4 questions you should always ask your doctor | Christer Mjåset

Translator: Alexandra Sirpis Reviewer: Servizo de Normalización Lingüística

I am a neurosurgeon,

Son neurocirurxián

and I'm here to tell you today that people like me need your help.

e estou aquí para dicirvos que precisamos da vosa axuda.

And in a few moments, I will tell you how.

Axiña vos hei dicir como.

But first, let me start off by telling you about a patient of mine.

Primeiro, vou contarvos algo dunha paciente miña.

This was a woman in her 50s,

Era unha muller duns 50 anos

she was in generally good shape,

e estaba máis ou menos en forma,

but she had been in and out of hospital a few times

pero levaba un tempo entrando e saíndo do hospital

due to curative breast cancer treatment.

por un tratamento de cancro de mama.

Now she had gotten a prolapse from a cervical disc,

Tivo entón un prolapso de disco cervical

giving her radiating pain of a tense kind,

que lle provocaba unha dor

out into the right arm.

que se estendía ata o brazo dereito.

Looking at her MRI before the consultation,

Ao ver a súa resonancia antes da consulta,

I decided to suggest an operation.

decidín suxerirlle que se operase.

Now, neck operations like these are standardized, and they're quick.

As operacións de pescozo son rutineiras e rápidas.

But they carry a certain risk.

Porén, teñen certo risco.

You make an incision right here,

Faise unha incisión aquí,

and you dissect carefully past the trachea,

disécase con coidado a través da traquea

the esophagus,

e do esófago

and you try not to cut into the internal carotid artery.

e téntase non perforar a arteria carótide.

(Laughter)

(Risas)

Then you bring in the microscope,

Entón, co microscopio cirúrxico,

and you carefully remove the disc and the prolapse

extráese con coidado o disco e o prolapso

in the nerve root canal,

do canle do nervio

without damaging the cord and the nerve root

sen danar a medula nin a raíz nerviosa,

lying only millimeters underneath.

que se atopan uns milímetros máis abaixo.

The worst case scenario is the damage to the cord,

O peor que podería pasar sería danar a medula,

which can result in paralysis from the neck down.

o que causaría unha parálise do pescozo cara a abaixo.

Explaining this to the patient, she fell silent.

Ao explicarlle isto, a paciente quedou calada.

And after a few moments,

Tras un instante,

she uttered a few very decisive words for me and for her.

pronunciou unhas palabras decisivas para ambos:

"Doctor, is this really necessary?"

“Doutor, isto é realmente necesario?”

(Laughter)

(Risas)

And you know what I realized, right there and then?

Saben de que me din de conta nese momento?

It was not.

De que non o era.

In fact, when I get patients like this woman,

Cando recibo pacientes como esta muller,

I tend to advise not to operate.

adoito recomendarlles non operarse.

So what made me do it this time?

Que me levou a facelo esta vez?

Well, you see,

Pois ben,

this prolapse was so delicate,

este prolapso era tan delicado

I could practically see myself pulling it out of the nerve root canal

que me vía extraéndoo do canle do nervio

before she entered the consultation room.

xa antes de que ela entrase na consulta.

I have to admit it, I wanted to operate on her.

Teño que admitilo: quería operala.

I'd love to operate on her.

Encantaríame operala.

Operating, after all, is the most fun part of my job.

Á fin e ao cabo, operar é o máis divertido do meu traballo.

(Laughter)

(Risas)

I think you can relate to this feeling.

Supoño que vos sentiredes identificados.

My architect neighbor says he loves to just sit and draw

Ao meu veciño arquitecto gústalle sentarse a debuxar

and design houses.

e deseñar casas.

He'd rather do that all day

Preferiría facer iso

than talk to the client paying for the house

no canto de falar co cliente que paga a casa

that might even give him restrictions on what to do.

e que lle poría restricións do que facer.

But like every architect,

Como todo arquitecto,

every surgeon needs to look their patient in the eye

todo cirurxián debe mirar o seu paciente aos ollos

and together with the patient,

e decidir con el

they need to decide on what is best for the person having the operation.

cal é a mellor solución para quen vai operarse.

And that might sound easy.

Quizais soe fácil,

But let's look at some statistics.

pero vexamos algúns datos estatísticos.

The tonsils are the two lumps in the back of your throat.

As amígdalas son dous vultos da parte de atrás da gorxa.

They can be removed surgically,

Extráense mediante unha operación

and that's called a tonsillectomy.

coñecida como amigdalotomía.

This chart shows the operation rate of tonsillectomies in Norway

Este gráfico mostra a taxa de amigdalotomías en Noruega

in different regions.

en diferentes rexións.

What might strike you is that there is twice the chance

O que vos pode sorprender é que hai o dobre de posibilidades

that your kid -- because this is for children --

de que o voso fillo (porque isto é para nenos)

will get a tonsillectomy in Finnmark than in Trondheim.

se someta a unha amigdalotomía en Finnmark que en Trondheim.

The indications in both regions are the same.

As indicacións son iguais en ambos casos.

There should be no difference, but there is.

Non debería haber diferenzas, pero hainas.

Here's another chart.

Velaquí outro gráfico.

The meniscus helps stabilize the knee

O menisco axuda a estabilizar o xeonllo

and can be torn or fragmented acutely,

e pódese desgarrar ou fragmentar gravemente,

topically during sports like soccer.

especialmente en deportes como o fútbol.

What you see here is the operation rate for this condition.

O que vedes aquí é a taxa de operación desta afección.

And you see that the operation rate in Møre og Romsdal

Vese que a taxa de operación en Møre og Romsdal

is five times the operation rate in Stavanger.

é cinco veces superior á de Stavanger.

Five times.

Cinco veces.

How can this be?

Como pode ser?

Did the soccer players in Møre og Romsdal

Os xogadores de Møre og Romsdal

play more dirty than elsewhere in the country?

xogan máis sucio que os demais?

(Laughter)

(Risas)

Probably not.

Probablemente non.

I added some information now.

Engadín algo de información.

What you see now is the procedures performed

O que vedes agora son os procedementos

in public hospitals, in light blue,

en hospitais públicos, en azul,

the ones in private clinics are light green.

e os de clínicas privadas, en verde.

There is a lot of activity in the private clinics

Hai moita actividade nas clínicas privadas

in Møre og Romsdal, isn't there?

en Møre og Romsdal, non é?

What does this indicate?

Isto que indica?

A possible economic motivation to treat the patients.

Unha posible motivación económica para tratar os pacientes.

And there's more.

E aínda hai máis.

Recent research has shown that the difference of treatment effect

Houbo estudos recentes respecto á diferenza dos efectos

between regular physical therapy and operations for the knee --

entre a terapia física normal e unha operación de xeonllo

there is no difference.

que amosaron que non a hai.

Meaning that most of the procedures performed

O que significa que a maioría das operacións

on the chart I've just shown

que se mostran na gráfica

could have been avoided, even in Stavanger.

poderían evitarse, mesmo en Stavanger.

So what am I trying to tell you here?

Que quero dicir con isto?

Even though most indications for treatments in the world

Aínda que a maioría das indicacións dos tratamentos

are standardized,

están estandarizadas,

there is a lot of unnecessary variation of treatment decisions,

hai moitas diferenzas innecesarias nos tratamentos,

especially in the Western world.

especialmente no mundo occidental.

Some people are not getting the treatment that they need,

Algúns non reciben o tratamento que necesitan

but an even greater portion of you

e mesmo moitos de vós

are being overtreated.

recibides un tratamento innecesario.

"Doctor, is this really necessary?"

“Doutor, isto é realmente necesario?”

I've only heard that question once in my career.

Escoitei esa pregunta unha soa vez na miña carreira.

My colleagues say they never heard these words from a patient.

Os meus colegas din que nunca oíron esas palabras.

And to turn it the other way around,

E, para darlle a volta ao asunto,

how often do you think you'll get a "no" from a doctor

con que frecuencia cren que un médico dirá que non

if you ask such a question?

se lle fan esa pregunta?

Researchers have investigated this,

Investigouse ao respecto

and they come up with about the same "no" rate

e houbo a mesma porcentaxe de “non”

wherever they go.

en todas partes:

And that is 30 percent.

un 30 %.

Meaning, three out of 10 times,

É dicir, en 3 de cada 10 casos,

your doctor prescribes or suggests something

o médico receita ou aconsella algo

that is completely unnecessary.

que é completamente innecesario.

And you know what they claim the reason for this is?

Sabedes cal é a razón pola que din que o fan?

Patient pressure.

A presión do paciente.

In other words, you.

Noutras palabras: vós.

You want something to be done.

Vós queredes que se faga algo.

A friend of mine came to me for medical advice.

Un amigo meu pediume consello médico.

This is a sporty guy,

É un tipo deportista,

he does a lot of cross-country skiing in the winter time,

practica moito esquí de fondo en inverno

he runs in the summer time.

e corre en verán.

And this time, he'd gotten a bad back ache whenever he went jogging.

Resulta que, sempre que corría, doíanlle moito as costas,

So much that he had to stop doing it.

tanto que tivo que deixar de correr.

I did an examination, I questioned him thoroughly,

Examineino, fíxenlle todas as preguntas oportunas

and what I found out is that he probably had a degenerated disc

e vin que o máis probable é que tivese un disco deteriorado

in the lower part of his spine.

na parte baixa da espiña dorsal.

Whenever it got strained, it hurt.

Sempre que facía forza, doíalle.

He'd already taken up swimming instead of jogging,

Xa empezara a facer natación en vez de correr.

there was really nothing to do,

Non había nada máis que facer

e díxenlle: “Tes que ser máis selectivo

so I told him, "You need to be more selective

when it comes to training.

á hora de exercitarte.

Some activities are good for you,

Algúns exercicios son bos para ti,

some are not."

outros non.”

His reply was,

A súa resposta foi:

"I want an MRI of my back."

“Quero unha resonancia das costas.”

"Why do you want an MRI?"

“Por que unha resonancia?”

"I can get it for free through my insurance at work."

“Co seguro laboral sáeme de balde.”

"Come on," I said -- he was also, after all, my friend.

“Oe”, contesteille. Á fin de e ao cabo era o meu amigo.

"That's not the real reason."

“Ese non é o motivo real.”

"Well, I think it's going to be good to see how bad it looks back there."

“Creo que sería bo ver se a cousa está moi mal.”

"When did you start interpreting MRI scans?" I said.

“Desde cando interpretas resonancias magnéticas?”

(Laughter)

(Risas)

"Trust me on this.

“Confía en min.

You're not going to need the scan."

Non che fai falla a resonancia.”

"Well," he said,

“Ben…”, dixo.

and after a while, he continued, "It could be cancer."

E despois dunha pausa, engadiu: “Podería ser cancro.”

(Laughter)

(Risas)

He got the scan, obviously.

Fixo a resonancia, claro.

And through his insurance at work,

E, por medio do seu seguro médico,

he got to see one of my colleagues at work,

comprobou como un dos meus colegas

telling him about the degenerated disc,

lle contaba o do seu disco deteriorado:

that there was nothing to do,

que non había nada que facer

and that he should keep on swimming and quit the jogging.

e que era mellor seguir coa natación e esquecerse de correr.

After a while, I met him again and he said,

Tempo despois veu de novo e díxome:

"At least now I know what this is."

“Polo menos xa sei o que é.”

But let me ask you a question.

Déixenme preguntarlles:

What if all of you in this room with the same symptoms had an MRI?

E se todos os que teñen os mesmos síntomas fan unha resonancia?

And what if all the people in Norway

E se todo o mundo en Noruega

had an MRI due to occasional back pain?

fixese unha resonancia por unha dor de costas esporádica?

The waiting list for an MRI would quadruple, maybe even more.

A lista de espera para facela cuadriplicaríase ou incluso máis.

And you would all take the spot on that list

E ocuparían o lugar nesa lista

from someone who really had cancer.

de alguén que si ten cancro.

So a good doctor sometimes says no,

Así que un bo médico di que non de cando en vez

but the sensible patient also turns down, sometimes,

e, ás veces, un paciente prudente rexeita

an opportunity to get diagnosed or treated.

a oportunidade de que o diagnostiquen ou o traten.

"Doctor, is this really necessary?"

“Doutor, isto é realmente necesario?”

I know this can be a difficult question to ask.

Sei que é unha pregunta difícil.

In fact, if you go back 50 years,

De feito, hai 50 anos

this was even considered rude.

mesmo se consideraba de mala educación.

(Laughter)

(Risas)

If the doctor had decided what to do with you,

Se o médico xa decidira que facer contigo,

that's what you did.

iso é o que se facía.

A colleague of mine, now a general practitioner,

A unha colega miña, médica de cabeceira,

was sent away to a tuberculosis sanatorium as a little girl,

enviárona de nena a un sanatorio para tuberculosos

for six months.

durante seis meses.

It was a terrible trauma for her.

Foi moi traumático para ela.

She later found out, as a grown-up,

De adulta, descubriu

that her tests on tuberculosis had been negative all along.

que as súas probas de tuberculose sempre foran negativas.

The doctor had sent her away on nothing but wrong suspicion.

O médico mandáraa unicamente por unha sospeita errada.

No one had dared or even considered confronting him about it.

Ninguén se atreveu nin considerou levarlle a contra.

Not even her parents.

Nin os seus pais.

Today, the Norwegian health minister

Na actualidade, o ministro de Sanidade noruegués

talks about the patient health care service.

fala sobre o servizo de saúde do paciente.

The patient is supposed to get advice from the doctor about what to do.

Suponse que o paciente debe recibir consello sobre que facer.

This is great progress.

É un gran progreso,

But it also puts more responsibility on you.

pero tamén implica máis responsabilidade para vós.

You need to get in the front seat with your doctor

Debedes sentar cos vosos médicos

and start sharing decisions on where to go.

para tomar decisións xuntos.

So, the next time you're in a doctor's office,

Así que, a próxima vez que esteades na consulta do médico,

quero que lle preguntedes:

I want you to ask,

"Doctor, is this really necessary?"

“Doutor, isto é realmente necesario?”

And in my female patient's case,

No caso da miña paciente,

the answer would be no,

a resposta sería “non”,

but an operation could also be justified.

pero a intervención podería estar xustificada.

"So doctors, what are the risks attached to this operation?"

“Entón, cales son os riscos da intervención?”

Well, five to ten percent of patients will have worsening of pain symptoms.

Do 5 ao 10 % dos pacientes experimentan máis dor.

One to two percent of patients

Do 1 ao 2 % dos pacientes

will have an infection in the wound or even a rehemorrhage

sufrirán unha infección na ferida ou mesmo unha hemorraxia

that might end up in a re-operation.

que pode necesitar doutra intervención.

0.5 percent of patients also experience permanent hoarseness

O 0,5 % dos pacientes tamén sofren rouquén permanente

and a few, but still a few,

e algúns, aínda que poucos,

will experience reduced function in the arms or even legs.

sufrirán unha redución na función dos brazos ou das pernas.

"Doctor, are there other options?"

“Doutor, hai outras opcións?”

Yes, rest and physical therapy over some time

Si. Co tempo, o repouso e a fisioterapia

might get you perfectly well.

poden facer que mellores.

"And what happens if I don't do anything?"

“Que pasa se non fago nada?”

It's not recommended,

Non é recomendable,

pero aínda así existe unha pequena posibilidade de melloría.

but even then, there's a slight chance that you will get well.

Four questions.

Catro preguntas.

Simple questions.

Preguntas sinxelas.

Consider them your new toolbox to help us.

Considerádeas unha ferramenta para axudarnos a nós.

Is this really necessary?

Isto é realmente necesario?

What are the risks?

Cales son os riscos?

Are there other options?

Hai outras opcións?

And what happens if I don't do anything?

Que pasa se non fago nada?

Ask them when your doctor wants to send you to an MRI,

Preguntade isto cando o médico queira unha resonancia,

when he prescribes antibiotics

cando vos receite antibióticos

or suggests an operation.

ou vos propoña operarvos.

What we know from research

O que din as investigacións

é que 1 de cada 5 de vós, un 20 %,

is that one out of five of you, 20 percent,

will change your opinion on what to do.

cambiará de opinión.

And by doing that, you will not only have made your life

E con isto non só simplificarán a vosa vida

a whole lot easier, and probably even better,

e seguramente a mellorarán,

but the whole health care sector

senón que todo o sistema de saúde

will have benefited from your decision.

se beneficiará da vosa decisión.

Thank you.

Grazas.

(Applause)

(Aplausos)