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  • When I first became a doctor

    譯者: Lilian Chiu 審譯者: Melody Tang

  • in Benin City, Nigeria,

    我在奈及利亞的貝寧城 成為一位醫生時,

  • some 30-odd years ago,

    那是在大約三十多年前。

  • I was drawn to help people live full lives.

    那時我渴望協助大家好好過生活。

  • But often, I found myself feeling impotent.

    但,我常感到自己很無能。

  • Here I was, a brand-new doctor with all these skills,

    當時的我是個新手醫生, 身懷各種技巧,

  • but I couldn't cure my patients who had chronic diseases --

    但我卻無法治癒慢性病的病人——

  • illnesses like heart disease, asthma, diabetes --

    比如心臟疾病、氣喘、糖尿病——

  • and needed more than just handing them a prescription

    他們需要的不只是 我們開處方給他們,

  • or providing grief counseling in the office to get the job done.

    或者在辦公室裡提供 處理悲傷的諮詢服務。

  • Fast-forward 15 years later:

    快轉十五年,

  • I'm in Atlanta, Georgia;

    我在喬治亞州的亞特蘭大;

  • it's a different world,

    那是個不同的世界,

  • but it was déjà vu all over again.

    但同樣的情況又出現了。

  • As doctors, we see our patients who have chronic illnesses

    身為醫生,我們治療 慢性病病人的方式,

  • in an episodic way.

    是片斷式的。

  • In between,

    在兩次就診之間,病人必須學習

  • the patients have to learn how to make a lot of decisions for themselves.

    如何自己做許多決定。

  • I'll give you examples.

    讓我舉例說明。

  • If you have medications you're supposed to take every day,

    若你有每天應服用的藥物,

  • what do you do when you're sick?

    當你生病時要怎麼辦?

  • Are you still supposed to take it?

    你仍然要吃那些藥物嗎?

  • How do you recognize a complication when it happens?

    併發症發生時,你如何辨識?

  • How do you recognize a side effect when it happens?

    副作用發生時,你如何辨識並處理?

  • What do you do with it?

    除了這些之外,

  • In addition to all of this,

    他們還要處理無可避免的 寂寞、孤獨、焦慮,

  • they're dealing with the inevitable loneliness, isolation and anxiety

    那些慢性病病人都得面對的。

  • that people who have chronic illnesses deal with.

    光是在美國, 十個成人中就有六個有慢性病。

  • In the US alone, six in 10 adults have a chronic illness.

    總數達一億兩千五百萬人。

  • That's 125 million people.

    羅伯特伍德約翰遜基金會 最近有一篇報告指出,

  • A recent report from the Robert Wood Johnson Foundation

    人們的健康狀態,

  • showed that health habits account for 50 percent

    有一半是健康有關的習慣造成的,

  • of the health outcomes that people experience,

    只有兩成是醫療照護。

  • while medical care only accounts for 20 percent.

    事實上,疾病管制署說,

  • In fact, the Centers for Disease Control

    如果我們能消除抽菸、

  • says that if we could eliminate smoking,

    缺乏身體活動,以及營養不良,

  • physical inactivity and poor nutrition,

    我們就可以預防八成的心臟疾病、

  • that we can prevent 80 percent of heart disease,

    八成的第二型糖尿病,

  • 80 percent of type 2 diabetes

    以及四成的癌症。

  • and 40 percent of cancer.

    但,我們也知道,

  • But we also know

    改變健康相關習慣是很困難的事。

  • that changing health behaviors is very difficult.

    所以,我們要問:如果,

  • So we asked the question:

    如果我們能創造一種資源

  • What if we could create a resource

    來激勵大家改變健康 相關習慣,會如何?

  • that could motivate people to change health behavior?

    事實上,外面有很多這類資源

  • The truth is, there are a lot of these resources out there

    能協助大家學習到 所謂的自我管理技能。

  • that help people acquire these so-called self-management skills.

    但,通常,這些資源不易取得, 或很難感受到關聯性,

  • But many a time, they're not easily accessible or relatable,

    對於少數族群及缺乏服務的 社區而言更是如此。

  • particularly to individuals within minority and underserved communities,

    他們除了被歧視,還要面對 語言和文化的障礙,

  • who face bias in addition to barriers like language and culture

    以及健康保險範圍的不足。

  • and inadequate health insurance coverage.

    所以,在過去十二年間,

  • And so in the last 12 years,

    我和我在摩爾豪斯醫學院的同事,

  • my colleagues and I at Morehouse School of Medicine

    創造了一個以科技 為基礎的應用程式,

  • have created a technology-based application

    來協助慢性疾病者的照護。

  • to assist with chronic illness care.

    在網路上可以免費

  • It's freely available on the web

    下載這個應用程式。

  • and as an app.

    我們所做的,是讓大家追蹤變數——

  • And what we do is get people to track variables --

    血壓、血糖——

  • blood pressure, blood sugar --

    然後我們以不同顏色顯示的 格式回報給他們。

  • and then report it back to them in a color-coded format.

    綠色代表的是健康的範圍,

  • So green would indicate a healthy range,

    紅色代表有問題需要處理。

  • and red would indicate a problem that needs something done about it.

    我們連結這些統計數字和相關課程。

  • We link these stats to a curriculum.

    相關課程協助每個人了解 自己的健康狀況,

  • The curriculum helps the individual learn about their health condition,

    不論他們的慢性疾病是哪一種。

  • whatever the chronic illness is.

    他們也和健康教練合作,

  • They also work with a health coach

    學習自我管理的技能。

  • to learn self-management skills,

    這些技能可以協助他們 預防疾病造成的併發症。

  • skills that'll help them prevent complications of their illness.

    教練若要能成功幫助病人,

  • In order for the coach to be successful,

    他們必須能取得合作對象的信賴。

  • they have to be able to gain the trust

    我們在診所裡測試這個應用程式,

  • of the individual that they're working with.

    在那裡,健康教練是醫療助理。

  • We tested this application

    我們也在都市裡的大型教堂中測試,

  • in clinics, where the health coaches were medical assistants,

    在那裡,健康教練則是 來自健康署的志工。

  • and in a large urban church,

    一年後,三分之一的參與者

  • where the health coaches were volunteers from the health ministry.

    能夠學到三項新的自我管理技能,

  • A year later, a third of the participants

    並持續維持這些技能到足以改善

  • were able to acquire three new self-management skills

    他們的血壓、血糖,

  • and maintain them to the extent that it was able to improve

    以及他們的運動。

  • their blood pressures, their blood sugar

    有一點讓我們 很驚訝的簡單事實是,

  • and their exercise.

    比起在純粹醫療照護底下的群體,

  • Now, what was simple yet fascinating to us

    教堂群體的表現一樣好或甚至更好。

  • was that the group from the church did just as well or even better

    我們想要知道為什麼會這樣。

  • than the group that were under purely medical care.

    所以我們做了進一步的研究——

  • And we wanted to learn why that was.

    從四百小時的對話錄音——

  • So we looked a little further into the research --

    我們的發現是,教堂的教練

  • 400 hours of recorded conversation --

    的確有比較多時間 可以花在病人身上,

  • and what we learned was that the coaches from the church

    他們能接觸到病人的家人,

  • did have more time to spend with the patients,

    所以他們能得知大家需要什麼,

  • they had access to the patients' families,

    並提供他們所需要的資源。

  • and so they could figure out what people needed

    我和我的團隊將之稱為 「契合文化的輔導」。

  • and provide those resources for them.

    為了說明「契合文化的輔導」 這個概念,

  • My team and I call this "culturally congruent coaching."

    我要跟各位談談 我們的病人柏薩女士。

  • To illustrate this concept of culturally congruent coaching,

    柏薩女士八十三歲, 有糖尿病及高血壓。

  • I want to tell you about one of our patients.

    她被指派給安,也就是 她的教會的健康教練。

  • I'll call her Ms. Bertha.

    安剛好是她家多年的朋友,

  • So Ms. Bertha is an 83-year-old lady with diabetes and hypertension.

    他們是同教會的會友。

  • She was assigned to Anne, her health coach in the church.

    在前幾次造訪之後,安觀察到

  • Anne also happened to be a family friend to Ms. Bertha for many years,

    雖然柏薩女士有如實 記錄她的統計數字,

  • and they were fellow congregants.

    數字仍然都呈現紅色。

  • Anne observed after the first few visits

    所以她更深入探究,

  • that even though Ms. Bertha faithfully recorded her stats,

    試圖了解柏薩女士的 狀況是怎麼回事,

  • they were all showing up as red.

    而柏薩女士告訴她最真的真相。

  • So she probed a little deeper

    (笑聲)

  • to try to understand what was going on with Ms. Bertha,

    她告訴她,有些時候,

  • and Ms. Bertha gave her the real-real.

    她的藥物會讓她感覺怪怪的,

  • (Laughter)

    她就不會照處方吃藥, 因為她認為是藥物造成的,

  • She told her that there were times

    但她沒有告訴醫生這件事。

  • when her medications made her feel weird,

    有時她也因為各種理由 而沒有去預約的門診,

  • and she wouldn't take them the way they were prescribed,

    其中一個理由是她並沒有變好,

  • because she thought it was due to the medicines

    而她不想讓她的醫生生氣, 所以她乾脆不去了。

  • but she didn't tell her doctor that.

    於是,安和柏薩女士談,

  • She also skipped out on some doctor appointments

    並請她在下次造訪時 帶她女兒一起來,她也照做了。

  • for a variety of reasons,

    在那次造訪時,

  • but one of them was she wasn't doing better

    安把柏薩女士所收集的統計數字

  • and she didn't want to make her doctor mad,

    通通都印出來,

  • so she just didn't go.

    交給她,並鼓勵她們一起 去看醫生,她們也照做了。

  • So Anne talked to Ms. Bertha

    有了那些資訊,醫生便能針對 柏薩女士的治療方式做調整。

  • and asked her to bring her daughter in for the next visit, which she did.

    不到三個月,柏薩女士的 數字就變成綠色了。

  • And at that visit,

    沒有人比柏薩女士 還要更興奮或驚訝。

  • Anne was able to print out a log of all these stats

    安扮演的健康教練十分成功,

  • that Ms. Bertha had been collecting,

    因為她的關心夠深入,穿越表層,

  • gave them to her and encouraged them to go see the doctor together,

    去深究柏薩女士深藏的文化,

  • which they did.

    並在那個層級上和她交流。

  • With that information,

    她知道如何傾聽, 她知道如何問對的問題,

  • the doctor was able to make changes to Ms. Bertha's treatment.

    以取得需要的資訊。

  • Within three months, Ms. Bertha's numbers were all in the green.

    我們都有在潛意識深處的規則,

  • No one was more excited or surprised than Ms. Bertha herself.

    影響我們做出健康相關的決定。

  • Now, Anne was successful as a health coach

    那是我們的文化。

  • because she cared enough to go below the surface

    安和柏薩女士之間的關係和對話

  • and probe Ms. Bertha's deep culture

    說明了有不同的可能性,

  • and was able to reach her at that level.

    只要我們能和病人、我們的朋友,

  • She knew how to listen,

    和我們的鄰居,在深層的 文化層級進行對話。

  • and she knew how to ask the right questions

    我個人非常興奮,

  • to get to what was needed.

    因為只要用這個簡單的 「契合文化的輔導」概念,

  • We all have deep unconscious rules

    我們就可以協助美國 一億兩千五百萬

  • that drive the way we make our health decisions.

    及世界各地更多的慢性疾病 病人改善他們的生活。

  • That's our culture.

    謝謝。

  • The relationship and the conversation between Anne and Ms. Bertha

    (掌聲)

  • illustrates what's possible

  • when we have conversations with our patients,

  • our friends and our neighbors

  • on a deep cultural level.

  • And personally, I'm beyond excited

  • to think that with this simple concept of culturally congruent coaching,

  • we could change the lives of 125 million Americans

  • and many others across the world

  • that are living with chronic diseases.

  • Thank you.

  • (Applause)

When I first became a doctor

譯者: Lilian Chiu 審譯者: Melody Tang

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