TED演讲稿-----医生犯错能说吗
Before I actually begin the meat of my talk, let's begin with a bit of baball. Hey, why not?We're near t猫吃狗粮
he end, we're getting clo to the World Series. We all love baball, don't we?(Laughter) Ba ball is filled with some amazing statistics. And there's hundreds of them."Moneyball" is about to come out, and it's all about statistics and using statistics to build a great baball team.
I'm going to focus on one stat that I hope a lot of you have heard of. It's called batting average. So we talk about a 300, a batter who bats 300. That means that ballplayer batted safely, hit safely three times out of 10 at bats. That means hit the ball into the outfield, it dropped, it didn't get caught, and whoever tried to throw it to first ba didn't get there in timeand the runner was safe. Three times out of 10. Do you know what they call a 300 hitter in Major League Baball? Good, really good, maybe an all-star. Do you know what they call a 400 baball hitter? That's somebody who hit, by the way, four times safely out of every 10.Legendary -- a s in Ted Williams legendary -- the last Major League Baball player to hit over 400 during a regular ason.
劳动的好处Now let's take this back into my world of medicine where I'm a lot more comfortable, or perhaps a bit less comfortable after what I'm going to talk to you about. Suppo you have appendicitis and you're referred to a surgeon who's batting 400 on appendectomies.(Laughter) Somehow this isn't working out, is it? Now suppo you live in a certain part of a certain remote place and you have a loved one who has blockages in two coronary arteriesand your family doctor refers that loved one to a cardiolo
gist who's batting 200 on angioplastie s. But, but, you know what? She's doing a lot better this year. She's on the comeback trail. And she's hitting a 257. Somehow this isn't working.
But I'm going to a sk you a question. What do you think a batting average for a cardiac surgeon or a nur practitioner or an orthopedic surgeon, an OBGYN, a paramedic is suppod to be? 1,000, very good. Now truth of the matter is, nobody know s in all of medicine what a good surgeon or physician or paramedic is suppod to bat. What we do though is we nd each one of them, including mylf, out into the world with the admonition, be perfect. Never ever, ever make a mistake, but you worry about the details, about how that's going to happen.
And that was the message that I absorbed when I was in med school. I was an
所有权转让ob ssive compulsive student. In high school, a classmate once said that Brian Goldman would study for a blood test. (Laughter) And so I did. And I studied in my little garret at the nur s' residence at Toronto General Hospital, not far from here. And I memorized everything. I memorized in my anatomy class the origins and exertions of every muscle, every branch of every artery that came off the aorta, differential diagno s obscure and common. I even knew the differential diagnosis in how to classify renal tubular acidosis. And all the while, I was amassing more and more knowledge.
And I did well, I graduated with honors, cum laude. And I came out of medical
school with the impression that if I memorized everything and knew everything, or as much as possible, as clo to everything as possible, that it would immunize me against making mistake s. And it worked for a while, until I met Mrs. Drucker.
I was a resident at a teaching hospital here in Toronto when Mrs. Drucker was brought to the emergency department of the hospital where I was working. At the time I was assigned to the cardiology rvice on a cardiology rotation. And it was my job, when the emergency staff called for a cardiology consult, to e that patient in emerg. and to report back to my attending. And I saw Mrs. Drucker, and she was breathless. And when I listened to her, she was making a wheezy sound. And when I listened to her chest with a stethoscope, I could hear crackly sounds on both side s that told me that she was in conge stive heart failure. This is a condition in which the heart fails, and instead of being able to pump all the blood forward,some of the blood backs up into the lung, the lungs fill up with blood, and that's why you have shortne ss of breath.
And that wasn't a difficult diagnosis to make. I made it and I t to work treating her. I gave her aspirin. I gave her medications to relieve the strain on her heart. I gave her medications that we call 写事的作文600字
diuretics, water pills, to get her to pee out the access fluid. And over the cour of the next hour and a half or two, she started to feel better. And I felt really good. And that's when I made my first mistake; I nt her home.
Actually, I made two more mistake s. I nt her home without speaking to my attending. I didn't pick up the phone and do what I was suppod to do, which was call my attending and run the story by him so he would have a chance to e her for
himlf. And he knew her, he would have been able to furnish additional information about her. Maybe I did it for a good reason. Maybe I didn't want to be a
埃及港口
high-maintenance resident. Maybe I wanted to be so succe ssful and so able to take responsibility that I would do so and I would be able to take care of my attending's patients without even having to contact him.
The cond mistake that I made was wor. In nding her home, I disregarded a little voice deep down inside that was trying to tell me, "Goldman, not a good idea. Don't do this." In fact, so lacking in confidence was I that I actually asked the nur who was looking after Mrs. Drucker, "Do you think it's okay if she goes home?" And the nur thought about it and said very matter-of-factly, "Yeah, I thi
nk she'll do okay." I can remember that like it was yesterday.
So I signed the discharge papers, and an ambulance came, paramedics came to take her home. And I went back to my work on the wards. All the rest of that day, that afternoon, I had this kind of gnawing feeling inside my stomach. But I carried on with my work. And at the end of the day, I packed up to leave the hospital and walked to the parking lot to take my car and drive home when I did something that I don't usually do. I walked through the emergency department on my way home.
台式机电源And it was there that another nur, not the nur who was looking after Mrs. Drucker before, but another nur, said three words to me that are the three words that most emergency physicians I know dread. Others in medicine dread them as well, but there's something particular about emergency medicine becau we e patients so fleetingly. The three words are: Do you remember? "Do you remember that patient you nt home?" the other nur a sked matter-of-factly. "Well she's back," in just that tone of voice.
Well she was back all right. She was back and near death. About an hour after she had arrived home, after I'd nt her home, she collapd and her family called 911 and the
paramedics brought her back to the emergency department where she had a blood pressure of 50,
which is in vere shock. And she was barely breathing and she was blue. And the emerg. staff pulled out all the stops. They gave her medications to rai her blood pressure.They put her on a ventilator.
And I was shocked and shaken to the core. And I went through this roller
字谜难度大一些coaster, becau after they stabilized her, she went to the intensive care unit, and I hoped against hope that she would recover. And over the next two or three days, it was clear that she was never going to wake up. She had irreversible brain damage. And the family gathered. And over the cour of the next eight or nine days, they re signed themlve s to what was happening. And at about the nine day mark, they let her go
-- Mrs. Drucker, a wife, a mother and a grandmother.
They say you never forget the names of tho who die. And that was my first time to be acquainted with that. Over the next few weeks, I beat mylf up and I experienced for the first time the unhealthy shame that exists in our culture of medicine -- where I felt alone, isolated,not feeling the healthy kind of shame that you feel, becau you can't talk about it with your colleagues. You know that healthy kind, when you betray a cret that a best friend made you promi never to reveal and then you get
busted and then your be st friend confronts youand you have terrible discussions, but at the end of it all that sick feeling guides you and you say, I'll never make that mistake again. And you make amends and you never make that mistake again. That's the kind of shame that is a teacher.
The unhealthy shame I'm talking about is the one that makes you so sick inside. It's the one that says, not that what you did was bad, but that you are bad. And it was what I was feeling.And it wasn't becau of my attending; he was a doll. He talked to the family, and I'm quite sure that he smoothed things over and made sure that I didn't get
sued. And I kept asking mylf the questions. Why didn't I ask my attending? Why
did I nd her home? And then at my worst moments: Why did I make such a stupid mistake? Why did I go into medicine?
Slowly but surely, it lifted. I began to feel a bit better. And on a cloudy day, there was a crack in the clouds and the sun started to come out and I wondered, maybe I could feel better again. And I made mylf a bargain that if only I redouble my efforts to be
perfect and never make another mistake again, plea make the voices stop. And they did. And I went back to work. And then it happened again.
Two years later I was an attending in the emergency department at a community hospital just north of Toronto, and I saw a 25 year-old man with a sore throat. It was busy, I was in a bit of a hurry. He kept pointing here. I looked at his throat, it was a little bit pink. And I gave him a prescription for penicillin and nt him on his way. And even as he was walking out the door,he was still sort of pointing to his throat.
And two days later I came to do my next emergency shift, and that's when my chief asked to speak to me quietly in her office. And she said the three words: Do you remember? "Do you remember that patient you saw with the sore throat?" Well it turns out, he didn't have a strep throat. He had a potentially life-threatening condition called epiglottitis. You can Google it, but it's an infection, not of the throat, but of the upper airway, and it can actually cau the airway to clo. And fortunately he didn't die. He
was placed on intravenous antibiotics and he recovered after a few days. And I went through the same period of shame and recriminationsand felt cleand and went back to work, until it happened again and again and again.抗扭强度
Twice in one emergency shift, I misd appendicitis. Now that takes some
doing, especially when you work in a hospital that at the time saw but 14 people a night. Now in both cas, I didn't nd them home and I don't think there was any gap in their care. One I thought had a kidney stone. I ordered a kidney X-ray. When it turned out to be normal, my colleague who was doing a reas ssment of the patient noticed some tenderness in the right lower quadrant and called the surgeons. The other one had a lot of diarrhea. I ordered some fluids to rehydrate him and asked my colleague to reas ss him. And he did and when he noticed some tenderness in the right lower quadrant, called the surgeons. In both ca s, they had their operations and they did okay. But each time, they were gnawing at me, eating at me.
And I'd like to be able to say to you that my worst mistake s only happened in the first five years of practice as many of my colleagues say, which is total
B.S. (Laughter) Some of my doozies have been in the last five years. Alone, ashamed and unsupported. Here's the problem: If I can't come clean and talk about my
mistake s, if I can't find the still-small voicethat tells me what really happened, how can I share it with my colleagues? How can I teach them about what I did so that they don't do the same thing? If I were to walk into a room -- like right now, I have no idea what you think of me.
When was the last time you heard somebody talk about failure after failure after failure? Oh yeah, you go to a cocktail party and you might hear about some other doctor, but you're not going to hear somebody talking about their own mistakes. If I were to walk into a room filled with my colleages and ask for their support right
now and start to tell what I've just told you right now, I probably wouldn't get through two of tho storie s before they would start to get really uncomfortable, somebody would crack a joke, they'd change the subject and we would move on. And in fact, if I knew and my colleagues knew that one of my orthopedic colleagues took off the wrong leg in my hospital, believe me, I'd have trouble making eye contact with that person. That's the system that we have. It's a complete denial of mistake s. It's a system in which there are two kinds of physicians -- tho who make mistake s and tho who don't, tho who can't handle sleep deprivation and tho who can, tho who have lousy outcomes and tho who have great outcomes. And it's almost like an ideological reaction, like the antibodies begin to attack that person. And we have this idea that if we drive the people who make mistakes out of medicine, what will we be left with, but a safe system.
But there are two problems with that. In my 20 years or so of medical broadcasting and journalism, I've made a personal study of medical malpractice and medical errors to learn everything I can, from
one of the first articles I wrote for the Toronto Star to my show "White Coat, Black Art." And what I've learned is that errors are absolutely ubiquitous. We work in a system where errors happen every day, where one in 10 medications are either the wrong medication given in hospital or at the wrong dosage, where hospital-acquired infections are getting more and more
