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1、www.XiYuS锡育软件We change as people through games,because wereinvolved,and were playing,and were learning as we do so.Thank you.(Applause)I think we have to do something abouta piece of the culture of medicine that has to change.我们通过玩游戏发生改变,因为我们既是玩游戏的人,又是游戏的一部分,与此同时,我们能学到东西。谢谢。（掌声）我觉得在当今的医学文化中,有一部份文化必须
2、要开始改变,1146500And I think it starts with one physician,and thats me.而这个改变可以从一个医生开始,那就是我。00:17And maybe Ive been around long enough that I can affordto give away some of my false prestige to be able to do that.或许是因为我已经行医多年,我可以承受放弃一些虚无的名利 来开始这样的改变。00:20Before I actually begin the meat of my talk,lets b
3、egin with abit of baseball.在进入主题之前,让我们先谈谈棒球吧。00:26Hey,why not?为什么不呢？00:30Were near the end,were getting close to the World Series.常规赛季就快结束,世界职业棒球大赛即将开始。00:32We all love baseball,dont we?我们都喜爱棒球,不是吗？00:35(Laughter)Baseball is filled with some amazing statistics.（笑声）棒球的世界中充斥着百千个00:38And theres hundred
4、s of them.让人咋舌的统计数据。00:43Moneyball is about to come out,and its all about statisticsand using statistics to build a great baseball team.即将上映的电影“点球成金”,便是完全关于统计数据,以及如何在这些数据的基础上建造一个伟大的球队。00:46Im going to focus on one stat that I hope a lot of you haveheard of.我想讲一个 我希望大家都听说过的数据,00:51give away:放弃;泄露;分发;
5、出卖 begin with:以开始;开始于 statistics:n.统计;统计学;统计统计资料 stat:n.静;斯达(放射性强度单位)Its called batting average.叫做击球率。00:56So we talk about a 300,a batter who bats 300.当我们说一名挥棒球员的击球率为三成的时候,00:58That means that ballplayer batted safely,hit safely threetimes out of 10 at bats.我们是指这位球员的打击非常稳定,每十次种就会有三次安打。01:01That mea
6、ns hit the ball into the outfield,it dropped,it didntget caught,and whoever tried to throw it to first base didntget there in time and the runner was safe.安打意味着球会被击中并被打入外野,而且并不会被立刻接杀,球也不会在跑者成功上到一垒之前 被及时的传回。01:08Three times out of 10.十次中有三次安打。01:17Do you know what they call a 300 hitter in Major Leag
7、ueBaseball?各位知道棒球大联盟如何评论 这些击球率上了三成的球员吗？01:20Good,really good,maybe an all-star.很棒,非常棒,明星球员一般的棒。01:25Do you know what they call a 400 baseball hitter?各位知道他们又是如何称呼一位 击球率有着四成,01:31Thats somebody who hit,by the way,four times safely out ofevery 10.也就是每十次打击 就会打出四个安打的球员吗？01:35Legendary-as in Ted Williams
8、legendary-the last MajorLeague Baseball player to hit over 400 during a regularseason.是传奇-像 泰德.威廉斯那样的传奇。他是棒球大联盟里最后一个在常规赛中 拥有超过四成击球率的球员。01:39batting:n.打击;打球;棉絮/v.击球;打击(bat的ing形式)ballplayer:n.棒球手;参加球赛的人(尤指棒球)batted:adj.击出的/v.击打;眨眼;拍(bat的过去分词)outfield:n.外场;边境;偏远的田园 hitter:n.击球员;打击者 all-star:adj.全明星的/n.
9、明星运动员 Legendary:adj.传说的,传奇的/n.传说集;圣徒传Now lets take this back into my world of medicine where Ima lot more comfortable,or perhaps a bit less comfortableafter what Im going to talk to you about.现在让我们回到我的世界-医疗领域。这个领域我比较熟悉,但我接下来要说的 却让我有些困扰。01:49Suppose you have appendicitis and youre referred to asurgeo
10、n whos batting 400 on appendectomies.假设你得了阑尾炎,然后你被推荐给了一位 在阑尾移除手术中有着四成“击球率”的外科医生。01:58(Laughter)Somehow this isnt working out,is it?（笑声）这听起来怪怪的,对吧？02:04Now suppose you live in a certain part of a certain remote又假设你住在 某一个较为偏远的地区,而你所爱的人的 两条冠状动脉都被堵塞。你的家庭医生将她TED演讲者：Brian Goldman|布莱恩.高德曼演讲标题：Brian Goldman
11、:Doctors make mistakes.Can we talk about that?|医生们会犯错误，我们能否谈论他们所犯过的错误呢?内容概要：Brian Goldman is an emergency-room physician in Toronto,and the host of CBCRadio.s White Coat,Black Art.每个医生都会犯错。但是，医师布莱恩高德曼提道，医学界的否认（和耻感）文化让医生们无法诉说他们曾经犯过的错误，以至于无法从错误中学习与进步。从讲述自己的故事开始，他号召医生们开始谈论他们曾经犯过的错误。Now suppose you live
12、 in a certain part of a certain remoteplace and you have a loved one who has blockages in twocoronary arteries and your family doctor refers that lovedone to a cardiologist whos batting 200 on angioplasties.人的 两条冠状动脉都被堵塞。你的家庭医生将她推荐给了一位在血管成形手术上 有着两成“击球率”的心脏科医师。02:10But,but,you know what?但是,等等,你知道吗？02
13、:27Shes doing a lot better this year.Shes on the comebacktrail.她今年的表现有着很大的提高,她的水准也在恢复。02:29And shes hitting a 257.她的“击球率”达到了两成五。02:31Somehow this isnt working.但是这样还是不能被接受。02:34But Im going to ask you a question.而我现在想问各位一个问题。02:36appendicitis:n.医阑尾炎;盲肠炎 appendectomies:n.外科阑尾切除术 blockages:n.堵塞,堵塞;封锁;妨
14、碍 coronary:adj.冠的;冠状的;花冠的 arteries:n.解剖动脉(artery的复数)/v.给提供动脉(artery的单数第三人称)cardiologist:n.心脏病学家;心脏病科医师 comeback:n.恢复;复原What do you think a batting average for a cardiac surgeon ora nurse practitioner or an orthopedic surgeon,an OBGYN,aparamedic is supposed to be?你们认为,一位心脏外科医生,或一位职业护理师,一位骨科外科医生 妇产科医生
15、或急救人员的“击球率”应该是多少？02:381,000,very good.十成？非常好。02:49Now truth of the matter is,nobody knows in all of medicinewhat a good surgeon or physician or paramedic is supposedto bat.事实上,医学界中没有人知道 一个好的外科医生,医师或急救人员 应该有多少的“击球率”。02:52What we do though is we send each one of them,includingmyself,out into the world
16、 with the admonition,be perfect.我们将他们每个人,包括我自己,送上职业岗位后便告诫他们以完美来要求自己-03:02Never ever,ever make a mistake,but you worry about thedetails,about how thats going to happen.绝对,绝对不能作出错误的诊断-但我们让他们自己考虑细节,考虑如何达到这样的标准。03:08And that was the message that I absorbed when I was inmed school.这就是我在医学院时 得到的信息。03:13I
17、was an obsessive compulsive student.我是一个有着强迫症倾向的学生。03:17In high school,a classmate once said that Brian Goldmanwould study for a blood test.在中学时,有个同学曾经说 布莱恩.高德曼会为了血液测验复习。03:20cardiac:n.强心剂;强胃剂/adj.心脏的;心脏病的;贲门的 practitioner:n.开业者,从业者,执业医生 orthopedic:adj.整形外科的(等于orthopaedic)paramedic:n.护理人员;伞兵军医;伞降医务人
18、员 admonition:n.警告 absorbed:adj.被吸收的;一心一意的/v.吸收;使全神贯注(absorb的过去分词形式)med:abbr.基础教学法硕士(MasterofElementaryDidactics);中古时代的(=medieval);中间的(=medium);医学的(=medical)obsessive:adj.强迫性的;着迷的;分神的 compulsive:adj.强制的;强迫的(Laughter)And so I did.（笑声）而我的确这么做了。03:25And I studied in my little garret at the nurses reside
19、nce atToronto General Hospital,not far from here.我在离这不远处的多伦多总医院中,护士住宅里的一个小阁楼中 完成了我的学业。03:30And I memorized everything.我背下了所有东西。03:36I memorized in my anatomy class the origins and exertionsof every muscle,every branch of every artery that came offthe aorta,differential diagnoses obscure and common.我
20、背下了解剖课中 提到的每一块肌肉的起端和伸展方式,每一条从主动脉延伸出来的动脉的分支系统,以及一切鲜为人知的或者常见的鉴别诊断。03:38I even knew the differential diagnosis in how to classify renaltubular acidosis.我甚至知道如何鉴别诊断 不同的肾小管性酸中毒症。03:48And all the while,I was amassing more and more knowledge.在这段时间中,我积累了越来越多的知识。03:52And I did well,I graduated with honors,cu
21、m laude.我的表现很好,并以优等的成绩毕业。03:56garret:n.阁楼;顶楼 residence:n.住宅,住处;居住 far from:adv.远离;远非;完全不 memorized:记住(memorize的过去式和过去分词)exertions:n.发挥;运用;努力 artery:n.动脉；干道；主流 aorta:n.解剖主动脉 differential:adj.微分的;差别的;特异的/n.微分;差别 diagnoses:n.诊断;调查分析;评价(diagnosis的复数形式)diagnosis:n.诊断 renal:adj.解剖肾脏的,解剖肾的 tubular:adj.管状的
22、acidosis:n.内科酸中毒,酸毒症;酸液过多症 amassing:n.积累;积聚 cum:prep.附有;连同/n.精液;精子And I came out of medical school with the impression that if Imemorized everything and knew everything,or as much aspossible,as close to everything as possible,that it wouldimmunize me against making mistakes.当我从医学院出来时,我觉得 我只要记下和明白了所有
23、的东西 或者稍退一步 将近所有的东西,那我犯医疗错误的几率就会微乎其微。04:00And it worked for a while,until I met Mrs.Drucker.而我在一段时间之内 的确没有犯错。直到我遇到了 Drucker 女士。04:14I was a resident at a teaching hospital here in Toronto whenMrs.Drucker was brought to the emergency department ofthe hospital where I was working.Drucker 女士被带入多伦多的 一家教学
24、医院的急诊室时,我正作为一个实习医生在那里工作。04:22At the time I was assigned to the cardiology service on acardiology rotation.当时我正因心脏科轮调 而被指派在心血管诊所。04:29And it was my job,when the emergency staff called for acardiology consult,to see that patient in emerg.我的工作是,当紧急救护人员需要有关于心脏的专业会诊时,在急症室诊断病人,04:33www.XiYuS锡育软件and to rep
25、ort back to my attending.并在之后向负责我的主治医生汇报。04:40And I saw Mrs.Drucker,and she was breathless.当我见到Drucker女士的时候,她的气息已经很微弱。04:42And when I listened to her,she was making a wheezy sound.在我与她交谈时,我听到她的呼吸有喘息的声音。04:45immunize:vt.使免疫;赋予免疫性 resident:adj.居住的;住院医师;定居的/n.居民 cardiology:n.内科心脏病学 rotation:n.旋转;循环,轮流
26、breathless:adj.喘不过气来的;停止呼吸的 wheezy:adj.气喘的;老生常谈的And when I listened to her chest with a stethoscope,I couldhear crackly sounds on both sides that told me that she wasin congestive heart failure.当我用听诊器聆听她的胸腔时,两边都传来的爆裂的声音告诉我,这是郁血性心脏衰竭。04:48This is a condition in which the heart fails,and instead ofbei
27、ng able to pump all the blood forward,some of the bloodbacks up into the lung,the lungs fill up with blood,andthats why you have shortness of breath.这是由于心脏在衰竭后 无法将所有的血液完全的输送出去 而导致部分血液回流入肺脏。肺脏里充满了血液 而造成呼吸短促。04:55And that wasnt a difficult diagnosis to make.这不是一个困难的诊断。05:05I made it and I set to work
28、treating her.作出诊断后我开始着手帮她治疗。05:08I gave her aspirin.I gave her medications to relieve the strainon her heart.我开给了她阿司匹林,并给了她一些可以减轻她心脏负担的药物。05:11I gave her medications that we call diuretics,water pills,toget her to pee out the access fluid.我还给了她一些利尿剂,俗称水丸,帮助她将体内多余的水分排出。05:14And over the course of the
29、 next hour and a half or two,shestarted to feel better.在接下来的一两个小时里,她开始觉得好转,05:20stethoscope:vt.用听诊器诊断/n.临床听诊器 crackly:adj.容易破裂的 congestive:adj.充血的,充血性的 fill up:填补;装满;堵塞 shortness:n.不足;简略 set to:开始认真干 aspirin:n.阿司匹林(解热镇痛药)medications:n.药物(medication的复数形式);药物治疗 diuretics:n.药利尿剂 pee:n.尿;撒尿/vi.撒尿/vt.小便
30、fluid:adj.流动的;流畅的;不固定的/n.流体;液体And I felt really good.我也感到高兴。05:24And thats when I made my first mistake;I sent her home.而就在此时我犯了第一个错误:我让她回了家。05:27Actually,I made two more mistakes.正确的来说,我还犯了两个错误。05:32I sent her home without speaking to my attending.我在和我的主治汇报之前 便让她回了家。05:35I didnt pick up the phone a
31、nd do what I was supposed to do,which was call my attending and run the story by him so hewould have a chance to see her for himself.我没有做我照着我应该做的,拿起电话打给我的主治并让他看一下这个案例,给他一个亲自见见这名病患的机会。05:39And he knew her,he would have been able to furnishadditional information about her.我的主治认识她,因此可以提供更详细的病历资料。05:47M
32、aybe I did it for a good reason.或许我有这么做的理由。05:52Maybe I didnt want to be a high-maintenance resident.或许我并不想做一个需要经常地指导的实习医生。05:54Maybe I wanted to be so successful and so able to takeresponsibility that I would do so and I would be able to takecare of my attendings patients without even having tocont
33、act him.也许我太想 可以独当一面,可以不需要 和我的主治沟通 便照顾好他的病患。05:57The second mistake that I made was worse.而我犯的第二个错误更加严重。06:07In sending her home,I disregarded a little voice deep downinside that was trying to tell me,Goldman,not a good idea.Dont do this.在让她回家时,我忽视了我内心一个微小的声音。这个声音试图告诉我:“高德曼,这样不好,不要这么做。”06:11high-mai
34、ntenance:高维护;难伺候 disregarded:不顾,不理会,无视(disregard的过去式和过去分词)In fact,so lacking in confidence was I that I actually askedthe nurse who was looking after Mrs.Drucker,Do you thinkits okay if she goes home?其实,当时的我是如此的没有自信,以至于我甚至向照顾Drucker女士 的护士寻求了意见:“你觉得让她回家好么？”06:20And the nurse thought about it and said
35、 very matter-of-factly,Yeah,I think shell do okay.那位护士想了想,然后就事论事的说:“嗯,我觉得没有问题。”06:30I can remember that like it was yesterday.这一切对我来说,都还像是发生在了昨天。06:34So I signed the discharge papers,and an ambulance came,paramedics came to take her home.我在出院单上签了名,一辆救护车来后急救人员将她送回了家。06:37And I went back to my work on
36、 the wards.之后我回到了我在诊所的工作。06:42All the rest of that day,that afternoon,I had this kind ofgnawing feeling inside my stomach.在接下来的一天中,那天下午,我的肠胃有着一种翻滚的感觉。06:45But I carried on with my work.但我还是照常的继续工作。06:52And at the end of the day,I packed up to leave the hospitaland walked to the parking lot to take m
37、y car and drive homewhen I did something that I dont usually do.在工作结束后,我整理了下便离开了医院。在我走向停车场 去取我的车的路程中,我做了一件我平常不会做的事情。06:55I walked through the emergency department on my wayhome.我从急诊室借了道。07:05lacking:adj.缺乏的;没有的;不足的/v.缺少;不足(lack的ing形式)in confidence:秘密地 paramedics:n.护理人员,辅助医务人员;护理学(paramedic复数形式)wards
38、:n.医病房(ward的复数);守卫;受监护的未成年人;监禁/v.守卫;避开(ward的第三人称单数形式)gnawing:adj.令人痛苦的;折磨人的/n.咬;不断的苦痛/v.咬;侵蚀(gnaw的ing形式)And it was there that another nurse,not the nurse who waslooking after Mrs.Drucker before,but another nurse,saidthree words to me that are the three words that mostemergency physicians I know drea
39、d.而就在那里,另外一位护士,不是之前照顾Drucker女士的那位,对我说了 绝大部分急诊医生 都害怕听到的三个字。07:08Others in medicine dread them as well,but theressomething particular about emergency medicine because wesee patients so fleetingly.其他科系的医生也害怕这三个字,但因为急诊医生看的病人都来去匆匆,这三个字对我们有着特别的意义。07:21The three words are:Do you remember?这三个字是:记得吗？07:29Do
40、you remember that patient you sent home?“记得吗？你送回家的那个患者？”07:35the other nurse asked matter-of-factly.那位护士就事论事的问道。07:38Well shes back,“她又回来了。”07:40in just that tone of voice.她就用了这样平常的语调。07:42Well she was back all right.她的确回来了。07:44She was back and near death.回来时已经濒临死亡。07:46About an hour after she had
41、arrived home,after Id sent herhome,she collapsed and her family called 911 and theparamedics brought her back to the emergency departmentwhere she had a blood pressure of 50,which is in severeshock.在我让她回家后 大约一个小时后,她昏倒在了地上,她的家人打了911,急救人员将她重新带回了急诊室。此时的她已严重休克,血压只有 50。07:49physicians:n.内科内科医生(physician的
42、复数)dread:n.恐惧;可怕的人(或物)/vi.惧怕;担心/vt.惧怕;担心/adj.可怕的fleetingly:adv.疾驰地;飞快地;短暂地 collapsed:adj.倒塌的;暴跌的;收缩的;倾陷了的/v.倒塌;崩溃(collapse的过去分词);价格暴跌And she was barely breathing and she was blue.她的呼吸极其微弱,面色发青。08:02And the emerg.staff pulled out all the stops.急救人员们使出了浑身解数。08:05They gave her medications to raise her
43、blood pressure.他们给了她提升血压的药物,08:08They put her on a ventilator.并将她连接上了人工呼吸器。08:11And I was shocked and shaken to the core.我震惊不已,吓得不得了。08:13And I went through this roller coaster,because after theystabilized her,she went to the intensive care unit,and Ihoped against hope that she would recover.之后我的心情便
44、像是做着云霄飞车一般。因为当他们将她的情况稳定下来后 便将她送进了加护病房。我在绝望中希望她能够醒过来。08:18And over the next two or three days,it was clear that she wasnever going to wake up.但在接下来的两三天中,她再也不会醒来的可能性越来越大。08:26She had irreversible brain damage.她的脑部已经受到了无法逆转的损伤。08:30And the family gathered.她的家人聚在了一起。08:33And over the course of the next
45、eight or nine days,theyresigned themselves to what was happening.在接下来的八到九天里,他们慢慢的接受了这件事实。08:35And at about the nine day mark,they let her go-Mrs.Drucker,a wife,a mother and a grandmother.在第九天,他们选择让她离开人间-Drucker女士,一个家庭的妻子,母亲,和祖母。08:40ventilator:n.通风设备;换气扇;医呼吸机 coaster:n.沿岸贸易船;杯托,小托盘;雪橇 stabilized:adj
46、.稳定的;减摇的/v.稳定(stabilize的过去分词)irreversible:adj.不可逆的；不能取消的；不能翻转的 resigned:adj.顺从的;已辞职的;己放弃的/v.辞职;顺从(resign的过去分词)They say you never forget the names of those who die.有人说你永远不会忘记那些(因你的疏忽而过世的）人的名字,08:50And that was my first time to be acquainted with that.而那是我第一次意识到这句话的现实。08:54Over the next few weeks,I be
47、at myself up and I experiencedfor the first time the unhealthy shame that exists in ourculture of medicine-where I felt alone,isolated,在接下来的几个星期内,我无比的沮丧,并第一次经历了 那种在医学文化中存在的 危险的羞愧感-我觉得孤单无助。08:57not feeling the healthy kind of shame that you feel,becauseyou cant talk about it with your colleagues.这不是那
48、种健康的羞愧感,因为你不能和你的同事提起讨论它。09:11You know that healthy kind,when you betray a secret that abest friend made you promise never to reveal and then youget busted and then your best friend confronts you and youhave terrible discussions,就是那种,当你背叛了对挚友的承诺而说出了答应要保守的秘密,并被他知道了以后,你的挚友找你算账时,虽然你们会争执不休,09:15but at th
49、e end of it all that sick feeling guides you and yousay,Ill never make that mistake again.但最后那层罪恶感仍然会主导你说,我绝对不会再犯同样的错误。09:26And you make amends and you never make that mistakeagain.如是,你做了修正的承诺,然后你永不会再犯那样的错。09:31Thats the kind of shame that is a teacher.这种羞愧有着教导的作用。09:34The unhealthy shame Im talking
50、 about is the one that makesyou so sick inside.而我所说的那种非良性的羞愧 会让你愧对于心。09:37acquainted:adj.熟识的;知晓的;有知识的/v.使了解(acquaint的过去分词)unhealthy:adj.不健康的;危险的;有害身心健康的busted:adj.被降级的;破产了的;失败了的/v.爆裂;破产;开除;崩溃(bust的过去分词形式)confronts:vt.面对;遭遇;比较amends:n.赔偿;赔罪/v.修订(amend的第三人称单数);改进Its the one that says,not that what you