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  • Translator: Joseph Geni Reviewer: Morton Bast

    我要分享一些我的朋友和故事

  • I want to share some personal friends and stories with you

    我從來沒有公開談過

  • that I've actually never talked about in public before

    我的目的是要說明一種想法、

  • to help illustrate the idea

    一種需求、一種希望

  • and the need and the hope

    以重塑全球的醫療照護系統

  • for us to reinvent our health care system around the world.

    24年前,我還是個大二學生

  • Twenty-four years ago, I had -- a sophomore in college,

    我昏迷了好幾次,不是因為酒醉

  • I had a series of fainting spells. No alcohol was involved.

    我被送到學生健康中心

  • And I ended up in student health,

    做了一些檢驗後,立刻得知

  • and they ran some labwork and came back right away,

    是腎臟問題

  • and said, "Kidney problems."

    我還沒搞清楚狀況,就開始了

  • And before I knew it, I was involved and thrown into

    六個月的檢驗、考驗和折磨

  • this six months of tests and trials and tribulations

    由2家醫院的6位醫生診治

  • with six doctors across two hospitals

    這些醫界權威互相爭執

  • in this clash of medical titans

    想釐清誰才正確

  • to figure out which one of them was right

    診斷出我的病情

  • about what was wrong with me.

    做完超音波後,我坐在候診室

  • And I'm sitting in a waiting room some time later for an ultrasound,

    6位醫生同時出現

  • and all six of these doctors actually show up in the room at once,

    我想:「糟了,一定是壞消息!」

  • and I'm like, "Uh oh, this is bad news."

    醫生診斷說:

  • And their diagnosis was this:

    「你得了兩種罕見的腎臟疾病,

  • They said, "You have two rare kidney diseases

    最終會讓你的腎臟壞死,

  • that are going to actually destroy your kidneys eventually,

    你的免疫系統中有類似癌症細胞,

  • you have cancer-like cells in your immune system

    必須立即治療。

  • that we need to start treatment right away,

    你永遠不可能符合換腎資格,

  • and you'll never be eligible for a kidney transplant,

    最多還能活2到3年。」

  • and you're not likely to live more than two or three years."

    這項診斷好像世界末日

  • Now, with the gravity of this doomsday diagnosis,

    讓我立刻認定

  • it just sucked me in immediately,

    自己就是病人

  • as if I began preparing myself as a patient

    將在醫生宣判的日期死亡

  • to die according to the schedule that they had just given to me,

    我在候診室遇到另一位病人薇娜 (Verna)

  • until I met a patient named Verna in a waiting room,

    她成了我的好友,有天她拉著我

  • who became a dear friend, and she grabbed me one day

    帶我到醫學圖書館

  • and took me off to the medical library

    仔細研究我的疾病和診斷

  • and did a bunch of research on these diagnoses and these diseases,

    然後說:「得到這些疾病的人,

  • and said, "Eric, these people who get this

    通常都是七、八十歲,

  • are normally in their '70s and '80s.

    他們根本不了解你,醒醒吧,

  • They don't know anything about you. Wake up.

    掌握自己的健康、好好的生活!」

  • Take control of your health and get on with your life."

    我真的這麼做了

  • And I did.

    宣告我病症的人

  • Now, these people making these proclamations to me

    都不是壞人

  • were not bad people.

    他們都是仁心仁術的專科醫師

  • In fact, these professionals were miracle workers,

    但他們在有缺陷、昂貴、錯誤 的系統下工作

  • but they're working in a flawed, expensive system that's set up the wrong way.

    所有的照護都依賴醫院與診所

  • It's dependent on hospitals and clinics for our every care need.

    依賴只看我們部分身體的專科醫師

  • It's dependent on specialists who just look at parts of us.

    依賴基於猜測的診斷 以及亂槍打鳥的用藥

  • It's dependent on guesswork of diagnoses and drug cocktails,

    他不成功,你就成仁

  • and so something either works or you die.

    這系統也依賴消極的病人

  • And it's dependent on passive patients

    默默承受、不問問題

  • who just take it and don't ask any questions.

    以上這種模式是有問題的

  • Now the problem with this model

    以全球來說,是無法永續的

  • is that it's unsustainable globally.

    也是無法負擔的

  • It's unaffordable globally.

    我們要發展「個人化健康系統」

  • We need to invent what I call a personal health system.

    個人化健康系統是什麼?

  • So what does this personal health system look like,

    有哪些新技術、新角色?

  • and what new technologies and roles is it going to entail?

    我現在要與各位分享

  • Now, I'm going to start by actually sharing with you

    我的新朋友「利比」(Libby)

  • a new friend of mine, Libby,

    過去半年我們關係密切

  • somebody I've become quite attached to over the last six months.

    這就是利比 也可說是利比的超音波影像

  • This is Libby, or actually, this is an ultrasound image of Libby.

    是我本來永遠等不到的移植腎臟

  • This is the kidney transplant I was never supposed to have.

    這是幾週前照的影像

  • Now, this is an image that we shot a couple of weeks ago for today,

    請注意角落

  • and you'll notice, on the edge of this image,

    那裡有些陰影,我很擔心

  • there's some dark spots there, which was really concerning to me.

    我要在現場進行檢驗

  • So we're going to actually do a live exam

    看看利比的狀況好不好

  • to sort of see how Libby's doing.

    不是衣服有問題,我要脫掉皮帶

  • This is not a wardrobe malfunction. I have to take my belt off here.

    前排的請不要擔心

  • Don't you in the front row worry or anything.

    (笑聲)

  • (Laughter)

    我要開始使用行動檢測公司 (Mobisante) 所開發的儀器

  • I'm going to use a device from a company called Mobisante.

    叫做行動超音波

  • This is a portable ultrasound.

    可連接手機或平板電腦

  • It can plug into a smartphone. It can plug into a tablet.

    行動檢測公司在華盛頓州雷德蒙市

  • Mobisante is up in Redmond, Washington,

    他們好心訓練我自助使用

  • and they kindly trained me to actually do this on myself.

    他們沒有獲准這麼做 病人也沒獲准這麼用

  • They're not approved to do this. Patients are not approved to do this.

    先講清楚,這只是概念的展示

  • This is a concept demo, so I want to make that clear.

    塗上凝膠

  • All right, I gotta gel up.

    現在前排觀眾很緊張了 (笑聲)

  • Now the people in the front row are very nervous. (Laughter)

    我要介紹貝謝克醫師 (Dr. Thomas Batiuk)

  • And I want to actually introduce you to Dr. Batiuk,

    他是我的另一位朋友

  • who's another friend of mine.

    在奧勒岡州波特蘭市的撒馬利亞 慈善醫院 (Legacy Good Samaritan)

  • He's up in Legacy Good Samaritan Hospital in Portland, Oregon.

    先確認一下,貝醫生,聽得到嗎?

  • So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay?

    還有,你看得到「利比」嗎?

  • And actually, can you see Libby?

    貝醫師:嗨!艾瑞克,你好 (即演講者 Eric Dishman)

  • Thomas Batuik: Hi there, Eric.

    你看起來好忙啊!你好!

  • You look busy. How are you?

    艾瑞克:我很好,我剛脫了衣服

  • Eric Dishman: I'm good. I'm just taking my clothes off

    有幾百位觀眾在看,感覺真好!

  • in front of a few hundred people. It's wonderful.

    我想知道這是不是你要看的影像?

  • So I just wanted to see, is this the image you need to get?

    請幫我檢查那些陰影還在不在?

  • And I know you want to look and see if those spots are still there.

    貝醫師:請往周圍掃描一下

  • TB: Okay. Well let's scan around a little bit here,

    我先看一下整體狀況

  • give me a lay of the land.

    艾瑞克:好的 貝醫師:往裡面一點

  • ED: All right.TB: Okay. Turn it a little bit inside,

    往中間一點點

  • a little bit toward the middle for me.

    好,很好,往上一點點

  • Okay, that's good. How about up a little bit?

    停,這個影像正是我要的

  • Okay, freeze that image. That's a good one for me.

    艾瑞克:上週停住時

  • ED: All right. Now last week, when I did this,

    你要我量陰影的大小

  • you had me measure that spot to the right.

    現在要做嗎?

  • Should I do that again?

    貝醫師:沒錯,量一下

  • TB: Yeah, let's do that.

    艾瑞克:這有點難

  • ED: All right. This is kind of hard to do

    一手在腹部,另一手還要操作

  • with one hand on your belly and one hand on measuring,

    我想我作到了

  • but I've got it, I think,

    我把影像存檔,再寄給你

  • and I'll save that image and send it to you.

    請告訴我那個陰影是什麼

  • So tell me a little bit about what this dark spot means.

    我不太安心

  • It's not something I was very happy about.

    貝醫師:很多人在腎臟移植後

  • TB: Many people after a kidney transplant

    腎臟周圍會積水

  • will develop a little fluid collection around the kidney.

    大部分不會造成傷害

  • Most of the time it doesn't create any kind of mischief,

    但是需要注意

  • but it does warrant looking at,

    很高興今天有機會檢查

  • so I'm happy we've got an opportunity to look at it today,

    確認沒有變大、不會造成問題

  • make sure that it's not growing, it's not creating any problems.

    與先前影像比較

  • Based on the other images we have,

    我很滿意今天的狀況

  • I'm really happy how it looks today.

    艾瑞克:我去看診時請再檢查一次

  • ED: All right. Well, I guess we'll double check it when I come in.

    再幾週就要做6個月的切片檢查

  • I've got my six month biopsy in a couple of weeks,

    我會請你幫忙

  • and I'm going to let you do that in the clinic,

    因為我沒辦法自己作切片

  • because I don't think I can do that one on myself.

    貝醫師:沒錯 艾瑞克:謝謝你,貝醫師

  • TB: Good choice.ED: All right, thanks, Dr. Batiuk.

    好的,各位剛才看到的

  • All right. So what you're sort of seeing here

    是革命性的創新技術

  • is an example of disruptive technologies,

    包括行動裝置、社群、分析技術

  • of mobile, social and analytic technologies.

    是未來個人化健康照護的基礎

  • These are the foundations of what's going to make personal health possible.

    有三大支柱支撐著…

  • Now there's really three pillars

    接下來要談的個人化健康照護

  • of this personal health I want to talk to you about now,

    就是照護行動化、網路化、客製化

  • and it's care anywhere, care networking and care customization.

    剛才只匆匆一瞥前兩項

  • And you just saw a little bit of the first two

    看到我和貝醫生的互動

  • with my interaction with Dr. Batiuk.

    現在從第一點開始,照護行動化

  • So let's start with care anywhere.

    建立醫院和診所的構想,起源自

  • Humans invented the idea of hospitals and clinics

    1780年,現在該重新思考了

  • in the 1780s. It is time to update our thinking.

    我們該將醫生和病人

  • We have got to untether clinicians and patients

    都要走到一棟專用

  • from the notion of traveling to a special

    建築物進行醫療的做法中 釋放出來

  • bricks-and-mortar place for all of our care,

    對醫療目的而言,這往往是錯誤的

  • because these places are often the wrong tool,

    而且昂貴的

  • and the most expensive tool, for the job.

    對重病患者有時並不安全

  • And these are sometimes unsafe places to send our sickest patients,

    尤其是這個超級細菌、

  • especially in an era of superbugs

    及院內感染橫行的時代

  • and hospital-acquired infections.

    許多國家想直接跳過實體醫院

  • And many countries are going to go brickless from the start

    因為太貴了,永遠負擔不起…

  • because they're never going to be able to afford

    已開發國家的這種大型醫學中心

  • the mega-medicalplexes that a lot of the rest of the world has built.

    我個人的經驗是,醫院

  • Now I personally learned that hospitals

    對小孩來說,是個很危險的地方

  • can be a very dangerous place at a young age.

    這是小學三年級的我

  • This was me in third grade.

    手肘嚴重骨折,需要動手術

  • I broke my elbow very seriously, had to have surgery,

    我很怕會失去整隻手臂

  • worried that they were going to actually lose the arm.

    手術後的住院期間,我得了褥瘡

  • Recovering from the surgery in the hospital, I get bedsores.

    褥瘡受到感染

  • Those bedsores become infected,

    抗生素治療造成嚴重過敏

  • and they give me an antibiotic which I end up being allergic to,

    最後全身爆發…

  • and now my whole body breaks out,

    全面性的感染

  • and now all of those become infected.

    住院越久,我病得越重

  • The longer I stayed in the hospital, the sicker I became,

    醫藥費也越高

  • and the more expensive it became,

    全球每年數百萬人都是相同情形

  • and this happens to millions of people around the world every year.

    我講的未來個人化健康照護

  • The future of personal health that I'm talking about

    是以居家照護為優先

  • says care must occur at home as the default model,

    不是目前的醫院或診所

  • not in a hospital or clinic.

    你想進醫院或診所

  • You have to earn your way into those places

    要病到有必要的程度才行

  • by being sick enough to use that tool for the job.

    現在我們用的智慧型手機

  • Now the smartphones that we're already carrying

    已可外接各種診斷裝置,如超音波

  • can clearly have diagnostic devices like ultrasounds plugged into them,

    及其他許多裝置

  • and a whole array of others, today,

    智慧型手機還內建多種感測器

  • and as sensing is built into these,

    可進行生命跡像監測

  • we'll be able to do vital signs monitor

    及過去沒聽過的行為監測

  • and behavioral monitoring like we've never had before.

    未來我們之中許多人可能會植入

  • Many of us will have implantables that will actually look

    即時監控血液中化學物質

  • real-time at what's going on with our blood chemistry

    及蛋白質的裝置

  • and in our proteins right now.

    軟體越來越聰明,對吧?

  • Now the software is also getting smarter, right?

    就像是線上的教練或經紀人

  • Think about a coach, an agent online,

    可幫我們安全的自我照顧

  • that's going to help me do safe self-care.

    像我剛才展示超音波的互動

  • That same interaction that we just did with the ultrasound

    未來可能會有即時影像處理

  • will likely have real-time image processing,

    機器會指揮我上下左右

  • and the device will say, "Up, down, left, right,

    說:「就是這個位置,影像存檔,

  • ah, Eric, that's the perfect spot to send that image

    傳給你的醫生吧!」

  • off to your doctor."

    如果我們有了這些網路裝置

  • Now, if we've got all these networked devices

    照護行動化就可以達成

  • that are helping us to do care anywhere,

    當然,我們需要一個團隊

  • it stands to reason that we also need a team

    來進行相關互動

  • to be able to interact with all of that stuff,

    這就需要我說的第二根支柱

  • and that leads to the second pillar I want to talk about,

    照護網路化

  • care networking.

    我們要突破傳統模式

  • We have got to go beyond this paradigm

    也就是獨立專科醫師 分別進行部分照護

  • of isolated specialists doing parts care

    進而由多科別團隊進行個人化照護

  • to multidisciplinary teams doing person care.

    今日缺乏協調的照護,不僅昂貴

  • Uncoordinated care today is expensive at best,

    還可能致命

  • and it is deadly at worst.

    80%的醫療錯誤是因為

  • Eighty percent of medical errors are actually caused

    溝通協調問題

  • by communication and coordination problems

    存在醫療團隊成員間

  • amongst medical team members.

    在念研究所時我有心驚膽顫的經驗

  • I had my own heart scare years ago in graduate school,

    那時在治療腎臟

  • when we're under treatment for the kidney,

    突然有人說:「你得了心臟病!」

  • and suddenly, they're like, "Oh, we think you have a heart problem."

    接著我出現了心悸

  • And I have these palpitations that are showing up.

    進行了5個星期檢驗

  • They put me through five weeks of tests --

    又貴又可怕- 最後有位護士注意到

  • very expensive, very scary -- before the nurse finally notices

    一張紙,我的藥單

  • the piece of the paper, my meds list

    我每次約診都帶的單子

  • that I've been carrying to every single appointment,

    他說:「天哪!」

  • and says, "Oh my gosh."

    有三位專科醫師開了

  • Three different specialists had prescribed

    相同的處方藥

  • three different versions of the same drug to me.

    我心臟沒病,是用藥過量

  • I did not have a heart problem. I had an overdose problem.

    是照護缺乏協調的問題

  • I had a care coordination problem.

    這每年發生在數百萬人身上

  • And this happens to millions of people every year.

    我想用現有的科技

  • I want to use technology that we're all working on and making happen

    使健康照護成為合作的團隊運動

  • to make health care a coordinated team sport.

    才能解決這件讓我最害怕的事

  • Now this is the most frightening thing to me.

    我曾在世界各地的醫院及診所診治

  • Out of all the care I've had in hospitals and clinics around the world,

    我第一次感受到 真正的醫療團隊照護

  • the first time I've ever had a true team-based care experience

    就是過去半年在撒馬利亞慈善醫院 (Legacy Good Samaritan)

  • was at Legacy Good Sam these last six months

    讓我有此感受

  • for me to go get this.

    這是我在醫院的畢業團隊照片

  • And this is a picture of my graduation team from Legacy.

    有好幾位,這位是貝醫師

  • There's a couple of the folks here. You'll recognize Dr. Batiuk.

    剛和他通電話 這是珍妮,其中一位護士

  • We just talked to him. Here's Jenny, one of the nurses,

    這是艾利森,他幫忙處理移植清單

  • Allison, who helped manage the transplant list,

    還有十幾位不在相片中

  • and a dozen other people who aren't pictured,

    有藥師、心理醫師、營養師

  • a pharmacist, a psychologist, a nutritionist,

    甚至還有財務顧問,麗莎

  • even a financial counselor, Lisa,

    她幫我們處理所有保險事務

  • who helped us deal with all the insurance hassles.

    我畢業那天哭了

  • I wept the day I graduated.

    我應該要高興,因為病已好到

  • I should have been happy, because I was so well

    可以回去看一般的醫師了

  • that I could go back to my normal doctors,

    我哭是因為和團隊感情深厚

  • but I wept because I was so actually connected to this team.

    這才是最重要的部份

  • And here's the most important part.

    照片上還有我,以及我太太艾希莉

  • The other people in this picture are me and my wife, Ashley.

    醫院訓練我們在家自行照護

  • Legacy trained us on how to do care for me at home

    醫院和診所就不必那麼忙碌

  • so that they could offload the hospitals and clinics.

    這是這種模式成功的唯一方式

  • That's the only way that the model works.

    我的團隊其實在中國工作

  • My team is actually working in China

    從事自助照護模式

  • on one of these self-care models

    稱為「年齡友善城市」計畫

  • for a project we called Age-Friendly Cities.

    我們嘗試建立社群網路

  • We're trying to help build a social network

    以幫助追蹤並且訓練年長者

  • that can help track and train the care of seniors

    能自已照顧自己

  • caring for themselves

    以及由家人提供照護

  • as well as the care provided by their family members

    還有社區的健康照護志工

  • or volunteer community health workers,

    另外還有線上照護交換網站

  • as well as have an exchange network online,

    例如我每天照顧你媽三小時

  • where, for example, I can donate three hours of care a day to your mom,

    而有人可以幫我送餐點

  • if somebody else can help me with transportation to meals,

    大家在網路上交換工作

  • and we exchange all of that online.

    我要強調的重點是

  • The most important point I want to make to you about this

    可怕而又太理想化的

  • is the sacred and somewhat