a 40 year-old woman came to an emergency room

一位四十歲的婦人來到急診室

in a hospital close to where I live,

在我住處附近的一家醫院內

and she was brought in confused.

她被送進來時，身體狀況混亂

Her blood pressure was an alarming

她的血壓拉警報

230 over 170.

收縮壓230，舒張壓170

Within a few minutes, she went into cardiac collapse.

幾分鐘內，她的心臟衰竭

She was resuscitated, stabilized,

她被施以心肺復甦、穩定下來

whisked over to a CAT scan suite

快速送到電腦斷層掃瞄室

right next to the emergency room,

就在急診室旁

because they were concerned about blood clots in the lung.

因為他們擔心肺部有血塊

And the CAT scan revealed

電腦斷層掃瞄顯示

no blood clots in the lung,

在肺部沒有血塊

but it showed bilateral, visible, palpable breast masses,

但胸部兩邊，有許多明顯、觸即可知的腫塊

breast tumors,

胸部腫瘤

that had metastasized widely

已經轉移擴散

all over the body.

遍及全身

And the real tragedy was, if you look through her records,

真正可悲的是，若你翻閱其病歷表記錄

she had been seen

她已在其他四、五家

in four or five other health care institutions

醫療照護機構中接受過檢查

in the preceding two years.

接著幾年下來

Four or five opportunities

有四到五次的機會

to see the breast masses, touch the breast mass,

可以發現那些胸部腫塊

intervene at a much earlier stage

甚至也摸的出更早期就出現的胸部腫塊

than when we saw her.

不用等到我們見到她

Ladies and gentlemen,

各位女士、各位先生

that is not an unusual story.

這不是一個非比尋常的故事

Unfortunately, it happens all the time.

很遺憾的是，這事老是發生

I joke, but I only half joke,

我開玩笑；但只是半開玩笑

that if you come to one of our hospitals missing a limb,

如果你斷了一肢手臂或腿來到全美任何一家醫院

no one will believe you till they get a CAT scan, MRI

沒有人會相信你，除非他們做了電腦斷層掃瞄、磁共振造影

or orthopedic consult.

或骨外科會診

I am not a Luddite.

我不是一個反科技的人(Luddite)

I teach at Stanford.

我在史丹佛授課

I'm a physician practicing with cutting-edge technology.

我是一個以尖端科技執業的醫生

But I'd like to make the case to you

但我在接下來的

in the next 17 minutes

17分鐘想向你們證實

that when we shortcut the physical exam,

當我們省略檢查身體的步驟

when we lean towards ordering tests

當我們依賴安排測試

instead of talking to and examining the patient,

而非跟病人談話、檢查病人

we not only overlook simple diagnoses

我們不只輕忽簡單的診斷 --

that can be diagnosed at a treatable, early stage,

在可療癒的初期階段就能被診斷 --

but we're losing much more than that.

而且我們錯失的還不只是那樣

We're losing a ritual.

我們遺失一項儀式

We're losing a ritual that I believe is transformative, transcendent,

我們正失掉了一種我相信是能改變、能超越的儀式

and is at the heart

這同時也是

of the patient-physician relationship.

醫病關係中的核心

This may actually be heresy to say this at TED,

在TED大會說這個，也許確實怪異，

but I'd like to introduce you

但我想向你們推介

to the most important innovation,

這個極重要的變革

I think, in medicine

我認為，在醫學方面

to come in the next 10 years,

在下一個十年的來臨

and that is the power of the human hand --

是人類手的威力 --

to touch, to comfort, to diagnose

去碰觸、紓解、診斷

and to bring about treatment.

並且帶入治療

I'd like to introduce you first to this person

我首先想介紹你們這個人

whose image you may or may not recognize.

他的照片你們也許認得，也許不認得

This is Sir Arthur Conan Doyle.

這是亞瑟‧柯南‧道爾先生( Sir Arthur Conan Doyle)

Since we're in Edinburgh, I'm a big fan of Conan Doyle.

從我們在愛丁堡，我就是個超級柯南‧道爾迷

You might not know that Conan Doyle went to medical school

你們可能不曉得柯南‧道爾進入醫學院

here in Edinburgh,

在愛丁堡這兒

and his character, Sherlock Holmes,

而他筆下的人物夏洛克‧福爾摩斯(Sherlock Holmes)

was inspired by Sir Joseph Bell.

是以喬瑟夫‧貝爾 (Sir Joseph Bell)為創作靈感

Joseph Bell was an extraordinary teacher by all accounts.

根據各方說法，喬瑟夫‧貝爾是一位超凡出色的老師

And Conan Doyle, writing about Bell,

柯南‧道爾描寫貝爾

described the following exchange

描述下述

between Bell and his students.

貝爾和其學生間的交流

So picture Bell sitting in the outpatient department,

想像貝爾坐在門診部

students all around him,

學生們包圍住他

patients signing up in the emergency room

病人在急診室填寫資料

and being registered and being brought in.

然後被登記並領入

And a woman comes in with a child,

一位女士帶著一個孩子進來

and Conan Doyle describes the following exchange.

柯南‧道爾描寫下述的交談

The woman says, "Good Morning."

那女人說：「早安」

Bell says, "What sort of crossing did you have

貝爾問：「從奔提斯蘭(Burntisland)

on the ferry from Burntisland?"

搭渡輪過海行程怎樣啊?」

She says, "It was good."

她回答：「一切平順。」

And he says, "What did you do with the other child?"

他接著問：「你的另一個小孩呢?」

She says, "I left him with my sister at Leith."

她回答：「我留他在里斯(Leith)我姊姊家。」

And he says,

他接著問：

"And did you take the shortcut down Inverleith Row

「你走捷徑往印佛里斯(Inverleith Row)

to get here to the infirmary?"

來到醫院這兒的嗎?」

She says, "I did."

她回應：「是的。」

And he says, "Would you still be working at the linoleum factory?"

他接著問：「你仍是在油蠟地板工廠工作嗎?」

And she says, "I am."

她回應：「是的。」

And Bell then goes on to explain to the students.

貝爾接著轉向學生解說

He says, "You see, when she said, 'Good morning,'

他說：「你們瞧，在她說『早安』時

I picked up her Fife accent.

我學起她的Fife(位於蘇格蘭東方)口音

And the nearest ferry crossing from Fife is from Burntisland.

從Fife來最近的渡輪旅程是由奔提斯蘭(Burntisland)

And so she must have taken the ferry over.

因而，她必定乘渡輪而來。

You notice that the coat she's carrying

你們有注意到她拿著的那件外套

is too small for the child who is with her,

對和她一道來的那孩子而言，太小了

and therefore, she started out the journey with two children,

因此，她開始是和兩個孩童同行

but dropped one off along the way.

但在途中放下一個小孩

You notice the clay on the soles of her feet.

你們注意看她雙腳底下的土

Such red clay is not found within a hundred miles of Edinburgh,

這樣的紅土在愛丁堡方圓一百英里內看不到

except in the botanical gardens.

除了在植物園

And therefore, she took a short cut down Inverleith Row

由此可知，她走捷徑往印佛里斯(Inverleith Row)

to arrive here.

來到這兒的

And finally, she has a dermatitis

最後一點，她有皮膚炎

on the fingers of her right hand,

在她右手的手指

a dermatitis that is unique

該皮膚炎是好發於

to the linoleum factory workers in Burntisland."

奔提斯蘭(Burntisland)油蠟地板工廠的工人。」

And when Bell actually strips the patient,

而其實，當貝爾讓病人脫去衣物

begins to examine the patient,

開始檢查病人，

you can only imagine how much more he would discern.

你能想像到，他會覺察出的又更多

And as a teacher of medicine, as a student myself,

身為一位醫學老師，也身為一位學生

I was so inspired by that story.

這故事激發我的靈感

But you might not realize

但你可能不了解

that our ability to look into the body

我們以這樣簡單的方式

in this simple way, using our senses,

使用我們的感官，來檢查身體

is quite recent.

是相當近代的方法

The picture I'm showing you is of Leopold Auenbrugger

我讓你們看的這張圖像是李奧波得‧奧恩布魯格(Leopold Auenbrugger)

who, in the late 1700s,

在18世紀末

discovered percussion.

他發現「叩診法」

And the story is that Leopold Auenbrugger

故事是李奧波得‧奧恩布魯格(Leopold Auenbrugger)

was the son of an innkeeper.

是一位旅館老闆的兒子

And his father used to go down into the basement

他的父親過去常會到地下室

to tap on the sides of casks of wine

輕敲酒桶側面

to determine how much wine was left

以判定還剩多少酒

and whether to reorder.

決定是否要再訂酒

And so when Auenbrugger became a physician,

因此當李奧波得(Auenbrugger)成為一名醫生

he began to do the same thing.

他開始效法其父之舉

He began to tap on the chests of his patients,

他開始輕敲病患的胸膛

on their abdomens.

他們的腹部

And basically everything we know about percussion,

基本上，我們對叩診的了解

which you can think of as an ultrasound of its day --

你可以想成是那個時代的超音波 --

organ enlargement, fluid around the heart, fluid in the lungs,

器官腫大、心臟周圍的流體、肺中流體

abdominal changes --

腹部變化 --

all of this he described in this wonderful manuscript

所有叩診法門他都敍述在這本精采的手冊

"Inventum Novum," "New Invention,"

《創新發明(Inventum Novum拉丁文)》

which would have disappeared into obscurity,

這本書本會如石沈大海，無人聞問

except for the fact that this physician, Corvisart,

要不是這名醫生柯比沙特(Corvisart)

a famous French physician --

他是位有名的法國醫生 --

famous only because he was physician to this gentleman --

出名只因為他是這位男士的醫生 --

Corvisart repopularized and reintroduced the work.

柯比沙特(Corvisart)重新宣揚並採用這法門

And it was followed a year or two later

約一、兩年後，接著

by Laennec discovering the stethoscope.

雷涅克(Laennec)發明了聽診器

Laennec, it is said, was walking in the streets of Paris

據說，雷涅克(Laennec)當時走在巴黎的街道

and saw two children playing with a stick.

看到二個小孩玩著一根棍子

One was scratching at the end of the stick,

一個小孩在一端刮著

another child listened at the other end.

另一個小孩在另一頭聽著

And Laennec thought this would be a wonderful way

雷涅克(Laennec)認為這會是一種妙法

to listen to the chest or listen to the abdomen

來聽診胸部或腹部

using what he called "the cylinder."

用他稱之為「圓筒」的東西

Later he renamed it the stethoscope.

稍後他為其重新命名為聽診器(stethoscope)

And that is how stethoscope and auscultation was born.

這就是聽診器和聽診問世的原由

So within a few years,

所以在幾年內

in the late 1800s, early 1900s,

在十九世紀末、二十世紀初

all of a sudden,

倏然

the barber surgeon had given way

「理髮師兼外科手術師」已被

to the physician who was trying to make a diagnosis.

試圖作診斷的醫生取代

If you'll recall, prior to that time,

如果回想在那以前

no matter what ailed you, you went to see the barber surgeon

無論什麼讓你不適、痛苦，你向「理髮師兼外科手術師」求助

who wound up cupping you,

他們到頭來對你拔罐

bleeding you, purging you.

放血、通腸

And, oh yes, if you wanted,

當然，若你想的話

he would give you a haircut -- short on the sides, long in the back --

他會幫你理髮 -- 兩旁短，後面長 --

and pull your tooth while he was at it.

順便拔掉你的牙

He made no attempt at diagnosis.

他無心診斷

In fact, some of you might well know

事實上，你們某些人也很可能知道

that the barber pole, the red and white stripes,

理髮師的紅白相間圓筒招牌

represents the blood bandages of the barber surgeon,

代表「理髮師兼外科手術師」的血液繃帶

and the receptacles on either end

而底座的托盆

represent the pots in which the blood was collected.

則相當於承接血液的鍋盆

But the arrival of auscultation and percussion

但聽診和叩診的問世

represented a sea change,

意味著瞬息巨大的轉變

a moment when physicians were beginning to look inside the body.

醫生開始檢察人體內部的時期開始

And this particular painting, I think,

而我認為這張獨特的畫作

represents the pinnacle, the peak, of that clinical era.

象徵著臨床時代的巔峰高點

This is a very famous painting:

這是一幅很有名的彩畫

"The Doctor" by Luke Fildes.

《醫生》由路克‧菲爾德茲(Luke Fildes)

Luke Fildes was commissioned to paint this by Tate,

路克‧菲爾德茲受塔特(Tate)所託

who then established the Tate Gallery.

此人當時創立英國塔特美術館(Tate Gallery)

And Tate asked Fildes to paint a painting

塔特要求菲爾德茲繪出

of social importance.

「社會的重要性」的畫

And it's interesting that Fildes picked this topic.

而有趣的是，菲爾德茲選擇了這個主題

Fildes' oldest son, Philip,

菲爾德茲之長子菲力普(Philip)

died at the age of nine on Christmas Eve

在九歲時的聖誕節前夕

after a brief illness.

在一場短暫的病後歸天

And Fildes was so taken by the physician

而菲爾德茲深深感念醫師的舉措 --

who held vigil at the bedside for two, three nights,

這位醫生在一旁守護兩、三夜

that he decided that he would try and depict

他便決定嘗試描繪

the physician in our time --

美國那時代的醫生 --

almost a tribute to this physician.

可說是對該醫生致敬意

And hence the painting "The Doctor," a very famous painting.

因而此畫作《醫生》頗負盛名

It's been on calendars, postage stamps in many different countries.

在很多國家的日曆或月曆和郵票上都可以看到

I've often wondered, what would Fildes have done

我常在想，菲爾德茲會怎麼做

had he been asked to paint this painting

要是他被要求畫這幅畫

in the modern era,

在現代?

in the year 2011?

在2011年?

Would he have substituted a computer screen

他會改繪畫「電腦銀幕」

for where he had the patient?

在「病人」的位置嗎?

I've gotten into some trouble in Silicon Valley

在矽谷(Silicon Valley)我已惹上一些麻煩

for saying that the patient in the bed

因我說在病榻的病人

has almost become an icon

已幾乎成了雕像

for the real patient who's in the computer.

在電腦內的是真正的病人

I've actually coined a term for that entity in the computer.

事實上，我給電腦內的實體造了個詞

I call it the iPatient.

我稱其為「iPatient」

The iPatient is getting wonderful care all across America.

全美「iPatient」得到無微不至的看照

The real patient often wonders,

真正的病人常奇怪

where is everyone?

人都上哪去了?

When are they going to come by and explain things to me?

他們何時才會來向我說明我的情況?

Who's in charge?

誰負責的?

There's a real disjunction between the patient's perception

確實有分歧存在於病人的觀感

and our own perceptions as physicians of the best medical care.

和身為最佳醫療保健醫師的我們自己的觀感

I want to show you a picture

我要讓你們看張照片

of what rounds looked like

關於巡診是怎麼一回事

when I was in training.

當我還在受訓時

The focus was around the patient.

焦點是投注在病人身上

We went from bed to bed. The attending physician was in charge.

我們一張病床巡過一張病床，由主治醫生負責

Too often these days,

這些日子大多數

rounds look very much like this,

巡診八九不離十看起來就像這樣

where the discussion is taking place

病情討論的地點

in a room far away from the patient.

就在遠離病人的小會議室

The discussion is all about images on the computer, data.

討論的內容不外乎是電腦影像、數據資料

And the one critical piece missing

而遺漏了關鍵的那部分

is that of the patient.

就是病人

Now I've been influenced in this thinking

現在我有這種想法，而且我已經受兩件

by two anecdotes that I want to share with you.

發生在我周遭的事所影響，我要跟你們分享。

One had to do with a friend of mine who had a breast cancer,

一件是與我的那位曾罹患胸癌的友人有關

had a small breast cancer detected --

其被偵察到有小型胸癌

had her lumpectomy in the town in which I lived.

在我過去居住的城市中，進行她的乳房腫瘤切除

This is when I was in Texas.

這是當我還在德州時發生的事

And she then spent a lot of time researching

而且她那時花了好多時間研究

to find the best cancer center in the world

為了找出世界最佳癌症中心

to get her subsequent care.

獲得後續照護

And she found the place and decided to go there, went there.

她找到那個地方、決定去那並到了那裡。

Which is why I was surprised a few months later

那是為何我會訝異，在幾個月後

to see her back in our own town,

看到她重返我們自己的城市

getting her subsequent care with her private oncologist.

接受私人腫瘤專家的後續照護

And I pressed her, and I asked her,

我打破砂鍋似的追問她：

"Why did you come back and get your care here?"

「為何你回來這兒接受照護?」

And she was reluctant to tell me.

而她不情不願的告訴我。

She said, "The cancer center was wonderful.

她說：「那間癌症中心是好極了

It had a beautiful facility,

有完備的設施

giant atrium, valet parking,

有寬敞的中庭、代客泊車

a piano that played itself,

自動彈奏的鋼琴

a concierge that took you around from here to there.

領著你四處逛的接待

But," she said,

但......」，她說：

"but they did not touch my breasts."

「但他們不觸碰我的胸部。」

Now you and I could argue

此時你和我會爭論

that they probably did not need to touch her breasts.

他們大可能不用觸碰她的胸部

They had her scanned inside out.

他們將她由裡到外掃瞄

They understood her breast cancer at the molecular level;

他們了解她胸癌的分子狀態

they had no need to touch her breasts.