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  • Ten years ago,

    十年前,

  • I got a phone call that changed my life.

    我接到了一通電話,改變了一生,

  • At the time, I was cardiologist at UCLA,

    那時我是加州大學洛杉磯分校的心臟病學家,

  • specializing in cardiac imaging techniques.

    專門從事於心臟影像技術,

  • The call came from a veterinarian at the Los Angeles Zoo.

    這通電話由洛杉磯動物園的一位獸醫師打過來,

  • An elderly female chimpanzee

    有一隻年老的母猩猩

  • had woken up with a facial droop

    睡醒時面部下垂,

  • and the veterinarians were worried that she'd had a stroke.

    獸醫師擔心牠中風。

  • They asked if I'd come to the zoo

    他們問我可否去一趟動物園,

  • and image the animal's heart

    給母猩猩的心臟拍一張照片,

  • to look for a possible cardiac cause.

    看看心臟有沒有問題。

  • Now, to be clear, North American zoos are staffed

    先說明一下,

  • by highly qualified, board-certified veterinarians

    北美洲的動物園都會雇用高水準兼持有執照的獸醫師,

  • who take outstanding care of their animal patients.

    為生病的動物提供良好照顧,

  • But occasionally, they do reach into the human medical community,

    但是他們偶爾也會向照顧人類的醫師尋求協助,

  • particularly for some speciality consultation,

    特別是一些專業的諮詢,

  • and I was one of the lucky physicians who was invited in to help.

    而我是有幸受邀前去幫助他們的其中一位醫師,

  • I had a chance to rule out a stroke in this chimpanzee

    因此我有機會為這隻猩猩排除中風的疑慮,

  • and make sure that this gorilla didn't have a torn aorta,

    確保這隻大猩猩的主動脈未曾破裂,

  • evaluate this macaw for a heart murmur,

    替這隻金剛鸚鵡測量心跳聲,

  • make sure that this California sea lion's pericardium wasn't inflamed,

    確保這隻加州海獅沒有患上心包炎,

  • and in this picture, I'm listening to the heart of a lion

    在這張照片裡,我正在給一隻獅子聽診,

  • after a lifesaving, collaborative procedure

    這是在獸醫師和內科醫師合作

  • with veterinarians and physicians

    進行了一次救生之後,

  • where we drained 700 cc's of fluid from the sac

    我們從這隻獅子心臟的心包

  • in which this lion's heart was contained.

    排掉700毫升的液體,

  • And this procedure, which I have done on many human patients,

    這個步驟跟我曾在很多病人身上實施過的完全相同,

  • was identical, with the exception of that paw and that tail.

    除了那隻爪子和尾巴。

  • Now most of the time, I was working at UCLA Medical Center with physicians,

    現在我經常會跟加州大學洛杉磯分校醫學中心的內科醫師共事,

  • discussing symptoms and diagnoses and treatments

    討論我們病「人」的

  • for my human patients,

    症狀、診斷和療法,

  • but some of the time, I was working at the Los Angeles Zoo

    但是有時候我會到洛杉磯動物園工作,

  • with veterinarians, discussing symptoms and diagnoses and treatments

    為了他們的動物患者,和那裡的獸醫師一起

  • for their animal patients.

    討論症狀、診斷和療法,

  • And occasionally, on the very same day,

    偶爾在同一天,

  • I went on rounds at UCLA Medical Center

    我會在加州大學洛杉磯分校的醫學中心

  • and at the Los Angeles Zoo.

    和洛杉磯動物園之間來回跑,

  • And here's what started coming into very clear focus for me.

    而在這裡開始變得非常明確清晰,

  • Physicians and veterinarians were essentially taking care

    就是醫師和獸醫師根本在處理同樣的疾病,

  • of the same disorders in their animal and human patients:

    不管在人類還是動物身上:

  • congestive heart failure, brain tumors,

    充血性心臟衰竭、腦部腫瘤、

  • leukemia, diabetes, arthritis, ALS, breast cancer,

    白血病、糖尿病、關節炎、漸凍症、乳癌,

  • even psychiatric syndromes like depression, anxiety,

    甚至精神病症狀如憂鬱症、焦慮症、

  • compulsions, eating disorders and self-injury.

    強迫症、飲食障礙症或自我傷害。

  • Now, I've got a confession to make.

    現在我必須承認,

  • Even though I studied comparative physiology and evolutionary biology

    雖然我在大學主修對比生理學和演化生物學—

  • as an undergrad --

    甚至畢業論文寫的是關於達爾文理論—

  • I had even written my senior thesis on Darwinian theory --

    當理解到動物和人類疾病之間

  • learning about the significant overlap

    存在著明顯的重疊部份時,

  • between the disorders of animals and humans,

    我突然靈光乍現,

  • it came as a much needed wake-up call for me.

    於是我開始想,既然有這麼多的重疊,

  • So I started wondering, with all of these overlaps,

    為甚麼從來沒想過請求獸醫師的意見,

  • how was it that I had never thought to ask a veterinarian,

    或者查找獸醫方面的文獻,

  • or consult the veterinary literature,

    以更好地瞭解我的病人呢?

  • for insights into one of my human patients?

    為甚麼我或是我詢問過的醫師朋友和同事

  • Why had I never, nor had any of my physician friends and colleagues

    都沒參加獸醫學的會議呢?

  • whom I asked, ever attended a veterinary conference?

    既然人類和動物的疾病是重疊的,那麼又有甚麼奇怪的呢?

  • For that matter, why was any of this a surprise?

    我的意思是每位醫師都知道

  • I mean, look, every single physician accepts some biological connection

    動物和人類之間有著生物學上的聯繫。

  • between animals and humans.

    我們所處方的每份藥物,或者我們自己的用藥,

  • Every medication that we prescribe or that we've taken ourselves

    或者給我們家人的用藥,

  • or we've given to our families

    都曾經先在動物身上進行試驗。

  • has first been tested on an animal.

    但是情況也有很大的不同,

  • But there's something very different

    給動物用一種藥或是患上人類疾病時,

  • about giving an animal a medication or a human disease

    及動物得了充血性心臟衰竭、

  • and the animal developing congestive heart failure

    或糖尿病、乳癌。

  • or diabetes or breast cancer on their own.

    但現在讓我們感到驚訝的是,

  • Now, maybe some of the surprise

    也許在我們這個世界裡

  • comes from the increasing separation in our world

    城市與鄉郊之間日漸擴大的隔閡,

  • between the urban and the nonurban.

    我們聽說過那些城市裡的孩子,

  • You know, we hear about these city kids

    他們認為羊毛是在樹上生長的,

  • who think that wool grows on trees

    或者乳酪從植物長出來的。

  • or that cheese comes from a plant.

    今天人類的醫院

  • Well, today's human hospitals,

    正逐漸變成一些閃耀的科技教堂,

  • increasingly, are turning into these gleaming cathedrals of technology.

    使在醫院治療的病人

  • And this creates a psychological distance between the human patients

    跟生活在海洋、農田和森林間

  • who are being treated there

    的動物患者

  • and animal patients who are living in oceans

    產生一種心理上的距離感。

  • and farms and jungles.

    但我認為還有一個更深層次的原因,

  • But I think there's an even deeper reason.

    我們作為醫師和科學家,理智上明白到

  • Physicians and scientists, we accept intellectually that our species,

    人類作為一個物種,也只不過是一個物種,

  • Homo sapiens, is merely one species,

    並不比其他物種更為獨特。

  • no more unique or special than any other.

    但其實在我們內心,我們並不完全認同。

  • But in our hearts, we don't completely believe that.

    當我聽莫扎特的音樂時,

  • I feel it myself when I'm listening to Mozart

    或在蘋果電腦上看火星探測器的照片,我自己是這麼感覺的。

  • or looking at pictures of the Mars Rover on my MacBook.

    我感受到人類特殊論的勝利,

  • I feel that tug of human exceptionalism,

    即使我意識到人類以科學方式孤立自身所付出的代價,

  • even as I recognize the scientifically isolating cost

    把自己隔開看做一種上等的物種。

  • of seeing ourselves as a superior species, apart.

    現時我正在嘗試,

  • Well, I'm trying these days.

    當我替病人看病時,我總會問,

  • When I see a human patient now, I always ask,

    獸醫對這個問題會否知道那些我不知道的事嗎?

  • what do the animal doctors know about this problem that I don't know?

    還有如果我把病人看做人類動物患者,

  • And, might I be taking better care of my human patient

    能否給他們更好的治療?

  • if I saw them as a human animal patient?

    下面是幾個讓人興奮的聯繫的例子,

  • Here are a few examples of the kind of exciting connections

    就是這種想法讓我聯想到那些點子。

  • that this kind of thinking has led me to.

    恐懼誘發心臟衰竭—

  • Fear-induced heart failure.

    2000年左右,

  • Around the year 2000,

    人類心臟學家「發現」情緒會誘發心臟衰竭,

  • human cardiologists "discovered" emotionally induced heart failure.

    文獻曾經記述過一個嗜賭成性的父親,

  • It was described in a gambling father who had lost his life's savings

    他一次擲骰子就輸光畢生積蓄,

  • with a roll of the dice,

    一個在聖壇前面被離棄的新娘,

  • in a bride who'd been left at the alter.

    但最後我們發現這種「全新」的人類疾病,

  • But it turns out, this "new" human diagnosis

    既不新奇又不為人類所獨有,

  • was neither new, nor was it uniquely human.

    獸醫早就已經在診斷、治療甚至防止

  • Veterinarians had been diagnosing, treating and even preventing

    動物身上的情緒誘發症狀,

  • emotionally induced symptoms in animals

    從猴子到火烈鳥、從鹿到兔子,

  • ranging from monkeys to flamingos, from to deer to rabbits,

    乃自 19 世紀 70 年代起開始。

  • since the 1970s.

    如果急診室和心臟專科醫師能運用

  • How many human lives might have been saved

    這一點獸醫學的知識,

  • if this veterinary knowledge had been put into the hands

    那麼有多少人類生命可被拯救?

  • of E.R. docs and cardiologists?

    自殘—

  • Self-injury.

    有些病人會傷害自己,

  • Some human patients harm themselves.

    有些會拔出整把頭髮,

  • Some pluck out patches of hair,

    有些會實際地切割自己。

  • others actually cut themselves.

    有些動物患者也傷害自己,

  • Some animal patients also harm themselves.

    有些鳥類會拔掉自己的羽毛,

  • There are birds that pluck out feathers.

    有些成年公馬反覆地咬自己的側腹直到流血。

  • There are stallions that repetitively bite their flanks until they bleed.

    但是獸醫師使用一些特定且有效的方式

  • But veterinarians have very specific and very effective ways

    去治療甚至防止自我傷害的動物

  • of treating and even preventing self-injury

    在身上自殘。

  • in their self-injuring animals.

    難道這些有關獸醫學的知識

  • Shouldn't this veterinary knowledge be put into the hands

    不該被努力對抗自殘的精神治療師、

  • of psychotherapists and parents and patients

    父母和病人所運用嗎?

  • struggling with self-injury?

    產後抑鬱症和產後精神錯亂—

  • Postpartum depression and postpartum psychosis.

    有時就在生產之後不久,

  • Sometimes, soon after giving birth,

    有些婦女會變得憂鬱,

  • some women become depressed,

    有時她們患上嚴重憂鬱症甚至精神錯亂,

  • and sometimes they become seriously depressed and even psychotic.

    她們或者會忽視剛出生的寶寶,

  • They may neglect their newborn,

    在些極端的案例中,

  • and in some extreme cases,

    甚至會傷害她們的孩子。

  • even harm the child.

    馬專科獸醫師也知道

  • Equine veterinarians also know that occasionally,

    偶爾一頭母馬剛剛生產後,

  • a mare, soon after giving birth,

    也會忽視小馬,拒絕餵奶,

  • will neglect the foal, refusing to nurse,

    有些時候會踢牠,甚至把牠們踢死。

  • and in some instances, kick the foal, even to death.

    但是獸醫師設計出

  • But veterinarians have devised

    一種介入方法以處理這類馬駒抗拒症狀,

  • an intervention to deal with this foal rejection syndrome

    就是增加母馬體內的催產素。

  • that involves increasing oxytocin in the mare.

    催產素是一種跟聯繫有關的荷爾蒙,

  • Oxytocin is the bonding hormone,

    它會給母馬重新

  • and this leads to renewed interest,

    感到對小馬的興趣。

  • on the part of the mare, in her foal.

    難道這種知識不應該

  • Shouldn't this information

    被正在與產後憂鬱症和精神錯亂抗爭的

  • be put into the hands of ob/gyn's

    婦產管理者、醫師

  • and family doctors and patients

    和病人所運用嗎?

  • who are struggling with postpartum depression and psychosis?

    好吧,即使這些都已實現,

  • Well, despite all of this promise,

    不幸地在我們領域間的鴻溝還很大,

  • unfortunately the gulf between our fields remains large.

    為了解釋這一點,我恐怕要揭露一些陰暗面,

  • To explain it, I'm afraid I'm going to have to air some dirty laundry.

    有些醫師是完完全全的勢利眼,

  • Some physicians can be real snobs

    他們看不起不是醫學博士的醫師,

  • about doctors who are not M.D.'s.

    我指的是牙醫、配鏡師和心理醫師,

  • I'm talking about dentists and optometrists and psychologists,

    也尤其指獸醫師。

  • but maybe especially animal doctors.

    當然大多數醫師意識不到

  • Of course, most physicians don't realize that it is harder

    現在進入獸醫學院較進入醫學院更難,

  • to get into vet school these days than medical school,

    而且當我們上醫學院時,

  • and that when we go to medical school,

    我們在那裡所學的全部東西

  • we learn everything there is to know

    都只為瞭解一個物種—人類,

  • about one species, Homo sapiens,

    但是獸醫師需要學習哺乳動物、

  • but veterinarians need to learn about health and disease

    兩棲動物、爬行動物、魚類和鳥類的健康和疾病,

  • in mammals, amphibians, reptiles, fish and birds.

    因此我不會責怪獸醫師,

  • So I don't blame the vets for feeling annoyed

    因著我的專業所帶來的優越感與無知而感到厭煩,

  • by my profession's condescension and ignorance.

    但是獸醫有個說法:

  • But here's one from the vets:

    你會把一個只能照顧

  • What do you call a veterinarian

    某一物種的獸醫師叫做甚麼?

  • who can only take care of one species?

    一位醫師(笑聲)

  • A physician. (Laughter)

    將兩者的差距縮小變成我的熱情,

  • Closing the gap has become a passion for me,

    而我正在通過一些專案來做這件事,

  • and I'm doing this through programs

    比如加州大學洛杉磯分校的「達爾文巡邏員」專案,

  • like Darwin on Rounds at UCLA,

    我們把動物專家和演化生物學家找來,

  • where we're bringing animal experts and evolutionary biologists

    安插在我們的醫療隊伍中,

  • and embedding them on our medical teams

    跟我們的實習生和住院醫師一起工作。

  • with our interns and our residents.

    而且通過「人獸同源學」會議,

  • And through Zoobiquity conferences,

    我們讓醫學院和獸醫學院聚在一起,

  • where we bring medical schools together with veterinary schools

    討論動物患者

  • for collabortive discussions

    和人類病者之間

  • of the shared diseases and disorders

    的共同疾病和失調,

  • of animal and human patients.

    在「人獸同源學」會議上,

  • At Zoobiquity conferences,

    參與者學習到替老虎治療乳腺癌

  • participants learn how treating breast cancer in a tiger

    將會如何幫助我們更好地治療

  • can help us better treat breast cancer

    一位幼兒園老師的乳腺癌;

  • in a kindergarten teacher;

    好好瞭解荷斯坦牛的多囊卵巢

  • how understanding polycystic overies in a Holstein cow

    將會如何幫助我們

  • can help us better take care

    更好地照顧一位受經痛困擾的舞蹈老師;

  • of a dance instructor with painful periods;

    深入瞭解一隻患上分離焦慮症

  • and how better understanding the treatment of separation anxiety

    且高度緊張的喜樂蒂牧羊犬的治療,

  • in a high-strung Sheltie

    將會如何幫助一個首天上學就感費力的焦慮幼孩。

  • can help an anxious young child struggling with his first days of school.

    在美國,而且現時在全球, 於「人獸同源學」會議上,

  • In the United States and now internationally, at Zoobiquity conferences

    醫師和獸醫師會將態度以及成見留在會議室外,

  • physicians and veterinarians check their attitudes and their preconceptions

    然後以同行的身份、

  • at the door and come together as colleagues,

    同輩的身份、以及醫師的身份聚在一起。

  • as peers, as doctors.

    畢竟我們人類也是動物,

  • After all, we humans are animals, too,

    是時候讓我們醫師去接受

  • and it's time for us physicians to embrace

    我們同時是病人和動物的本質,

  • our patients' and our own animal natures

    和獸醫師合作

  • and join veterinarians

    以跨越物種的方式處理健康問題。

  • in a species-spanning approach to health.

    因為最後證明是

  • Because it turns out,

    一些最好且最合乎人道主義的藥物治療,

  • some of the best and most humanistic medicine

    正被患者並不是人類的醫師所使用,

  • is being practiced by doctors whose patients aren't human.

    而我們照顧人類患者的最好方法之一

  • And one of the best ways we can take care

    就是密切注意

  • of the human patient is by paying close attention

    在這星球上其他病患者

  • to how all the other patients on the planet

    是如何生活、成長、患病以及康復。

  • live, grow, get sick and heal.

    謝謝!

  • Thank you.

    (掌聲)

  • (Applause).

Ten years ago,

十年前,

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B2 中高級 中文 美國腔 TED 醫師 動物 人類 心臟 獸醫

【TED】獸醫知道些什麼醫師不知道的東西 (Barbara Natterson-Horowitz: What veterinarians know that doctors don't)

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    CUChou 發佈於 2015 年 06 月 03 日
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