A doctor's case for medical marijuana | David Casarett

Translator: Marta García Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

I would like to tell you about the most embarrassing thing

Gustaríame contarlles a cousa máis embarazosa

that has ever happened to me in my years of working as a palliative care physician.

que me pasou nestes anos traballando

como médico de coidados paliativos.

This happened a couple of years ago.

Isto aconteceu hai un par de anos.

I was asked as a consultant to see a woman in her 70s --

Pedíronme que consultara a unha muller que tería sobre uns 70 anos.

retired English professor who had pancreatic cancer.

Unha profesora de inglés retirada que tiña cancro de páncreas.

I was asked to see her because she had pain, nausea, vomiting ...

Pedíronme que a consultara porque tiña dores, náuseas, vómitos...

When I went to see her, we talked about those symptoms

Cando fun vela falamos sobre eses síntomas

and in the course of that consultation,

e durante a consulta

she asked me whether I thought that medical marijuana might help her.

preguntoume se pensaba que a marihuana medicinal

lle podería axudar.

I thought back to everything

Intentei lembrar todo

that I had learned in medical school about medical marijuana,

o que aprendera na universidade sobre marihuana medicinal.

which didn't take very long because I had learned absolutely nothing.

Non me levou moito xa que non aprendera nada en absoluto.

And so I told her that as far as I knew,

Polo tanto, díxenlle todo o que sabía:

medical marijuana had no benefits whatsoever.

que a marihuana medicinal non tiña ningún beneficio.

And she smiled and nodded and reached into the handbag next to the bed,

Ela sorriu, asentiu e colleu o bolso que tiña ao lado da cama

and pulled out a stack of about a dozen randomized controlled trials

e sacou unha morea de ensaios aleatorizados controlados

showing that medical marijuana has benefits

que mostraban que a marihuana medicinal é beneficiosa

for symptoms like nausea and pain and anxiety.

para síntomas como as náuseas, a dor ou a ansiedade.

She handed me those articles and said,

Ela pasoume eses artigos e dixo:

"Maybe you should read these before offering an opinion ...

"Quizais debería ler isto antes de dar unha opinión...

doctor."

doutor".

(Laughter)

(Risos)

So I did.

E fíxeno.

That night I read all of those articles and found a bunch more.

Esa noite lin os artigos e atopei moitos máis.

When I came to see her the next morning,

Cando volvín vela á mañá seguinte

I had to admit that it looks like there is some evidence

tiven que admitir que parecía que si que había probas

that marijuana can offer medical benefits

de que a marihuana pode ofrecer beneficios médicos

and I suggested that if she really was interested,

e suxerín que se ela estaba realmente interesada

she should try it.

debería probala.

You know what she said?

Saben o que dixo?

This 73-year-old, retired English professor?

Esta profesora de inglés retirada de 73 anos?

She said, "I did try it about six months ago.

Dixo: "Xa a probei hai seis meses.

It was amazing.

Foi xenial.

I've been using it every day since.

Estouna consumindo dende aquela.

It's the best drug I've discovered.

É o mellor remedio que descubrín.

I don't know why it took me 73 years to discover this stuff. It's amazing."

Non sei como me levou 73 anos descubrila.

É xenial".

(Laughter)

(Risos)

That was the moment at which I realized

Nese momento decateime

I needed to learn something about medical marijuana

de que precisaba aprender algo sobre a marihuana medicinal

because what I was prepared for in medical school

porque a formación que me deran na facultade

bore no relationship to reality.

non tiña nada que ver coa realidade.

So I started reading more articles, I started talking to researchers,

Entón comecei a ler máis artigos e a falar con investigadores.

I started talking to doctors,

Comecei a falar con doutores

and most importantly, I started listening to patients.

e o máis importante: comecei a ouvir aos pacientes.

I ended up writing a book based on those conversations,

Acabei escribindo un libro sobre esas conversas.

and that book really revolved around three surprises --

E ese libro centrábase sobre todo en tres sorpresas.

surprises to me, anyway.

Sorpresas para min, polo menos.

One I already alluded to --

Sobre unha xa falei.

that there really are some benefits to medical marijuana.

Que realmente hai algúns beneficios na marihuana medicinal.

Those benefits may not be as huge or as stunning

Pode que eses beneficios non sexan tan grandes nin sorprendentes

as some of the most avid proponents of medical marijuana

como a maioría dos defensores da marihuana medicinal

would have us believe,

nos farían crer.

but they are real.

Pero son reais.

Surprise number two:

Sorpresa número dúas:

medical marijuana does have some risks.

a marihuana medicinal ten algúns riscos.

Those risks may not be as huge and as scary

Pode que eses riscos non sexan tan grandes nin aterradores

as some of the opponents of medical marijuana would have us believe,

como a maioría dos opositores da marihuana medicinal nos farían crer.

but they are real risks, nonetheless.

Non obstante, son riscos reais.

But it was the third surprise that was most ...

Pero foi a terceira sorpresa a máis...

surprising.

sorprendente.

And that is that a lot of the patients I talked with

Moitos dos pacientes cos que falei

who've turned to medical marijuana for help,

recorreran á marihuana medicinal en busca de axuda.

weren't turning to medical marijuana because of its benefits

Non recorreran a ela polos seus beneficios

or the balance of risks and benefits,

ou o equilibrio entre riscos e beneficios

or because they thought it was a wonder drug,

ou porque pensaran que era unha droga marabillosa.

but because it gave them control over their illness.

Senón porque lles daba control sobre a súa enfermidade.

It let them manage their health

Permítelles xestionar a súa saúde

in a way that was productive and efficient

de forma produtiva, eficiente e cómoda para eles.

and effective and comfortable for them.

Para amosárllelo falareilles doutra paciente.

To show you what I mean, let me tell you about another patient.

Robin tiña sobre 40 anos cando a coñecín.

Robin was in her early 40s when I met her.

She looked though like she was in her late 60s.

Pero semellaba que tiña máis de 60.

She had suffered from rheumatoid arthritis for the last 20 years,

Sufrira de artrite reumatoide durante os últimos 20 anos.

her hands were gnarled by arthritis,

Tiña as mans tortas pola artrite.

her spine was crooked,

A columna vertebral encurvada.

she had to rely on a wheelchair to get around.

Dependía da cadeira de rodas para desprazarse.

She looked weak and frail,

Víase débil e fráxil.

and I guess physically she probably was,

E supoño que fisicamente o era.

but emotionally, cognitively, psychologically,

Mais emocionalmente, cognitivamente e psicoloxicamente

she was among the toughest people I've ever met.

era unha das persoas máis fortes que xamais coñecín.

And when I sat down next to her

Cando sentei ao seu lado

in a medical marijuana dispensary in Northern California

nun dispensario de marihuana medicinal en California

to ask her about why she turned to medical marijuana,

para preguntarlle por que recorrera á marihuana medicinal,

what it did for her and how it helped her,

que fixera por ela e como lle axudara,

she started out by telling me things

comezou contándome cousas

that I had heard from many patients before.

que xa lles escoitara a moitos pacientes.

It helped with her anxiety;

Axudoulle coa ansiedade.

it helped with her pain;

Axudoulle coa dor.

when her pain was better, she slept better.

Cando a dor mingua dorme mellor.

And I'd heard all that before.

Todo iso xa o escoitara.

But then she said something that I'd never heard before,

Pero logo dixo algo que nunca escoitara antes:

and that is that it gave her control over her life

que lle dera control sobre a súa vida

and over her health.

e sobre a súa saúde.

She could use it when she wanted,

Podía consumila cando quixera,

in the way that she wanted,

como quixera,

at the dose and frequency that worked for her.

a dose e frecuencia que lle viña mellor.

And if it didn't work for her, then she could make changes.

E se non lle ía ben podía facer algúns cambios.

Everything was up to her.

Ela podía decidir.

The most important thing she said

O máis importante era

was she didn't need anybody else's permission --

que non precisaba o permiso de ninguén

not a clinic appointment, not a doctor's prescription,

nin unha cita médica, nin unha receita

not a pharmacist's order.

nin un pedido do farmacéutico.

It was all up to her.

Era ela a que decidía.

She was in control.

Era ela quen tiña o control.

And if that seems like a little thing for somebody with chronic illness,

E se iso parece pouco para alguén con unha doenza crónica

non o é en absoluto.

it's not -- not at all.

When we face a chronic serious illness,

Cando nos enfrontamos a unha doenza crónica

whether it's rheumatoid arthritis or lupus or cancer or diabetes,

sexa artrite reumatoide, lupus, cancro,

diabetes ou cirrose

or cirrhosis,

we lose control.

perdémo-lo control.

And note what I said: "when," not "if."

E decátense de que digo "cando", non "se".

All of us at some point in our lives will face a chronic serious illness

Porque nalgún momento das nosas vidas

sufriremos unha doenza crónica seria

that causes us to lose control.

que nos fará perder o control.

We'll see our function decline, some of us will see our cognition decline,

Veremos como as nosas funcións diminúen.

Algúns verán como a cognición diminúe.

we'll be no longer able to care for ourselves,

Non poderemos coidarnos a nós mesmos.

to do the things that we want to do.

Facer as cousas que queiramos.

Our bodies will betray us,

Os nosos corpos traizoarannos

and in that process, we'll lose control.

e nese proceso, perderémo-lo control.

And that's scary.

E iso mete medo.

Not just scary -- that's frightening,

Non so mete medo, senón que é temible.

it's terrifying.

É aterrador.

When I talk to my patients, my palliative care patients,

Cando falo cos meus pacientes de coidados paliativos,

many of whom are facing illnesses that will end their lives,

moitos dos cales se enfrontan a doenzas que acabaran coas súas vidas,

they have a lot of be frightened of --

teñen moito que temer:

pain, nausea, vomiting, constipation, fatigue,

dores, náuseas, vómitos, estrinximento, canseira,

their impending mortality.

a súa inminente mortalidade.

But what scares them more than anything else

Pero o que os aterra máis que nada

is this possibility that at some point,

é a posibilidade de que nalgún momento,

tomorrow or a month from now,

ben sexa mañá ou dentro dun mes,

they're going to lose control of their health,

van perder o control sobre a súa saúde,

of their lives,

a súa vida,

of their healthcare,

a súa atención sanitaria,

and they're going to become dependent on others,

e volveranse dependentes doutra persoa,

and that's terrifying.

e iso é aterrador.

So it's no wonder really that patients like Robin,

Por iso non é sorprendente que pacientes como Robin,

who I just told you about,

da que lles acabo de falar,

who I met in that clinic,

e a quen coñecín nesa clínica,

turn to medical marijuana

recorrera á marihuana medicinal

to try to claw back some semblance of control.

para tentar recuperar un pouco de control.

How do they do it though?

Pero como o fan?

How do these medical marijuana dispensaries --

Como estes dispensarios de marihuana medicinal

like the one where I met Robin --

como aquel en que coñecín a Robin,

how do they give patients like Robin back the sort of control that they need?

lles devolven aos pacientes coma ela

o tipo de control que precisan?

And how do they do it

E como o fan

in a way that mainstream medical hospitals and clinics,

dunha forma na que hospitais e clínicas convencionais

at least for Robin, weren't able to?

polo menos para Robin, non foron capaces?

What's their secret?

Cal é o seu segredo?

So I decided to find out.

Decidín achalo.

I went to a seedy clinic in Venice Beach in California

Fun a unha clínica con mala fama en Venice Beach, California

and got a recommendation

e conseguín unha recomendación

that would allow me to be a medical marijuana patient.

que me permitiría ser un paciente de marihuana medicinal.

I got a letter of recommendation that would let me buy medical marijuana.

Conseguín unha carta de recomendación

que me permitiría comprar marihuana medicinal.

I got that recommendation illegally,

Conseguina de forma ilegal

because I'm not a resident of California --

porque non son residente en California.

I should note that.

Debería mencionalo.

I should also note, for the record,

Tamén debo facer constar

that I never used that letter of recommendation to make a purchase,

que nunca a usei para facer unha compra.

and to all of you DEA agents out there --

E a todos os axentes da DEA que andan por aí...

(Laughter)

(Risos)

adoro o traballo que fan.

love the work that you're doing,

keep it up.

Sigan así.

(Laughter)

(Risos)

Even though it didn't let me make a purchase though,

Aínda que non me permitira facer unha compra

that letter was priceless because it let me be a patient.

esa carta era valiosísima porque me permitía ser un paciente.

It let me experience what patients like Robin experience

Permitíame pórme na pel de pacientes coma Robin

when they go to a medical marijuana dispensary.

cando van a un dispensario de marihuana medicinal.

And what I experienced --

E o que experimentei,

what they experience every day,

o que eles experimentan cada día,

hundreds of thousands of people like Robin --

centos de miles de persoas coma Robin

was really amazing.

foi asombroso.

I walked into the clinic,

Entrei na clínica

and from the moment that I entered many of these clinics and dispensaries,

e dende o momento en que entrei en moitas desas clínicas e dispensarios

I felt like that dispensary, that clinic,

sentín que ese dispensario, esa clínica

was there for me.

estaba aí para min.

There were questions at the outset about who I am,

Ao comezo había preguntas sobre quen era,

what kind of work I do,

cal era o meu traballo,

what my goals are in looking for a medical marijuana prescription,

con que fins buscaba

receitas de marihuana medicinal,

or product,

ou produtos,

what my goals are, what my preferences are,

cales eran os meus obxectivos, as miñas preferencias,

what my hopes are,

cales eran as miñas esperanzas,

how do I think, how do I hope this might help me,

como pensaba ou esperaba que me ía axudar,

what am I afraid of.

que temía...

These are the sorts of questions

Este é o tipo de preguntas

that patients like Robin get asked all the time.

que pacientes coma Robin reciben todo o tempo.

These are the sorts of questions that make me confident

Este é o tipo de preguntas que me fan confiar en que

that the person I'm talking with really has my best interests at heart

a persoa coa que estou falando pensa nos meus mellores intereses

and wants to get to know me.

e quere coñecerme.

The second thing I learned in those clinics

A segunda cousa que aprendín nestas clínicas

is the availability of education.

é a dispoñibilidade da educación.

Education from the folks behind the counter,

Educación das persoas ao outro lado do mostrador.

but also education from folks in the waiting room.

Pero tamén das persoas na sala de espera.

People I met were more than happy, as I was sitting next to them --

Coñecín persoas que estaban encantadas, cando eu sentaba á súa beira,

people like Robin --

xente coma Robin,

to tell me about who they are, why they use medical marijuana,

de contarme quen eran e por que consumían marihuana medicinal,

what helps them, how it helps them,

en que lles axudaba e como,

and to give me advice and suggestions.

e de darme consellos e suxestións.

Those waiting rooms really are a hive of interaction, advice and support.

Esas salas de espera son coma unha colmea

de interacción, consello e apoio.

And third, the folks behind the counter.

E o terceiro, a xente de detrás do mostrador.

I was amazed at how willing those people were

Estaba asombrado por como esa xente estaba disposta

to spend sometimes an hour or more talking me through the nuances

a estar unha hora ou máis explicando os matices

of this strain versus that strain,

entre distintas cepas,

smoking versus vaporizing,

entre fumala e vaporizala,

edibles versus tinctures --

entre comestibles e tinturas.

all, remember, without me making any purchase whatsoever.

E recorden, todo isto sen eu ter intención de facer compra ningunha.

Think about the last time you went to any hospital or clinic

Pensen na última vez que foron a un hospital ou clínica

and the last time anybody spent an hour explaining those sorts of things to you.

e alguén estivo unha hora explicándolles ese tipo de cousas.

The fact that patients like Robin are going to these clinics,

O feito de que pacientes coma Robin

vaian a estas clínicas e dispensarios

are going to these dispensaries

and getting that sort of personalized attention

e reciban este tipo de atención personalizada

and education and service,

e educación e servizo

really should be a wake-up call to the healthcare system.

debería ser unha chamada de atención para o sistema sanitario.

People like Robin are turning away from mainstream medicine,

Xente coma Robin está rexeitando a medicina convencional,

turning to medical marijuana dispensaries

e acudindo a dispensarios de marihuana medicinal

because those dispensaries are giving them what they need.

porque estes ofrécenlles o que precisan.

If that's a wake-up call to the medical establishment,

Se é unha chamada de atención para o sistema sanitario,

it's a wake-up call that many of my colleagues are either not hearing

é unha chamada que moitos dos meus compañeiros non escoitan

or not wanting to hear.

ou non queren escoitar.

When I talk to my colleagues, physicians in particular,

Cando falo cos meus compañeiros, en particular con doutores,

about medical marijuana,

sobre marihuana medicinal din:

they say, "Oh, we need more evidence.

"Precisamos máis probas.

We need more research into benefits, we need more evidence about risks."

Precisamos máis estudos sobre os beneficios

e máis probas sobre os riscos".

And you know what? They're right.

E saben que? Teñen razón.

They're absolutely right.

Toda a razón.

We do need much more evidence about the benefits of medical marijuana.

Si que precisamos moitas máis probas

sobre os beneficios da marihuana medicinal.

We also need to ask the federal government to reschedule marijuana to Schedule II,

Tamén debemos pedirlle ao goberno federal que modifique as restricións da marihuana

or to deschedule it entirely to make that research possible.

para facer posible ese estudo.

We also need more research into medical marijuana's risks.

Tamén precisamos máis estudos sobre os riscos da marihuana medicinal.

Medical marijuana's risks --

Os riscos da marihuana medicinal...

we know a lot about the risks of recreational use,

Sabemos moito sobre os do uso recreativo

we know next to nothing about the risks of medical marijuana.

pero non sabemos nada sobre os da marihuana medicinal.

So we absolutely do need research,

Por iso precisamos investigar,

but to say that we need research

pero dicir que precisamos investigar

and not that we need to make any changes now

e non dicir que precisamos facer cambios agora

is to miss the point entirely.

non ten sentido ningún.

People like Robin aren't seeking out medical marijuana

Xente coma Robin non busca marihuana medicinal

because they think it's a wonder drug,

porque a consideren unha droga marabillosa

or because they think it's entirely risk-free.

ou porque pensen que non ten ningún risco.

They seek it out because the context in which it's delivered and administered

Búscana porque o contorno

no que se vende, administra ou usa

and used,

gives them the sort of control they need over their lives.

dálles o control que precisan sobre as súas vidas.

And that's a wake-up call we really need to pay attention to.

E esa é unha chamada de atención á que lle temos que facer caso.

The good news though is that there are lessons we can learn today

O bo é que hai leccións que hoxe podemos aprender

from those medical marijuana dispensaries.

dos dispensarios de marihuana medicinal.

And those are lessons we really should learn.

E son leccións que deberiamos aprender.

These are often small, mom-and-pop operations

Estes son normalmente pequenos negocios familiares

run by people with no medical training.

xestionados por xente sen formación médica.

E aínda que é vergoñento pensar

And while it's embarrassing to think

that many of these clinics and dispensaries are providing services

que moitas destas clínicas e dispensarios están ofrecendo servizos e apoio

and support and meeting patients' needs

e cubrindo as necesidades dos pacientes

in ways that billion-dollar healthcare systems aren't --

dun xeito que os millonarios sistemas sanitarios non fan

we should be embarrassed by that --

--debería darnos vergoña--,

but we can also learn from that.

tamén podemos aprender diso.

And there are probably three lessons at least

E hai polo menos tres leccións

that we can learn from those small dispensaries.

que podemos aprender deses pequenos dispensarios.

One: we need to find ways to give patients more control

Unha: precisamos atopar formas de darlles máis control aos pacientes

in small but important ways.

en cousas pequenas pero importantes.

How to interact with healthcare providers,

Como conversar con profesionais médicos,

when to interact with healthcare providers,

cando conversar con eles,

how to use medications in ways that work for them.

como usar os medicamentos de forma que funcionen para eles.

In my own practice,

No meu caso

I've gotten much more creative and flexible

volvinme moito máis creativo e flexible

in supporting my patients in using drugs safely

apoiando aos meus pacientes para que usen

os medicamentos de forma segura

to manage their symptoms --

para xestionar os síntomas

with the emphasis on safely.

pondo énfase na seguridade.

Many of the drugs I prescribe are drugs like opioids or benzodiazepines

Moitos dos medicamentos que prescribo son opioides ou benzodiacepinas

which can be dangerous if overused.

que poden ser perigosos se se consomen en exceso.

But here's the point.

Mais esta é a cuestión.

They can be dangerous if they're overused,

Poden ser perigosos se se usan en exceso,

but they can also be ineffective if they're not used in a way

pero poden ser ineficaces se non se usan de xeito consistente

that's consistent with what patients want and need.

co que os pacientes queren e precisan.

So that flexibility, if it's delivered safely,

Polo que esa flexibilidade, se se ofrece de forma segura

can be extraordinarily valuable for patients and their families.

pode ser moi valiosa para os pacientes e as súas familias.

That's number one.

Esa é a número un.

Number two: education.

Número dous: educación.

Huge opportunities

Grandes oportunidades

to learn from some of the tricks of those medical marijuana dispensaries

para aprender algúns trucos deses dispensarios de marihuana

to provide more education

para ofrecer máis formación

that doesn't require a lot of physician time necessarily,

que pode non requirirlle a un médico moito máis tempo,

or any physician time,

ou ningún,

but opportunities to learn about what medications we're using

senón oportunidades para aprender sobre que medicamentos usan

and why,

e por que,

prognoses, trajectories of illness,

prognoses, traxectoria da doenza,

and most importantly,

e o máis importante,

opportunities for patients to learn from each other.

oportunidades para os pacientes de aprender uns doutros.

How can we replicate what goes on

Como podemos imitar o que pasa

in those clinic and medical dispensary waiting rooms?

nas salas de espera desas clínicas ou dispensarios médicos?

How patients learn from each other, how people share with each other.

Como os pacientes aprenden uns doutros, como a xente comparte.

And last but not least,

E por último,

putting patients first the way those medical marijuana dispensaries do,

pór aos pacientes primeiro, igual que fan os dispensarios.

making patients feel legitimately like what they want,

Facer que os pacientes sintan de verdade que o que eles queren,

what they need,

o que precisan

is why, as healthcare providers,

é a razón pola que estamos aquí como profesionais médicos.

we're here.

Asking patients about their hopes, their fears, their goals and preferences.

Preguntarlles sobre as súas esperanzas, temores, metas e preferencias.

As a palliative care provider,

Como provedor de coidados paliativos

I ask all my patients what they're hoping for and what they're afraid of.

pregúntolles a todos os meus pacientes que esperan e que temen.

But here's the thing.

Pero esta é a cuestión:

Patients shouldn't have to wait until they're chronically seriously ill,

Eles non deberían ter que esperar ata sufriren unha doenza crónica,

often near the end of life,

a miúdo ao final das súas vidas.

they shouldn't have to wait until they're seeing a physician like me

Non deberían ter que esperar a ver un doutor coma min

before somebody asks them,

antes de que alguén lles pregunte:

"What are you hoping for?"

"Cales son as súas esperanzas? E os seus temores?"

"What are you afraid of?"

That should be baked into the way that healthcare is delivered.

Debería ir implícito na forma na que se ofrece o servizo sanitario.

We can do this --

Podemos facelo.

we really can.

De verdade que si.

Medical marijuana dispensaries and clinics all across the country

Os dispensarios e clínicas de marihuana de todo o país

are figuring this out.

están logrando resolvelo.

They're figuring this out

Están logrando resolvelo

in ways that larger, more mainstream health systems are years behind.

mentres os sistemas sanitarios máis grandes e convencionais

se están quedando anos atrás.

But we can learn from them,

Pero podemos aprender deles

and we have to learn from them.

e temos que facelo.

All we have to do is swallow our pride --

Só temos que tragar o orgullo

put aside the thought for a minute

e deixar de pensar por un minuto

that because we have lots of letters after our name,

que como temos moitas letras detrás do noso nome,

because we're experts,

somos expertos,

because we're chief medical officers of a large healthcare system,

ou somos directores médicos dun gran sistema sanitario

we know all there is to know about how to meet patients' needs.

xa o sabemos todo sobre como cubrir as necesidades dos pacientes.

We need to swallow our pride.

Debemos tragar o orgullo.

We need to go visit a few medical marijuana dispensaries.

Temos que visitar algúns dispensarios de marihuana medicinal.

We need to figure out what they're doing.

Temos que comprender o que fan.

We need to figure out why so many patients like Robin

Temos que descubrir por que moitos pacientes coma Robin

are leaving our mainstream medical clinics

abandonan as clínicas convencionais

and going to these medical marijuana dispensaries instead.

e acoden aos dispensarios de marihuana medicinal.

We need to figure out what their tricks are,

Temos que descubrir cales son os seus trucos

what their tools are,

e as súas ferramentas

and we need to learn from them.

e precisamos aprender deles.

If we do,

Se o facemos,

and I think we can, and I absolutely think we have to,

e penso que podemos, e por suposto penso que debemos,

we can guarantee all of our patients will have a much better experience.

podemos garantir que todos os pacientes terán unha mellor experiencia.

Thank you.

Grazas.

(Applause)

(Aplausos)