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AtulGawande_2012-_拿什么拯救你，我们的医疗_
I got my start in writing and research as a surgical trainee , as someone who was a long ways away from becoming any kind of an expert at anything. 我的职业生涯 从写作、研究开始 当时还是个外科实习医生 像很多人一样,需要经历漫漫长路 才能成为某个领域的专家
surgical:adj.外科的;外科手术的; trainee:n.练习生,实习生;受训者;新兵;训练中的动物;
So the natural question you ask then at that point is, how do I get good at what I'm trying to do? 因而,在当时那个阶段你自然要问 我该如何做好自己所尝试做的这一领域？
And it became a question of, how do we all get good at what we're trying to do? 这个问题会演变成 我们怎样才能做好 我们正在努力做的这件事？
It's hard enough to learn to get the skills, try to learn all the material you have to absorb at any task you're taking on. 要掌握技术着实不易 需要对所学内容都吸收消化 无论做什么
absorb:v.吸收;使并入;吞并;同化;理解;吸收;耗费;承受;
I had to think about how I sew and how I cut, but then also how I pick the right person to come to an operating room. 就拿我来说,我必须学会如何缝合、如何开刀 还得知道如何选择对的人 进入手术室
sew:v.缝;缝制;缝补;做针线活;
And then in the midst of all this came this new context for thinking about what it meant to be good. 在以上思考过程中 还隐藏这一个问题 那就是:究竟什么才是造福于人？
midst:n.当中,中间;prep.在…中间(等于amidst); context:n.环境;上下文;来龙去脉;
In the last few years we realized we were in the deepest crisis of medicine's existence due to something you don't normally think about when you're a doctor concerned with how you do good for people, which is the cost of health care . 在过去几年中 我们意识到自己深陷 医学危机 原因在于有些事情 作为医生很难考虑到 关于如何造福于人 例如,医疗卫生的 成本问题
crisis:n.危机;危险期;决定性时刻;adj.危机的;用于处理危机的; normally:adv.正常地;通常地,一般地; concerned with:关心;涉及;忙于;与…有关; health care:n.卫生保健;
There's not a country in the world that now is not asking whether we can afford what doctors do. 世界上没有一个国家 不在问 自己是否能支付医疗行为的代价
afford:v.给予,提供;买得起;
The political fight that we've developed has become one around whether it's the government that's the problem or is it insurance companies that are the problem. 这也引发了政治上的争论 争论焦点围绕着 究竟是政府 还是保险公司才是罪魁祸首
insurance:n.保险;保险业;保险费;保费;adj.胜券在握的;
And the answer is yes and no; it's deeper than all of that. 答案既“是”,也“否” 还有更深层次的回答
The cause of our troubles is actually the complexity that science has given us. 造成麻烦的根源 其实是科学带来的复杂性
complexity:n.复杂性;难以理解的局势
And in order to understand this, 为了让大家更好地理解这个观点
I'm going to take you back a couple of generations. 让我带大家回顾几代人之前的情况
I want to take you back to a time when Lewis Thomas was writing in his book, "The Youngest Science." 我想带大家回到 刘易斯-托马斯写下《最年轻的科学》的那个时代
Lewis Thomas was a physician-writer, one of my favorite writers. 刘易斯-托马斯是一位医生兼作家 也是我最喜爱的作家之一
And he wrote this book to explain, among other things, what it was like to be a medical intern at the Boston City Hospital in the pre-penicillin year of 1937. 他在书中描述了 作一名实习医生的生活 在当时的波士顿市立医院 在盘尼西林尚未发现的年代 那是1937年
intern:n.实习医生; v.(战争期间或由于政治原因未经审讯)拘留; Boston:n.波士顿(美国城市);
It was a time when medicine was cheap and very ineffective . 当时药物很便宜 但疗效也不好
ineffective:adj.无效的,失效的;不起作用的;
If you were in a hospital, he said, it was going to do you good only because it offered you some warmth, some food, shelter, and maybe the caring attention of a nurse. 他写道:如果你去看病 医院对你的唯一帮助 就是提供了 给你提供了温暖、食物、住所, 或许还有来自护士的 关怀
Doctors and medicine made no difference at all. 医生和药物的作用 无关紧要
That didn't seem to prevent the doctors from being frantically busy in their days, as he explained. 即使这样 当时的医生们还是忙得不可开交 对此,他解释道
frantically:adv.疯狂似地;狂暴地;
What they were trying to do was figure out whether you might have one of the diagnoses for which they could do something. 他们努力想做的 就是弄清楚患者是否适用于某种诊断 是他们可以治疗的
diagnoses:n.诊断;调查分析;评价(diagnosis的复数形式);
And there were a few. 这样的病症不多
You might have a lobar pneumonia , for example, and they could give you an antiserum , an injection of rabid antibodies to the bacterium streptococcus , if the intern sub-typed it correctly. 比如说,你患有大叶性肺炎 医生可以对你进行抗血清治疗 为你注射狂犬病抗体 以此对抗链球菌 前提是实习医生分类正确
lobar:adj.叶的;肺叶的; pneumonia:n.肺炎; antiserum:n.[免疫]抗血清; injection:n.注射;大量资金的投入;(液体的)注入; rabid:adj.激烈的;狂暴的;偏激的;患狂犬病的; antibodies:n.[免疫]抗体(antibody的复数); bacterium:n.[微]细菌;杆菌属; streptococcus:n.链球菌;链球菌属;
If you had an acute congestive heart failure , they could bleed a pint of blood from you by opening up an arm vein , giving you a crude leaf preparation of digitalis and then giving you oxygen by tent. 如果你不幸突发急性充血性心脏衰竭 医生可以给你放一品脱的血 从割开的手臂静脉里 他们会为你准备一剂粗糙的洋地黄叶制剂 然后让你在氧幕里吸氧
acute:adj.严重的,[医]急性的;敏锐的;激烈的;尖声的; congestive:adj.充血的,充血性的; heart failure:n.心力衰竭; bleed:v.流血;失血;放掉;散开;n.[印]出血版 opening up:n.解禁;开放;供开发;启用; vein:n.血管;叶脉;[地质]岩脉;纹理;翅脉;性情;vt.使成脉络;象脉络般分布于; crude:adj.粗略的;简略的;大概的;粗糙的;n.原油;石油; digitalis:n.洋地黄;[植]毛地黄;
If you had early signs of paralysis and you were really good at asking personal questions, you might figure out that this paralysis someone has is from syphilis , in which case you could give this nice concoction of mercury and arsenic -- as long as you didn't overdose them and kill them. 如果你出现瘫痪的前期症状 如果你很善于问个人问题 你或许会发现 这个病人的瘫痪很有可能是梅毒引发的 因此你可以开出 汞和砷的混合药剂 只要不过量使用,不会置他们于死地
paralysis:n.麻痹;无力;停顿; personal:adj.个人的;身体的;亲自的;n.人事消息栏;人称代名词; syphilis:n.[性病]梅毒; concoction:n.混合;调合;调合物; mercury:n.[化]汞,水银;[天]水星;温度表;精神,元气; arsenic:n.砷;砒霜;三氧化二砷;adj.砷的;含砷的; as long as:conj.只要;长达;如果;既然; overdose:n.(一次用药)过量;v.一次用药过量;
Beyond these sorts of things, a medical doctor didn't have a lot that they could do. 除此之外 医师能做的事并不多
This was when the core structure of medicine was created -- what it meant to be good at what we did and how we wanted to build medicine to be. 也就在那个时代,医疗的核心 形成了 那就是如何做好我们所做的事 以及如何建立医疗体系
core:n.核心;要点;果心;[计]磁心;vt.挖...的核; structure:n.结构;构造;建筑物;vt.组织;构成;建造;
It was at a time when what was known you could know, you could hold it all in your head, and you could do it all. 当时 医生能知道当时所有的医疗技术 一个人就可以记住所有的医疗知识,也能实施所有的医疗行为
If you had a prescription pad , if you had a nurse, if you had a hospital that would give you a place to convalesce , maybe some basic tools, you really could do it all. 如果你有处方权 如果你有一名护士 如果你有一所医院 或许可以给你一个栖身之所,得到一些基本的工具 你凭一己之力可以完成所有的事
prescription:n.处方;药方;医生开的药;开处方; pad:n.软垫,护垫;便笺本;爪垫;肉掌;v.填充,覆盖,保护;蹑手蹑脚地走;做黑账; convalesce:vi.渐愈;渐渐康复;
You set the fracture , you drew the blood, you spun the blood, looked at it under the microscope , you plated the culture, you injected the antiserum. 你可以处理骨折,可以抽血 可以验血 可以用显微镜观察 你可以组织切片,可以注射抗血清
fracture:n.(指事实)骨折;(指状态)断裂;破裂;v.(使)断裂;破裂;(使)分裂; spun:adj.纺成的;v.纺(spin的过去分词);旋转; microscope:n.显微镜; injected:v.(给…)注射(药物等); (inject的过去分词和过去式)
This was a life as a craftsman . 这是工匠一般的生活
craftsman:n.工匠;手艺人;技工;
As a result , we built it around a culture and set of values that said what you were good at was being daring, at being courageous , at being independent and self-sufficient . 最终,我们成功 建立起了医疗文化和价值体系 医生最应擅长的事 就是行事大胆 充满勇气 并且要独立工作,自给自足
As a result:结果; courageous:adj.有胆量的,勇敢的; independent:adj.独立的; n.无党派议员(或候选人等); self-sufficient:adj.自给自足的;极为自负的;过于自信的;
Autonomy was our highest value. 自主是至高无上的价值观
Autonomy:n.自治,自治权;
Go a couple generations forward to where we are, though, and it looks like a completely different world. 往后推几代人 来看今天 世界好像完全变了个样
We have now found treatments for nearly all of the tens of thousands of conditions that a human being can have. 我们现在的治疗手段 几乎能处理上万种 人类可能患上的疑难杂症
treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数)
We can't cure it all. 尽管不能治愈所有疾病
We can't guarantee that everybody will live a long and healthy life. 我们不能保证每个人都长命百岁、无病无患
guarantee:n.保证;担保;保证人;保证书;抵押品;v.保证;担保;
But we can make it possible for most. 但是我们可以让多数人 过上健康长寿的生活
But what does it take? 但是,实现这一结果的代价是什么呢？
Well, we've now discovered 4,000 medical and surgical procedures . 如今我们已经发现了 4000种药物介入和外科手术
procedures:n.程序;规程(procedure的复数);
We've discovered 6,000 drugs that I'm now licensed to prescribe . 我们研制了6000种药物 这还仅仅是我现在处方权允许的范围
licensed:adj.得到许可的;获准拥有的;v.批准;许可(license的过去分词和过去式) prescribe:v.给…开(药);让…采用(疗法);开(处方);命令;
And we're trying to deploy this capability , town by town, to every person alive -- in our own country, let alone around the world. 我们正在尝试把这些治疗手段和药物,推广到更多地方 挨家挨户地 深入大众 覆盖我们国家的每一寸土地 乃至全球各个角落
deploy:v.部署;利用;[军事]展开;(使)张开; capability:n.才能,能力;性能,容量; let alone:更不必说;听任;不打扰;
And we've reached the point where we've realized, as doctors, we can't know it all. 我们已经到了这样的地步 作为医生 我们认识到自己不能知晓一切
We can't do it all by ourselves. 也不能一一做到 仅凭一己之力是不行的
There was a study where they looked at how many clinicians it took to take care of you if you came into a hospital, as it changed over time. 曾经有一项研究 调查了不同时代下,照顾一名患者 在医院里 需要多少医务人员
clinicians:临床医生(clinician的名词复数);
And in the year 1970, it took just over two full-time equivalents of clinicians. 在1970年 一般需要两名全职临床医务人员
full-time:adj.专职的;全日制的;全部时间的; equivalents:n.[化学]当量(equivalent的复数);同等设备;等同物;
That is to say , it took basically the nursing time and then just a little bit of time for a doctor who more or less checked in on you once a day. 也就是说 基本上是护士照料时间 加上医生的一点点时间 医生的时间只用来做查房 一般一天一次
That is to say:就是;即;换言之; basically:adv.主要地,基本上; more or less:或多或少;
By the end of the 20th century, it had become more than 15 clinicians for the same typical hospital patient -- specialists, physical therapists , the nurses. 到了20世纪末年 这一数字上升到15名临床医务人员 照顾同样一名典型的住院患者 包括专科医生、普科医生 以及护士
typical:adj.典型的;特有的;象征性的; patient:adj.有耐心的,能容忍的;n.病人;患者; physical:adj.[物]物理的;身体的;物质的;符合自然法则的;n.体格检查; therapists:n.治疗专家(therapist的复数);
We're all specialists now, even the primary care physicians . 如今我们都是专科医生 即便是基本卫生医疗单位的医生
physicians:n.[内科]内科医生(physician的复数);
Everyone just has a piece of the care. 每个人也只 提供自己专业范围内的一点点关怀
But holding onto that structure we built around the daring, independence , self-sufficiency of each of those people has become a disaster . 但是为了坚持我们建立的医疗价值体系 针对“勇敢”、“独立” “自给自足” 对所有这些人而言 就会变成一场灾难
independence:n.独立;独立性;自恃心;独立不羁的精神; self-sufficiency:n.自给自足;自负; disaster:n.灾难,灾祸;不幸;
We have trained, hired and rewarded people to be cowboys. 我们培训、雇佣、奖励医生 把他们变成牛仔那样
rewarded:v.奖励;奖赏;给以报酬;(reward的过去分词和过去式)
But it's pit crews that we need, pit crews for patients . 但是我们真正需要的是赛车维修队 针对病人的维修队
pit:n.深洞;深坑;矿井;麻子;v.使…表面有斑点;在…上打洞;去掉…的果核; patients:n.接受治疗者,病人;(patient的复数)
There's evidence all around us: 40 percent of our coronary artery disease patients in our communities receive incomplete or inappropriate care. 我们身边就有这样的实例证明 我们社区中40%的 冠状动脉患者 接受的治疗是不全面或不妥当的
evidence:n.证据,证明;迹象;明显;v.证明; coronary artery:n.冠状动脉; disease:n.病,[医]疾病;弊病;vt.传染;使…有病; communities:n.社区;社会;团体;共有(community的复数) incomplete:n.未完成;adj.不完整的;不完全的;不完善的; inappropriate:adj.不适当的;不相称的;
60 percent of our asthma , stroke patients receive incomplete or inappropriate care. 60% 哮喘、中风病人 接受的治疗是不全面或不妥当的
asthma:n.[内科][中医]哮喘,气喘; stroke:n.中风;笔画;钟声;抚摩;v.抚摩(动物的毛皮);轻抚;轻挪;轻触;
Two million people come into hospitals and pick up an infection they didn't have because someone failed to follow the basic practices of hygiene . 200万人在医院的时候 受到感染 这些感染是他们原本所没有的 因为有人忽略了 最基本的卫生问题
infection:n.感染;传染;(身体某部位的)感染;传染病; hygiene:n.卫生;卫生学;保健法;
Our experience as people who get sick, need help from other people, is that we have amazing clinicians that we can turn to -- hardworking, incredibly well-trained and very smart -- that we have access to incredible technologies that give us great hope, but little sense that it consistently all comes together for you from start to finish in a successful way. 我们的经验表明 当人们生病时 需要得到别人的帮助 应该是医生们的帮助 可以让我们找到那些令人放心的医生 勤奋努力、受过良好培训、并且聪明过人 还可以得益于尖端技术 这些都会给我们莫大的希望 但极少能见到 所有这些持续地共同作用于你 贯穿整个医疗过程 并且确保成功
incredibly:adv.难以置信地;非常地; well-trained:adj.训练有素的;良好训练; incredible:adj.难以置信的,惊人的; technologies:n.技术;科技(technology的复数); consistently:adv.一贯地;一致地;坚实地;
There's another sign that we need pit crews, and that's the unmanageable cost of our care. 另外一个征兆 我们需要维修队的原因 是现有医疗体系高昂到无法控制的 成本问题
unmanageable:adj.难处理的,处理不了的;难管理的;难操纵的;
Now we in medicine, I think, are baffled by this question of cost. 我想,在我们的医疗行业 百思不得其解的就是这个成本问题
baffled:adj.带有挡板的;v.阻碍;使迷惑(baffle的过去式);
We want to say, "This is just the way it is. 我们想说:“这就是现实……
This is just what medicine requires." 这就是医药行业必需的“
When you go from a world where you treated arthritis with aspirin , that mostly didn't do the job, to one where, if it gets bad enough, we can do a hip replacement , a knee replacement that gives you years, maybe decades, without disability, a dramatic change, well is it any surp rise tha t that $40,000 hip replacement replacing the 10-cent aspirin is more expensive? 当你从 用阿司匹林治疗关节炎的地方 那往往是没有效果的 到现在,对于严重病患 我们可以做手术更换人工髋关节或膝盖 那将帮助病人恢复原本可能丧失的功能 安好地度过几十年 这是一个多戏剧化的改变啊 因此,如果说 花4万美元进行个髋关节移植手术 而不是花10美分买阿司匹林来缓解 哪个更昂贵呢？
treated:v.以…态度对待;把…看作;(treat的过去分词和过去式) arthritis:n.[外科]关节炎; aspirin:n.阿司匹林(解热镇痛药); hip:n.臀部;蔷薇果;忧郁;adj.熟悉内情的;非常时尚的; replacement:n.替换;更换;替代品;接替者;
It's just the way it is. 这就是现实
But I think we're ignoring certain facts that tell us something about what we can do. 但我认为,我们忽略了一些事实 这些事实告诉我们,我们能做的其实有很多
ignoring:v.忽略,忽视;(ignore的现在分词);
As we've looked at the data about the results that have come as the complexity has increased, we found that the most expensive care is not necessarily the best care. 我们看到一些数据 关于医疗行为的结果 尽管环境日益复杂 我们发现 最昂贵的医疗 不见得是最好的
necessarily:adv.必要地;必定地,必然地;
And vice versa , the best care often turns out to be the least expensive -- has fewer complications, the people get more efficient at what they do. 反之亦然 最好的医疗 通常花不了几个钱 而且更简单 人们在那种情况下效率更高
vice versa:反之亦然; efficient:adj.有效率的;有能力的;生效的;
And what that means is there's hope. 这一发现的含义在于 我们还有希望
Because [if] to have the best results, you really needed the most expensive care in the country, or in the world, well then we really would be talking about rationing who we're going to cut off from Medicare . 因为,假如我们想要获得最好的结果 要用到最贵的医疗 在一国范围内、或者在世界范围内最贵 那么我们真的要去讨论的就是配额制度 决定哪些人不能享受医疗保险
rationing:n.[计划]定量配给; Medicare:n.(美,加)医疗保险(等于medicare);
That would be really our only choice. 那将会成为唯一的选择
But when we look at the positive deviants -- the ones who are getting the best results at the lowest costs -- we find the ones that look the most like systems are the most successful. 但如果我们看看积极的反面事例 确实存在以最低的成本 获得最佳效果的例子 我们发现最像“系统”的 是最成功的
positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片; deviants:n.不正常者;偏移值;变异物;adj.不正常的;离经叛道的;
That is to say, they found ways to get all of the different pieces, all of the different components , to come together into a whole. 也就是说,我们发现了 平衡所有不同部分 不同因素的方法 让各个部分变成一个整体
components:n.部件;组件;成份(component复数);
Having great components is not enough, and yet we've been obsessed in medicine with components. 仅有好的组成部分是远远不够的 然而我们正是对医药的组成部分太过痴迷了
obsessed:v.使痴迷;使迷恋;使着迷;(obsess的过去式和过去分词)
We want the best drugs, the best technologies, the best specialists, but we don't think too much about how it all comes together. 我们想要最好的药物、最好的技术 最好的专科医生 但我们却不曾想过 这些如何组合在一起
It's a terrible design strategy actually. 这其实是个很糟糕的战略设计
strategy:n.策略;行动计划;部署;战略;
There's a famous thought experiment that touches exactly on this that said, what if you built a car from the very best car parts? 有一个很著名的思考实验 验证了这个想法 实验是这样的,假如你用最好的汽车零件 能造出怎样一辆车？
what if:如果…怎么办?
Well it would lead you to put in Porsche brakes, a Ferrari engine, a Volvo body, a BMW chassis . 你可以用保时捷的刹车 法拉利的引擎 沃尔沃的车身,宝马的底盘
Porsche:n.保时捷(德国知名汽车厂商或其出产的轿车品牌名); Ferrari:n.法拉利; chassis:n.底盘,底架;
And you put it all together and what do you get? 你把这些都组装在一起会得到一辆怎样的车呢？
A very expensive pile of junk that does not go anywhere. 答案是:一堆很贵的垃圾,一辆完全不能开的车
pile:n.桩;堆;摞;桩柱;v.堆放;摞起;叠放;放置;
And that is what medicine can feel like sometimes. 有时候医药行业也是这样
It's not a system. 它并非一个系统
Now a system, however, when things start to come together, you realize it has certain skills for acting and looking that way. 然而,为了组建一个体系 当所有部分都组合到一起 你需要有特定的技巧 来让它运作起来,让它看起来像回事儿
Skill number one is the ability to recognize success and the ability to recognize failure. 首当其冲的是 辨识成功的能力 以及辨识失败的能力
recognize:v.认识;认出;辨别出;承认;意识到;
When you are a specialist, you can't see the end result very well. 假如你是一名专科医生 如果你无法很好地设想最终结果
end result:n.最终结果;
You have to become really interested in data, unsexy as that sounds. 你必须认真分析数据 这听上去非常无趣
unsexy:很不性感;
One of my colleagues is a surgeon in Cedar Rapids, Iowa, and he got interested in the question of, well how many CT scans did they do for their community in Cedar Rapids? 我的一个外科医生同事,在爱荷华州锡达拉皮兹工作 他对一个问题产生了兴趣 那就是:他们在锡达拉皮兹 做了多少个CT扫描？
colleagues:n.同事;同行(colleague的复数); surgeon:n.外科医生; Cedar:n.雪松;香柏;西洋杉木; community:n.社区;[生态]群落;共同体;团体;
He got interested in this because there had been government reports, newspaper reports, journal articles saying that there had been too many CT scans done. 他对此很感兴趣 因为政府报告 新闻报道、期刊论文 都在说现在做的CT扫描过量了
journal:n.杂志;日记;日志;(用于报纸名)…报;
He didn't see it in his own patients. 但他没在自己的病人中看到这个问题
And so he asked the question, "How many did we do?" 因此他提出这一疑问:”我们究竟做了多少CT扫描呢？“
and he wanted to get the data. 他想得到这一数据
It took him three months. 于是他花了3个月时间
No one had asked this question in his community before. 此前,在他的社区,没人有过这个疑问
And what he found was that, for the 300,000 people in their community, in the previous year they had done 52,000 CT scans. 后来,他发现 在社区的300,000人中 过去一年间 他们曾做了52,000次CT扫描
previous:adj.以前的;早先的;过早的;adv.在先;在…以前;
They had found a problem. 于是他们发现了一个问题
Which brings us to skill number two a system has. 也就引出了我要说的运作系统的第二项技巧
Skill one, find where your failures are. 技巧1是:发现我们错在哪里
Skill two is devise solutions. 技巧2是:设计解决方案
devise:v.设计; n.[法]遗赠财产的遗嘱(或其中的条款);
I got interested in this when the World Health Organization came to my team asking if we could help with a project to reduce deaths in surgery . 我对此也颇感兴趣 世界卫生组织曾来找我的团队 问我们是否能帮他们做一个项目 来降低外科手术的死亡率
Organization:n.组织;机构;体制;团体; surgery:n.外科;外科手术;手术室;诊疗室;
The volume of surgery had spread around the world, but the safety of surgery had not. 如今外科手术在世界范围内 数量日益增长 但是手术的安全性 却令人担忧
volume:n.体积;容积;音量;响度;一册;合订本
Now our usual tactics for tackling problems like these are to do more training, give people more specialization or bring in more technology . 现在我们普遍的做法是 开展更多培训 让医生更加专业 或者提高技术
tactics:n.战术:策略:手段:兵法(tactic的复数) tackling:n.装备,用具;扭住;v.处理;抓住;(tackle的现在分词); specialization:n.专门化;特殊化;特化作用; technology:n.技术;工艺;术语;
Well in surgery, you couldn't have people who are more specialized and you couldn't have people who are better trained. 所以,在手术中,我们的医生都是非常专业的 受过非常好的教育和培训
specialized:adj.专业的; v.专门研究(或从事); (specialize的过去式和过去分词)
And yet we see unconscionable levels of death, disability that could be avoided. 然而我们还是看到高得不正常的 死亡率和致残率 这些原本都是可以避免的
unconscionable:adj.不合理的;昧着良心的;肆无忌惮的;过度的;
And so we looked at what other high-risk industries do. 因此我们参考了其他高风险行业的做法
high-risk:adj.高危险度的;
We looked at skyscraper construction , we looked at the aviation world, and we found that they have technology, they have training, and then they have one other thing: 我们观察了摩天大楼的建设 我们研究了飞机制造业 然后发现 他们有技术、他们有培训 而且他们还有一样东西
skyscraper:n.摩天楼,超高层大楼;特别高的东西; construction:n.建设;建筑物;解释;造句; aviation:n.航空;飞行术;飞机制造业;
They have checklists . 那就是检查表
checklists:n.清单(checklist的复数);
I did not expect to be spending a significant part of my time as a Harvard surgeon worrying about checklists. 我没有想到自己 作为一名哈佛外科医生 会把大部分时间 用来烦恼检查表这个东西
significant:adj.重大的;有效的;有意义的;值得注意的;意味深长的;n.象征;有意义的事物; Harvard:n.哈佛大学;哈佛大学学生;
And yet, what we found were that these were tools to help make experts better. 然而,我们发现 正是这个工具 帮助专家达到最佳效果
We got the lead safety engineer for Boeing to help us. 我们得到了波音公司首席安全工程师的帮助
Could we design a checklist for surgery? 我们请教他如何设计一张用于外科手术的清单？
Not for the lowest people on the totem pole , but for the folks who were all the way around the chain, the entire team including the surgeons . 并非为了社会底层人士 而是针对 在这条产业链的每个环节上的人 包括外科医生在内的整个团队
totem pole:n.图腾柱;推拉输出电路; surgeons:n.外科医生;(surgeon的复数)
And what they taught us was that designing a checklist to help people handle complexity actually involves more difficulty than I had understood. 他们教我们的是 要设计好检查表 来帮助人们处理复杂问题 其实比想象的要难
handle:n.[建]把手;柄;手感;口实;v.处理;操作;运用;买卖;触摸; involves:v.包含;需要;牵涉;牵连;影响;(使)参加,加入(involve的第三人称单数)
You have to think about things like pause points. 你必须考虑很多问题 比如“暂停时点”
You need to identify the moments in a process when you can actually catch a problem before it's a danger and do something about it. 你需要认识到整个流程中的一些时刻 能够在危险来临前及时发现问题 作出处理以免酿成大祸
identify:v.识别:鉴定:确认:发现: process:v.处理;加工;列队行进;n.过程,进行;方法,adj.经过特殊加工(或处理)的;
You have to identify that this is a before-takeoff checklist. 你必须把它当做 是一张飞机起飞前的检查表
And then you need to focus on the killer items . 你一定要关注一些至关重要的项目
items:n.项目;一件商品(或物品);一则,一条(新闻)(item的复数)
An aviation checklist, like this one for a single-engine plane, isn't a recipe for how to fly a plane, it's a reminder of the key things that get forgotten or missed if they're not checked. 在一份飞机制造检查表上 就像这张针对单引擎飞机的检查清单 它可不是驾驶飞机的窍门 而是对关键问题的提醒 如果他们不去检查 很可能会遗漏这些问题
single-engine:单引擎; recipe:n.食谱;方法;诀窍;烹饪法;
So we did this. 因此我们也效仿了他们的做法
We created a 19-item two-minute checklist for surgical teams. 我们设计了一张检查表,19个项目,用时2分钟 针对手术团队
We had the pause points immediately before anesthesia is given, immediately before the knife hits the skin, immediately before the patient leaves the room. 其中包含“暂停时点” 例如,实施麻醉前 手术刀接触病人皮肤之前 病人离开手术室之前
anesthesia:n.麻醉;麻木(等于anaesthesia);
And we had a mix of dumb stuff on there -- making sure an antibiotic is given in the right time frame because that cuts the infection rate by half -- and then interesting stuff, because you can't make a recipe for something as complicated as surgery. 检查表上不乏很多看上去很简单的事情 例如,确保在正确的时间使用抗生素 光这一点就让感染率下降了一半 还有些有意思的事 你无法为手术这样复杂的事情事先开出处方
dumb:adj.哑的,无说话能力的;不说话的,无声音的; stuff:n.东西:物品:基本特征:v.填满:装满:标本: antibiotic:adj.抗生的;抗菌的;n.抗生素,抗菌素; time frame:n.期间时限; complicated:adj.复杂的;难懂的;v.使复杂化;(complicate的过去分词和过去式)
Instead, you can make a recipe for how to have a team that's prepared for the unexpected . 然而,你却可以开处方 给这个团队,使他们能更好地去面对突发状况
unexpected:adj.意外的,想不到的;
And we had items like making sure everyone in the room had introduced themselves by name at the start of the day, because you get half a dozen people or more who are sometimes coming together as a team for the very first time that day that you're coming in. 我们列出的项目中就包括:确保每个在房间的人 都在手术开始前互相做了自我介绍 因为很多时候,起码有六个人 在这个新组建的团队中 都是初次见面
We implemented this checklist in eight hospitals around the world, deliberately in places from rural Tanzania to the University of Washington in Seattle . 后来,我们在世界上8所医院 执行、推广了这份检查表 其中包括坦桑尼亚的乡村 也包括在西雅图的华盛顿大学
implemented:v.使生效;贯彻;执行;实施;(implement的过去式和过去分词) deliberately:adv.故意地;谨慎地;慎重地; rural:adj.农村的,乡下的;田园的,有乡村风味的; Seattle:n.西雅图(美国一港市);
We found that after they adopted it the complication rates fell 35 percent. 我们发现,当他们使用了这份检查表之后 复杂程度大大降低 降低了35%
adopted:adj.被收养的;被采用的;v.采用;接受;(adopt的过去式和过去分词); complication:n.并发症;复杂;复杂化;混乱;
It fell in every hospital it went into. 每所医院都是如此
The death rates fell 47 percent. 死亡率也降低了 降低了47%
This was bigger than a drug. 这比任何一种药物都管用
(Applause) （掌声）
And that brings us to skill number three, the ability to implement this, to get colleagues across the entire chain to actually do these things. 这将引出 第三项技巧 执行能力 让所有产业链上的同事 都能切实地这样做事
And it's been slow to spread. 推广这些很花时间
This is not yet our norm in surgery -- let alone making checklists to go onto childbirth and other areas. 这还不是我们做手术的规范 更别说 应用于例如分娩等其他紧迫的领域
childbirth:n.分娩;
There's a deep resistance because using these tools forces us to confront that we're not a system, forces us to behave with a different set of values. 在执行中往往会遇到强大的阻力 因为使用这些工具 会迫使我们去面对 我们还未成为“系统”这一事实 会迫使我们不得不用另一套价值观去操作
resistance:n.电阻;抵抗;阻力;抗力; confront:v.直面;无法回避;降临于;处理;对抗; behave:v.表现;(机器等)运转;举止端正;(事物)起某种作用;
Just using a checklist requires you to embrace different values from the ones we've had, like humility , discipline , teamwork. 使用一份检查表 需要你用与以往不同的价值操守 例如谦虚 纪律 团队合作
embrace:n.拥抱,怀抱;v.拥抱;乐意采纳(思想、建议等);信奉;包括; humility:n.谦卑,谦逊; discipline:n.纪律;训练;自制力;风纪;v.训练;管教;惩罚;处罚;
This is the opposite of what we were built on: independence, self-sufficiency, autonomy. 这与我们所建立的价值观刚好背道而驰: 独立、自给自足 自治
I met an actual cowboy, by the way . 说到这儿,我想起来曾经遇到过一个真正的牛仔
by the way:顺便说一下;
I asked him, what was it like to actually herd a thousand cattle across hundreds of miles? 我问他:牛仔到底是如何 将上千头牛 放牧几百英里
herd:n.兽群,畜群;放牧人;vi.成群,聚在一起;vt.放牧;使成群;
How did you do that? 你们是怎么做的？
And he said, "We have the cowboys stationed at distinct places all around." 他回答说:“我们有牛仔驻扎在牧区的几个地点”
distinct:adj.明显的;独特的;清楚的;有区别的;
They communicate electronically constantly , and they have protocols and checklists for how they handle everything -- 他们通过电子设备不断交流 他们有规章制度和各种检查表 去处理发生的各种情况
electronically:adv.电子地; constantly:adv.不断地;时常地; protocols:n.协议; v.拟定议定书;
(Laughter) （笑声）
- from bad weather to emergencies or inoculations for the cattle. 比如,恶劣天气 比如,突发事件,或者为牛群接种
emergencies:n.突发事件;紧急情况;(emergency的复数) inoculations:n.[医]接种;接木;接插芽;
Even the cowboys are pit crews now. 如今,就连牛仔们也组成了维修队
And it seemed like time that we become that way ourselves. 似乎是时候 我们也变成那样了
Making systems work is the great task of my generation of physicians and scientists. 靠“系统”来工作 这正是我们这代人 作为医生和科学家的的首要任务
But I would go further and say that making systems work, whether in health care, education, climate change, making a pathway out of poverty , is the great task of our generation as a whole . 进一步说 要让“系统”运转起来 无论是医疗、教育 还是气候变化 还是消除贫困 都是我们这代人,作为一个整体需要完成的重要任务
pathway:n.路,道;途径,路径; poverty:n.贫困;困难;缺少;低劣; as a whole:总的来说;
In every field, knowledge has exploded , but it has brought complexity, it has brought specialization. 在各个领域都有知识爆炸 情况更加复杂 专业性更强
exploded:adj.分解的; v.爆炸; (explode的过去分词和过去式)
And we've come to a place where we have no choice but to recognize, as individualistic as we want to be, complexity requires group success. 我们别无选择 只能去认识到 尽管我们都崇尚个人主义 但复杂性要求我们 取得集体成功
individualistic:adj.个人主义的;利己主义的;
We all need to be pit crews now. 我们全都需要成为维修队
Thank you. 谢谢大家
(Applause) （掌声）