演講MP3+雙語文稿:去醫(yī)院看病時，這4個問題，一定要問醫(yī)生
聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學習使用。本文主要內容為演講MP3+雙語文稿:去醫(yī)院看病時，這4個問題，一定要問醫(yī)生，希望你會喜歡！
【演講人及介紹】Christer Mjaset
醫(yī)學博士，神經外科醫(yī)生，作家，專欄作家和講師，目前是哈佛大學公共衛(wèi)生學院Harkness研究員，研究基于價值的醫(yī)療保健模式
【演講主題】你應該經常問醫(yī)生的四個問題
【演講文稿-中英文】
翻譯者 Nan Yang
校對人員 psjmz mz
00:13
I am a neurosurgeon, and I'm here to tell you today that people like me need your help. And in a few moments, I will tell you how.
我是一個神經外科醫(yī)生， 我今天要告訴你們， 像我一樣的人需要你們的幫助。 過一會兒，我會告訴你們怎么做。
00:22
But first, let me start off by telling you about a patient of mine. This was a woman in her 50s, she was in generally good shape, but she had been in and out of hospital a few times due to curative breast cancer treatment. Now she had gotten a prolapse from a cervical disc, giving her radiating pain of a tense kind, out into the right arm. Looking at her MRI before the consultation, I decided to suggest an operation. Now, neck operations like these are standardized, and they're quick. But they carry a certain risk. You make an incision right here, and you dissect carefully past the trachea, the esophagus, and you try not to cut into the internal carotid artery.
但是首先，讓我跟你們 聊一下我的一個病人。 她是一個五十多歲的女士， 身材基本上保持的不錯， 但是她已經為了根治乳腺癌 多次進出醫(yī)院。 現(xiàn)在她的頸椎間盤有脫落， 帶給她放射性的疼痛， 一直影響到她的右胳膊。 在診療之前我看了 她的核磁共振成像， 我決定建議她進行手術。 現(xiàn)在這種脖頸手術已經 很標準化，而且手術時間短， 但是仍帶有一定的風險。 要在這里做一個切口， 然后剖開，小心的穿過氣管， 食道， 還要盡量不切到頸內動脈。
01:09
(Laughter)
(笑聲)
01:10
Then you bring in the microscope, and you carefully remove the disc and the prolapse in the nerve root canal, without damaging the cord and the nerve root lying only millimeters underneath. The worst case scenario is the damage to the cord, which can result in paralysis from the neck down.
然后要利用顯微鏡， 仔細的在神經根管中 移除間盤和脫垂， 同時不能損害 在下方僅幾毫米處的 索狀組織和神經根。 最壞的情況就是損害了索狀組織， 會導致頸部以下的癱瘓。
01:29
Explaining this to the patient, she fell silent. And after a few moments, she uttered a few very decisive words for me and for her. "Doctor, is this really necessary?"
我把這些解釋給病人時，她沉默了。 然后過了一會， 她對我和她自己說了 一句非常果斷的話。 ”醫(yī)生，這個手術真的必要嗎？“
01:42
(Laughter)
（笑聲）
01:44
And you know what I realized, right there and then? It was not. In fact, when I get patients like this woman, I tend to advise not to operate. So what made me do it this time? Well, you see, this prolapse was so delicate, I could practically see myself pulling it out of the nerve root canal before she entered the consultation room. I have to admit it, I wanted to operate on her. I'd love to operate on her. Operating, after all, is the most fun part of my job.
你們知道那一刻我意識到什么嗎？ 這個手術并不必要。 實際上，當我面對 像這位女士的病人時， 我傾向于建議她們不做手術。 為什么我這次卻建議她做呢？ 是這樣的， 這個脫垂非常精巧， 在她進入診療室之前， 我?guī)缀蹩梢钥匆娮约?正在把脫垂從神經根管中取出。 我不得不承認， 我想給她做手術。 我非常希望給她做手術。 畢竟，手術是我工作中 最有趣的部分。
02:19
(Laughter)
（笑聲）
02:23
I think you can relate to this feeling. My architect neighbor says he loves to just sit and draw and design houses. He'd rather do that all day than talk to the client paying for the house that might even give him restrictions on what to do. But like every architect, every surgeon needs to look their patient in the eye and together with the patient, they need to decide on what is best for the person having the operation. And that might sound easy. But let's look at some statistics.
我覺得你們可以體會這種感受。 我的建筑師鄰居 說他就喜歡坐在那 設計房子。 寧可坐在那一天， 他也不想跟客戶討論 付款買房的事項， 這甚至有可能限制他的設計。 就像每個建筑師， 每個外科醫(yī)生需要 看著病人的眼睛， 然后跟病人一起 決定對病人來說最好的手術。 這個聽起來可能簡單。 但是讓我們來看一些統(tǒng)計數(shù)據(jù)。
02:56
The tonsils are the two lumps in the back of your throat. They can be removed surgically, and that's called a tonsillectomy. This chart shows the operation rate of tonsillectomies in Norway in different regions. What might strike you is that there is twice the chance that your kid -- because this is for children -- will get a tonsillectomy in Finnmark than in Trondheim. The indications in both regions are the same. There should be no difference, but there is.
扁桃體是 在你喉嚨后面的兩個腫塊。 它們可以通過手術切除， 即扁桃體切除手術。 這個兒童數(shù)據(jù)表展示了 在挪威不同地區(qū) 進行扁桃體手術的比例。 可能會嚇到你的是， 在芬馬克郡的孩子 需要做扁桃體切除手術的幾率是 特隆赫姆的孩子的兩倍。 在這兩個地方 患病的跡象是相同的。 所以不應該有區(qū)別，但是現(xiàn)在有。
03:27
Here's another chart. The meniscus helps stabilize the knee and can be torn or fragmented acutely, topically during sports like soccer. What you see here is the operation rate for this condition. And you see that the operation rate in M?re og Romsdal is five times the operation rate in Stavanger. Five times. How can this be? Did the soccer players in M?re og Romsdal play more dirty than elsewhere in the country?
這是另一個表。 半月板有助于穩(wěn)定膝蓋， 但是容易被撕裂或發(fā)生急性碎裂， 特別是在像足球這種運動過程中。 你們會看見的是 這種情況下的手術比例。 在默勒市的比例 是在斯塔萬格市的五倍。 五倍。 為什么會這樣？ 是在默勒的足球運動員 比國家其它地方玩得更野蠻嗎？
03:55
(Laughter)
（笑聲）
03:57
Probably not. I added some information now. What you see now is the procedures performed in public hospitals, in light blue, the ones in private clinics are light green. There is a lot of activity in the private clinics in M?re og Romsdal, isn't there? What does this indicate? A possible economic motivation to treat the patients. And there's more.
可能不是。 我現(xiàn)在加入一些信息。 現(xiàn)在你們看見的 淺藍色的是在公立醫(yī)院 執(zhí)行的治療程序， 在私人診所的是淺綠色的。 在默勒的私人診所治療記錄 有很多，對嗎？ 這表明了什么？ 原因可能是治療病人的經濟動機。 不僅如此。
04:24
Recent research has shown that the difference of treatment effect between regular physical therapy and operations for the knee -- there is no difference. Meaning that most of the procedures performed on the chart I've just shown could have been avoided, even in Stavanger. So what am I trying to tell you here? Even though most indications for treatments in the world are standardized, there is a lot of unnecessary variation of treatment decisions, especially in the Western world. Some people are not getting the treatment that they need, but an even greater portion of you are being overtreated.
最近的研究展示了常規(guī)的物理治療 和膝蓋手術的治療效果 并沒有不同。 意思是在這個我剛展示的圖表中， 大部分被執(zhí)行的手術 是本可以被避免的， 甚至是在斯塔萬格。 所以我在試圖告訴你們什么呢？ 盡管世界上大部分的治療指示 已經標準化了， 但是有很多是沒必要的 治療手段的變形， 特別是在西方國家。 一些人沒有得到他們需要的治療， 而你們當中很多人 在被過度治療。
05:09
"Doctor, is this really necessary?" I've only heard that question once in my career. My colleagues say they never heard these words from a patient. And to turn it the other way around, how often do you think you'll get a "no" from a doctor if you ask such a question? Researchers have investigated this, and they come up with about the same "no" rate wherever they go. And that is 30 percent. Meaning, three out of 10 times, your doctor prescribes or suggests something that is completely unnecessary. And you know what they claim the reason for this is? Patient pressure. In other words, you. You want something to be done.
“醫(yī)生，這個手術真的必要嗎？” 我在我的職業(yè)生涯中 只聽見過一次這個問題。 我的同事們說他們從未 聽過病人這樣問。 換一種方式說， 如果你問這種問題， 你們覺得有幾次 會聽見一個醫(yī)生說”沒必要“？ 調查人員對此進行了調查， 他們得到了不論在哪里 都大概相同的比例。 是30%。 意思是，10 次里有 3 次 你的醫(yī)生會給你開出或者建議 完全沒必要的東西。 你們知道他們聲稱的原因是什么？ 患者給的壓力。 換句話說，是你們。 你們希望我們一定要做點什么。
05:59
A friend of mine came to me for medical advice. This is a sporty guy, he does a lot of cross-country skiing in the winter time, he runs in the summer time. And this time, he'd gotten a bad back ache whenever he went jogging. So much that he had to stop doing it. I did an examination, I questioned him thoroughly, and what I found out is that he probably had a degenerated disc in the lower part of his spine. Whenever it got strained, it hurt. He'd already taken up swimming instead of jogging, there was really nothing to do, so I told him, "You need to be more selective when it comes to training. Some activities are good for you, some are not." His reply was, "I want an MRI of my back." "Why do you want an MRI?" "I can get it for free through my insurance at work." "Come on," I said -- he was also, after all, my friend. "That's not the real reason." "Well, I think it's going to be good to see how bad it looks back there." "When did you start interpreting MRI scans?" I said.
我的一個朋友曾經來找我 咨詢醫(yī)療方面的建議。 他是一個愛運動的人。 他在冬天經常穿梭在 不同國家進行越野滑雪， 夏天跑步。 這次，他在跑步時 感覺到了嚴重的背疼。 疼得他不能再跑步。 我做了一個檢查， 全面的對他進行問詢， 我發(fā)現(xiàn)很可能在他的脊椎下半部分 有椎間盤退變。 每次收緊的時候，都會疼痛。 他已經接受用游泳代替慢跑， 實際上沒有什么可以做的， 所以我告訴他： ”你在訓練的時候， 必須有選擇性的進行。 一些活動對你有好處， 另一些沒有?！?他的回答是， “我想做背部的核磁共振成像。” “為什么你想做這個?” “我可以用公司保險報銷這個花費。” “拜托，”我說 —— 畢竟，他是我的朋友。 ”那不是真正的原因。” “哦，我覺得能看一下 我的后背到底多糟糕比較好?！?“你什么時候開始能看懂 核磁共振掃描了？”我說。
07:06
(Laughter)
（笑聲）
07:08
"Trust me on this. You're not going to need the scan." "Well," he said, and after a while, he continued, "It could be cancer."
“這件事你要相信我。 你不需要這個掃描?！?”唔，”他說， 過了一會兒，他繼續(xù)說， “可能是癌癥。”
07:18
(Laughter)
（笑聲）
07:20
He got the scan, obviously. And through his insurance at work, he got to see one of my colleagues at work, telling him about the degenerated disc, that there was nothing to do, and that he should keep on swimming and quit the jogging. After a while, I met him again and he said, "At least now I know what this is."
很明顯，他還是做了掃描。 通過他們公司的保險計劃， 他找了我的一個同事， 告訴他椎間盤退化的事， 還是沒什么其它可以做的， 他應該繼續(xù)游泳，停止慢跑。 過了一段時間， 我又遇見了他， 他說：“至少我現(xiàn)在知道 是怎么回事了?！?/p>
07:41
But let me ask you a question. What if all of you in this room with the same symptoms had an MRI? And what if all the people in Norway had an MRI due to occasional back pain? The waiting list for an MRI would quadruple, maybe even more. And you would all take the spot on that list from someone who really had cancer. So a good doctor sometimes says no, but the sensible patient also turns down, sometimes, an opportunity to get diagnosed or treated.
但是讓我問你們一個問題。 如果這個房間里有同樣癥狀的人 都來做核磁共振成像呢？ 如果挪威所有人都因為偶爾的背疼 去做核磁共振成像呢？ 核磁共振成像的排隊人數(shù) 會增至四倍，甚至更多。 而你們會占用了名單上那些 真的有癌癥的人的名額。 所以一個好的醫(yī)生有時候會說不， 但敏感的病人有時候也會拒絕掉 一個被診斷和治療的機會。
08:17
"Doctor, is this really necessary?" I know this can be a difficult question to ask. In fact, if you go back 50 years, this was even considered rude.
醫(yī)生，這個真的必要嗎？” 我知道這是一個 很難啟齒的問題。 實際上，如果倒退 50 年， 這甚至會被認為粗魯。
08:29
(Laughter)
（笑聲）
08:30
If the doctor had decided what to do with you, that's what you did. A colleague of mine, now a general practitioner, was sent away to a tuberculosis sanatorium as a little girl, for six months. It was a terrible trauma for her. She later found out, as a grown-up, that her tests on tuberculosis had been negative all along. The doctor had sent her away on nothing but wrong suspicion. No one had dared or even considered confronting him about it. Not even her parents.
如果醫(yī)生已經決定如何治療你， 你就要遵醫(yī)囑。 我的一個同事， 現(xiàn)在是一個全科醫(yī)生， 在還是個小女孩的時候 曾經被送到肺結核療養(yǎng)院 六個月。 對她來說是可怕的創(chuàng)傷。 在她成年后發(fā)現(xiàn)， 她的肺結核測試結果 一直都是陰性的。 醫(yī)生只是基于錯誤的懷疑 就送她去了療養(yǎng)院。 沒有人敢或者甚至想過 去反抗他的做法。 甚至她的父母都沒有。
09:04
Today, the Norwegian health minister talks about the patient health care service. The patient is supposed to get advice from the doctor about what to do. This is great progress. But it also puts more responsibility on you. You need to get in the front seat with your doctor and start sharing decisions on where to go.
如今，挪威衛(wèi)生部長 談及患者的醫(yī)療保健服務。 患者應該從醫(yī)生那 得到治療建議。 這是巨大的進步。 但是這同樣給了你們 更多的責任。 你們需要坐在醫(yī)生面前 一起討論接下來的決定。
09:28
So, the next time you're in a doctor's office, I want you to ask, "Doctor, is this really necessary?" And in my female patient's case, the answer would be no, but an operation could also be justified.
所以，下一次 當你在醫(yī)生辦公室里， 我希望你們可以問， “醫(yī)生，這個真的必要嗎？” 在我那個女性患者的案例中， 答案是不， 但是有的手術也有可能是合理的。
09:44
"So doctors, what are the risks attached to this operation?" Well, five to ten percent of patients will have worsening of pain symptoms. One to two percent of patients will have an infection in the wound or even a rehemorrhage that might end up in a re-operation. 0.5 percent of patients also experience permanent hoarseness and a few, but still a few, will experience reduced function in the arms or even legs.
所以醫(yī)生， 這個手術有哪些風險？” 5 - 10% 的患者疼痛癥狀會加重。 1-2% 的患者 會傷口感染或甚至是出血 這就需要第二次的手術。 0.5% 的患者也會經歷 永久性的聲音嘶啞， 還有一些 手臂或者腿功能會衰減。
10:15
"Doctor, are there other options?" Yes, rest and physical therapy over some time might get you perfectly well.
醫(yī)生，有其他的選擇嗎？” 是的，一段時間的休息和物理治療 可能會讓你完全恢復。
10:25
"And what happens if I don't do anything?" It's not recommended, but even then, there's a slight chance that you will get well. Four questions. Simple questions. Consider them your new toolbox to help us. Is this really necessary? What are the risks? Are there other options? And what happens if I don't do anything? Ask them when your doctor wants to send you to an MRI, when he prescribes antibiotics or suggests an operation.
如果我什么都不做會怎么樣？” 不建議這樣， 但是盡管那樣， 也有很小的可能你會康復。 四個問題。 簡單的問題。 把它們當作你的新工具箱 來幫助我們。 “這真的必要嗎？” “有什么風險？” “有沒有其它選擇？” “如果我什么都不做會怎么樣？” 當醫(yī)生讓你做核磁共振成像時 要問醫(yī)生， 還有當他給你開抗生素 或者建議手術時也要問。
10:59
What we know from research 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.
從研究中我們知道 5 個人中有 1 個， 也就是 20%， 在問了之后 會改變你們的想法。 做到這樣，你不僅會讓你的生活 變得更容易，甚至更好， 而且會讓整個醫(yī)療保健部門 受益于你的決定。
11:20
Thank you.
（謝謝大家）
11:21
(Applause)
（掌聲）
