ABOUT THE SPEAKER
Timothy Ihrig - Palliative care physician
Timothy Ihrig advocates for an approach to healthcare that prioritizes a patient's personal values.

Why you should listen

Dr. Timothy Ihrig, MD practices palliative medicine, caring for the most vulnerable and sickest people, and helps other providers improve the quality and value of the care they provide to this population. His work has shown how patient-centered care improves quality and length of life, and that it has significant economic benefits to patients, healthcare systems and the economy.

Ihrig is nationally recognized for his expertise in continuum population health and community-based palliative care. He holds appointments as content expert to the Accountable Care Learning Collaborative, an industry-leading healthcare innovation collaborative co-chaired by former Health and Human Services Secretary and Utah Governor Mike Leavitt and former Food and Drug Administration Commissioner Dr. Mark McClellan. Ihrig is a member of the Advisory Council of the Iowa Healthcare Collaborative, a think-tank for strategies in health care quality, safety and value for the state of Iowa. He also serves as an Iowa Alternate-Delegate to the American Medical Association.

Ihrig has been an expert source for palliative care development for the Brookings Institution, and he was the sole practicing physician assisting the Iowa General Assembly in raising minimum standard requirements for Iowa physicians with respect to end-of-life care and oversight of prescriptive narcotics. He also acted as an expert clinician in support of Iowa Physician Orders for Life-Sustaining Treatment bill. He holds appointments as Clinical Adjunct Professor in the Department of Medicine at the University of Iowa Carver School of Medicine and acts as Palliative Care clinical instructor. He is on the board of the Hospice and Palliative Care Association of Iowa, is the former chair of the Advocacy Committee and sits on the Palliative Care Advisory Committee.

Ihrig's other interests include sexuality at the end of life and global health. He served as the Medical Chair of the Health Services Committee for Empower Tanzania Incorporated, whose mission is the development of sustainable healthcare solutions in sub-Saharan Africa for individuals suffering with HIV/AIDS, cancer and other life-limited illnesses.

More profile about the speaker
Timothy Ihrig | Speaker | TED.com
TEDxDesMoines

Timothy Ihrig: What we can do to die well

提摩西·伊理各: 尊嚴離世,安寧善終

Filmed:
1,397,148 views

美國醫療界太重視病理學、手術及藥理學,即醫師能在病患身上「做」什麼治療,卻忽略了病患身為人的價值所應得的照護。安寧照護醫師提摩西·伊理各說明一種迥異的方法,不但能促進病人的整體生活品質,也讓病人尊嚴離世,安寧善終。
- Palliative care physician
Timothy Ihrig advocates for an approach to healthcare that prioritizes a patient's personal values. Full bio

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

00:13
I am a palliative治標不治本 care關心 physician醫師
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我是安寧照護醫師,
00:14
and I would like to talk to you
today今天 about health健康 care關心.
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今天我想跟大家談談健康照護。
00:18
I'd like to talk to you
about the health健康 and care關心
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我想跟大家談
我國最脆弱的一群人
他們的健康與照護,
00:22
of the most vulnerable弱勢
population人口 in our country國家 --
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00:25
those people dealing交易 with the most
complex複雜 serious嚴重 health健康 issues問題.
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這群人對抗著
最複雜最嚴重的健康問題。
00:32
I'd like to talk to you
about economics經濟學 as well.
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我也想跟你們談一談經濟。
00:35
And the intersection路口 of these two
should scare the hell地獄 out of you --
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這兩者交會之處應該會把大家嚇死,
00:39
it scares恐慌 the hell地獄 out of me.
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至少我是怕死了。
00:42
I'd also like to talk to you
about palliative治標不治本 medicine醫學:
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我也想跟大家談談安寧療護:
00:45
a paradigm範例 of care關心 for this population人口,
grounded接地 in what they value.
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這是基於這群病患的價值觀
而產生的照護模式。
00:52
Patient-centric以病人為中心 care關心 based基於 on their values
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以病人為中心,
根據他們的價值觀而做的照護,
00:55
that helps幫助 this population人口
live生活 better and longer.
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幫助這個族群活得更好更久。
01:00
It's a care關心 model模型 that tells告訴 the truth真相
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這個照護模式會對病人說實話,
01:03
and engages嚙合 one-on-one一對一
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並與他們進行一對一對談,
01:05
and meets符合 people where they're at.
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並在患者所在之處碰面。
01:09
I'd like to start開始 by telling告訴 the story故事
of my very first patient患者.
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我想以我第一個病人的故事
來做開場白。
01:13
It was my first day as a physician醫師,
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那是我當醫師的第一天,
01:15
with the long white白色 coat塗層 ...
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穿著白袍,
01:17
I stumbled迷迷糊糊 into the hospital醫院
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我一走進醫院,
01:19
and right away there's a gentleman紳士,
Harold哈羅德, 68 years年份 old,
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就碰到一位先生,海樂,68 歲,
01:21
came來了 to the emergency department.
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到急診室報到。
01:23
He had had headaches頭痛 for about six weeks
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他頭痛了六個星期,
01:25
that got worse更差 and worse更差
and worse更差 and worse更差.
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病情愈來愈重,愈來愈難過。
01:28
Evaluation評估 revealed透露 he had cancer癌症
that had spread傳播 to his brain.
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診斷發現他有癌症,
而且已經擴散到腦部。
01:33
The attending出席 physician醫師 directed針對 me
to go share分享 with Harold哈羅德 and his family家庭
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他的主治醫生指示我去跟海樂和家屬
01:39
the diagnosis診斷, the prognosis預測
and options選項 of care關心.
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談他的診斷結果、預後及照護方案。
01:44
Five hours小時 into my new career事業,
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我的職業生涯才過了五個小時,
01:47
I did the only thing I knew知道 how.
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我只能做我唯一會做的事。
01:49
I walked in,
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我走進去,
01:51
satSAT down,
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坐下,
01:53
took Harold's哈羅德的 hand,
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握住海樂的手,
01:55
took his wife's妻子 hand
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握住他太太的手,
01:58
and just breathed無聲.
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然後就一直呼吸。
02:00
He said, "It's not good
news新聞 is it, sonny桑尼?"
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他說:「不是什麼好消息,
對吧,小夥子?」
02:03
I said, "No."
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我說:「不是。」
02:04
And so we talked
and we listened聽了 and we shared共享.
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然後我們開始談話、傾聽、分享。
02:08
And after a while I said,
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過一陣子之後我說:
02:10
"Harold哈羅德, what is it
that has meaning含義 to you?
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「海樂,什麼對你最有意義?
02:13
What is it that you hold保持 sacred神聖?"
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你最看重的東西是什麼?」
02:15
And he said,
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他說:
02:16
"My family家庭."
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「我的家人。」
02:18
I said, "What do you want to do?"
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我說:「那你想怎麼辦?」
02:20
He slapped耳光 me on the knee膝蓋
and said, "I want to go fishing釣魚."
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他拍拍我的膝蓋說:
「我想去釣魚。」
02:23
I said, "That, I know how to do."
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我說:「這個簡單,
我知道該怎麼做。」
02:26
Harold哈羅德 went fishing釣魚 the next下一個 day.
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海樂隔天就去釣魚了。
02:29
He died死亡 a week later後來.
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他在一星期後去世。
02:32
As I've gone走了 through通過
my training訓練 in my career事業,
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現在我已在職場受到不少訓練,
02:35
I think back to Harold哈羅德.
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我就回想起海樂。
02:36
And I think that this is a conversation會話
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我在想像這樣的對話
02:40
that happens發生 far too infrequently不常.
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太少發生了。
02:43
And it's a conversation會話
that had led us to crisis危機,
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這樣的對話帶領我們到危機之處,
02:48
to the biggest最大 threat威脅
to the American美國 way of life today今天,
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對今天的美式生活產生最大的威脅,
02:50
which哪一個 is health健康 care關心 expenditures支出.
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就是醫療支出。
02:53
So what do we know?
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所以我們知道什麼?
02:55
We know that
this population人口, the most ill生病,
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我們知道這個族群病得最重,
02:58
takes up 15 percent百分
of the gross domestic國內 product產品 --
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吃掉了 15% 的
國內生產毛額 (GDP),
03:00
nearly幾乎 2.3 trillion dollars美元.
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將近二兆三千億美金。
03:04
So the sickest最病 15 percent百分
take up 15 percent百分 of the GDPGDP.
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所以病得最重的 15%
吃掉 15% 的 GDP。
03:07
If we extrapolate推斷 this out
over the next下一個 two decades幾十年
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照這樣推斷未來二十年,
03:11
with the growth發展 of baby寶寶 boomers,
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隨著嬰兒潮逐漸老化,
03:14
at this rate it is 60 percent百分 of the GDPGDP.
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這個數字會是 60% 的 GDP。
03:20
Sixty六十 percent百分 of the gross
domestic國內 product產品
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美國 GDP 的 60%──
03:22
of the United聯合的 States狀態 of America美國 --
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到了這個地步,
已經不再是醫療的問題了,
03:24
it has very little to do
with health健康 care關心 at that point.
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03:27
It has to do with a gallon加侖 of milk牛奶,
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而是變成買牛奶、
03:29
with college學院 tuition學費.
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大學學費的問題。
03:31
It has to do with
every一切 thing that we value
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這跟我們重視的一切
03:34
and every一切 thing that we know presently目前.
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及我們目前知道的一切有關。
03:38
It has at stake賭注 the free-market自由市場
economy經濟 and capitalism資本主義
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這會賭上美國自由市場
及資本主義的成敗。
03:42
of the United聯合的 States狀態 of America美國.
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03:46
Let's forget忘記 all the statistics統計
for a minute分鐘, forget忘記 the numbers數字.
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讓我們先擱下統計數字。
03:50
Let's talk about the value we get
for all these dollars美元 we spend.
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我們先來談一下花大錢得到什麼。
03:54
Well, the Dartmouth達特茅斯 Atlas輿圖,
about six years年份 ago,
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達特茅斯醫療照護地圖集
在大約六年前
03:57
looked看著 at every一切 dollar美元
spent花費 by Medicare醫保 --
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看了一下聯邦醫療保險
花掉的每一塊錢,
04:00
generally通常 this population人口.
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大多是這個族群花掉的。
04:01
We found發現 that those patients耐心 who have
the highest最高 per capita人頭 expenditures支出
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我們發現有最高
人均醫療費用的病人,
04:08
had the highest最高 suffering痛苦,
pain疼痛, depression蕭條.
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同時也是最受苦、
最痛、最憂鬱的病人。
04:12
And, more often經常 than not, they die sooner.
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而且屢見不鮮,他們也比較快死。
04:15
How can this be?
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怎麼會這樣呢?
04:17
We live生活 in the United聯合的 States狀態,
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我們活在美國,
04:19
it has the greatest最大 health健康 care關心
system系統 on the planet行星.
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這裡有地球上最棒的醫療系統。
04:21
We spend 10 times more on these patients耐心
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我們花在這些病人身上的錢,
04:24
than the second-leading第二,領先
country國家 in the world世界.
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比第二名的國家高出十倍。
04:27
That doesn't make sense.
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這沒有道理。
04:29
But what we know is,
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但是我們知道的是,
04:31
out of the top最佳 50 countries國家 on the planet行星
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全球前 50 個
04:34
with organized有組織的 health健康 care關心 systems系統,
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有醫療保健系統計畫的國家,
04:37
we rank 37th.
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我們排名第 37 位。
04:42
Former前任的 Eastern Bloc集團 countries國家
and sub-Saharan撒哈拉以南 African非洲人 countries國家
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中歐東歐等前東方集團國家
及下撒哈拉非洲國家
04:46
rank higher更高 than us
as far as quality質量 and value.
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排名都比我們還高,
品質及價值也比我們好。
04:52
Something I experience經驗
every一切 day in my practice實踐,
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每天我看診時都會經歷一件事,
04:55
and I'm sure, something many許多 of you
on your own擁有 journeys旅程 have experienced有經驗的:
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而且我敢保證,
在座很多人自己都經歷過:
04:59
more is not more.
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多不代表好。
05:04
Those individuals個人 who had more tests測試,
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做愈多檢查,
05:06
more bells鐘聲, more whistles口哨,
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愈精密複雜的儀器,
05:07
more chemotherapy化療,
more surgery手術, more whatever隨你 --
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愈多化療,愈多手術,不管是什麼,
05:09
the more that we do to someone有人,
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只要我們在病人身上做愈多,
05:13
it decreases降低 the quality質量 of their life.
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就愈降低他們的生活品質。
05:17
And it shortens縮短 it, most often經常.
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而且更常看到的是縮短壽命。
05:21
So what are we going to do about this?
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所以我們要怎麼辦?
05:23
What are we doing about this?
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我們要怎麼做?
05:25
And why is this so?
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而且為什麼會這樣?
05:27
The grim嚴峻 reality現實, ladies女士們 and gentlemen紳士,
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嚴峻的現實是,各位先生女士,
05:29
is that we, the health健康 care關心 industry行業 --
long white-coat白大衣 physicians醫師 --
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我們,醫療業界的人
——穿著白袍的醫師——
05:32
are stealing偷竊行為 from you.
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從你們身上偷東西。
05:34
Stealing偷竊行為 from you the opportunity機會
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從你們身上偷走
05:37
to choose選擇 how you want to live生活 your lives生活
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選擇如何過活的機會,
05:40
in the context上下文 of whatever隨你 disease疾病 it is.
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不管你得的是什麼病。
05:42
We focus焦點 on disease疾病
and pathology病理 and surgery手術
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我們專注在疾病、病理、手術
05:45
and pharmacology藥理.
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及藥理。
05:49
We miss小姐 the human人的 being存在.
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我們沒看到人。
05:53
How can we treat對待 this
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我們要怎麼治療這個
05:54
without understanding理解 this?
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卻不了解這個的存在?
05:59
We do things to this;
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我們為此做了許多;
06:02
we need to do things for this.
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現在我們必須為這個做點什麼。
06:08
The triple三倍 aim目標 of healthcare衛生保健:
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醫療有三重目標:
06:09
one, improve提高 patient患者 experience經驗.
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一,改善患者經驗。
06:13
Two, improve提高 the population人口 health健康.
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二,改善此族群的健康。
06:17
Three, decrease減少 per capita人頭 expenditure支出
across橫過 a continuum連續.
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三,降低照護過程的人均醫療費用。
06:23
Our group, palliative治標不治本 care關心,
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我們的安寧照護團隊
06:25
in 2012, working加工 with
the sickest最病 of the sick生病 --
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在 2012 年與病得最重的患者合作,
06:31
cancer癌症,
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癌症、
06:32
heart disease疾病, lung disease疾病,
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心臟病、肺病、
06:34
renal disease疾病,
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腎臟病、
06:35
dementia癡呆 --
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失智等等,
06:37
how did we improve提高 patient患者 experience經驗?
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我們如何改善病患經驗?
06:41
"I want to be at home, Doc文件."
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「醫生,我想待在家。」
06:42
"OK, we'll bring帶來 the care關心 to you."
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「好,我們會去你家照護你。」
06:44
Quality質量 of life, enhanced增強.
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生活品質提高。
06:47
Think about the human人的 being存在.
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想想人。
06:49
Two: population人口 health健康.
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第二點:族群健康。
06:51
How did we look
at this population人口 differently不同,
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我們怎麼用不同的觀點看這個族群,
06:53
and engage從事 with them
at a different不同 level水平, a deeper更深 level水平,
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在不同的層面、
更深的層次與他們交流,
06:56
and connect to a broader更廣泛 sense
of the human人的 condition條件 than my own擁有?
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如何將他們以人來看待,
而不是從本位來想?
07:01
How do we manage管理 this group,
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我們怎麼管理這個族群,
07:04
so that of our outpatient門診病人 population人口,
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讓我們 94% 的門診病人
07:06
94 percent百分, in 2012,
never had to go to the hospital醫院?
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在 2012 年都不用進醫院?
07:11
Not because they couldn't不能.
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不是因為他們不能去,
07:15
But they didn't have to.
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而是他們不需要去。
07:17
We brought the care關心 to them.
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我們把醫療照護帶給他們。
07:19
We maintained保持 their value, their quality質量.
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我們維持他們的價值,他們的品質。
07:25
Number three: per capita人頭 expenditures支出.
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第三:人均醫療費用。
07:28
For this population人口,
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對這個族群而言,
07:30
that today今天 is 2.3 trillion dollars美元
and in 20 years年份 is 60 percent百分 of the GDPGDP,
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現在的花費是二兆三千億美元,
二十年後是 60% 的國內生產毛額,
07:35
we reduced減少 health健康 care關心 expenditures支出
by nearly幾乎 70 percent百分.
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我們減低了幾乎
70% 的人均醫療費用。
07:40
They got more of what they wanted
based基於 on their values,
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他們本著自己的價值觀
得到更多自己想要的,
07:44
lived生活 better and are living活的 longer,
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可以活得更好,現在活得更久,
07:47
for two-thirds三分之二 less money.
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只要三分之一的花費。
07:54
While Harold's哈羅德的 time was limited有限,
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雖然哈樂的時間不多,
07:57
palliative治標不治本 care's護理的 is not.
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安寧照護卻非如此。
08:00
Palliative姑息 care關心 is a paradigm範例
from diagnosis診斷 through通過 the end結束 of life.
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安寧照護模式要看顧
從診斷到臨終這整段時間。
08:06
The hours小時,
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可能是幾小時、
08:08
weeks, months個月, years年份,
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幾週、幾個月、幾年、
08:11
across橫過 a continuum連續 --
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連續整段時間,
08:13
with treatment治療, without treatment治療.
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有沒有治療都是。
08:15
Meet遇見 Christine克里斯汀.
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來看克里斯汀的例子。
08:17
Stage階段 IIIIII cervical頸椎 cancer癌症,
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第三期子宮頸癌,
08:19
so, metastatic轉移性 cancer癌症
that started開始 in her cervix宮頸,
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轉移癌,從她的子宮開始,
08:22
spread傳播 throughout始終 her body身體.
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擴散到整個身體。
08:24
She's in her 50s and she is living活的.
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她五十幾歲,還活得很好。
08:28
This is not about end結束 of life,
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我們不是在講臨終,
08:30
this is about life.
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我們是在講生命。
08:33
This is not just about the elderly老年,
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我們不只在說老年人,
08:35
this is about people.
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我們在說人。
08:37
This is Richard理查德.
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這位是理查。
08:39
End-stage終末期 lung disease疾病.
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肺病末期。
08:42
"Richard理查德, what is it
that you hold保持 sacred神聖?"
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「理查,你最重視什麼?」
08:45
"My kids孩子, my wife妻子 and my Harley哈雷."
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「我的孩子,老婆和哈雷摩托車。」
08:49
(Laughter笑聲)
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(笑聲)
08:50
"Alright好的!
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「好!
08:52
I can't drive駕駛 you around on it
because I can barely僅僅 pedal踏板 a bicycle自行車,
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我不能騎它載著你到處跑,
因為我連腳踏車都不會騎,
08:55
but let's see what we can do."
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但是來看看能做什麼。」
08:58
Richard理查德 came來了 to me,
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理查來找我,
09:00
and he was in rough shape形狀.
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情況很糟。
09:04
He had this little voice語音 telling告訴 him
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有個小小的聲音告訴他,
09:06
that maybe his time was weeks to months個月.
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大概只剩幾個星期或幾個月了。
09:09
And then we just talked.
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我們就只是聊聊。
09:10
And I listened聽了 and tried試著 to hear --
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我聽著,也試圖去聽言外之意,
09:14
big difference區別.
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這兩者有很大的差別。
09:16
Use these in proportion比例 to this.
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多聽少說。
09:20
I said, "Alright好的, let's take it
one day at a time,"
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我說:「好吧!過一天是一天。」
09:23
like we do in every一切
other chapter章節 of our life.
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就像生命中其它章節一樣。
09:26
And we have met會見 Richard理查德
where Richard's理查德的 at day-to-day日復一日.
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我們天天去理查住的地方。
09:31
And it's a phone電話 call or two a week,
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一星期一通或兩通電話,
09:35
but he's thriving in the context上下文
of end-stage終末期 lung disease疾病.
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以他肺病末期的狀況而言,
他過得很好。
09:43
Now, palliative治標不治本 medicine醫學 is not
just for the elderly老年,
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現在,安寧照護不只照顧老年人,
09:45
it is not just for the middle-aged中年.
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也不只照顧中年人,
09:49
It is for everyone大家.
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我們照護每一個人。
09:51
Meet遇見 my friend朋友 Jonathan喬納森.
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來看看我的朋友強納生。
09:53
We have the honor榮譽 and pleasure樂趣
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我們很榮幸
09:55
of Jonathan喬納森 and his father父親
joining加盟 us here today今天.
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請到強納生和他的父親來到現場。
09:57
Jonathan喬納森 is in his 20s,
and I met會見 him several一些 years年份 ago.
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強納生二十多歲,我幾年前遇到他。
10:00
He was dealing交易 with
metastatic轉移性 testicular睾丸 cancer癌症,
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他在與轉移性睪丸癌奮鬥,
10:04
spread傳播 to his brain.
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擴散到腦部。
10:06
He had a stroke行程,
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他有過中風,
10:08
he had brain surgery手術,
195
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他曾動過腦部手術,
10:09
radiation輻射, chemotherapy化療.
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2012
做過放療、化療。
10:13
Upon meeting會議 him and his family家庭,
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在跟他及家人會診時,
10:15
he was a couple一對 of weeks away
from a bone marrow骨髓 transplant移植,
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他才做完骨髓移植幾星期。
10:18
and in listening and engaging,
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他很仔細聽,
10:20
they said, "Help us
understand理解 -- what is cancer癌症?"
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他們說:「可不可以讓我們
了解一下什麼是癌症?」
10:27
How did we get this far
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我們怎麼撐到這一步,
10:30
without understanding理解
what we're dealing交易 with?
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一點都不了解我們到底在對抗什麼?
10:33
How did we get this far
without empowering授權 somebody
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我們是怎麼走到這一步,
沒有教育任何人,
10:35
to know what it is they're dealing交易 with,
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讓他們了解他們到底在對抗什麼,
10:37
and then taking服用 the next下一個 step and engaging
in who they are as human人的 beings眾生
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再帶他們走下一步,
讓他們以人類的身分參與,
10:41
to know if that is what we should do?
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明白我們到底該不該那樣做?
10:43
Lord knows知道 we can do
any kind of thing to you.
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天知道我們會在你們身上做什麼。
10:49
But should we?
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但是我們應該做嗎?
10:53
And don't take my word for it.
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你可以不信我的話。
10:55
All the evidence證據 that is related有關
to palliative治標不治本 care關心 these days
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但所有跟現今安寧照護有關的證據
11:00
demonstrates演示 with absolute絕對 certainty肯定
people live生活 better and live生活 longer.
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都很確定患者活得更好更久。
11:04
There was a seminal article文章
out of the New England英國 Journal日誌 of Medicine醫學
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2010 年,新英格蘭醫學雜誌
發表了一篇影響深遠的文章。
11:07
in 2010.
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11:09
A study研究 doneDONE at Harvard哈佛
by friends朋友 of mine, colleagues同事.
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我在哈佛的同事好友做了一個研究,
11:12
End-stage終末期 lung cancer癌症:
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在講末期肺癌:
11:13
one group with palliative治標不治本 care關心,
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一組有安寧照護,
11:16
a similar類似 group without.
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另一組沒有。
11:19
The group with palliative治標不治本 care關心
reported報導 less pain疼痛,
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有安寧照護那組的報告說
他們比較不痛,
11:23
less depression蕭條.
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不那麼沮喪。
11:25
They needed需要 fewer hospitalizations住院治療.
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他們比較少住院。
11:28
And, ladies女士們 and gentlemen紳士,
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而且各位,
11:30
they lived生活 three to six months個月 longer.
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他們能多活三到六個月。
11:35
If palliative治標不治本 care關心 were a cancer癌症 drug藥物,
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如果安寧照護是治療癌症的藥物,
11:39
every一切 cancer癌症 doctor醫生 on the planet行星
would write a prescription處方 for it.
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地球上每一位癌症醫師都應該
開這種藥給病人。
11:44
Why don't they?
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他們為什麼不開呢?
11:47
Again, because we goofy高飛,
long white-coat白大衣 physicians醫師
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再說一次,因為我們這群
穿著白袍的傻瓜醫師
11:50
are trained熟練 and of the mantra口頭禪
of dealing交易 with this,
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只受過訓練處理這樣的問題,
11:56
not with this.
228
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不是這樣的問題。
12:02
This is a space空間 that we will
all come to at some point.
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我們遲早都會碰到
(經濟與健康)交會之處,
12:07
But this conversation會話 today今天
is not about dying垂死,
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但是今天的演講跟死亡無關,
12:10
it is about living活的.
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而是跟怎麼活著有關。
12:12
Living活的 based基於 on our values,
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基於我們的價值觀而活,
12:13
what we find sacred神聖
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我們視為神聖的東西,
12:15
and how we want to write
the chapters of our lives生活,
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我們想怎麼寫自己生命的章節,
12:17
whether是否 it's the last
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無論是最後一章,
12:19
or the last five.
236
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還是最後五章。
12:22
What we know,
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我們知道的,
12:24
what we have proven證明,
238
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我們已證明的,
12:26
is that this conversation會話
needs需求 to happen發生 today今天 --
239
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就是這樣的對話今天就該發生,
12:29
not next下一個 week, not next下一個 year.
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不是下星期,也不是明天。
12:32
What is at stake賭注 is our lives生活 today今天
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有危急的是我們今天的生活,
12:34
and the lives生活 of us as we get older舊的
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及我們老了之後的生活,
12:36
and the lives生活 of our children孩子
and our grandchildren孫子.
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還有我們的子子孫孫的生活。
12:40
Not just in that hospital醫院 room房間
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不僅是在醫院病房裡,
12:42
or on the couch長椅 at home,
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或是家裡的沙發。
12:44
but everywhere到處 we go
and everything we see.
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無論我們在哪裡看到什麼都一樣,
12:48
Palliative姑息 medicine醫學 is the answer回答
to engage從事 with human人的 beings眾生,
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安寧醫護就是答案,將病患視為人,
12:53
to change更改 the journey旅程
that we will all face面對,
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改變我們都要面對的旅程,
12:58
and change更改 it for the better.
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而且要變得更好。
13:02
To my colleagues同事,
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給我的同事,
13:04
to my patients耐心,
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我的病患,
13:06
to my government政府,
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我的政府,
13:08
to all human人的 beings眾生,
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及所有人類,
13:10
I ask that we stand and we
shout and we demand需求
254
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我要大家都站起來、呼喊、要求
13:14
the best最好 care關心 possible可能,
255
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最好的照護,
13:17
so that we can live生活 better today今天
256
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讓我們今天能活得更好,
13:19
and ensure確保 a better life tomorrow明天.
257
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並確保明天的生活更好。
13:21
We need to shift轉移 today今天
258
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我們今天就要改變,
13:24
so that we can live生活 tomorrow明天.
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明天才能享受人生。
13:28
Thank you very much.
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謝謝各位!
13:30
(Applause掌聲)
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(掌聲)
Translated by Regina Chu
Reviewed by Marssi Draw

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ABOUT THE SPEAKER
Timothy Ihrig - Palliative care physician
Timothy Ihrig advocates for an approach to healthcare that prioritizes a patient's personal values.

Why you should listen

Dr. Timothy Ihrig, MD practices palliative medicine, caring for the most vulnerable and sickest people, and helps other providers improve the quality and value of the care they provide to this population. His work has shown how patient-centered care improves quality and length of life, and that it has significant economic benefits to patients, healthcare systems and the economy.

Ihrig is nationally recognized for his expertise in continuum population health and community-based palliative care. He holds appointments as content expert to the Accountable Care Learning Collaborative, an industry-leading healthcare innovation collaborative co-chaired by former Health and Human Services Secretary and Utah Governor Mike Leavitt and former Food and Drug Administration Commissioner Dr. Mark McClellan. Ihrig is a member of the Advisory Council of the Iowa Healthcare Collaborative, a think-tank for strategies in health care quality, safety and value for the state of Iowa. He also serves as an Iowa Alternate-Delegate to the American Medical Association.

Ihrig has been an expert source for palliative care development for the Brookings Institution, and he was the sole practicing physician assisting the Iowa General Assembly in raising minimum standard requirements for Iowa physicians with respect to end-of-life care and oversight of prescriptive narcotics. He also acted as an expert clinician in support of Iowa Physician Orders for Life-Sustaining Treatment bill. He holds appointments as Clinical Adjunct Professor in the Department of Medicine at the University of Iowa Carver School of Medicine and acts as Palliative Care clinical instructor. He is on the board of the Hospice and Palliative Care Association of Iowa, is the former chair of the Advocacy Committee and sits on the Palliative Care Advisory Committee.

Ihrig's other interests include sexuality at the end of life and global health. He served as the Medical Chair of the Health Services Committee for Empower Tanzania Incorporated, whose mission is the development of sustainable healthcare solutions in sub-Saharan Africa for individuals suffering with HIV/AIDS, cancer and other life-limited illnesses.

More profile about the speaker
Timothy Ihrig | Speaker | TED.com