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  • A few months ago,

    幾個月前,

  • 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.

    他們不需觸碰她的胸部

  • But to her, it mattered deeply.

    但對她而言,卻是很重要

  • It was enough for her to make the decision

    足以讓她作出決定

  • to get her subsequent care with her private oncologist

    聘用她私人的腫瘤專家作後續照護

  • who, every time she went,

    每次那腫瘤專家看診