
One day, when I was a resident居民 physician醫師,
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我還是住院醫師的某一天,
12:21
I got a call to say that she was
in the intensive集約 care關心 unit單元.
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接到電話說她在加護病房。
12:25
By the time I got there,
she was about to be intubated插管
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我趕過去的時候,她就快被插管,
12:29
and put on a breathing呼吸 machine.
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而且要接上呼吸機了。
我說:「這不是她要的治療。
12:31
"But this is not what she wants,"
I said, "and we have documents文件."
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我們有她簽的指示文件。」
12:36
The ICUICU doctor醫生 looked看著 at me in the eye,
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加護病房的醫生看著我的眼睛,
12:38
pointed at my then 16-year-old-歲
sister妹妹, and said,
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746891
4127
指著我 16 歲的妹妹,然後說:
「你還記得在你妹妹那般年紀時,
12:43
"Do you remember記得 when you were that age年齡?
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751043
2118
12:45
How would you have liked喜歡 to grow增長 up
without your mother母親?"
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你會要過沒有媽媽的日子嗎?」
12:49
Her oncologist腫瘤科醫生 was there too, and said,
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757568
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她的腫瘤科醫師也在那裡,說道:
12:52
"This is your mother母親.
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「這可是你的母親,
12:54
Can you really face面對 yourself你自己
for the rest休息 of your life
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如果你不為她做出任何行動的話,
12:56
if you don't do everything for her?"
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764830
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你真的能在未來的日子裡
坦然面對自己嗎?」
13:00
I knew知道 my mother母親 so well.
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2060
我太了解我母親了。
13:02
I understood了解 what
her directives指令 meant意味著 so well,
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770435
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我很清楚理解她的指示,
13:05
but I was a physician醫師.
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773595
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但我是一個醫生。
我此生做過最艱難的決定
13:09
That was the single hardest最難
decision決定 I ever made製作,
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777413
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就是讓她平靜的過世。
13:13
to let her die in peace和平,
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13:16
and I carry攜帶 those words
of those doctors醫生 with me
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我每天都記得
那些醫生對我說的話。
13:19
every一切 single day.
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我們可以在病人所需
13:23
We can bridge the disconnect斷開
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791142
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13:25
between之間 what doctors醫生 do
and what patients耐心 need.
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793356
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和醫生所為之間的斷層搭起橋樑。
我們能做到,因為我們做過,
13:30
We can get there,
because we've我們已經 been there before,
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798157
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而且我們知道公開透明必將得到信任。
13:32
and we know that transparency透明度
gets得到 us to that trust相信.
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2493
13:35
Research研究 has shown顯示 us
that openness透明度 also helps幫助 doctors醫生,
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803331
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研究告訴我們公開也會幫助醫生,
13:38
that having open打開 medical records記錄,
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806096
1606
藉由公開醫療紀錄,
13:39
being存在 willing願意 to talk
about medical errors錯誤,
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807702
2037
願意討論醫療過失,
13:41
will increase增加 patient患者 trust相信,
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809739
1690
就能提升病人對我們的信任感,
13:43
improve提高 health健康 outcomes結果,
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811429
1721
改善治療結果,
13:45
and reduce減少 malpractice弊端.
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813150
2060
進而減少醫療疏失。
13:47
That openness透明度, that trust相信,
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815210
1480
那份透明,那份信任,
在從關注疾病的傳染
轉為關注疾病的行為模式時,
13:48
is only going to be more important重要
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816749
1634
13:50
as we move移動 from the infectious傳染病
to the behavioral行為的 model模型 of disease疾病.
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818423
3590
會更加為重要。
13:54
Bacteria may可能 not care關心 so much
about trust相信 and intimacy親密關係,
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822013
3474
細菌並不關心信任和人際關係,
13:57
but for people to tackle滑車
the hard lifestyle生活方式 choices選擇,
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825487
3943
但是人們面對選擇
攸關性命的生活模式時,
14:01
to address地址 issues問題 like smoking抽煙 cessation戒菸,
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829430
2298
像是在戒煙、
14:03
blood-pressure血壓 management管理
and diabetes糖尿病 control控制,
302
831728
3037
血壓控制和糖尿病控制,
14:06
well, that requires要求 us to establish建立 trust相信.
303
834765
2730
就需要建立彼此的信任。
14:11
Here's這裡的 what other transparent透明
doctors醫生 have said.
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839003
2870
這裡是其他支持醫療透明化的醫生所說的。
14:13
Brandon布蘭登 Combs庫姆斯, an internist內科醫生 in Denver丹佛:
305
841873
2917
布蘭德.柯布,來自丹佛的內科醫生說:
14:16
"This has brought me
closer接近 to my patients耐心.
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844790
3013
「這(透明化)縮短了
我和病人之間的距離,
14:19
The type類型 of relationship關係 I've developed發達
307
847803
2699
我建立的醫病關係,
是我從事醫療工作的原因。」
14:22
that's why I entered進入 medicine醫學."
308
850547
2015
14:26
Aaron亞倫 StuppleStupple, an internist內科醫生 in Denver丹佛:
309
854117
2673
艾倫.斯泰普,來自丹佛的內科醫生:
14:28
"I tell my patients耐心
that I am totally完全 open打開 with them.
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856790
3496
「我告訴我的病人,我對他們完全公開。
14:32
I don't hide隱藏 anything from them.
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860286
2074
我不向他們隱瞞任何事情。
14:34
This is me. Now tell me about you.
312
862360
2926
這就是我,告訴我你的故事,
14:37
We're in this together一起."
313
865286
2232
我們一起解決你的問題。」
14:39
May可能 Nguyen, a family家庭 physician醫師 in Houston休斯頓:
314
867518
2402
阮梅,休斯頓的家庭醫師說:
14:41
"My colleagues同事 are astounded震驚
by what I'm doing.
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869920
4078
「我的同事對我做的事感到震驚,
他們問我為什麼能如此勇敢。」
14:45
They ask me how I could be so brave勇敢.
316
873998
2586
14:48
I said, I'm not being存在 brave勇敢,
317
876584
2888
我回答:「 這不是勇敢,
14:51
it's my job工作."
318
879552
1389
我只是在做我的工作而已。」
在此,我留下最後一點讓大家思考。
14:55
I leave離開 you today今天 with a final最後 thought.
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883024
2194
完全透明是一件十分恐怖的事情。
14:58
Being存在 totally完全 transparent透明 is scary害怕.
320
886428
3304
你有一種全身赤裸、
15:01
You feel naked, exposed裸露 and vulnerable弱勢,
321
889772
3330
毫無遮掩、脆弱的感覺,
15:05
but that vulnerability漏洞, that humility謙遜,
322
893102
3638
然而那份脆弱感,那份謙遜,
對行醫會有極大的好處。
15:08
it can be an extraordinary非凡 benefit效益
to the practice實踐 of medicine醫學.
323
896740
4516
15:13
When doctors醫生 are willing願意
to step off our pedestals基座,
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901256
2408
當醫生願意放下架子,
15:15
take off our white白色 coats大衣,
325
903664
1476
脫下白袍,
15:17
and show顯示 our patients耐心 who we are
and what medicine醫學 is all about,
326
905140
3381
並且向病人展示我們是怎樣的人,
以及醫療是怎樣運作的時候,
15:20
that's when we begin開始
to overcome克服 the sickness疾病 of fear恐懼.
327
908521
3265
這才是我們開始克服恐懼症的開始。
15:23
That's when we establish建立 trust相信.
328
911786
1929
那才是我們建立信任的時候,
15:25
That's when we change更改
the paradigm範例 of medicine醫學
329
913715
2460
那才是我們改變醫療模式的時候,
15:28
from one of secrecy保密 and hiding
330
916175
1810
對我們的病人
從隱藏躲閃,
15:29
to one that is fully充分 open打開 and engaged訂婚
331
917985
2359
到完全公開、全心全意的投入。
15:32
for our patients耐心.
332
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1374
15:35
Thank you.
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1897
謝謝。
(掌聲)
15:36
(Applause掌聲)
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4000
Translated by Melody Tang
Reviewed by Marssi Draw

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ABOUT THE SPEAKER
Leana Wen - Emergency physician, public health advocate
Dr. Leana Wen is Baltimore City's Health Commissioner.

Why you should listen

Dr. Leana Wen is the Baltimore City Health Commissioner. A physician and public health advocate, she has traveled the world listening to patients’ stories. Born in Shanghai, she was a Rhodes Scholar at Oxford, a reporter with The New York Times’ Nick Kristof, a fellow at the World Health Organization and the Director of Patient-Centered Care Research in the Department of Emergency Medicine at George Washington University.

Inspired by struggles during her mother’s long illness, she wrote When Doctors Don't Listen, a book about empowering patients to avoid misdiagnoses and unnecessary tests.

As an outspoken leader among a new generation of physicians, she served as President of the American Medical Student Association and as Chair of the International Young Professionals Commission. She also helped create Who’s My Doctor, a campaign for radical transparency in medicine. Read her own transparency statement, and find more resources on TEDMED.

In October 2015, she wrote a blanket prescription, or "standing order," in Baltimore City which covers anyone trained to administer naloxone, a medication that reverses the effects of drug overdoses. Under the order, medication will be available on demand to everyone with the proper training to use it, potentially saving many lifes that might have been lost to overdoses.

More profile about the speaker
Leana Wen | Speaker | TED.com