4 questions you should always ask your doctor | Christer Mjåset

Prevoditelj: Djurdjica Ercegovac Recezent: Sanda L

I am a neurosurgeon,

Ja sam neurokirurg

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

i danas sam ovdje kako bih vam rekao da ljudi poput mene trebaju vašu pomoć.

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

I za tren ću vam reći kako.

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

No, prvo, dozvolite da vam kažem nešto o jednom svom pacijentu.

This was a woman in her 50s,

To je bila žena u pedesetima,

she was in generally good shape,

općenito je bila u dobroj formi,

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

ali je u nekoliko navrata boravila u bolnici

due to curative breast cancer treatment.

zbog liječenja raka dojke.

Now she had gotten a prolapse from a cervical disc,

Ovog puta imala je prolaps vratnog diska,

giving her radiating pain of a tense kind,

što joj je uzrokovalo isijavajuću bol u vidu napetosti

out into the right arm.

koja se širila u desnu ruku.

Looking at her MRI before the consultation,

Pogledavši njenu MR snimku prije konzultacije,

I decided to suggest an operation.

odlučio sam predložiti operaciju.

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

Operacije vrata poput te, standardizirane su i brze,

But they carry a certain risk.

ali nose određeni rizik.

You make an incision right here,

Napravite rez upravo ovdje

and you dissect carefully past the trachea,

i pažljivo secirate duž dušnika,

the esophagus,

jednjaka,

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

i nastojite da ne zarežete unutarnju vratnu arteriju.

(Laughter)

(Smijeh)

Then you bring in the microscope,

Onda uvučete mikroskop

and you carefully remove the disc and the prolapse

i pažljivo uklonite disk i prolaps

in the nerve root canal,

u kanalu korijena živca

without damaging the cord and the nerve root

tako da ne oštetite moždinu i korijen živca

lying only millimeters underneath.

koji se nalaze samo par milimetara ispod.

The worst case scenario is the damage to the cord,

Scenarij najgoreg slučaja je oštećenje leđne moždine,

which can result in paralysis from the neck down.

što može rezultirati paralizom od vrata naniže.

Explaining this to the patient, she fell silent.

Objasnivši to pacijentici, ona je zanijemila.

And after a few moments,

I nakon nekoliko trenutaka

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

izustila je svega nekoliko riječi koje su bile odlučne za mene i nju.

"Doctor, is this really necessary?"

"Doktore, je li to zaista nužno?"

(Laughter)

(Smijeh)

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

I znate li što sam shvatio upravo u tom trenutku?

It was not.

Nije bilo nužno.

In fact, when I get patients like this woman,

Ustvari, kada mi dođu pacijenti poput te žene,

I tend to advise not to operate.

nisam sklon savjetovati operaciju.

So what made me do it this time?

Pa što me onda nagnalo na to ovaj put?

Well, you see,

Pa, vidite,

this prolapse was so delicate,

taj prolaps je bio tako delikatan,

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

mogao sam praktički vidjeti sebe kako ga izvlačim iz kanala korijena živca

before she entered the consultation room.

i prije no što je ušla u ordinaciju.

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

Moram priznati, želio sam je operirati.

I'd love to operate on her.

Volio bih je operirati.

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

Operiranje je, na koncu, najzabavniji dio mog posla.

(Laughter)

(Smijeh)

I think you can relate to this feeling.

Mislim da možete shvatiti taj osjećaj.

My architect neighbor says he loves to just sit and draw

Moj susjed, arhitekt, kaže da voli samo sjesti i crtati

and design houses.

i dizajnirati kuće.

He'd rather do that all day

Radije bi to radio cijeli dan

than talk to the client paying for the house

nego razgovarao s klijentom koji plaća za kuću

that might even give him restrictions on what to do.

i koji bi mu čak mogao zadati ograničenja za ono što radi.

But like every architect,

No, kao i svaki arhitekt,

every surgeon needs to look their patient in the eye

svaki kirurg mora pogledati svog pacijenta u oči

and together with the patient,

i zajedno s pacijentom

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

odlučiti što je najbolje za osobu koja se operira.

And that might sound easy.

A to možda zvuči lako.

But let's look at some statistics.

No, pogledajmo par statistika.

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

Krajnici su dvije izrasline na stražnjoj strani grla.

They can be removed surgically,

Mogu se kirurški odstraniti,

and that's called a tonsillectomy.

i to se zove tonzilektomija.

This chart shows the operation rate of tonsillectomies in Norway

Ovaj graf prikazuje stopu operacija tonzilektomije u Norveškoj

in different regions.

u različitim regijama.

What might strike you is that there is twice the chance

Možda će vas iznenaditi da je duplo veća šansa

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

da će vaše dijete -- jer ovo se odnosi na djecu --

will get a tonsillectomy in Finnmark than in Trondheim.

proći tonzilektomiju u Finnmarku nego u Trondheimu.

The indications in both regions are the same.

Indikacije u obje regije su jednake.

There should be no difference, but there is.

Ne bi trebala postojati razlika, ali postoji.

Here's another chart.

Evo još jednog grafa.

The meniscus helps stabilize the knee

Meniskus pomaže stabilizaciji koljena

and can be torn or fragmented acutely,

i može biti pokidan ili akutno fragmentiran,

topically during sports like soccer.

tipično u sportovima kao što je nogomet.

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

Ono što ovdje vidite je stopa operacija za to stanje.

And you see that the operation rate in Møre og Romsdal

I vidite da je stopa operacija u regiji Møre og Rosdal

is five times the operation rate in Stavanger.

pet puta veća od stope operacija u Stavangeru.

Five times.

Pet puta.

How can this be?

Kako to može biti?

Did the soccer players in Møre og Romsdal

Igraju li nogometaši u Møre og Romsdalu prljaviju igru

play more dirty than elsewhere in the country?

nego u drugim dijelovima zemlje?

(Laughter)

(Smijeh)

Probably not.

Vjerojatno ne.

I added some information now.

Sad sam dodao još neke informacije.

What you see now is the procedures performed

Ono što sada vidite su operacije izvršene

in public hospitals, in light blue,

u javnim bolnicama, svjetloplavo,

the ones in private clinics are light green.

one u privatnim klinikama su svjetlozelene.

There is a lot of activity in the private clinics

Mnogo je aktivnosti u privatnim klinikama

in Møre og Romsdal, isn't there?

u Møre og Romsdalu, zar ne?

What does this indicate?

Na što to ukazuje?

A possible economic motivation to treat the patients.

Moguću ekonomsku motivaciju za liječenje pacijenata.

And there's more.

A ima još toga.

Recent research has shown that the difference of treatment effect

Najnovija istraživanja pokazuju da razlika u učinkovitosti tretmana

between regular physical therapy and operations for the knee --

između redovne fizikalne terapije i operacije koljena --

there is no difference.

nema razlike.

Meaning that most of the procedures performed

Što znači da je većina obavljenih operacija,

on the chart I've just shown

na grafu koji sam upravo pokazao,

could have been avoided, even in Stavanger.

mogla biti izbjegnuta, čak i u Stavangeru.

So what am I trying to tell you here?

Dakle, što vam ovime pokušavam reći?

Even though most indications for treatments in the world

Unatoč tome što je u svijetu većina indikacija za liječenje

are standardized,

standardizirana,

there is a lot of unnecessary variation of treatment decisions,

postoji mnogo nepotrebnih varijacija u odlukama o liječenju,

especially in the Western world.

posebno u zapadnom svijetu.

Some people are not getting the treatment that they need,

Neki ljudi ne dobivaju tretman koji im je potreban,

but an even greater portion of you

ali još veći dio vas

are being overtreated.

je previše tretiran.

"Doctor, is this really necessary?"

"Doktore, je li to zaista nužno?"

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

To sam pitanje čuo samo jednom u svojoj karijeri.

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

Moji kolege kažu da nikada nisu čuli te riječi od pacijenta.

And to turn it the other way around,

A da to preokrenemo:

što mislite koliko puta bi vam liječnik odgovorio "Ne"

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

if you ask such a question?

kad biste mu postavili takvo pitanje?

Researchers have investigated this,

Znanstvenici su to istraživali

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

i došli su do otprilike iste stope za odgovor "Ne"

wherever they go.

kojim god putem krenuli.

And that is 30 percent.

A to je 30 posto.

Meaning, three out of 10 times,

Što znači, u tri od deset slučajeva

your doctor prescribes or suggests something

vaš liječnik propisuje ili predlaže nešto

that is completely unnecessary.

što je potpuno nepotrebno.

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

A znate li što tvrde da je tome razlog?

Patient pressure.

Pritisak pacijenta.

In other words, you.

Drugim riječima, vi.

You want something to be done.

Vi želite da se nešto učini.

A friend of mine came to me for medical advice.

Jedan moj prijatelj obratio mi se za medicinski savjet.

This is a sporty guy,

To je sportski momak,

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

mnogo se bavi cross-country skijanjem zimi,

he runs in the summer time.

ljeti trči.

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

A ovoga puta je imao ozbiljne bolove u leđima kad god je džogirao.

So much that he had to stop doing it.

Toliko jako da je morao prestati s tim.

I did an examination, I questioned him thoroughly,

Ja sam ga pregledao, temeljito ga ispitao,

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

i ustanovio sam da vjerojatno ima degeneraciju diska

in the lower part of his spine.

u donjem dijelu kralježnice.

Whenever it got strained, it hurt.

Kad god je napregnuta, to boli.

He'd already taken up swimming instead of jogging,

On je već počeo s plivanjem umjesto džogiranja,

there was really nothing to do,

stvarno se ništa nije moglo učiniti,

pa sam mu rekao,"Moraš biti selektivniji

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

kad je u pitanju vježbanje.

when it comes to training.

Some activities are good for you,

Neke aktivnosti su dobre za tebe,

some are not."

neke nisu."

His reply was,

Njegov je odgovor bio,

"I want an MRI of my back."

"Želim magnetsku rezonanciju leđa."

"Why do you want an MRI?"

"Zašto želiš MR?"

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

"Mogu to dobiti besplatno preko svog osiguranja na poslu."

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

"Ma, hajde," rekao sam -- na koncu, bio mi je i prijatelj.

"That's not the real reason."

"To nije pravi razlog."

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

"Pa, mislim da bi bilo dobro vidjeti koliko loše izgleda to odostraga."

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

"Otkada si ti počeo tumačiti MR snimke?", rekao sam.

(Laughter)

(Smijeh)

"Trust me on this.

"Vjeruj mi,

You're not going to need the scan."

neće ti trebati to snimanje."

"Well," he said,

"Pa," rekao je on,

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

i nakon nekog vremena nastavio, "mogao bi biti rak."

(Laughter)

(Smijeh)

He got the scan, obviously.

Dobio je taj snimak, očito.

And through his insurance at work,

A preko svog osiguranja na poslu,

he got to see one of my colleagues at work,

dobio je pregled kod jednog od mojih kolega s posla,

telling him about the degenerated disc,

koji mu je rekao za degeneraciju diska,

that there was nothing to do,

da se tu ne može ništa

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

i da treba nastaviti s plivanjem i prestati džogirati.

Nakon nekog vremena ponovo sam ga sreo i rekao je,

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

"At least now I know what this is."

"Sada bar znam što je to."

But let me ask you a question.

No, dozvolite da vas pitam,

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

što kad biste svi vi u ovoj dvorani s istim simptomima otišli na MR?

And what if all the people in Norway

I što kad bi svi ljudi u Norveškoj

had an MRI due to occasional back pain?

išli na MR zbog povremenih bolova u leđima?

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

Lista čekanja na MR bi se učetvorostručila, možda i više.

And you would all take the spot on that list

A svi biste vi uzeli mjesto na toj listi

from someone who really had cancer.

nekom drugom tko stvarno ima rak.

So a good doctor sometimes says no,

Zato dobar liječnik ponekad kaže ne,

but the sensible patient also turns down, sometimes,

a razuman pacijent također odbija, ponekad,

an opportunity to get diagnosed or treated.

priliku za dijagnozu i liječenje.

"Doctor, is this really necessary?"

"Doktore, je li to zaista nužno?"

I know this can be a difficult question to ask.

Znam da može biti teško postaviti to pitanje.

In fact, if you go back 50 years,

Ustvari, ako se vratite 50 godina unatrag,

this was even considered rude.

to se čak smatralo nepristojnim.

(Laughter)

(Smijeh)

If the doctor had decided what to do with you,

Ako je liječnik odlučio što učiniti s vama,

that's what you did.

to ste i učinili.

A colleague of mine, now a general practitioner,

Jedna moja kolegica, liječnica opće medicine,

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

bila je, kao mala djevojčica, poslana u sanatorij za liječenje tuberkuloze

for six months.

na šest mjeseci.

It was a terrible trauma for her.

To je za nju bila užasna trauma.

She later found out, as a grown-up,

Kasnije je otkrila, kao odrasla,

that her tests on tuberculosis had been negative all along.

da su njeni testovi na tuberkulozu cijelo vrijeme bili negativni.

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

Liječnik ju je poslao samo na temelju svoje pogrešne sumnje.

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

Nitko se nije usuđivao proturječiti mu u tome.

Not even her parents.

Čak ni njeni roditelji.

Today, the Norwegian health minister

Danas, norveški ministar zdravstva

talks about the patient health care service.

govori o zdravstvenoj usluzi pacijenata.

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

Pacijent bi trebao dobiti savjet od liječnika o tome što učiniti.

This is great progress.

To je veliki napredak.

But it also puts more responsibility on you.

Ali to također prenosi više odgovornosti na vas.

You need to get in the front seat with your doctor

Vi morate sjesti sa svojim liječnikom

and start sharing decisions on where to go.

i početi dijeliti odluke o tome kojim smjerom krenuti.

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

Pa sljedeći puta kada budete u liječničkoj ordinaciji,

I want you to ask,

želim da ga upitate,

"Doctor, is this really necessary?"

"Doktore, je li to zaista nužno?"

And in my female patient's case,

A u slučaju moje pacijentice,

the answer would be no,

odgovor bi bio 'nije'.

but an operation could also be justified.

Ali i operacija bi također mogla biti opravdana.

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

"Doktore, koji su rizici povezani s tom operacijom?"

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

Pa, pet do deset posto pacijenata će imati pogoršanje bolnih simptoma.

One to two percent of patients

Jedan do dva posto pacijenata

will have an infection in the wound or even a rehemorrhage

imat će infekciju rane ili čak hemoragiju

that might end up in a re-operation.

koja može završiti ponovnom operacijom.

0.5 percent of patients also experience permanent hoarseness

0,5 posto pacijenata će osjećati stalnu promuklost,

and a few, but still a few,

a nekoliko, ali samo nekoliko,

will experience reduced function in the arms or even legs.

doživjet će smanjenu funkciju ruku ili čak nogu.

"Doctor, are there other options?"

"Doktore, postoje li druge opcije?"

Yes, rest and physical therapy over some time

Da, odmor i fizikalna terapija tijekom nekog vremena

might get you perfectly well.

mogli bi dovesti do potpunog oporavka.

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

"A što se događa ako ne učinim ništa?"

It's not recommended,

To nije preporučljivo,

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

no čak i tada postoji mala nada da ćete se oporaviti.

Four questions.

Četiri pitanja.

Simple questions.

Jednostavna pitanja.

Consider them your new toolbox to help us.

Smatrajte ih svojim novim alatom kojim ćete nam pomoći.

Is this really necessary?

Je li to zaista nužno?

What are the risks?

Koji su rizici?

Are there other options?

Postoje li druge opcije?

And what happens if I don't do anything?

I što se događa ako ne učinim ništa?

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

Upitajte ih kada vas vaš doktor želi poslati na MR,

when he prescribes antibiotics

kad prepisuje antibiotike

or suggests an operation.

ili predlaže operaciju.

What we know from research

Ono što znamo iz istraživanja

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

je da će jedan između petoro vas,

20 posto,

will change your opinion on what to do.

promijeniti svoje mišljenje o tome što učiniti.

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

A učinivši to, ne samo da ćete svoj život učiniti mnogo lakšim,

a whole lot easier, and probably even better,

a vjerojatno čak i boljim,

but the whole health care sector

nego će i cijeli sektor zdravstva imati koristi od vaše odluke.

will have benefited from your decision.

Thank you.

Hvala.

(Applause)

(Pljesak)