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DavidCasarett_2016P-_一位医生对药用大麻的探讨_
I would like to tell you about the most embarrassing thing that has ever happened to me in my years of working as a palliative care physician . 我想跟你们说说, 在我担任临终关怀治疗师的时候, 曾经发生过最尴尬的一件事。
embarrassing:adj.令人尴尬的; v.使尴尬; (embarrass的现在分词) palliative:n.辩解;缓和剂;暂时姑息的手段;adj.缓和的;掩饰的;可斟酌的; physician:n.[医]医师;内科医师;
This happened a couple of years ago. 那是在好几年前发生的。
I was asked as a consultant to see a woman in her 70s -- retired English professor who had pancreatic cancer . 我受托去见一位 70 多岁的女士, 担任她的医疗顾问── 她是一位退休的英文教授, 罹患胰腺癌。
consultant:n.顾问;高级顾问医师;会诊医师; pancreatic:adj.胰的;胰腺的; cancer:n.癌症;恶性肿瘤;
I was asked to see her because she had pain, nausea , vomiting ... 我被找去是因为她觉得 疼痛、恶心、想吐......
nausea:n.恶心,晕船;极端的憎恶; vomiting:v.呕吐(vomit的现在分词);
When I went to see her, we talked about those symptoms and in the course of that consultation , she asked me whether I thought that medical marijuana might help her. 当我去见她的时候, 我们谈论了这些症状; 而在谘询的过程中, 她问我是否认为 药用大麻能幫助到她。
symptoms:n.症状;征候;征兆;(symptom的复数) in the course of:在…过程中;在…期间; consultation:n.咨询;磋商;[临床]会诊;讨论会; marijuana:n.大麻;大麻毒品;
I thought back to everything that I had learned in medical school about medical marijuana, which didn't take very long because I had learned absolutely nothing. 我回想了所有在医学院学过的, 关于药用大麻的知识; 这并不需要很多时间,
absolutely:adv.绝对地;完全地;
And so I told her that as far as I knew, medical marijuana had no benefits whatsoever . 所以我告诉她: 据我所知,药用大麻 并没有什么用处。
as far as:至于…; whatsoever:pron.无论什么;
And she smiled and nodded and reached into the handbag next to the bed, and pulled out a stack of about a dozen randomized controlled trials showing that medical marijuana has benefits for symptoms like nausea and pain and anxiety . 她微笑并点点头, 然后从床边的提袋里, 拿出将近一打的 随机对照试验报告, 结果都显示药用大麻有助于减缓 恶心、疼痛、焦虑等症状。
stack:n.堆栈;一摞;大量;许多;v.(使)放成整齐的一叠(或一摞,一堆); randomized:adj.[数]随机化的,随机的;v.使随机化;做任意排列(randomize的过去分词); anxiety:n.焦虑;渴望;挂念;令人焦虑的事;
She handed me those articles and said, "Maybe you should read these before offering an opinion ...doctor." 她把那些报告递给我,并且说: 「或许你应该先读读这些, 再发表意见......医生。」
(Laughter) （笑声）
So I did. 于是我照做了。
That night I read all of those articles and found a bunch more. 那天晚上,我把那些报告全读过了,
bunch:n.群;串;突出物;vi.隆起;打褶;形成一串;vt.使成一串;使打褶;
When I came to see her the next morning, 当我第二天去见她的时候,
I had to admit that it looks like there is some evidence that marijuana can offer medical benefits and I suggested that if she really was interested, she should try it. 我不得不承认, 看起来的确有一些证据, 支持大麻具有医疗效果; 于是我建议, 如果她真的有意愿的话, 她应该试一试。
evidence:n.证据,证明;迹象;明显;v.证明;
You know what she said? 你知道她怎么回答吗？
This 73-year-old, retired English professor? 那位 73 岁的退休英文教授？
She said, "I did try it about six months ago. 她说:「我大约六个月前就试过了。
It was amazing. 它超级棒。
I've been using it every day since. 之后我每天都用,
It's the best drug I've discovered. 这是我所发现过最棒的药。
I don't know why it took me 73 years to discover this stuff . It's amazing." 我不晓得为何花了 73 年 才发现这个东西,它棒极了。」
stuff:n.东西:物品:基本特征:v.填满:装满:标本:
(Laughter) （笑声）
That was the moment at which I realized 那时我才意识到,
I needed to learn something about medical marijuana because what I was prepared for in medical school bore no relationship to reality. 我需要学习药用大麻相关的知识, 因为我在医学院里所学到的, 已经和现实脱节了。
bore:v.钻孔;使烦扰;n.孔;令人讨厌的人;
So I started reading more articles, I started talking to researchers, 于是我开始阅读更多资料, 开始和研究人员交流,
I started talking to doctors, and most importantly , I started listening to patients . 开始和医生们交流, 更重要的是, 我开始倾听患者的声音。
and most importantly:最主要的是…; patients:n.接受治疗者,病人;(patient的复数)
I ended up writing a book based on those conversations, and that book really revolved around three surprises -- surprises to me, anyway. 基于那些对话,我后来写了一本书, 那本书以三件 「意料之外」的事件为中心── 反正对我来说是意料之外的,
revolved:v.旋转(revolve的过去式,过去分词);n.旋转曲面;回转面;转体;adj.旋转的;
One I already alluded to -- that there really are some benefits to medical marijuana. 第一件事我刚刚已经提到了── 药用大麻的确是有一些效果的。
alluded:vi.暗指,转弯抹角地说到;略为提及,顺便提到;
Those benefits may not be as huge or as stunning as some of the most avid proponents of medical marijuana would have us believe, but they are real. 或许那些药用大麻的成效, 并不像某些积极拥护者 所希望我们相信的── 但是它真的有效。
stunning:adj.惊人的; v.使昏迷; (stun的现在分词) avid:adj.渴望的,贪婪的;热心的; proponents:n.支持者;建议者(proponent的复数);
Surprise number two: medical marijuana does have some risks. 第二个意料之外是: 药用大麻也具有某些危害。
Those risks may not be as huge and as scary as some of the opponents of medical marijuana would have us believe, but they are real risks, nonetheless . 但那些危害并没有严重或者恐怖到, 药用大麻的反对者 想让我们相信的程度, 尽管如此,它的确具有危害。
opponents:n.对手(opponent的复数形式); nonetheless:adv.尽管如此,但是;
But it was the third surprise that was most ... 但第三个意料之外,
surprising. 是最令人惊讶的。
And that is that a lot of the patients I talked with who've turned to medical marijuana for help, weren't turning to medical marijuana because of its benefits or the balance of risks and benefits, or because they thought it was a wonder drug, but because it gave them control over their illness. 许多我曾经接触过, 求助于药用大麻的患者, 并不是为了疗效而使用药用大麻的, 也不是基于危害和效用的平衡, 更不是因为他们觉得 那是一种特效药, 而是因为能给予他们 对疾病的控制感,
It let them manage their health in a way that was productive and efficient and effective and comfortable for them. 让他们能用有效果、有效率、 有效益、觉得舒服的方式, 来管控自己的健康。
productive:adj.能生产的;生产的,生产性的;多产的;富有成效的; efficient:adj.有效率的;有能力的;生效的; effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
To show you what I mean, let me tell you about another patient. 为了表达的更清楚, 让我来聊聊另一位患者。
Robin was in her early 40s when I met her. 我遇到罗缤的时候她 40 多岁,
Robin:知更鸟,罗宾(人名)
She looked though like she was in her late 60s. 但她看起来像是快要 70 岁了。
She had suffered from rheumatoid arthritis for the last 20 years, her hands were gnarled by arthritis, her spine was crooked , she had to rely on a wheelchair to get around . 过去的 20 年,她受到 类风湿性关节炎的折磨, 她的手因为关节炎扭曲, 脊柱也弯了, 她必须靠轮椅来移动。
rheumatoid arthritis:n.类风湿(性)关节炎; gnarled:adj.[木]多节的;粗糙的;多瘤的;v.把…扭曲;长木瘤(gnarl的过去分词); spine:n.脊柱,脊椎;刺;书脊; crooked:adj.扭曲的;弯曲的;不直的;v.(手指或手臂)弯曲;(crook的过去分词和过去式) rely:vi.依靠;信赖; wheelchair:n.轮椅; get around:到处走走;逃避;说服;传开来(等于getround);有办法应付;有办法应付局面;
She looked weak and frail , and I guess physically she probably was, but emotionally , cognitively , psychologically , she was among the toughest people I've ever met. 她在外表上、身体上 看起来很虚弱,一碰即碎; 但是在精神上、意识上、心理上, 她是我所遇到过最坚强的人。
frail:adj.脆弱的;虚弱的;n.灯心草篓;少妇;少女; emotionally:adv.感情上;情绪上;令人激动地;情绪冲动地; cognitively:adv.认知地; psychologically:adv.心理上地;心理学地;
And when I sat down next to her in a medical marijuana dispensary in Northern California to ask her about why she turned to medical marijuana, what it did for her and how it helped her, she started out by telling me things that I had heard from many patients before. 当我在她身边坐下, 那是在加州北部 一间药用大麻药局里, 我问她为什么开始使用药用大麻, 这对她有什么作用？如何幫助了她？ 她告诉我一些事, 那些也是我从许多患者那里听过的:
dispensary:n.药房;(学校,兵营或工厂的)诊疗所;防治站;
It helped with her anxiety; it helped with her pain; when her pain was better, she slept better. 它有助于解决焦虑; 有助于解决疼痛; 当疼痛减缓时,她就能睡得比较好。
And I'd heard all that before. 这些原因都是我听过的。
But then she said something that I'd never heard before, and that is that it gave her control over her life and over her health. 然而她接下来说的, 我却从来没听过: 药用大麻让她能掌控 自己的生活和健康。
She could use it when she wanted, in the way that she wanted, at the dose and frequency that worked for her. 她可以在想用的时候就用, 以她想要的方式、 以适合她的用量和频率使用。
in the way:妨碍;挡道; dose:n.剂量;一剂,一服;v.服药;给药;给…服药; frequency:n.频率;发生率;重复率;频繁;
And if it didn't work for her, then she could make changes. 如果没有效果,她可以做出调整。
Everything was up to her. 所有的事她都能自己作主。
The most important thing she said was she didn't need anybody else's permission -- not a clinic appointment , not a doctor's prescription , not a pharmacist's order. 最重要的就是,她说: 她不需要得到其他人的允许── 不需要预约诊所, 不需要医生的处方, 不需要向药剂师购买。
clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间; appointment:n.任命;约定;任命的职位; prescription:n.处方;药方;医生开的药;开处方;
It was all up to her. 一切都由她作主。
She was in control. 她说了算。
And if that seems like a little thing for somebody with chronic illness, it's not -- not at all . 对于罹患慢性病的人来说, 这是一件小事吗？ 不是的,完全不是。
chronic:adj.慢性的;长期的;习惯性的; not at all:毫无;一点也不;不用谢;
When we face a chronic serious illness, whether it's rheumatoid arthritis or lupus or cancer or diabetes , or cirrhosis , we lose control. 当我们面对严重的慢性疾病时, 不论是类风湿性关节炎、 狼疮、癌症、糖尿病 还是肝硬化, 我们都失去了控制权。
lupus:n.[内科][皮肤]狼疮;天狼座; diabetes:n.糖尿病;多尿症; cirrhosis:n.硬化;[内科]肝硬化;
And note what I said: "when," not "if." 注意我是说「当」你患病的时候, 而不是用「如果」。
All of us at some point in our lives will face a chronic serious illness that causes us to lose control. 我们所有人,到了人生的某个阶段, 都要面对严重的慢性病, 这导致我们失去控制权。
We'll see our function decline , some of us will see our cognition decline , we'll be no longer able to care for ourselves, to do the things that we want to do. 我们看着自己的机能衰退, 有的人还会经历智力衰退, 我们不再有能力照顾自己, 做我们自己想做的事。
decline:v.下降;衰退;减少;谢绝;n.下降; cognition:n.认识;知识;认识能力;
Our bodies will betray us, and in that process , we'll lose control. 我们的身体终将背叛我们, 而在那个过程中, 我们失去了控制权。
betray:v.出卖;泄露(机密);辜负; 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;
And that's scary. 这挺吓人的。
Not just scary -- that's frightening , it's terrifying . 不止是吓人,简直令人恐惧, 寝食难安。
frightening:adj.可怕的;骇人的;引起恐惧的;v.使惊吓;使惊恐(frighten的现在分词) terrifying:adj.令人恐惧的;骇人的;极大的;v.使害怕,使恐怖;(terrify的现在分词)
When I talk to my patients, my palliative care patients, many of whom are facing illnesses that will end their lives, they have a lot of be frightened of -- pain, nausea, vomiting, constipation , fatigue , their impending mortality . 我和我的病患, 也就是临终关怀患者交流时, 他们之中有许多人 正面临将夺走他们生命的疾病, 他们对很多事情感到恐惧── 痛楚、恶心、呕吐、便秘、疲倦、 即将到来的死亡。
frightened:adj.害怕的;受惊的;惊吓的;v.使惊吓;使惊恐;(frighten的过去分词和过去式) constipation:n.[临床]便秘;受限制; fatigue:n.疲劳;劳累;厌倦;(金属或木材的)疲劳;v.疲劳;使疲乏;(士兵)担任杂役; impending:adj.迫在眉睫的; v.(事件,危险等)逼近; (impend的现在分词) mortality:n.死亡数,死亡率;必死性,必死的命运;
But what scares them more than anything else is this possibility that at some point, tomorrow or a month from now, they're going to lose control of their health, of their lives, of their healthcare , and they're going to become dependent on others, and that's terrifying. 但和其他所有事相比, 他们更恐惧的事情, 是可能在某个时候, 也许是明天,或是下个月, 他们将会失去对自己健康的控制权, 对生活的控制权, 对医疗的控制权, 他们变得必须依赖他人, 这是很可怕的。
healthcare:n.医疗保健;健康护理,健康服务;卫生保健; dependent on:依赖于;依靠;
So it's no wonder really that patients like Robin, who I just told you about, who I met in that clinic, turn to medical marijuana to try to claw back some semblance of control. 所以像罗缤这样的患者, 就是我刚刚告诉过你们的, 在诊所里遇到的那一位, 不意外的,她会选择使用药用大麻, 是为了试图抓住 一些表面上的控制权。
claw:n.爪;螯,钳;爪形器具;v.用爪抓(或挖); semblance:n.外貌;假装;类似;
How do they do it though? 但他们怎么做到的呢？
How do these medical marijuana dispensaries -- like the one where I met Robin -- how do they give patients like Robin back the sort of control that they need? 这些贩售药用大麻的药局, 例如我遇到罗缤的那一间, 他们是如何让罗缤这样的患者
dispensaries:n.药房;(学校,兵营或工厂的)诊疗所;防治站;
And how do they do it in a way that mainstream medical hospitals and clinics , at least for Robin, weren't able to? 他们是如何做到那些, 主流的医院和诊所 无法对罗缤做的？
mainstream:n.主流; clinics:n.诊所(clinic的复数形式);
What's their secret? 他们的秘密是什么？
So I decided to find out. 我决定要搞清楚。
I went to a seedy clinic in Venice Beach in California and got a recommendation that would allow me to be a medical marijuana patient. 我去了位于加州威尼斯海滩 一间破破的诊所, 拿到一份同意书, 允许我成为一名使用 药用大麻的病患。
seedy:adj.多种子的;结籽的;破烂的;没精打采的;下流的; Venice:n.威尼斯(意大利港市);
I got a letter of recommendation that would let me buy medical marijuana. 我拿到了一份同意书, 能让我购买药用大麻。
a letter of recommendation:推荐信;一封推荐信;引荐信;一封保举信;
I got that recommendation illegally , because I'm not a resident of California -- 我用不合法的方式拿到同意书, 因为我并不是加州居民──
illegally:adv.非法地; resident:adj.居住的;住院医师;定居的;n.居民;
I should note that. 我应该先声明这点。
I should also note, for the record, that I never used that letter of recommendation to make a purchase , and to all of you DEA agents out there -- 我还要声明,以供纪录, 就是我从未使用 那份同意书购买大麻, 以上的声明是要给 美国缉毒局的调查员的──
purchase:n.购买;采购;购买的东西;购买项目;v.购买;采购; agents:n.代理人,经纪人;原动力;(agent的复数)
(Laughter) （笑声）
love the work that you're doing, keep it up. 要热爱你们的工作, 继续坚持下去！
(Laughter) （笑声）
Even though it didn't let me make a purchase though, that letter was priceless because it let me be a patient. 尽管我并没有 用这份同意书进行购买, 但是它仍然无比珍贵, 因为它让我成为一名患者,
priceless:adj.无价的;极贵重的;非常有趣的;n.非卖品;
It let me experience what patients like Robin experience when they go to a medical marijuana dispensary. 让我体验到, 像罗缤这样的患者所经历的, 体验到她们在药用大麻药局 所得到的经验。
And what I experienced -- what they experience every day, hundreds of thousands of people like Robin -- was really amazing. 而我所体验到的── 就如同成百上千位 像罗缤一样的人, 每天都在经历的── 简直是棒极了。
I walked into the clinic, and from the moment that I entered many of these clinics and dispensaries, 我走进了药局, 从我走进这些 诊所和药局的那一刻起,
I felt like that dispensary, that clinic, was there for me. 我感觉到,这间药局、这间诊所, 是为我设立的。
There were questions at the outset about who I am, what kind of work I do, what my goals are in looking for a medical marijuana prescription, or product, what my goals are, what my preferences are, what my hopes are, how do I think, how do I hope this might help me, what am I afraid of. 一开始的时候, 他们会询问一些问题, 例如我是谁？我从事什么工作？ 我希望藉由药用大麻处方或产品 达到什么效果？ 我的目标是什么？喜好是什么？ 我的期望是什么？ 我是怎么想的？ 我期望带来什么幫助？ 我担心什么？
outset:n.开始;开端; preferences:n.偏爱;爱好;喜爱;偏爱的事物;(preference的复数)
These are the sorts of questions that patients like Robin get asked all the time. 像罗缤这样的患者, 会不断地被问到这些类型的问题。
These are the sorts of questions that make me confident that the person I'm talking with really has my best interests at heart and wants to get to know me. 像这样的问题,会让我有信心, 觉得这个和我谈话的人, 是从内心关注我的利益, 并且想要更瞭解我。
confident:adj.自信的;确信的;
The second thing I learned in those clinics is the availability of education. 我从这些诊所学到的第二件事, 是可以获得许多指导。
availability:n.可用性;有效性;实用性;
Education from the folks behind the counter, but also education from folks in the waiting room . 除了从柜台里的人得到指导, 也从等候室里的其他人得到指导。
waiting room:na.候车室;
People I met were more than happy, as I was sitting next to them -- people like Robin -- to tell me about who they are, why they use medical marijuana, what helps them, how it helps them, and to give me advice and suggestions. 当我坐在他们旁边时, 这些人都很高兴── 他们都是像罗缤那样的人── 他们告诉我:他们是谁, 为什么使用药用大麻？ 什么幫助了他们？如何幫助了他们？ 并给我意见和建议。
Those waiting rooms really are a hive of interaction , advice and support. 那些等候室就像是提供交流、 建议和支持的场所。
hive:vi.群居; n.蜂房,蜂巢; vt.入蜂箱; interaction:n.[计]交互,相互作用;相互交流;干扰;
And third, the folks behind the counter. 第三,坐在柜台里面的人,
I was amazed at how willing those people were to spend sometimes an hour or more talking me through the nuances of this strain versus that strain, smoking versus vaporizing , edibles versus tinctures -- all, remember, without me making any purchase whatsoever. 让我惊讶的是, 他们非常心甘情愿的, 愿意花一个小时甚至更多时间, 跟我讨论许多细节, 像是这个品种和那个品种的比较, 透过吸烟还是雾化方式, 食用的还是酊剂── 还记得吗,这是在我还没有 购买任何东西的情况下。
nuances:细微差别; strain:n.压力;品系;应力;张力;v.扭伤;拉紧;滤;损伤; versus:prep.对;与...相对;对抗; vaporizing:v.蒸发(vaporize的ing形式); edibles:n.可食物;食用品(edible的复数); tinctures:n.酊剂; v.着色; (tincture的复数)
Think about the last time you went to any hospital or clinic and the last time anybody spent an hour explaining those sorts of things to you. 回忆一下你上次去医院或诊所, 以及上一次有人花了一个小时 向你详细解释,是什么样的情况？
The fact that patients like Robin are going to these clinics, are going to these dispensaries and getting that sort of personalized attention and education and service, really should be a wake-up call to the healthcare system. 实际上像罗缤这样的患者, 会去这些诊所, 会去这些药局, 得到这种程度的关注、 指导和服务, 真是现今医疗系统的警钟。
personalized:v.在…上标明主人姓名; (personalize的过去分词和过去式) wake-up call:叫醒电话;叫醒服务;警钟;唤醒服务;
People like Robin are turning away from mainstream medicine, turning to medical marijuana dispensaries because those dispensaries are giving them what they need. 像罗缤这样的人,会放弃主流医疗, 转向药用大麻药局寻求协助, 是因为那些药局 能给予他们真正需要的。
If that's a wake-up call to the medical establishment , it's a wake-up call that many of my colleagues are either not hearing or not wanting to hear. 如果那是对于现今医疗机构的警钟, 那也是针对我那些不去聆听, 或是不愿聆听的同僚。
establishment:n.大型组织;企业;旅馆;权威人士;建立; colleagues:n.同事;同行(colleague的复数);
When I talk to my colleagues, physicians in particular , about medical marijuana, they say, "Oh, we need more evidence. 当我告诉我的同僚,特别是内科医生 关于药用大麻的事, 他们总是说: 「哦！我们需要更多证据。
physicians:n.[内科]内科医生(physician的复数); in particular:尤其,特别;
We need more research into benefits, we need more evidence about risks." 我们需要更多关于成效的研究, 以及更多关于危害的证据。」
And you know what? They're right. 你知道吗,他们是对的。
They're absolutely right. 他们绝对正确。
We do need much more evidence about the benefits of medical marijuana. 我们的确需要更多证据, 来证明药用大麻的成效。
We also need to ask the federal government to reschedule marijuana to Schedule II, or to deschedule it entirely to make that research possible. 我们也需要要求联邦政府, 把大麻重订为二类药物, 甚至是完全取消限制, 才能让研究进行。
federal:adj.联邦的;同盟的;联邦政府的;联邦制的;adv.联邦政府地; reschedule:v.将…改期;重新安排;推迟还款;
We also need more research into medical marijuana's risks. 我们也需要针对药用大麻的危害 进行更多研究。
Medical marijuana's risks -- we know a lot about the risks of recreational use, we know next to nothing about the risks of medical marijuana. 关于药用大麻的危害── 对于一般娱乐用大麻的危害, 我们了解很多, 但是对于药用大麻的危害, 我们几乎一无所知。
recreational:adj.娱乐的,消遣的;休养的;
So we absolutely do need research, but to say that we need research and not that we need to make any changes now is to miss the point entirely. 所以我们当然需要进行研究, 但话说回来,我们需要研究 并不等于现在就不必做出改变, 这是完全忽略了重点。
miss the point:没有抓住要领;
People like Robin aren't seeking out medical marijuana because they think it's a wonder drug, or because they think it's entirely risk-free . 像罗缤那样的人使用药用大麻, 不是因为他们认为那是万能药, 也不是因为他们觉得没有风险。
seeking:v.寻找;寻求;谋求;争取;(向人)请求(seek的现在分词) risk-free:adj.无风险的;
They seek it out because the context in which it's delivered and administered and used, gives them the sort of control they need over their lives. 他们追求的原因, 是由于大麻被递送、发放, 以及使用的环境, 这样的环境给予他们所需要的── 对生活的掌控权。
context:n.环境;上下文;来龙去脉; administered:v.管理;治理(国家);执行;给予;提供;(administer的过去分词和过去式)
And that's a wake-up call we really need to pay attention to . 而这是我们真正需要关注的警钟。
pay attention to:注意
The good news though is that there are lessons we can learn today from those medical marijuana dispensaries. 好消息是,今天我们能从 药用大麻的药局学到这一课。
And those are lessons we really should learn. 而那些正是我们应该学习的。
These are often small, mom-and-pop operations run by people with no medical training. 这些药局通常是小型的、家庭式的, 由未曾受过医疗训练的人士所经营。
mom-and-pop:adj.夫妻经营的;家庭经营的;
And while it's embarrassing to think that many of these clinics and dispensaries are providing services and support and meeting patients' needs in ways that billion-dollar healthcare systems aren't -- we should be embarrassed by that -- but we can also learn from that. 想到就令我们感到羞愧, 这些诊所和药局 一直在为患者提供服务、支持, 并满足他们的需求, 以一种数百亿规模的医疗系统 都做不到的方式── 我们应该对此感到羞愧── 但我们也应该向它学习。
embarrassed:adj.尴尬的;窘迫的;v.使...局促不安;(embarrass的过去分词和过去式)
And there are probably three lessons at least that we can learn from those small dispensaries. 我们能向这些小型药局学习的 至少有三个课题:
One: we need to find ways to give patients more control in small but important ways. 第一,我们需要找到 小巧但是重要的方法, 来给予患者更多的控制权。
How to interact with healthcare providers , when to interact with healthcare providers , how to use medications in ways that work for them. 例如如何与医疗人员沟通, 什么时候沟通, 如何以对患者有效的方式开药。
providers:n.供应者;提供者;供养人;(provider的复数) medications:n.药;药物;(medication的复数)
In my own practice, 在我自己的诊间里,
I've gotten much more creative and flexible in supporting my patients in using drugs safely to manage their symptoms -- with the emphasis on safely. 我已经找出更有创意和弹性的方式, 支持患者安全地使用药物 来控制他们的症状── 同时能强调安全性。
creative:adj.创造性的; flexible:adj.灵活的;柔韧的;易弯曲的; emphasis:n.强调;重视;重要性;(对某个词或短语的)强调;
Many of the drugs I prescribe are drugs like opioids or benzodiazepines which can be dangerous if overused . 我所开立的很多处方, 是属于鸦片类或苯二氮?类药物, 这些药物过量使用会有危险。
prescribe:v.给…开(药);让…采用(疗法);开(处方);命令; opioids:n.阿片类药物;类阿片;鸦片类药剂(opioid的复数形式); benzodiazepines:n.苯二氮平类药物;苯环类;苯二酚;苯二氮卓类; overused:adj.过度使用的;v.过度使用(overuse的过去分词);
But here's the point. 但这就是重点。
They can be dangerous if they're overused, but they can also be ineffective if they're not used in a way that's consistent with what patients want and need. 当他们过量使用时,会造成危险; 但如果不能依照 患者的意愿与需求来使用, 结果也是无效的。
ineffective:adj.无效的,失效的;不起作用的; consistent:adj.始终如一的,一致的;坚持的;
So that flexibility , if it's delivered safely, can be extraordinarily valuable for patients and their families. 所以在安全使用的前提下, 「提供弹性」对于患者和家属, 具有非常重要的意义。
flexibility:n.灵活性;弹性;适应性; extraordinarily:adv.非常;格外地;非凡地; valuable:adj.有价值的;贵重的;可估价的;n.贵重物品;
That's number one. 以上是第一点。
Number two: education. 第二个课题:指导。
Huge opportunities to learn from some of the tricks of those medical marijuana dispensaries to provide more education that doesn't require a lot of physician time necessarily , or any physician time, 这是个大好机会, 去向药用大麻药局学习 如何提供更多指导的技巧; 这并不会占用医师太多时间, 甚至根本不会占用任何时间,
necessarily:adv.必要地;必定地,必然地;
but opportunities to learn about what medications we're using and why, prognoses , trajectories of illness, and most importantly, opportunities for patients to learn from each other. 却能给我们一个机会了解: 我们正在用什么药物, 以及为何用这些药物, 如何预测判断疾病的预后, 以及最重要的, 这是患者之间彼此学习的机会。
prognoses:n.预测; trajectories:n.轨迹;轨道线(trajectory的复数形式);
How can we replicate what goes on in those clinic and medical dispensary waiting rooms? 我们如何复制出 在药用大麻药局等候室 所出现的情境呢？
replicate:vt.复制; vi.重复; adj.复制的; n.复制品;
How patients learn from each other, how people share with each other. 病人如何互相学习？ 人们如何彼此分享？
And last but not least , putting patients first the way those medical marijuana dispensaries do, making patients feel legitimately like what they want, what they need, is why, as healthcare providers,we're here. 最后但同样重要的一点, 就是像那些药用大麻药局所做的, 把病患放在第一位, 让病患能感觉到, 和他们的需求而存在的。 和他们的需求而存在的。
last but not least:最后但不是最不重要的一点; legitimately:adv.合理地;正当地;
Asking patients about their hopes, their fears, their goals and preferences. 向患者询问他们的 期望、恐惧、目标和偏好。
As a palliative care provider, 身为临终关怀从業人员,
I ask all my patients what they're hoping for and what they're afraid of. 我会询问所有的患者: 他们想要什么？担心什么？
But here's the thing. 而这就是重点。
Patients shouldn't have to wait until they're chronically seriously ill, often near the end of life, they shouldn't have to wait until they're seeing a physician like me before somebody asks them, "What are you hoping for?" 病人们不该等到罹患慢性绝症, 不该等到接近生命的尽头, 不该等到他们需要寻求 像我这类的医师, 才有人问他们: 「你想要什么？」
chronically:adv.长期地;慢性地;习惯性地;
'"What are you afraid of?" 「你担心什么？」
That should be baked into the way that healthcare is delivered. 这应该融入整个医疗体系的 提供项目之中。
baked:v.烘烤;焙;烤硬;灼热;(bake的过去分词和过去式)
We can do this -- we really can. 我们可以做到这些── 真的可以。
Medical marijuana dispensaries and clinics all across the country are figuring this out. 全国各地的药用大麻药局和诊所 都很清楚这件事。
They're figuring this out in ways that larger, more mainstream health systems are years behind. 规模更大、更主流的医疗系统 在这方面落后他们许多。
But we can learn from them, and we have to learn from them. 但我们可以向他们学习, 而且我们必须向他们学习。
All we have to do is swallow our pride -- put aside the thought for a minute that because we have lots of letters after our name, because we're experts, 我们需要做的 就是放下我们的骄傲── 暂时放下我们的想法, 放下我们名字后面的 一大堆头衔, 放下我们的专家身份,
swallow:v.吞下;咽下;吞没;相信;n.吞;咽;燕;一次吞咽的量; for a minute:一会儿;
because we're chief medical officers of a large healthcare system, we know all there is to know about how to meet patients' needs. 放下我们在大型 医疗机构里的主管权力, 我们所应该知道的, 是如何满足病患的需求。
We need to swallow our pride. 我们需要放下骄傲。
We need to go visit a few medical marijuana dispensaries. 我们需要去拜访几间药用大麻药局。
We need to figure out what they're doing. 我们需要搞清楚他们在做什么。
We need to figure out why so many patients like Robin are leaving our mainstream medical clinics and going to these medical marijuana dispensaries instead. 我们需要搞清楚 为什么很多像罗缤一样的病人, 会放弃主流医疗院所, 转向药用大麻药局。
We need to figure out what their tricks are, what their tools are, and we need to learn from them. 我们需要搞清楚他们的秘诀, 他们使用的工具, 我们需要向他们学习。
If we do, and I think we can, and I absolutely think we have to, we can guarantee all of our patients will have a much better experience. 如果我们这样做了, 我认为我们可以, 并且我们必须做到的, 我们可以确保所有的患者 都能得到更好的体验。
guarantee:n.保证;担保;保证人;保证书;抵押品;v.保证;担保;
Thank you. 谢谢大家。
(Applause) （掌声）