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  • I am a neurosurgeon,

    譯者: Lilian Chiu 審譯者: SF Huang

  • and I'm here to tell you today that people like me need your help.

    我是神經外科醫生,

  • And in a few moments, I will tell you how.

    今天我是來告訴大家, 像我這樣的人需要你們的協助。

  • But first, let me start off by telling you about a patient of mine.

    等一下我就會告訴大家怎麼做。

  • This was a woman in her 50s,

    但,首先讓我先談談我的一位病人。

  • she was in generally good shape,

    她是一位五十多歲的女子,

  • but she had been in and out of hospital a few times

    身體狀況大致不錯,

  • due to curative breast cancer treatment.

    但她因為治療乳癌

  • Now she had gotten a prolapse from a cervical disc,

    已經進出過醫院好幾次了。

  • giving her radiating pain of a tense kind,

    現在她因頸椎的椎間盤突出,

  • out into the right arm.

    而讓她的右手臂有很劇烈的

  • Looking at her MRI before the consultation,

    放射性疼痛。

  • I decided to suggest an operation.

    在諮詢之前我先看了她的磁振造影,

  • Now, neck operations like these are standardized, and they're quick.

    我決定要建議她動手術。

  • But they carry a certain risk.

    像這樣的頸部手術是 標準化且很快速的。

  • You make an incision right here,

    但仍然有一些風險。

  • and you dissect carefully past the trachea,

    從這裡切開,

  • the esophagus,

    小心地切過去,繞過氣管,

  • and you try not to cut into the internal carotid artery.

    繞過食道,

  • (Laughter)

    試著不要切到頸內動脈。

  • Then you bring in the microscope,

    (笑聲)

  • and you carefully remove the disc and the prolapse

    接著顯微鏡登場,

  • in the nerve root canal,

    然後小心地移除椎間盤 壓迫神經根管的地方,

  • without damaging the cord and the nerve root

    不能損害到就在底下幾毫米的 脊髓神經及神經根。

  • lying only millimeters underneath.

    最糟糕的狀況就是傷到脊髓神經,

  • The worst case scenario is the damage to the cord,

    可能會造成脖子以下癱瘓。

  • which can result in paralysis from the neck down.

    我向病人解釋這些之後,她沉默了。

  • Explaining this to the patient, she fell silent.

    一會兒之後,

  • And after a few moments,

    她說出了對我及對她來說 都非常果敢的話。

  • she uttered a few very decisive words for me and for her.

    「醫生,這真的有必要嗎?」

  • "Doctor, is this really necessary?"

    (笑聲)

  • (Laughter)

    各位知道我在那當下領悟了什麼嗎?

  • And you know what I realized, right there and then?

    沒有必要。

  • It was not.

    事實上,當我看到 像這名女子的病人時,

  • In fact, when I get patients like this woman,

    我會傾向建議不要動手術。

  • I tend to advise not to operate.

    那麼,這次我為什麼會這麼做?

  • So what made me do it this time?

    嗯,要知道,

  • Well, you see,

    這個突出是如此的微妙,

  • this prolapse was so delicate,

    在她進入諮詢室之前,

  • I could practically see myself pulling it out of the nerve root canal

    我就可以看見自己 把它從神經根管中拔出來。

  • before she entered the consultation room.

    我得承認,我想要幫她動手術。

  • I have to admit it, I wanted to operate on her.

    我很想幫她動手術。

  • I'd love to operate on her.

    畢竟,手術是我工作中 最有趣的部分。

  • Operating, after all, is the most fun part of my job.

    (笑聲)

  • (Laughter)

    我想你們可以體會這種感覺。

  • I think you can relate to this feeling.

    我那個當建築師的鄰居說,

  • My architect neighbor says he loves to just sit and draw

    他喜歡的就只是 坐下來繪製和設計房子。

  • and design houses.

    他寧可整天做這件事,

  • He'd rather do that all day

    也不想跟付錢買房子的客戶交談,

  • than talk to the client paying for the house

    這個客戶可能還會框限他的想法。

  • that might even give him restrictions on what to do.

    但就像建築師一樣, 每一位外科醫生

  • But like every architect,

    都得坦誠地與病人交流且和病人一起

  • every surgeon needs to look their patient in the eye

    決定動手術是否是最好的選擇。

  • and together with the patient,

    聽起來可能很簡單。

  • they need to decide on what is best for the person having the operation.

    但,讓我們來看些統計數字。

  • And that might sound easy.

    扁桃腺是喉嚨後面的兩塊隆起。

  • But let's look at some statistics.

    可以用手術將它們切除,

  • The tonsils are the two lumps in the back of your throat.

    那稱為扁桃腺切除術。

  • They can be removed surgically,

    這張圖上顯示的是在挪威不同區域的

  • and that's called a tonsillectomy.

    扁桃腺切除術施行率。

  • This chart shows the operation rate of tonsillectomies in Norway

    各位可能會感到驚訝的是,

  • in different regions.

    你的孩子—— 這是針對孩子的統計——

  • What might strike you is that there is twice the chance

    在芬馬克要動扁桃腺切除術的機率 是在特隆赫姆的兩倍。

  • that your kid -- because this is for children --

    這兩個區域的適應症都是一樣的。

  • will get a tonsillectomy in Finnmark than in Trondheim.

    動手術的機率理應沒差別,其實不然。

  • The indications in both regions are the same.

    這是另一張圖。

  • There should be no difference, but there is.

    半月板的功能是穩定膝蓋,

  • Here's another chart.

    有可能局部或全部被撕裂或破裂,

  • The meniscus helps stabilize the knee

    比如會因為踢足球等運動造成。

  • and can be torn or fragmented acutely,

    各位在這裡看到的是 針對這種狀況的開刀率。

  • topically during sports like soccer.

    可以發現,在默勒-魯姆斯達爾郡的

  • What you see here is the operation rate for this condition.

    開刀率是斯塔萬格的五倍。

  • And you see that the operation rate inre og Romsdal

    五倍之多。

  • is five times the operation rate in Stavanger.

    怎麼會這樣?

  • Five times.

    默勒-魯姆斯達爾郡的足球員踢球時 比全國其他的球員更會耍小動作嗎?

  • How can this be?

    (笑聲)

  • Did the soccer players inre og Romsdal

    可能不是。

  • play more dirty than elsewhere in the country?

    現在我再增加一些資訊。

  • (Laughter)

    各位現在可以看到,淺藍色的 是在公立醫院中所進行的手術,

  • Probably not.

    私人診所則用淺綠色表示。

  • I added some information now.

    在默勒-魯姆斯達爾郡的私人診所

  • What you see now is the procedures performed

    有很多活動,對吧?

  • in public hospitals, in light blue,

    那是什麼意思?

  • the ones in private clinics are light green.

    有可能他們是基於 經濟上的動機去治療病人。

  • There is a lot of activity in the private clinics

    還不只如此。

  • inre og Romsdal, isn't there?

    近期研究顯示,針對膝蓋所做的 一般物理治療和手術,

  • What does this indicate?

    在治療效果上的差別——

  • A possible economic motivation to treat the patients.

    是沒有差別。

  • And there's more.

    意思就是,在剛剛那張圖上

  • Recent research has shown that the difference of treatment effect

    大部分所執行的手術

  • between regular physical therapy and operations for the knee --

    其實是可以避免的, 在斯塔萬格也一樣。

  • there is no difference.

    所以,我想要告訴各位什麼?

  • Meaning that most of the procedures performed

    即使全世界大部分的治療適應症

  • on the chart I've just shown

    都已標準化,

  • could have been avoided, even in Stavanger.

    在治療的決策上仍然有不必要的差異,

  • So what am I trying to tell you here?

    特別是在西方世界。

  • Even though most indications for treatments in the world

    有些人沒有得到他們需要的治療,

  • are standardized,

    但,更高比例的人

  • there is a lot of unnecessary variation of treatment decisions,

    是被過度治療的。

  • especially in the Western world.

    「醫生,這真的有必要嗎?」

  • Some people are not getting the treatment that they need,

    我在職涯中只聽過一次這個問題。

  • but an even greater portion of you

    我同事說他們從來沒有 聽過病人這麼問過。

  • are being overtreated.

    換個方向來看,

  • "Doctor, is this really necessary?"

    你認為如果提出這個問題,

  • I've only heard that question once in my career.

    會多常從醫生口中聽到「沒必要」?

  • My colleagues say they never heard these words from a patient.

    研究者調查了這件事,

  • And to turn it the other way around,

    他們所得到的「沒必要」率

  • how often do you think you'll get a "no" from a doctor

    在各地都差不多。是三成。

  • if you ask such a question?

    也就是說,十次中有三次,

  • Researchers have investigated this,

    你的醫生開的處方或建議的治療

  • and they come up with about the same "no" rate

    是完全沒必要的。

  • wherever they go.

    各位知道他們為此 所宣稱的理由是什麼嗎?

  • And that is 30 percent.

    病人壓力。

  • Meaning, three out of 10 times,

    換言之,是你們。

  • your doctor prescribes or suggests something

    你們希望醫生做點什麼。

  • that is completely unnecessary.

    我有一位朋友來找我詢求醫療建議。

  • And you know what they claim the reason for this is?

    他愛運動,

  • Patient pressure.

    冬天時他很常越野滑雪,

  • In other words, you.

    夏天時則是跑步。

  • You want something to be done.

    這次,他只要慢跑就有嚴重的背痛。

  • A friend of mine came to me for medical advice.

    痛到他只得停止跑步。

  • This is a sporty guy,

    我幫他做了檢查,詳細的問診,

  • he does a lot of cross-country skiing in the winter time,

    我發現,他可能是脊椎下段

  • he runs in the summer time.

    發生了椎間盤退化。

  • And this time, he'd gotten a bad back ache whenever he went jogging.

    只要它受到壓力就會痛。

  • So much that he had to stop doing it.

    他已經用游泳取代慢跑, 已經沒其他的可做了。

  • I did an examination, I questioned him thoroughly,

    所以,我告訴他:「在訓練方面, 你得要仔細做選擇。

  • and what I found out is that he probably had a degenerated disc

    有些活動對你是好的, 有些則不是。」

  • in the lower part of his spine.

    他的回應是:

  • Whenever it got strained, it hurt.

    「我想要做背部磁振造影。」

  • He'd already taken up swimming instead of jogging,

    「你為何想做磁振造影?」

  • there was really nothing to do,

    「我的工作有投保,不用負擔費用。」

  • so I told him, "You need to be more selective

    「拜託,」我說—— 畢竟,他也是我的朋友。

  • when it comes to training.

    「那不是真正的原因。」

  • Some activities are good for you,

    「嗯,我認為能看看 背後有多糟也不錯。」

  • some are not."

    我說:「你何時開始解讀 磁振造影掃瞄結果了?」

  • His reply was,

    (笑聲)

  • "I want an MRI of my back."

    「這件事就相信我吧,

  • "Why do you want an MRI?"

    你不需要掃瞄。」

  • "I can get it for free through my insurance at work."

    他說:「嗯,」

  • "Come on," I said -- he was also, after all, my friend.

    一會兒,他繼續說: 「有可能是癌症。」

  • "That's not the real reason."

    (笑聲)

  • "Well, I think it's going to be good to see how bad it looks back there."

    很顯然,他還是做了掃瞄。

  • "When did you start interpreting MRI scans?" I said.

    透過他工作的保險, 他去找了我的一位同事,

  • (Laughter)

    同事告訴他椎間盤退化的事,

  • "Trust me on this.

    沒有其他可以做的,

  • You're not going to need the scan."

    所以他應該要繼續游泳,放棄慢跑。

  • "Well," he said,

    一陣子後,我和他再次見面,他說:

  • and after a while, he continued, "It could be cancer."

    「至少現在我知道它是什麼了。」

  • (Laughter)

    但,讓我請問各位。

  • He got the scan, obviously.

    如果這間房間中每個有這種 症狀的人都去做磁振造影會如何?

  • And through his insurance at work,

    如果每個在挪威偶爾有背痛的人

  • he got to see one of my colleagues at work,

    都去做磁振造影呢?

  • telling him about the degenerated disc,

    磁振造影的等候名單可能會 變成四倍或更長。

  • that there was nothing to do,

    你們會把在等候名單上

  • and that he should keep on swimming and quit the jogging.

    真正癌症患者的名額給佔去了。

  • After a while, I met him again and he said,

    所以,好的醫生有時會說不,

  • "At least now I know what this is."

    但,理性的病人有時也會拒絕

  • But let me ask you a question.

    被診斷或治療的機會。

  • What if all of you in this room with the same symptoms had an MRI?

    「醫生,這真的有必要嗎?」

  • And what if all the people in Norway

    我知道要問這個問題很難。

  • had an MRI due to occasional back pain?

    事實上,五十年前,

  • The waiting list for an MRI would quadruple, maybe even more.

    問這個問題可能還會被視為無禮。

  • And you would all take the spot on that list

    (笑聲)

  • from someone who really had cancer.

    如果醫生決定了 要如何處理你的狀況,

  • So a good doctor sometimes says no,

    你就要照做。

  • but the sensible patient also turns down, sometimes,

    我的一個同事,現在是家醫科醫師,

  • an opportunity to get diagnosed or treated.

    她小時候被送到結核病療養院,

  • "Doctor, is this really necessary?"

    待了六個月。

  • I know this can be a difficult question to ask.

    這對她來說是很大的創傷。

  • In fact, if you go back 50 years,

    長大後,她發現,

  • this was even considered rude.

    她的結核病檢測結果 一直都是陰性的。

  • (Laughter)

    醫生只因錯誤的臆測 就把她送進療養院。

  • If the doctor had decided what to do with you,

    沒有人敢,甚至沒有人 想過要和醫生對質。

  • that's what you did.

    連她的父母也沒有。

  • A colleague of mine, now a general practitioner,

    現今,挪威健康部長

  • was sent away to a tuberculosis sanatorium as a little girl,

    談到病人健康照護服務。

  • for six months.

    病人應該要向醫生取得 如何治療的建議。

  • It was a terrible trauma for her.

    這是很大的進展。

  • She later found out, as a grown-up,

    但這也會讓你們承擔更多的責任。

  • that her tests on tuberculosis had been negative all along.

    你們得要和醫生一起坐到前座上,

  • The doctor had sent her away on nothing but wrong suspicion.

    開始一起決定要往哪個方向走。

  • No one had dared or even considered confronting him about it.

    所以,下次進入醫生辦公室時,

  • Not even her parents.

    我希望各位能夠問:

  • Today, the Norwegian health minister

    「醫生,這真的有必要嗎?」

  • talks about the patient health care service.

    在我那位女病人的案例中,

  • The patient is supposed to get advice from the doctor about what to do.

    答案是不必要,

  • This is great progress.

    但如要動手術也是合理正當的。

  • But it also puts more responsibility on you.

    「那麼醫生,這項 手術的風險是什麼?」

  • You need to get in the front seat with your doctor

    5% 到 10% 的病人

  • and start sharing decisions on where to go.

    會有更糟的疼痛症狀。

  • So, the next time you're in a doctor's office,

    1% 到 2% 的病人

  • I want you to ask,

    傷口會感染或甚至發生大出血,

  • "Doctor, is this really necessary?"

    最後可能要重新開刀。

  • And in my female patient's case,

    0.5 % 的病人會有永久性的沙啞,

  • the answer would be no,

    雖然是少數,但仍然有人

  • but an operation could also be justified.

    會發現手臂甚至腿部的功能下降。

  • "So doctors, what are the risks attached to this operation?"

    「醫生,有其他選擇嗎?」

  • Well, five to ten percent of patients will have worsening of pain symptoms.

    是的,休息和物理治療一段時間

  • One to two percent of patients

    可能會讓你康復得很好。

  • will have an infection in the wound or even a rehemorrhage

    「如果我什麼都不做,會如何?」

  • that might end up in a re-operation.

    不建議這樣,

  • 0.5 percent of patients also experience permanent hoarseness

    但,如果真的如此, 也有微小的機會可能會好起來。

  • and a few, but still a few,

    四個問題。

  • will experience reduced function in the arms or even legs.

    很簡單的問題。

  • "Doctor, are there other options?"

    把它們視為你們用來 協助我們的新工具盒。

  • Yes, rest and physical therapy over some time

    這真的有必要嗎?

  • might get you perfectly well.

    風險是什麼?

  • "And what happens if I don't do anything?"

    有其他選擇嗎?

  • It's not recommended,

    如果我什麼都不做,會如何?

  • but even then, there's a slight chance that you will get well.

    對你的醫生提出上述問題, 當他要把你送去做磁振造影時、

  • Four questions.

    當他要開抗生素給你時,

  • Simple questions.

    或他建議你要動手術時。

  • Consider them your new toolbox to help us.

    我們從研究得知,

  • Is this really necessary?

    五個人中就有一個,即兩成,

  • What are the risks?

    會改變心意而做出不同的選擇。

  • Are there other options?

    藉由這麼做,你不僅讓你的人生

  • And what happens if I don't do anything?

    輕鬆許多,可能還會變得更好,

  • Ask them when your doctor wants to send you to an MRI,

    此外,整個健康照護部門

  • when he prescribes antibiotics

    也會因為你的選擇而受益。

  • or suggests an operation.

    謝謝。

  • What we know from research

    (掌聲)

  • is that one out of five of you, 20 percent,

  • will change your opinion on what to do.

  • And by doing that, you will not only have made your life

  • a whole lot easier, and probably even better,

  • but the whole health care sector

  • will have benefited from your decision.

  • Thank you.

  • (Applause)

I am a neurosurgeon,

譯者: Lilian Chiu 審譯者: SF Huang

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B1 中級 中文 美國腔 TED 醫生 治療 必要 手術 建議

【TED】Christer Mjåset:你應該經常問醫生的4個問題 (4個你應該經常問醫生的問題 | Christer Mjåset) (【TED】Christer Mjåset: 4 questions you should always ask your doctor (4 questions you should always ask your doctor | Christer Mjåset))

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    林宜悉 發佈於 2021 年 01 月 14 日
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