TEDGlobal>London
Daniel Levitin: How to stay calm when you know you'll be stressed
丹尼爾．列維廷: 知道自己處於壓力中時，如何保持冷靜？
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15,873,808 views
你的最佳狀態絕對不是在壓力之下。事實上，數千年來，人腦在高壓情況下都會釋放出皮質醇，抑制理性邏輯的思考，卻能幫助你在危急時保住性命，例如遭受獅子攻擊時。神經科學家丹尼爾．列維廷認為，當你處在壓力中、頭腦渾沌時，有個方法能幫助你避免錯誤決策 － 「事前剖析」。「我們無論如何都會出錯。」他說：「但我們可以事先想想會出什麼錯。」
Daniel Levitin - Neuroscientist
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Double-click the English transcript below to play the video.
00:13
A few years ago,
I broke into my own house.
I broke into my own house.
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幾年前，我闖進自己家裡。
當時我剛開車回到家，
00:16
I had just driven home,
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00:18
it was around midnight
in the dead of Montreal winter,
in the dead of Montreal winter,
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就在蒙特婁寒冬中的午夜時分，
我剛拜訪完住在
鎮上另一邊的朋友傑夫。
鎮上另一邊的朋友傑夫。
00:20
I had been visiting my friend,
Jeff, across town,
Jeff, across town,
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00:23
and the thermometer on the front porch
read minus 40 degrees --
read minus 40 degrees --
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門廊前的溫度計顯示零下40度 －
00:27
and don't bother asking
if that's Celsius or Fahrenheit,
if that's Celsius or Fahrenheit,
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就別問我是攝氏還是華氏了，
00:30
minus 40 is where the two scales meet --
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零下40度剛好是
攝氏等於華氏的溫度 －
攝氏等於華氏的溫度 －
00:33
it was very cold.
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非常地寒冷。
00:34
And as I stood on the front porch
fumbling in my pockets,
fumbling in my pockets,
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當我站在門廊前翻著口袋時，
00:37
I found I didn't have my keys.
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發現鑰匙不在自己身上。
00:40
In fact, I could see them
through the window,
through the window,
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事實上，我還能從窗外看到那串鑰匙，
00:42
lying on the dining room table
where I had left them.
where I had left them.
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它就被我擱在餐桌上靜靜地躺著。
00:45
So I quickly ran around
and tried all the other doors and windows,
and tried all the other doors and windows,
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所以我快速繞了一圈，
試了試所有的門和窗戶，
試了試所有的門和窗戶，
00:48
and they were locked tight.
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發現每一扇都鎖得緊緊的。
00:50
I thought about calling a locksmith --
at least I had my cellphone,
at least I had my cellphone,
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我想著要不要找鎖匠來 －
至少手機還在身上，
至少手機還在身上，
00:53
but at midnight, it could take a while
for a locksmith to show up,
for a locksmith to show up,
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但在這種午夜時分，
要找鎖匠來可有得等了，
要找鎖匠來可有得等了，
00:56
and it was cold.
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天氣又這麼冷。
我也不能再回去傑夫那借住一晚，
01:00
I couldn't go back to my friend
Jeff's house for the night
Jeff's house for the night
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01:03
because I had an early flight
to Europe the next morning,
to Europe the next morning,
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因為隔天一早我就得飛到歐洲，
01:05
and I needed to get
my passport and my suitcase.
my passport and my suitcase.
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我得拿到我的護照和行李。
01:08
So, desperate and freezing cold,
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所以，在這個令人絕望
又冷得要命的時刻，
又冷得要命的時刻，
01:10
I found a large rock and I broke
through the basement window,
through the basement window,
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我找到一塊大石後，
砸破地下室的玻璃，
砸破地下室的玻璃，
01:14
cleared out the shards of glass,
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清了清玻璃碎片後
01:16
I crawled through,
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就爬了進去，
01:17
I found a piece of cardboard
and taped it up over the opening,
and taped it up over the opening,
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然後找了一片厚紙板
貼在窗戶破掉的地方，
貼在窗戶破掉的地方，
01:21
figuring that in the morning,
on the way to the airport,
on the way to the airport,
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心裡估算著明天早上往機場的路上
01:24
I could call my contractor
and ask him to fix it.
and ask him to fix it.
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可以打電話給我的承包商，
請他幫我修好玻璃。
請他幫我修好玻璃。
01:26
This was going to be expensive,
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維修費一定很貴，
01:28
but probably no more expensive
than a middle-of-the-night locksmith,
than a middle-of-the-night locksmith,
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但應該不會比午夜時分
請鎖匠來開鎖還貴，
請鎖匠來開鎖還貴，
01:31
so I figured, under the circumstances,
I was coming out even.
I was coming out even.
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所以我想，在當時的情況下，
這個決定也沒讓我虧到。
這個決定也沒讓我虧到。
因為我是個受過訓練的神經學家，
01:36
Now, I'm a neuroscientist by training
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01:39
and I know a little bit
about how the brain performs under stress.
about how the brain performs under stress.
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對於大腦在壓力之下的運作略有了解，
01:43
It releases cortisol
that raises your heart rate,
that raises your heart rate,
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我知道它會釋出皮質醇，
增加你的心跳、
增加你的心跳、
01:46
it modulates adrenaline levels
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調解腎上腺素、
01:49
and it clouds your thinking.
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並讓你思緒渾沌不清。
01:51
So the next morning,
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所以第二天早上，
01:53
when I woke up on too little sleep,
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當我從嚴重不足的睡眠中醒來後，
01:55
worrying about the hole in the window,
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就開始擔心玻璃上的那個破洞，
01:58
and a mental note
that I had to call my contractor,
that I had to call my contractor,
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心裡一直惦記著要打電話給承包商，
02:01
and the freezing temperatures,
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天氣又冷得要命，
02:02
and the meetings I had upcoming in Europe,
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還有即將要在歐洲開的那些會議，
02:05
and, you know, with all
the cortisol in my brain,
the cortisol in my brain,
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而你知道的，因為有許多皮質醇在大腦裡，
02:08
my thinking was cloudy,
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我的思緒一片渾沌，
02:10
but I didn't know it was cloudy
because my thinking was cloudy.
because my thinking was cloudy.
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而正因它一片渾沌，
我根本沒發現它一片渾沌
我根本沒發現它一片渾沌
02:13
(Laughter)
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(笑聲)
02:15
And it wasn't until I got
to the airport check-in counter,
to the airport check-in counter,
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而當我到達機場的報到櫃台時，
02:18
that I realized I didn't have my passport.
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我才發現自己竟然沒帶護照。
02:20
(Laughter)
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(笑聲)
02:22
So I raced home in the snow
and ice, 40 minutes,
and ice, 40 minutes,
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所以我在冰雪中疾馳回家，
花了40分鐘，
花了40分鐘，
02:26
got my passport,
raced back to the airport,
raced back to the airport,
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拿到護照後再火速回到機場，
02:28
I made it just in time,
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在最後關頭總算趕上，
02:30
but they had given away
my seat to someone else,
my seat to someone else,
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但他們已經把我的座位
先讓給別人了，
先讓給別人了，
02:32
so I got stuck in the back of the plane,
next to the bathrooms,
next to the bathrooms,
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於是我只能被擠到
飛機的最後方、廁所旁的位子，
飛機的最後方、廁所旁的位子，
02:35
in a seat that wouldn't recline,
on an eight-hour flight.
on an eight-hour flight.
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座椅還無法向後倾斜，
而且得撐8小時。
而且得撐8小時。
好吧，至少在這8小時中
我有很多時間思考，反正也別想睡了。
我有很多時間思考，反正也別想睡了。
02:39
Well, I had a lot of time to think
during those eight hours and no sleep.
during those eight hours and no sleep.
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(笑聲)
02:43
(Laughter)
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然後我開始想，我能不能先做些什麼，
02:44
And I started wondering,
are there things that I can do,
are there things that I can do,
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或是設置好什麼機制，
02:47
systems that I can put into place,
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02:49
that will prevent bad things
from happening?
from happening?
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來幫助我避免壞事發生？
02:51
Or at least if bad things happen,
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或至少發生了壞事之後，
02:53
will minimize the likelihood
of it being a total catastrophe.
of it being a total catastrophe.
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能把造成重大損害的可能性降到最低，
所以我開始思考這些事，
02:59
So I started thinking about that,
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但我的思緒直到一個月後才漸漸清晰。
03:00
but my thoughts didn't crystallize
until about a month later.
until about a month later.
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那時我正和我的同事，諾貝爾經濟學獎
得主丹尼爾‧卡尼曼一起吃晚餐，
得主丹尼爾‧卡尼曼一起吃晚餐，
03:03
I was having dinner with my colleague,
Danny Kahneman, the Nobel Prize winner,
Danny Kahneman, the Nobel Prize winner,
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我有點不好意思地
提到破窗進入自己家裡、
提到破窗進入自己家裡、
03:07
and I somewhat embarrassedly told him
about having broken my window,
about having broken my window,
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03:10
and, you know, forgotten my passport,
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還有忘記帶護照等等的事，
03:13
and Danny shared with me
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於是丹尼爾和我分享
03:14
that he'd been practicing
something called prospective hindsight.
something called prospective hindsight.
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他正在實行一種叫做
「前瞻性後見之明」的東西。
「前瞻性後見之明」的東西。
03:19
(Laughter)
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(笑聲)
03:20
It's something that he had gotten
from the psychologist Gary Klein,
from the psychologist Gary Klein,
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這東西是他從心理學家
蓋瑞．克萊恩那裡得來的，
蓋瑞．克萊恩那裡得來的，
03:24
who had written about it
a few years before,
a few years before,
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幾年前他曾寫過相關著作，
03:26
also called the pre-mortem.
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又將其稱為「事前剖析」。
03:28
Now, you all know what the postmortem is.
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各位一定都知道事後剖析是什麼。
03:30
Whenever there's a disaster,
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每當有災難降臨，
03:31
a team of experts come in and they try
to figure out what went wrong, right?
to figure out what went wrong, right?
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一組專家就會來到事發現場，
設法釐清出了什麼問題，對吧？
設法釐清出了什麼問題，對吧？
03:36
Well, in the pre-mortem, Danny explained,
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那麼，事前剖析，根據丹尼爾的解釋，
03:38
you look ahead and you try to figure out
all the things that could go wrong,
all the things that could go wrong,
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就是你先往前看，
設法找出所有可能出錯的事，
設法找出所有可能出錯的事，
03:42
and then you try to figure out
what you can do
what you can do
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接著再嘗試找出對應的解決方式
03:45
to prevent those things from happening,
or to minimize the damage.
or to minimize the damage.
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來防止這些事發生或將傷害降到最低。
03:48
So what I want to talk to you about today
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所以今天要和各位聊的，
03:51
are some of the things we can do
in the form of a pre-mortem.
in the form of a pre-mortem.
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是我們能用「事前剖析」來做些什麼。
03:55
Some of them are obvious,
some of them are not so obvious.
some of them are not so obvious.
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有些顯而易見，有些不那麼明顯。
03:58
I'll start with the obvious ones.
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我先從顯而易見的開始。
03:59
Around the home, designate a place
for things that are easily lost.
for things that are easily lost.
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在房子四處，給每個容易
遺失的東西一個專屬位置。
遺失的東西一個專屬位置。
這聽起來像是常識，也確實是，
04:05
Now, this sounds
like common sense, and it is,
like common sense, and it is,
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04:09
but there's a lot of science
to back this up,
to back this up,
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但它有許多理論基礎可為其佐證，
04:12
based on the way our spatial memory works.
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像是我們空間記憶的運作方式。
04:15
There's a structure in the brain
called the hippocampus,
called the hippocampus,
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大腦裡有個結構叫做海馬體，
04:18
that evolved over tens
of thousands of years,
of thousands of years,
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它經過成千上萬年的演化而來，
04:21
to keep track of the locations
of important things --
of important things --
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負責追蹤每個重要物品的位置 －
04:25
where the well is,
where fish can be found,
where fish can be found,
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例如井的位置、哪裡可以捕到魚、
04:27
that stand of fruit trees,
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果樹的位置、
04:30
where the friendly and enemy tribes live.
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或是同盟及敵對的部落在哪裡等等。
04:32
The hippocampus is the part of the brain
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海馬體是大腦裡的一部分，
04:34
that in London taxicab drivers
becomes enlarged.
becomes enlarged.
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倫敦的計程車司機
這個部分比常人還大。
這個部分比常人還大。
04:38
It's the part of the brain
that allows squirrels to find their nuts.
that allows squirrels to find their nuts.
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松鼠可以順利找到松果
也是靠大腦的這個部分。
也是靠大腦的這個部分。
04:41
And if you're wondering,
somebody actually did the experiment
somebody actually did the experiment
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如果你有興趣，
有人的確做過這個實驗，
有人的確做過這個實驗，
04:44
where they cut off
the olfactory sense of the squirrels,
the olfactory sense of the squirrels,
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在他們切斷松鼠的嗅覺之後，
04:47
and they could still find their nuts.
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發現牠們仍能找到松果。
牠們用的不是嗅覺，而是海馬體，
04:49
They weren't using smell,
they were using the hippocampus,
they were using the hippocampus,
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04:52
this exquisitely evolved mechanism
in the brain for finding things.
in the brain for finding things.
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大腦裡一個為了找到東西
而高度演化而成的機制。
而高度演化而成的機制。
04:57
But it's really good for things
that don't move around much,
that don't move around much,
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但它對靜止不動的物體比較有用，
05:01
not so good for things that move around.
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對會移動的東西就沒那麼有效。
05:03
So this is why we lose car keys
and reading glasses and passports.
and reading glasses and passports.
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這就是為什麼我們很容易
遺失鑰匙、老花眼鏡和護照。
遺失鑰匙、老花眼鏡和護照。
05:07
So in the home,
designate a spot for your keys --
designate a spot for your keys --
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所以在家時，幫你的鑰匙
找個固定位置 －
找個固定位置 －
05:10
a hook by the door,
maybe a decorative bowl.
maybe a decorative bowl.
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例如掛在門上、或放在裝飾性的碗裡。
05:13
For your passport, a particular drawer.
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至於護照，擺在某個特定的抽屜裡。
05:15
For your reading glasses,
a particular table.
a particular table.
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老花眼鏡則可以固定放在某個桌子上。
05:18
If you designate a spot
and you're scrupulous about it,
and you're scrupulous about it,
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如果東西都放到定位而且你夠留意，
05:21
your things will always be there
when you look for them.
when you look for them.
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當需要時，永遠能在定位找到東西。
05:24
What about travel?
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那旅行時該怎麼辦？
05:25
Take a cell phone picture
of your credit cards,
of your credit cards,
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用手機幫你的信用卡拍幾張照，
05:28
your driver's license, your passport,
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還有駕照、護照也拍幾張，
05:30
mail it to yourself so it's in the cloud.
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然後寄給自己，照片就會在雲端留存。
05:32
If these things are lost or stolen,
you can facilitate replacement.
you can facilitate replacement.
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如果這些東西掉了或被偷，
至少有東西先擋著用。
至少有東西先擋著用。
05:37
Now these are some rather obvious things.
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這些都是相對明顯的事。
05:39
Remember, when you're under stress,
the brain releases cortisol.
the brain releases cortisol.
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記住，當你處在壓力中，
你的大腦會釋放皮質醇。
你的大腦會釋放皮質醇。
05:43
Cortisol is toxic,
and it causes cloudy thinking.
and it causes cloudy thinking.
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皮質醇是有害的，他會阻礙你的思考。
05:46
So part of the practice of the pre-mortem
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所以「事前剖析」部分的實踐方式，
05:49
is to recognize that under stress
you're not going to be at your best,
you're not going to be at your best,
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是要意識到壓力會讓你
無法處在最佳狀態，
無法處在最佳狀態，
05:53
and you should put systems in place.
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所以你得將事情安排得井然有序。
05:55
And there's perhaps
no more stressful a situation
no more stressful a situation
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而可能沒有任何狀況
05:58
than when you're confronted
with a medical decision to make.
with a medical decision to make.
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比當你面臨醫療決策時
更令人感到壓力了。
更令人感到壓力了。
06:02
And at some point, all of us
are going to be in that position,
are going to be in that position,
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在人生的某個時刻，
我們都面臨這樣的狀況，
我們都面臨這樣的狀況，
06:05
where we have to make
a very important decision
a very important decision
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迫使我們必須做出重大決策，
06:07
about the future of our medical care
or that of a loved one,
or that of a loved one,
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而這個決策可能事關
我們所愛的人未來的醫療照護，
我們所愛的人未來的醫療照護，
06:11
to help them with a decision.
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必須幫他們做個選擇。
06:12
And so I want to talk about that.
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所以我想談談這個情境。
06:14
And I'm going to talk about
a very particular medical condition.
a very particular medical condition.
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我特別想談論的是
這個特殊的醫療情境。
這個特殊的醫療情境。
06:17
But this stands as a proxy for all kinds
of medical decision-making,
of medical decision-making,
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但這個情境可以代表所有的醫療決策，
06:21
and indeed for financial decision-making,
and social decision-making --
and social decision-making --
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事實上，還可以代表財務決策、社交決策 －
06:25
any kind of decision you have to make
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任何一種你必須
06:27
that would benefit from a rational
assessment of the facts.
assessment of the facts.
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針對事實進行理性評估的決策。
06:31
So suppose you go to your doctor
and the doctor says,
and the doctor says,
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所以假如你去看醫生，醫生告訴你：
06:34
"I just got your lab work back,
your cholesterol's a little high."
your cholesterol's a little high."
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「我剛拿到你的檢驗報告，
你的膽固醇偏高。」
你的膽固醇偏高。」
在座各位都知道高膽固醇
06:39
Now, you all know that high cholesterol
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06:42
is associated with an increased risk
of cardiovascular disease,
of cardiovascular disease,
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可能會增加心血管疾病、
06:46
heart attack, stroke.
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心臟病及中風的風險。
06:47
And so you're thinking
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所以你開始想
06:49
having high cholesterol
isn't the best thing,
isn't the best thing,
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高膽固醇可不是什麼好事，
06:51
and so the doctor says,
"You know, I'd like to give you a drug
"You know, I'd like to give you a drug
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然後醫生接著說：「我想幫你開一種藥
06:54
that will help you
lower your cholesterol, a statin."
lower your cholesterol, a statin."
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來幫助你降低膽固醇，
叫斯達汀(statin)。」
叫斯達汀(statin)。」
06:57
And you've probably heard of statins,
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你可能聽過斯達汀類藥物，
知道它們是當今世上
最廣泛地被開立的藥物，
最廣泛地被開立的藥物，
06:59
you know that they're among
the most widely prescribed drugs
the most widely prescribed drugs
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你甚至可能認識正在服用的人。
07:01
in the world today,
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07:03
you probably even know
people who take them.
people who take them.
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所以你想著：
「好啊！給我來點斯達汀。」
「好啊！給我來點斯達汀。」
07:05
And so you're thinking,
"Yeah! Give me the statin."
"Yeah! Give me the statin."
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但這時候，你應該要問一個問題，
07:07
But there's a question
you should ask at this point,
you should ask at this point,
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07:10
a statistic you should ask for
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這個問題是大部分醫生
07:11
that most doctors
don't like talking about,
don't like talking about,
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都不願談論到的統計數據，
07:14
and pharmaceutical companies
like talking about even less.
like talking about even less.
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製藥公司甚至提到更少。
這個數據就是NNT--
「需要治療的人數」。
「需要治療的人數」。
07:18
It's for the number needed to treat.
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07:21
Now, what is this, the NNT?
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那麼，這個「NNT」是什麼呢？
( 用來衡量藥物治療有效性的一種指標 )
( 用來衡量藥物治療有效性的一種指標 )
07:23
It's the number of people
that need to take a drug
that need to take a drug
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它是指--某藥物或手術或療程
07:26
or undergo a surgery
or any medical procedure
or any medical procedure
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平均每多少人裡，
才有一人從中獲得助益。
才有一人從中獲得助益。
07:29
before one person is helped.
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你可能會想，這是哪門子統計數字？
07:31
And you're thinking,
what kind of crazy statistic is that?
what kind of crazy statistic is that?
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07:34
The number should be one.
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這個數據應該就是" 1 " 啊。
07:35
My doctor wouldn't prescribe
something to me
something to me
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我的醫生理當不會開立
07:37
if it's not going to help.
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對我沒有幫助的藥物。
07:39
But actually, medical practice
doesn't work that way.
doesn't work that way.
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但事實上，醫療的實務
不是這樣運作的。
不是這樣運作的。
07:41
And it's not the doctor's fault,
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而這不是醫生的錯，
07:43
if it's anybody's fault,
it's the fault of scientists like me.
it's the fault of scientists like me.
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如果一定要說是誰的錯，
那就是像我這樣的科學家。
那就是像我這樣的科學家。
07:46
We haven't figured out
the underlying mechanisms well enough.
the underlying mechanisms well enough.
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我們還不夠了解這些藥品
基礎的運作機制。
基礎的運作機制。
07:48
But GlaxoSmithKline estimates
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然而葛蘭素史克公司
(全球第三大製藥商)預測，
(全球第三大製藥商)預測，
07:51
that 90 percent of the drugs work
in only 30 to 50 percent of the people.
in only 30 to 50 percent of the people.
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高達90%的藥品
都只對30%至50%的人有效。
都只對30%至50%的人有效。
07:56
So the number needed to treat
for the most widely prescribed statin,
for the most widely prescribed statin,
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那麼對最廣泛應用的
斯達汀來說，所需治療人數
斯達汀來說，所需治療人數
08:00
what do you suppose it is?
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你猜猜看是多少？
08:02
How many people have to take it
before one person is helped?
before one person is helped?
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每多少人裡才有一人從中獲得助益？
08:05
300.
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1200
300....
這個數據來自一個研究，
08:07
This is according to research
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08:08
by research practitioners
Jerome Groopman and Pamela Hartzband,
Jerome Groopman and Pamela Hartzband,
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由醫療研究者傑若‧古柏曼
和潘蜜拉‧哈茨班德進行，
和潘蜜拉‧哈茨班德進行，
08:12
independently confirmed by Bloomberg.com.
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同時被Bloomberg.com網站
獨立證實的研究。
獨立證實的研究。
08:14
I ran through the numbers myself.
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我自己想了一下這個數字。
300個人必須服用這種藥物一年，
08:17
300 people have to
take the drug for a year
take the drug for a year
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08:20
before one heart attack, stroke
or other adverse event is prevented.
or other adverse event is prevented.
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才能阻止一次心臟病、
中風或其他病變。
中風或其他病變。
08:24
Now you're probably thinking,
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現在你可能在想，「好吧，至少
有 1/300的機率能降低我的膽固醇。
有 1/300的機率能降低我的膽固醇。
08:25
"Well, OK, one in 300 chance
of lowering my cholesterol.
of lowering my cholesterol.
177
493725
2811
08:28
Why not, doc? Give me
the prescription anyway."
the prescription anyway."
178
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2216
為何不要呢，醫生？還是開給我吧。」
08:30
But you should ask at this point
for another statistic,
for another statistic,
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2856
但這時你得問到另一個統計數據，
08:33
and that is, "Tell me
about the side effects." Right?
about the side effects." Right?
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也就是，「副作用是什麼？」對吧？
08:36
So for this particular drug,
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以這種藥而言，
08:37
the side effects occur
in five percent of the patients.
in five percent of the patients.
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3656
它會對5%的病患產生副作用。
08:41
And they include terrible things --
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它們包含很可怕的症狀 －
08:43
debilitating muscle and joint pain,
gastrointestinal distress --
gastrointestinal distress --
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4444
例如四肢無力、關節疼痛、
腸胃不適 －
腸胃不適 －
08:47
but now you're thinking, "Five percent,
185
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1859
但現在你可能又想，「就5%嘛，
不會這麼剛好發生在我身上，
08:49
not very likely
it's going to happen to me,
it's going to happen to me,
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2014
我還是吃這個藥吧。」
08:51
I'll still take the drug."
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但等一等。
08:52
But wait a minute.
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記得在壓力下你並沒有思考得很透徹。
08:54
Remember under stress
you're not thinking clearly.
you're not thinking clearly.
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所以事先想想你該怎麼處理這個狀況，
08:56
So think about how you're going
to work through this ahead of time,
to work through this ahead of time,
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你就不用事到臨頭再
進行一連串的推理了。
進行一連串的推理了。
08:59
so you don't have to manufacture
the chain of reasoning on the spot.
the chain of reasoning on the spot.
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每300個人，對吧？才有一個有用，
09:02
300 people take the drug, right?
One person's helped,
One person's helped,
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2492
這300人裡有5%會產生副作用，
09:05
five percent of those 300
have side effects,
have side effects,
193
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2407
09:07
that's 15 people.
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1480
也就是15人。
09:09
You're 15 times more likely
to be harmed by the drug
to be harmed by the drug
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這個藥對你造成傷害的可能性，
09:13
than you are to be helped by the drug.
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高達對你有所幫助的15倍之多。
09:16
Now, I'm not saying whether you
should take the statin or not.
should take the statin or not.
197
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2905
現在我要說的，
不是你應該服用斯達汀與否。
不是你應該服用斯達汀與否。
09:19
I'm just saying you should have
this conversation with your doctor.
this conversation with your doctor.
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而是你得和你的醫生談談。
在醫學道德上這是需要的，
09:22
Medical ethics requires it,
199
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1320
09:24
it's part of the principle
of informed consent.
of informed consent.
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這是知情同意原則的一部份。
09:26
You have the right to have access
to this kind of information
to this kind of information
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你有權得知這樣的資訊，
09:29
to begin the conversation about whether
you want to take the risks or not.
you want to take the risks or not.
202
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來和醫生討論
你是否願意承擔這些風險。
你是否願意承擔這些風險。
09:33
Now you might be thinking
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現在你可能在想，
09:34
I've pulled this number
out of the air for shock value,
out of the air for shock value,
204
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我只是為了嚇嚇大家才丟出這個數字，
09:37
but in fact it's rather typical,
this number needed to treat.
this number needed to treat.
205
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但實際上，這個治療所需人數
是相對具有代表性的。
是相對具有代表性的。
09:40
For the most widely performed surgery
on men over the age of 50,
on men over the age of 50,
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對於50歲以上男性最常進行的手術，
09:45
removal of the prostate for cancer,
207
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2216
做的最多的手術是為治療
前列腺癌而切除前列腺，
前列腺癌而切除前列腺，
09:47
the number needed to treat is 49.
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治療所需人數是49。
09:50
That's right, 49 surgeries are done
for every one person who's helped.
for every one person who's helped.
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沒錯，每49個手術
才有一人真正受益。
才有一人真正受益。
09:54
And the side effects in that case
occur in 50 percent of the patients.
occur in 50 percent of the patients.
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4656
而所有的病患中，
有50%可能產生副作用，
有50%可能產生副作用，
09:59
They include impotence,
erectile dysfunction,
erectile dysfunction,
211
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2856
包含陽痿、勃起功能障礙，
10:01
urinary incontinence, rectal tearing,
212
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尿失禁、直腸撕裂、
10:04
fecal incontinence.
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1456
和排糞失禁。
10:06
And if you're lucky, and you're one
of the 50 percent who has these,
of the 50 percent who has these,
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3496
如果你夠幸運，
而你是這50%之一的話，
而你是這50%之一的話，
10:09
they'll only last for a year or two.
215
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2040
這些副作用只會維持一到兩年。
10:12
So the idea of the pre-mortem
is to think ahead of time
is to think ahead of time
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3616
所以「事前剖析」這個方法是事先想好
10:16
to the questions
that you might be able to ask
that you might be able to ask
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2536
所有你能問的問題，
10:19
that will push the conversation forward.
218
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2376
讓討論能進行得更順利。
10:21
You don't want to have to manufacture
all of this on the spot.
all of this on the spot.
219
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3096
你不會希望事到臨頭才處理這些問題。
10:24
And you also want to think
about things like quality of life.
about things like quality of life.
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你也會希望能想想生活品質之類的事。
10:27
Because you have a choice oftentimes,
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因為很多時候你其實有選擇機會，
10:29
do you I want a shorter life
that's pain-free,
that's pain-free,
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「我想要短暫一點、
但沒有痛苦的人生，
但沒有痛苦的人生，
10:31
or a longer life that might have
a great deal of pain towards the end?
a great deal of pain towards the end?
223
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3776
還是長一點，但可能得
一路忍受痛苦的人生？」
一路忍受痛苦的人生？」
10:35
These are things to talk about
and think about now,
and think about now,
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這些都是值得思考的事，所以趕快
和家人及你所愛的人好好想想。
和家人及你所愛的人好好想想。
10:37
with your family and your loved ones.
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1816
你還是可能一時激動改變心意，
10:39
You might change your mind
in the heat of the moment,
in the heat of the moment,
226
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2496
但至少你已練習過這樣的思考。
10:42
but at least you're practiced
with this kind of thinking.
with this kind of thinking.
227
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3056
10:45
Remember, our brain under stress
releases cortisol,
releases cortisol,
228
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4616
請記住，我們的大腦
會在壓力下釋放皮質醇，
會在壓力下釋放皮質醇，
10:49
and one of the things
that happens at that moment
that happens at that moment
229
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2336
在此情況下會發生的事
10:52
is a whole bunch on systems shut down.
230
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1936
就是整個系統一起停工。
10:54
There's an evolutionary reason for this.
231
642280
1905
在生物演化上這是有道理的。
10:56
Face-to-face with a predator,
you don't need your digestive system,
you don't need your digestive system,
232
644209
3407
當獵食者就在你面前時，
你不需要你的消化系統、
你不需要你的消化系統、
10:59
or your libido, or your immune system,
233
647640
2456
也不需要性慾、或是免疫系統，
11:02
because if you're body is expending
metabolism on those things
metabolism on those things
234
650120
3656
因為如果你的身體將代謝反應
擴展到這些事情上，
擴展到這些事情上，
11:05
and you don't react quickly,
235
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1656
你無法快速反應，
11:07
you might become the lion's lunch,
and then none of those things matter.
and then none of those things matter.
236
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3976
可能讓你變成獅子的午餐，
然後這些事情就再也不重要了。
然後這些事情就再也不重要了。
11:11
Unfortunately,
237
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1416
很不幸地，
11:12
one of the things that goes out the window
during those times of stress
during those times of stress
238
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3616
能讓我們在這種高壓時刻
脫離險境的東西之一，
脫離險境的東西之一，
11:16
is rational, logical thinking,
239
664560
1976
就是理性、邏輯思考，
11:18
as Danny Kahneman
and his colleagues have shown.
and his colleagues have shown.
240
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3416
正如丹尼爾．卡尼曼
和他的同事證明的。
和他的同事證明的。
11:22
So we need to train ourselves
to think ahead
to think ahead
241
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所以我們得訓練自己
在遇到這種狀況前預先思考。
11:25
to these kinds of situations.
242
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2256
11:27
I think the important point here
is recognizing that all of us are flawed.
is recognizing that all of us are flawed.
243
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6176
我想此處的重點是
要認清我們自己並不是完美的。
要認清我們自己並不是完美的。
11:33
We all are going to fail now and then.
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2856
我們無論如何都會出錯。
11:36
The idea is to think ahead
to what those failures might be,
to what those failures might be,
245
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但我們可以預先思考可能會出什麼錯，
11:40
to put systems in place
that will help minimize the damage,
that will help minimize the damage,
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然後事先把事情安排妥當，
將傷害降到最低，
將傷害降到最低，
11:44
or to prevent the bad things
from happening in the first place.
from happening in the first place.
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或是在一開始就避免壞事發生。
回到蒙特婁那個大雪紛飛的夜晚，
11:48
Getting back to that
snowy night in Montreal,
snowy night in Montreal,
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11:50
when I got back from my trip,
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當我從歐洲回來後，
11:52
I had my contractor install
a combination lock next to the door,
a combination lock next to the door,
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我請承包商在門的旁邊
裝了一個密碼鎖，
裝了一個密碼鎖，
11:56
with a key to the front door in it,
an easy to remember combination.
an easy to remember combination.
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裡面裝著前門的鑰匙，
並設定了一個好記的密碼。
並設定了一個好記的密碼。
12:00
And I have to admit,
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而我必須承認，
12:01
I still have piles of mail
that haven't been sorted,
that haven't been sorted,
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我還有許多郵件沒有整理，
12:04
and piles of emails
that I haven't gone through.
that I haven't gone through.
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也有許多電子郵件還沒看完。
12:07
So I'm not completely organized,
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所以我並不是個井然有序的人，
12:09
but I see organization
as a gradual process,
as a gradual process,
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但我將井然有序視為一個漸進的過程，
12:12
and I'm getting there.
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而我會越來越井然有序。
12:13
Thank you very much.
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非常感謝各位。
12:14
(Applause)
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(掌聲)
ABOUT THE SPEAKER
Daniel Levitin - NeuroscientistDaniel Levitin incorporates findings from neuroscience into everyday life.
Why you should listen
Dr. Daniel Levitin is a neuroscientist at McGill University in Montreal, dean at Minerva Schools in San Francisco and a musician. His research focuses on pattern processing in the brain.
His three books This Is Your Brain on Music, The World in Six Songs, and the recent The Organized Mind are all bestsellers. A polymath at heart, he has performed with top musicians and holds a few gold and platinum records.
Levitin earned his B.A. in Cognitive Psychology and Cognitive Science at Stanford University, and went on to earn his Ph.D. in Psychology from the University of Oregon, researching complex auditory patterns and pattern processing in expert and non-expert populations. He completed post-doctoral training at Stanford University Medical School (in Neuroimaging) and at UC Berkeley (in Cognitive Psychology). He has consulted on audio sound source separation for the U.S. Navy, and on audio quality for several rock bands and record labels (including the Grateful Dead and Steely Dan), and served as one of the “Golden Ears” expert listeners in the original Dolby AC3 compression tests. He worked for two years at the Silicon Valley think tank Interval Research Corporation.
He taught at Stanford University in the Department of Computer Science, the Program in Human-Computer Interaction, and the Departments of Psychology, Anthropology, Computer Music, and History of Science.
Daniel Levitin | Speaker | TED.com