Brian Goldman: Doctors make mistakes. Can we talk about that?

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Prevoditelj: Senzos Osijek Recezent: Mislav Ante Omazić - EFZG
00:15
I think we have to do something
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Mislim da moramo učiniti nešto
00:17
about a piece of the culture of medicine that has to change.
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s dijelom medicinske kulture koji se mora promijeniti.
00:20
And I think it starts with one physician, and that's me.
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I smatram kako to počinje s jednim liječnikom, a to sam ja.
00:23
And maybe I've been around long enough
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Možda sam dovoljno dugo tu negdje
00:25
that I can afford to give away some of my false prestige
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da si mogu priuštiti odricanje od lažnog ugleda
00:27
to be able to do that.
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kako bih to mogao učiniti.
00:29
Before I actually begin the meat of my talk,
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Prije no što zapravo dođem do poante svog govora,
00:31
let's begin with a bit of baseball.
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počnimo s malo bejzbola.
00:33
Hey, why not?
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Hej, zašto ne?
00:35
We're near the end, we're getting close to the World Series.
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Pri kraju smo, bližimo se World Series-u.
00:38
We all love baseball, don't we?
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Svi mi volimo bejzbol, zar ne?
00:41
(Laughter)
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(Smijeh)
00:43
Baseball is filled with some amazing statistics.
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Bejzbol je pun nevjerojatne statistike.
00:46
And there's hundreds of them.
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I ima ih na stotine.
00:49
"Moneyball" is about to come out, and it's all about statistics
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"Igra pobjednika" (film) samo što nije izašla i cijeli je povezan sa statistikom
00:52
and using statistics to build a great baseball team.
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i korištenjem statistike kako bi se napravila odlična bejzbolska momčad.
00:54
I'm going to focus on one stat
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Usredotočit ću se na jednu statistiku
00:57
that I hope a lot of you have heard of.
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za koju se nadam kako su mnogi čuli za nju.
00:59
It's called batting average.
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Zove se prosjek udaranja.
01:01
So we talk about a 300, a batter who bats 300.
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Govorimo o 300, o igraču koji udara 300.
01:04
That means that ballplayer batted safely, hit safely
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To znači da je igrač udarao sigurno, pogodio sigurno
01:08
three times out of 10 at bats.
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tri puta od 10 udaraca.
01:11
That means hit the ball into the outfield,
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To znači pogoditi teren loptom,
01:13
it dropped, it didn't get caught,
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ona pada, nije uhvaćena
01:15
and whoever tried to throw it to first base didn't get there in time
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i tko god ju je pokušao baciti do prve baze nije stigao tamo na vrijeme
01:18
and the runner was safe.
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i trkač je siguran.
01:20
Three times out of 10.
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Tri puta od mogućih 10.
01:23
Do you know what they call a 300 hitter
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Znate li kako zovu udarača koji udara 300
01:26
in Major League Baseball?
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u Velikoj bejzbolskoj ligi?
01:28
Good, really good,
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Dobrim, jako dobrim,
01:31
maybe an all-star.
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možda čak zvijezdom.
01:34
Do you know what they call
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Znate li kako zovu udarača
01:36
a 400 baseball hitter?
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koji udara 400?
01:38
That's somebody who hit, by the way,
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To je netko tko je udario, usput,
01:40
four times safely out of every 10.
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četiri puta sigurno od svakih 10.
01:42
Legendary --
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Legendarnim –
01:45
as in Ted Williams legendary --
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poput legendarnog Teda Williamsa –
01:47
the last Major League Baseball player
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posljednjeg igrača Velike bejzbolske lige
01:49
to hit over 400 during a regular season.
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koji je udario 400 tijekom redovne sezone.
01:52
Now let's take this back into my world of medicine
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Vratimo se sad u moj svijet medicine
01:54
where I'm a lot more comfortable,
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u kojem se osjećam ugodnije
01:56
or perhaps a bit less comfortable
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ili možda malo manje ugodno
01:58
after what I'm going to talk to you about.
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nakon onoga što ću vam ispričati.
02:01
Suppose you have appendicitis
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Pretpostavimo da imate upalu slijepog crijeva
02:03
and you're referred to a surgeon
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i uputili su vas kirurgu
02:05
who's batting 400 on appendectomies.
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koji udara 400 na operacijama slijepog crijeva.
02:07
(Laughter)
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(Smijeh)
02:10
Somehow this isn't working out, is it?
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To nekako ne funkcionira, zar ne?
02:13
Now suppose you live
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Zamislite sad da živite
02:15
in a certain part of a certain remote place
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u određenom dijelu određenog udaljenog mjesta
02:18
and you have a loved one
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i imate voljenu osobu
02:20
who has blockages in two coronary arteries
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kojoj su zakrčene dvije koronarne arterije
02:23
and your family doctor refers that loved one to a cardiologist
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i vaš obiteljski liječnik upućuje tog voljenog kardiologu
02:26
who's batting 200 on angioplasties.
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koju udara 200 na angioplastici.
02:30
But, but, you know what?
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Ali, ali, znate što?
02:32
She's doing a lot better this year. She's on the comeback trail.
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Ona je mnogo bolja ove godine. Na povratnoj je stazi.
02:34
And she's hitting a 257.
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I udara 257.
02:37
Somehow this isn't working.
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To opet nekako ne funkcionira.
02:39
But I'm going to ask you a question.
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Ali postavit ću vam pitanje.
02:41
What do you think a batting average
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Što mislite,
02:43
for a cardiac surgeon or a nurse practitioner
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za kardiokirurga ili medicinsku sestru
02:45
or an orthopedic surgeon,
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ili kirurga ortopeda,
02:47
an OBGYN, a paramedic
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ginekologa ili bolničara;
02:49
is supposed to be?
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koliki bi trebao biti prosjek udaranja?
02:52
1,000, very good.
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1.000, vrlo dobro.
02:55
Now truth of the matter is,
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Istini za volju,
02:57
nobody knows in all of medicine
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u cijeloj medicini
02:59
what a good surgeon
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nitko ne zna koliko bi
03:01
or physician or paramedic
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trebao udarati dobar kirurg
03:03
is supposed to bat.
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ili liječnik ili bolničar.
03:05
What we do though is we send each one of them, including myself,
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Ono što radimo jest da pošaljemo svakog od njih, uključujući i sebe,
03:07
out into the world
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van u svijet sa savjetom,
03:09
with the admonition, be perfect.
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budi savršen.
03:11
Never ever, ever make a mistake,
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Nikada, ali nikada nemoj napraviti grešku,
03:13
but you worry about the details, about how that's going to happen.
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ali brini o detaljima, o tome kako će se to dogoditi.
03:16
And that was the message that I absorbed
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To je bila poruka koju sam upijao
03:18
when I was in med school.
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tijekom medicinskog fakulteta.
03:20
I was an obsessive compulsive student.
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Bio sam opsesivno kompulzivni student.
03:23
In high school, a classmate once said
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U srednjoj školi, prijatelj iz razreda jednom je rekao
03:26
that Brian Goldman would study for a blood test.
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da će Brian Goldman studirati za testiranje krvi.
03:28
(Laughter)
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(Smijeh)
03:31
And so I did.
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I jesam.
03:33
And I studied in my little garret
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I studirao sam na svom malom tavanu
03:35
at the nurses' residence at Toronto General Hospital,
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u prebivalištu medicinskih sestara u bolnici Toronto General,
03:37
not far from here.
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ne tako daleko odavde.
03:39
And I memorized everything.
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I upamtio sam sve.
03:41
I memorized in my anatomy class
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Na satovima anatomije
03:43
the origins and exertions of every muscle,
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pamtio sam početak i naprezanje svakog mišića,
03:45
every branch of every artery that came off the aorta,
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svake grane bilo koje arterije koja je došla iz aorte,
03:48
differential diagnoses obscure and common.
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diferencijalne dijagnoze – neuobičajene i uobičajene.
03:51
I even knew the differential diagnosis
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Čak sam znao diferencijalnu dijagnozu
03:53
in how to classify renal tubular acidosis.
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toga kako klasificirati bubrežnu tubularnu acidozu.
03:55
And all the while,
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I svo to vrijeme
03:57
I was amassing more and more knowledge.
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sam skupljao sve više i više znanja.
03:59
And I did well, I graduated with honors,
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I uspio sam, diplomirao sam s počastima,
04:01
cum laude.
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s pohvalom.
04:03
And I came out of medical school
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I izašao sam iz medicinskog fakulteta
04:06
with the impression
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s dojmom
04:08
that if I memorized everything and knew everything,
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da ako sam sve zapamtio i sve znao
04:10
or as much as possible,
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ili bar što je više moguće,
04:12
as close to everything as possible,
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gotovo blizu toga da je sve moguće,
04:14
that it would immunize me against making mistakes.
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da će me to cijepiti protiv pravljenja grešaka.
04:17
And it worked
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I to je djelovalo
04:19
for a while,
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neko vrijeme,
04:22
until I met Mrs. Drucker.
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sve dok nisam upoznao gđu. Drucker.
04:25
I was a resident at a teaching hospital here in Toronto
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Bio sam specijalizant u sveučilišnoj bolnici ovdje u Torontu
04:27
when Mrs. Drucker was brought to the emergency department
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kad je gđa. Drucker dovezena na odjel hitne
04:30
of the hospital where I was working.
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u bolnicu u kojoj sam radio.
04:32
At the time I was assigned to the cardiology service
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U to sam vrijeme bio dodijeljen kardiološkoj službi
04:34
on a cardiology rotation.
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kao kardiološka zamjena.
04:36
And it was my job,
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Moj je posao bio,
04:38
when the emergency staff called for a cardiology consult,
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kad je osoblje hitne pozvalo nekog na kardiološko savjetovanje,
04:40
to see that patient in emerg.
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da dođem vidjeti pacijenta na hitnu
04:43
and to report back to my attending.
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i da izvjestim o tome svog nadređenog.
04:45
And I saw Mrs. Drucker, and she was breathless.
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Vidio sam gđu. Drucker, bila je bez zraka.
04:48
And when I listened to her, she was making a wheezy sound.
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Kada sam je poslušao, ispuštala je šišteći zvuk.
04:51
And when I listened to her chest with a stethoscope,
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A kada sam poslušao njena prsa stetoskopom,
04:53
I could hear crackly sounds on both sides
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mogao sam čuti pucketajuće zvukove na obje strane
04:55
that told me that she was in congestive heart failure.
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što mi je govorilo da je imala kongestivno zatajenje srca.
04:58
This is a condition in which the heart fails,
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To je stanje u kojem srce zakazuje
05:01
and instead of being able to pump all the blood forward,
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i umjesto da je u mogućnosti da tjera svu krv naprijed,
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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krv se vraća natrag u pluća, pluća se pune krvlju
05:06
and that's why you have shortness of breath.
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i zato ostajete bez zraka.
05:08
And that wasn't a difficult diagnosis to make.
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To nije bila dijagnoza koju je bilo teško donijeti.
05:11
I made it and I set to work treating her.
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Donio sam je i krenuo je liječiti.
05:14
I gave her aspirin. I gave her medications to relieve the strain on her heart.
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Dao sam joj aspirin. Dao sam joj lijekove koji olakšavaju naprezanje njenog srca.
05:17
I gave her medications that we call diuretics, water pills,
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Dao sam joj lijekove koje zovemo diureticima, vodene pilule,
05:20
to get her to pee out the access fluid.
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kako bi izmokrila tekućinu.
05:23
And over the course of the next hour and a half or two,
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I tijekom sljedećih sat i pol ili dva,
05:25
she started to feel better.
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počela se bolje osjećati.
05:27
And I felt really good.
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I ja sam se osjećao stvarno dobro.
05:30
And that's when I made my first mistake;
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A tada sam učinio svoju prvu pogrešku;
05:33
I sent her home.
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poslao sam je kući.
05:35
Actually, I made two more mistakes.
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Zapravo, učinio sam još dvije greške.
05:38
I sent her home
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Poslao sam je kući
05:40
without speaking to my attending.
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bez da sam razgovarao sa svojim nadređenim.
05:42
I didn't pick up the phone and do what I was supposed to do,
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Nisam podigao telefonsku slušalicu i učinio što sam trebao,
05:45
which was call my attending and run the story by him
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a to je nazvati svog nadređenog, ispričati mu priču
05:47
so he would have a chance to see her for himself.
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kako bi on imao priliku otići je vidjeti sam.
05:50
And he knew her,
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A poznavao ju je,
05:52
he would have been able to furnish additional information about her.
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bio bi u stanju opskrbiti nas dodatnim informacijama o njoj.
05:55
Maybe I did it for a good reason.
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Možda sam to učinio s dobrim razlogom.
05:57
Maybe I didn't want to be a high-maintenance resident.
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Možda nisam želio biti specijalizant koji će privlačiti puno pozornosti.
06:00
Maybe I wanted to be so successful
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Možda sam želio biti toliko uspješan
06:02
and so able to take responsibility
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i toliko sposoban preuzeti odgovornost
06:04
that I would do so
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da sam to i učinio
06:06
and I would be able to take care of my attending's patients
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i bio bih u stanju pobrinuti se za pacijente svog nadređenog
06:08
without even having to contact him.
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bez da ga uopće kontaktiram.
06:10
The second mistake that I made was worse.
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Druga greška koju sam učinio je bila gora.
06:14
In sending her home,
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Šaljući je kući,
06:16
I disregarded a little voice deep down inside
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ignorirao sam mali glas duboko u sebi
06:18
that was trying to tell me,
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koji mi je pokušavao reći,
06:20
"Goldman, not a good idea. Don't do this."
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"Goldman, to nije dobra ideja. Nemoj to raditi."
06:23
In fact, so lacking in confidence was I
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Zapravo, toliko mi je nedostajalo povjerenja
06:26
that I actually asked the nurse
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da sam pitao sestru
06:28
who was looking after Mrs. Drucker,
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koja se brinula o gđi. Drucker,
06:30
"Do you think it's okay if she goes home?"
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"Mislite li kako je u redu da ide kući?"
06:33
And the nurse thought about it
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Sestra je razmislila o tome
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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i rekla veoma odvažno, "Da, mislim kako će biti dobro."
06:37
I can remember that like it was yesterday.
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Sjećam se toga kao da je bilo jučer.
06:40
So I signed the discharge papers,
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I tako sam potpisao otpusno pismo,
06:42
and an ambulance came, paramedics came to take her home.
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kola hitne pomoći su došla, bolničari su je odveli kući.
06:45
And I went back to my work on the wards.
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A ja sam se vratio svom poslu na odjelima.
06:48
All the rest of that day,
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Ostatak tog dana,
06:50
that afternoon,
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tog popodneva,
06:52
I had this kind of gnawing feeling inside my stomach.
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imao sam neki mučan osjećaj u želucu.
06:55
But I carried on with my work.
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Ali nastavio sam s poslom.
06:58
And at the end of the day, I packed up to leave the hospital
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Na kraju dana, spremao sam se otići iz bolnice
07:00
and walked to the parking lot
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i hodao sam prema parkiralištu
07:02
to take my car and drive home
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kako bih došao do svog auta i odvezao se kući,
07:04
when I did something that I don't usually do.
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no tada sam učinio nešto što inače ne radim.
07:08
I walked through the emergency department on my way home.
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Prošao sam kroz odjel hitne pomoći na svom putu kući.
07:11
And it was there that another nurse,
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A tamo je bila jedna druga sestra,
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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ne ona koja je brinula o gđi. Drucker ranije, već druga,
07:16
said three words to me
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rekla mi je tri riječi,
07:19
that are the three words
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a to su tri riječi
07:21
that most emergency physicians I know dread.
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kojih se većina liječnika hitne pomoći koje ja znam užasavaju.
07:24
Others in medicine dread them as well,
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I drugi u medicini ih se također užasavaju,
07:26
but there's something particular about emergency medicine
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ali nešto je posebno s hitnom pomoći
07:28
because we see patients so fleetingly.
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jer vidimo pacijente tako prolazno.
07:32
The three words are:
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Te tri riječi su:
07:34
Do you remember?
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Sjećate li se?
07:38
"Do you remember that patient you sent home?"
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"Sjećate li se te pacijentice koju ste poslali kući?"
07:41
the other nurse asked matter-of-factly.
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pitala je ta druga sestra odmah.
07:43
"Well she's back,"
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"Pa, vratila se,"
07:45
in just that tone of voice.
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tim tonom glasa.
07:47
Well she was back all right.
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Itekako se vratila.
07:49
She was back and near death.
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Vratila se i bila je blizu smrti.
07:52
About an hour after she had arrived home,
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Otprilike sat vremena nakon što je stigla kući,
07:54
after I'd sent her home,
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nakon što sam je poslao kući,
07:56
she collapsed and her family called 911
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pala je u nesvijesti i njena obitelj je nazvala 911
07:59
and the paramedics brought her back to the emergency department
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pa su je bolničari doveli natrag na odjel hitne pomoći
08:01
where she had a blood pressure of 50,
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gdje je imala krvni tlak 50,
08:03
which is in severe shock.
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što je težak šok.
08:05
And she was barely breathing and she was blue.
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Jedva je disala i poplavila je.
08:08
And the emerg. staff pulled out all the stops.
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Osoblje hitne pomoći učinilo je sve što je moglo.
08:11
They gave her medications to raise her blood pressure.
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Dali su joj lijekove za podizanje krvnog tlaka.
08:14
They put her on a ventilator.
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Stavili su je na ventilator.
08:16
And I was shocked
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Bio sam šokiran
08:19
and shaken to the core.
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i potresen do srži.
08:21
And I went through this roller coaster,
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Prolazio sam kroz taj 'vlak smrti'
08:23
because after they stabilized her,
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jer nakon što su je stabilizirali,
08:25
she went to the intensive care unit,
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prebačena je u jedinicu intenzivne njege
08:27
and I hoped against hope that she would recover.
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i nadao sam se protiv nade da će se oporaviti.
08:29
And over the next two or three days,
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Tijekom sljedeća dva ili tri dana,
08:31
it was clear that she was never going to wake up.
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postalo je jasno kako se nikada neće probuditi.
08:33
She had irreversible brain damage.
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Imala je nepopravljivo oštećenje mozga.
08:36
And the family gathered.
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Obitelj se okupila.
08:38
And over the course of the next eight or nine days,
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Tijekom sljedećih osam ili devet dana
08:41
they resigned themselves to what was happening.
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pomirili su se s onim što se događalo.
08:43
And at about the nine day mark, they let her go --
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Negdje tijekom devetog dana, pustili su je –
08:46
Mrs. Drucker,
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gđu. Drucker,
08:48
a wife, a mother
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ženu, majku
08:50
and a grandmother.
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i baku.
08:53
They say you never forget the names
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Kažu da nikada ne zaboravljate imena
08:55
of those who die.
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onih koji umru.
08:57
And that was my first time to be acquainted with that.
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I to je bio moj prvi put da sam se upoznao s time.
09:00
Over the next few weeks,
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Tijekom sljedećih nekoliko tjedana
09:02
I beat myself up
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grizao sam se
09:05
and I experienced for the first time
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i po prvi puta sam iskusio
09:07
the unhealthy shame that exists
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nezdravi sram koji postoji
09:09
in our culture of medicine --
221
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u našoj kulturi medicine –
09:11
where I felt alone, isolated,
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gdje sam se osjećao usamljeno, izolirano,
09:14
not feeling the healthy kind of shame that you feel,
223
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1976
nisam osjećao zdravu vrstu srama koju osjećate,
09:16
because you can't talk about it with your colleagues.
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jer ne možete o tome razgovarati s kolegama.
09:18
You know that healthy kind,
225
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Znate zdravu vrstu,
09:20
when you betray a secret that a best friend made you promise never to reveal
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kad odate tajnu za koju ste najboljem prijatelju obećali da je nikada nećete otkriti
09:23
and then you get busted
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i onda ste uhvaćeni
09:25
and then your best friend confronts you
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1976
i onda vam se vaš najbolji prijatelj suprotstavi
09:27
and you have terrible discussions,
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i obavite groznu diskusiju,
09:29
but at the end of it all that sick feeling guides you
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ali na kraju svega taj vas bolestan osjećaj vodi
09:32
and you say, I'll never make that mistake again.
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i kažete, "Više nikada neću ponoviti tu grešku."
09:34
And you make amends and you never make that mistake again.
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Popravite to i više nikada tako ne pogriješite.
09:37
That's the kind of shame that is a teacher.
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To je vrsta srama koja vas uči.
09:40
The unhealthy shame I'm talking about
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Nezdravi sram o kojem ja pričam
09:42
is the one that makes you so sick inside.
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je onaj od kojeg vam je zlo unutra.
09:45
It's the one that says,
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1976
To je onaj koji,
09:47
not that what you did was bad,
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1976
ne samo da kaže da je ono što ste učinili loše,
09:49
but that you are bad.
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1976
već da ste vi loši.
09:51
And it was what I was feeling.
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I to je ono što sam osjećao.
09:54
And it wasn't because of my attending; he was a doll.
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I to nije bilo zbog mog nadređenog; on je bio ljubazan.
09:57
He talked to the family, and I'm quite sure that he smoothed things over
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Razgovarao je s obitelji i prilično sam siguran da je izgladio stvari
10:00
and made sure that I didn't get sued.
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i osigurao da me ne tuže.
10:03
And I kept asking myself these questions.
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A ja sam si nastavio postavljati ova pitanja.
10:06
Why didn't I ask my attending? Why did I send her home?
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Zašto nisam pitao nadređenog? Zašto sam je poslao kući?
10:09
And then at my worst moments:
245
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1976
I u najgorim trenucima:
10:11
Why did I make such a stupid mistake?
246
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Zašto sam učinio tako glupu grešku?
10:14
Why did I go into medicine?
247
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1976
Zašto sam išao na medicinu?
10:16
Slowly but surely,
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1976
Polako, ali sigurno
10:18
it lifted.
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1976
dizao sam se natrag.
10:20
I began to feel a bit better.
250
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1976
Počeo sam se osjećati malo bolje.
10:22
And on a cloudy day,
251
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1976
A za vrijeme oblačnog dana,
10:24
there was a crack in the clouds and the sun started to come out
252
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postojala je rupa u oblacima i sunce je počelo izlaziti
pa sam se zapitao,
10:27
and I wondered,
253
627237
999
10:28
maybe I could feel better again.
254
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1976
možda bih se mogao ponovo bolje osjećati.
10:30
And I made myself a bargain
255
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Napravio sam pogodbu sam sa sobom
10:33
that if only I redouble my efforts to be perfect
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da samo ako udvostručim svoj napor da budem savršen
10:38
and never make another mistake again,
257
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1976
i nikada više ne učinim nijednu grešku,
10:40
please make the voices stop.
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1976
neka glasovi utihnu.
10:42
And they did.
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1976
I utihnuli su.
10:44
And I went back to work.
260
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1976
I krenuo sam natrag na posao.
10:46
And then it happened again.
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I onda se opet dogodilo.
10:49
Two years later I was an attending in the emergency department
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Dvije godine kasnije bio sam nadređeni u odjelu hitne
10:52
at a community hospital just north of Toronto,
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u općoj bolnici, sjeverno od Toronta
10:54
and I saw a 25 year-old man with a sore throat.
264
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2761
i primio sam 25-ogodišnjeg mladića s upalom grla.
10:57
It was busy, I was in a bit of a hurry.
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1976
Bilo je posla, bio sam u žurbi.
10:59
He kept pointing here.
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1976
On je opetovano pokazivao ovdje.
11:01
I looked at his throat, it was a little bit pink.
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Pogledao sam njegovo grlo, bilo je malkice ružičasto.
11:03
And I gave him a prescription for penicillin
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Dao sam mu recept za penicilin
11:05
and sent him on his way.
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i poslao ga dalje.
11:07
And even as he was walking out the door,
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1976
Čak i kad je izlazio kroz vrata,
11:09
he was still sort of pointing to his throat.
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još je uvijek na neki način pokazivao na svoje grlo.
11:12
And two days later I came to do my next emergency shift,
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Dva dana kasnije, došao sam odraditi svoju sljedeću smjenu u hitnoj,
11:15
and that's when my chief asked to speak to me quietly in her office.
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a onda me moja šefica zamolila da popričamo u njenom uredu.
11:18
And she said the three words:
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Rekla je tri riječi:
11:22
Do you remember?
275
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Sjećaš li se?
11:25
"Do you remember that patient you saw with the sore throat?"
276
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"Sjećaš li se pacijenta kojeg si vidio s upaljenim grlom?"
11:28
Well it turns out, he didn't have a strep throat.
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Ispalo je da nije imao streptokok u grlu.
11:30
He had a potentially life-threatening condition
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Imao je stanje koje potencijalno može ugroziti život
11:32
called epiglottitis.
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pod nazivom epiglotitis.
11:34
You can Google it,
280
694260
1976
Možete potražiti na Google-u,
11:36
but it's an infection, not of the throat, but of the upper airway,
281
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to je infekcija, ali ne grla, već gornjih dišnih puteva
11:39
and it can actually cause the airway to close.
282
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2809
i može prouzročiti zatvaranje dišnih puteva.
11:42
And fortunately he didn't die.
283
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Srećom, nije umro.
11:45
He was placed on intravenous antibiotics
284
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Stavljen je na intravenozne antibiotike
11:48
and he recovered after a few days.
285
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1976
i oporavio se nakon nekoliko dana.
11:50
And I went through the same period of shame and recriminations
286
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3976
A ja sam prošao isti period srama i uzajamnih optužbi
11:54
and felt cleansed and went back to work,
287
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i osjećao se očišćeno i vratio se natrag na posao
11:58
until it happened again and again and again.
288
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dok se nije dogodilo opet i opet i opet.
12:03
Twice in one emergency shift, I missed appendicitis.
289
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2976
Dva sam puta u hitnoj službi propustio upalu slijepog crijeva.
12:06
Now that takes some doing,
290
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2976
To treba znati,
12:09
especially when you work in a hospital
291
729260
1976
pogotovo kad radite u bolnici
12:11
that at the time saw but 14 people a night.
292
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2976
u kojoj istovremeno vidite 14 ljudi na noć.
12:14
Now in both cases, I didn't send them home
293
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2976
U oba slučaja nisam ih poslao kući
12:17
and I don't think there was any gap in their care.
294
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i smatram kako nije bilo propusta u njihovoj njezi.
12:19
One I thought had a kidney stone.
295
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Za jednog sam mislio da ima bubrežni kamenac.
12:21
I ordered a kidney X-ray. When it turned out to be normal,
296
741260
1976
Zatražio sam rendgen bubrega. Kad je ispalo da je rendgen normalan,
12:23
my colleague who was doing a reassessment of the patient
297
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2976
moj kolega koji je radio revidiranje pacijenta
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
298
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primijetio je mekoću u donjem desnom kvadrantu i pozvao je kirurge.
12:29
The other one had a lot of diarrhea.
299
749260
1976
Drugi je imao obilan proljev.
12:31
I ordered some fluids to rehydrate him
300
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2976
Naručio sam mnogo tekućine kako bi se rehidrirao
12:34
and asked my colleague to reassess him.
301
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i zamolio kolegu da revidira.
12:37
And he did
302
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1976
Revidirao je
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
303
759260
1976
i kad je osjetio mekoću u donjem desnom kvadrantu, pozvao je kirurge.
12:41
In both cases,
304
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1976
U oba su slučaja pacijenti
12:43
they had their operations and they did okay.
305
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2976
operirani i bili su dobro.
12:46
But each time,
306
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1976
Ali svaki put
12:48
they were gnawing at me, eating at me.
307
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1976
su me mučili, proždirali me.
12:50
And I'd like to be able to say to you
308
770260
1976
Volio bih da vam mogu reći
12:52
that my worst mistakes only happened in the first five years of practice
309
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kako su se moje najgore greške dogodile u prvih pet godina moje prakse
12:55
as many of my colleagues say, which is total B.S.
310
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2523
kao što mnogo mojih kolega kaže, što je totalno sr...e.
12:58
(Laughter)
311
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1976
(Smijeh)
13:00
Some of my doozies have been in the last five years.
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Neki od mojih bisera su se dogodili u posljednjih pet godina.
13:06
Alone, ashamed and unsupported.
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1976
Sami, posramljeni i bez podrške.
13:08
Here's the problem:
314
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1976
Evo u čemu je problem:
13:10
If I can't come clean
315
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1976
Ako ne mogu priznati
13:12
and talk about my mistakes,
316
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3976
i pričati o svojim greškama,
13:16
if I can't find the still-small voice
317
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1976
ako ne mogu pronaći tišinu – mali glas
13:18
that tells me what really happened,
318
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1976
koji mi govori što se zaista dogodilo,
13:20
how can I share it with my colleagues?
319
800260
1976
kako to mogu podijeliti s kolegama?
13:22
How can I teach them about what I did
320
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2976
Kako ih mogu naučiti o tome što sam ja učinio
13:25
so that they don't do the same thing?
321
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3976
kako oni ne bi ponovili istu grešku?
13:29
If I were to walk into a room --
322
809260
1976
Kad bih ja ušetao u prostoriju –
13:31
like right now, I have no idea what you think of me.
323
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2976
poput ove sada, ne bih imao pojma što mislite o meni.
13:34
When was the last time you heard somebody talk
324
814260
1976
Kada ste posljednji put čuli nekog da priča
13:36
about failure after failure after failure?
325
816260
2000
o neuspjehu neuspjeha nakon neuspjeha?
13:38
Oh yeah, you go to a cocktail party
326
818284
1952
O da, odete na koktel zabavu
13:40
and you might hear about some other doctor,
327
820260
2048
i možda ćete čuti o nekim drugim liječnicima,
13:42
but you're not going to hear somebody
328
822332
1904
ali nećete nikog čuti kako
13:44
talking about their own mistakes.
329
824260
1976
govori o vlastitim pogreškama.
13:46
If I were to walk into a room filled with my colleages
330
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2976
Da sam ušetao u prostoriju punu mojih kolega
13:49
and ask for their support right now
331
829260
1976
i zatražio ih potporu sada
13:51
and start to tell what I've just told you right now,
332
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2429
i počeo pričati ono što sam upravo vama ispričao,
13:53
I probably wouldn't get through two of those stories
333
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2523
vjerojatno ne bih došao ni do druge priče
13:56
before they would start to get really uncomfortable,
334
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2477
prije no što bi im postalo vrlo neugodno,
13:58
somebody would crack a joke,
335
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1475
netko bi izvalio šalu,
14:00
they'd change the subject and we would move on.
336
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3000
promijenili bi temu i nastavili dalje.
14:05
And in fact, if I knew and my colleagues knew
337
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2976
I zapravo, kad bih znao i kad bi moji kolege znali
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
338
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3976
kako je jedan od mojih kolega s ortopedije odrezao krivu nogu u mojoj bolnici,
14:12
believe me, I'd have trouble
339
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1976
vjerujte mi, imao bih problema
14:14
making eye contact with that person.
340
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1976
s uspostavljanjem kontakta oči u oči s tom osobom.
14:16
That's the system that we have.
341
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1976
To je sustav koji imamo.
14:18
It's a complete denial of mistakes.
342
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2976
To je potpuno poricanje grešaka.
14:21
It's a system
343
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1976
To je sustav
14:23
in which there are two kinds of physicians --
344
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3976
u kojem postoje dvije vrste pozicija –
14:27
those who make mistakes
345
867260
1976
oni koji griješe
14:29
and those who don't,
346
869260
1976
i oni koji ne griješe,
14:31
those who can't handle sleep deprivation and those who can,
347
871260
2976
oni koji ne mogu podnijeti gubitak sna i oni koji mogu,
14:34
those who have lousy outcomes
348
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1976
oni koji imaju traljave ishode
14:36
and those who have great outcomes.
349
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2976
i oni koji imaju odlične ishode.
14:39
And it's almost like an ideological reaction,
350
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2143
To je poput ideološke reakcije,
14:41
like the antibodies begin to attack that person.
351
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3809
poput antitijela koja počinju napadati tu osobu.
14:45
And we have this idea
352
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1976
Imamo tu ideju da
14:47
that if we drive the people who make mistakes
353
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2143
ako povučemo iz medicine one
14:49
out of medicine,
354
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1809
ljude koji rade greške,
14:51
what will we be left with, but a safe system.
355
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3976
što će nam ostati, nego siguran sustav.
14:55
But there are two problems with that.
356
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2976
Ali evo problema s takvom percepcijom.
14:58
In my 20 years or so
357
898260
1976
U mojih 20-ak godina
15:00
of medical broadcasting and journalism,
358
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2976
medicinskog emitiranja i novinarstva,
15:03
I've made a personal study of medical malpractice and medical errors
359
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3239
napravio sam privatnu studiju o pogrešnom liječenju i medicinskim greškama
15:06
to learn everything I can,
360
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1713
kako bih naučio sve što mogu,
15:08
from one of the first articles I wrote for the Toronto Star
361
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2810
od jednog od prvih članaka koje sam napisao za Toronto Star
do mog showa 'Bijela kuta, crna umjetnost'.
15:11
to my show "White Coat, Black Art."
362
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2142
15:13
And what I've learned
363
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1976
Ono što sam naučio je
15:15
is that errors are absolutely ubiquitous.
364
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2976
da su greške apsolutno sveprisutne.
15:18
We work in a system
365
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1976
Radimo u sustavu
15:20
where errors happen every day,
366
920260
1976
gdje se greške događaju svakog dana,
15:22
where one in 10 medications
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gdje je jedan od 10 lijekova
15:24
are either the wrong medication given in hospital
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2334
ili pogrešan lijek koji su vam dali u bolnici
15:26
or at the wrong dosage,
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ili je pogrešna doza,
15:28
where hospital-acquired infections are getting more and more numerous,
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gdje su bolničke infekcije sve brojnije i brojnije,
15:31
causing havoc and death.
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uzrokuju rasulo i smrt.
15:34
In this country,
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U ovoj zemlji,
15:36
as many as 24,000 Canadians die
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čak 24.000 Kanađana umire
15:38
of preventable medical errors.
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od medicinskih grešaka koje se mogu spriječiti.
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
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U Sjedinjenim Američkim Državama, Institut Medicine procijenio je to na 100.000.
15:44
In both cases, these are gross underestimates,
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U oba slučaja, to su podcijenjeni ukupni iznosi
15:47
because we really aren't ferreting out the problem
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jer se ne odnosimo prema problemu
15:49
as we should.
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kako bismo trebali.
15:51
And here's the thing.
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Evo u čemu je stvar.
15:54
In a hospital system
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U bolničkom sustavu
15:57
where medical knowledge is doubling
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gdje se medicinsko znanje udvostručuje
15:59
every two or three years, we can't keep up with it.
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svake dvije ili tri godine, ne možemo to sustići.
16:02
Sleep deprivation is absolutely pervasive.
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Nedostatak sna potpuno prožima.
16:05
We can't get rid of it.
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Ne možemo ga se riješiti.
16:07
We have our cognitive biases,
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Imamo svoje kognitivne sklonosti
16:09
so that I can take a perfect history on a patient with chest pain.
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tako što mogu uzeti odličnu anamnezu pacijenta s bolom u prsima.
16:12
Now take the same patient with chest pain,
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2000
Uzmite sad istog pacijenta s bolom u prsima,
16:14
make them moist and garrulous
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1785
učinite ga vlažnim i govorljivim,
16:16
and put a little bit of alcohol on their breath,
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1976
stavite malo alkohola u njihov zadah
16:18
and suddenly my history is laced with contempt.
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i odjednom je moja anamneza okovana prezirom.
16:20
I don't take the same history.
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Ne uzimam istu anamnezu.
16:22
I'm not a robot;
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Nisam robot;
16:24
I don't do things the same way each time.
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1976
ne radim stvari na isti način svaki put.
16:26
And my patients aren't cars;
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I moji pacijenti nisu automobili;
16:28
they don't tell me their symptoms in the same way each time.
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ne govore mi svoje simptome na isti način svaki put.
16:31
Given all of that, mistakes are inevitable.
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S obzirom na sve to, pogreške su neizbježne.
16:34
So if you take the system, as I was taught,
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Ako uzmete sustav, kao što su mene učili,
16:37
and weed out all the error-prone health professionals,
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i maknete sve medicinske profesionalce sklone greškama,
16:41
well there won't be anybody left.
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pa neće nitko ostati.
16:46
And you know that business
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1976
A znate ono kako ljudi
16:48
about people not wanting
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1976
ne žele govoriti
16:50
to talk about their worst cases?
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o svojim najgorim slučajevima?
16:53
On my show, on "White Coat, Black Art,"
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1976
U mojoj emisiji, "Bijela kuta, crna umjetnost'
16:55
I made it a habit of saying, "Here's my worst mistake,"
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2620
imam naviku govoriti, "Evo moje najgore greške,"
16:57
I would say to everybody
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1332
rekao bih to svima
16:59
from paramedics to the chief of cardiac surgery,
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od bolničara do šefova kardiokirurgije,
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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1976
"Evo moje najgore greške", bla, bla, bla, bla, bla,
17:04
"What about yours?" and I would point the microphone towards them.
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"Koja je vaša?" i uperio bih mikrofon prema njima.
17:07
And their pupils would dilate,
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1809
Zjenice bi im se raširile,
17:09
they would recoil,
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1976
ustuknuli bi,
17:11
then they would look down and swallow hard
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pogledali prema dolje, progutali knedlu
17:14
and start to tell me their stories.
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i počeli mi pričati svoje priče.
17:17
They want to tell their stories. They want to share their stories.
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Žele pričati svoje priče. Žele podijeliti svoje priče.
17:20
They want to be able to say,
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1810
Žele biti u mogućnosti da kažu,
17:22
"Look, don't make the same mistake I did."
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2000
"Gledaj, nemojte učiniti istu pogrešku koju sam ja učinio."
17:24
What they need is an environment to be able to do that.
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2621
Ono što im treba je okruženje u kojem to mogu učiniti.
17:26
What they need is a redefined medical culture.
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3309
Ono što im treba jest redefinirana medicinska kultura.
17:30
And it starts with one physician at a time.
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I počinje s jednim liječnikom.
17:33
The redefined physician is human,
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Redefinirani liječnik je čovjek,
17:36
knows she's human,
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1976
zna kako je čovjek,
17:38
accepts it, isn't proud of making mistakes,
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2048
prihvaća to, nije ponosan na pravljenje grešaka,
17:40
but strives to learn one thing
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1905
ali teži tome da nauči jednu stvar
17:42
from what happened
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1976
iz toga što se dogodilo
17:44
that she can teach to somebody else.
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1976
kako bi mogao naučiti nekog drugog.
17:46
She shares her experience with others.
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1976
Dijeli svoje iskustvo s drugima.
17:48
She's supportive when other people talk about their mistakes.
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Podupire kada ostali ljudi pričaju o svojim greškama.
17:51
And she points out other people's mistakes,
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2048
Ističe greške drugih ljudi,
17:53
not in a gotcha way,
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1904
ne na način – uhvatio sam te,
17:55
but in a loving, supportive way
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već na drag i podržavajući način
17:58
so that everybody can benefit.
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1976
kako bi svi mogli imati korist od toga.
18:00
And she works in a culture of medicine
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1976
I radi u kulturi medicine
18:02
that acknowledges
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1976
koja priznaje da
18:04
that human beings run the system,
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1976
ljudska bića vode sustav,
18:06
and when human beings run the system, they will make mistakes from time to time.
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a kada ljudska bića vode sustav, rade greške s vremena na vrijeme.
Sustav se razvija
18:10
So the system is evolving
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3142
18:13
to create backups
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kako bi stvorio rezerve
18:17
that make it easier to detect those mistakes
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2976
kako bi bilo lakše detektirati te greške
18:20
that humans inevitably make
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koje ljudi neizbježno rade
18:23
and also fosters in a loving, supportive way
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i također potiče na nježan, podupirući način
18:26
places where everybody who is observing
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mjesta gdje svi koji promatraju
18:29
in the health care system
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1976
u sustavu zdravstvene njege
18:31
can actually point out things that could be potential mistakes
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mogu zapravo izraziti stvari koje bi mogle biti potencijalne greške
18:34
and is rewarded for doing so,
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1976
i nagrađeni su za to,
18:36
and especially people like me, when we do make mistakes,
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i pogotovo za ljude poput mene, kada napravimo greške,
18:38
we're rewarded for coming clean.
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3285
nagrađeni smo što smo priznali.
18:42
My name is Brian Goldman.
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Moje ime je Brian Goldman.
18:45
I am a redefined physician.
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Redefinirani sam liječnik.
18:48
I'm human. I make mistakes.
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1976
Čovjek sam. Griješim.
18:50
I'm sorry about that,
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1976
Žao mi je zbog toga,
18:52
but I strive to learn one thing
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1976
ali nastojim naučiti jednu stvar
18:54
that I can pass on to other people.
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koju mogu proslijediti drugim ljudima.
18:57
I still don't know what you think of me,
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Još uvijek ne znam što mislite o meni,
19:00
but I can live with that.
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1976
ali mogu živjeti s tim.
19:02
And let me close with three words of my own:
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Dopustite mi da završim sa svoje tri riječi:
19:05
I do remember.
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"Da, sjećam se."
19:09
(Applause)
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(Pljesak)
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