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

Translator: Janka Krajka Komarka Reviewer: Jozef Očkay

I think we have to do something

Myslím, že je potrebné niečo podniknúť

about a piece of the culture of medicine that has to change.

v oblasti medicínskej praxe, ktorá si vyžaduje zmenu.

And I think it starts with one physician, and that's me.

Stojím tu pre vami ako zdravotník, ktorý sa na to podujal.

And maybe I've been around long enough

Snáď som v tejto branži dosť dlho na to,

that I can afford to give away some of my false prestige

že si môžem dovoliť

to be able to do that.

prísť o kus svojej falošnej prestíže.

Before I actually begin the meat of my talk,

Prv než prejdem k veci,

let's begin with a bit of baseball.

načriem z iného súdka...baseballového.

Hey, why not?

Prečo nie?

We're near the end, we're getting close to the World Series.

Sezóna je u konca, pred nami je čoskoro finálová Svetová séria.

We all love baseball, don't we?

Baseball máme radi všetci, či nie?

(Laughter)

(Smiech)

Baseball is filled with some amazing statistics.

Baseball je plný fascinujúcich štatistík.

And there's hundreds of them.

Sú ich celé stovky.

"Moneyball" is about to come out, and it's all about statistics

Do kín prichádza film Moneyball, ktorý sa venuje

and using statistics to build a great baseball team.

využitiu štatistík na vyskladanie skvelého baseballového družstva.

I'm going to focus on one stat

Jedným štatistickým údajom,

that I hope a lot of you have heard of.

ktorý asi veľa z vás pozná

It's called batting average.

je priemerná úspešnosť odpalu.

So we talk about a 300, a batter who bats 300.

Pri skóre 300 pálkar odpáli 300 nadhodov.

That means that ballplayer batted safely, hit safely

Inak povedané, hráč bezpečne odpálil

three times out of 10 at bats.

trikrát z 10 nadhodov.

That means hit the ball into the outfield,

Znamená to, že odpálil loptičku do zadného poľa,

it dropped, it didn't get caught,

spadla do poľa, nikto ju v lete nechytil,

and whoever tried to throw it to first base didn't get there in time

a k prvej méte sa nedostala skôr než bežec - útočník,

and the runner was safe.

ktorý si tým zaistil bezpečnú pozíciu.

Three times out of 10.

Tri z desiatich.

Do you know what they call a 300 hitter

Viete, ako hodnotia 300 bodového pálkara

in Major League Baseball?

v Hlavnej baseballovej lige?

Good, really good,

Ten je dobrý, vážne dobrý,

maybe an all-star.

možno dokonca hráč hviezdneho výberu.

Do you know what they call

Čo potom

a 400 baseball hitter?

400-bodový pálkar?

That's somebody who hit, by the way,

Len pre objasnenie, ide o pálkara,

four times safely out of every 10.

ktorý bezpečne odpálil štyrikrát z 10 nadhodov.

Legendary --

Ten je legendárny...

as in Ted Williams legendary --

ako napríklad Ted Williams...

the last Major League Baseball player

posledný hráč Hlavnej baseballovej ligy,

to hit over 400 during a regular season.

ktorý odpálil 400 nadhodov v riadnej hracej sezóne.

Now let's take this back into my world of medicine

Prenesme si to do sveta medicíny,

where I'm a lot more comfortable,

kde sa cítim viac vo svojej koži.

or perhaps a bit less comfortable

Teda až doposiaľ, kedže potom,

after what I'm going to talk to you about.

čo vám dnes poviem sa to môže zmeniť.

Suppose you have appendicitis

Dajme tomu, že máte zápal slepého čreva

and you're referred to a surgeon

a odporučia vás k chirurgovi,

who's batting 400 on appendectomies.

ktorý operuje slepé črevo so 400 bodovou úspešnosťou.

(Laughter)

(Smiech)

Somehow this isn't working out, is it?

Akosi to nepasuje, však?

Now suppose you live

A čo ak žijete

in a certain part of a certain remote place

niekde na odľahnom vidieku

and you have a loved one

a niekto z vašich blízkych

who has blockages in two coronary arteries

trpí nepriechodnosťou dvoch srdcových tepien?

and your family doctor refers that loved one to a cardiologist

Váš praktický lekár ho odporučí ku kardiologičke,

who's batting 200 on angioplasties.

ktorá v angioplastike odpaľuje na 200 bodovej úrovni.

But, but, you know what?

Ale viete vy čo?

She's doing a lot better this year. She's on the comeback trail.

Tento rok jej to ide omnoho lepšie. Je na vzostupe.

And she's hitting a 257.

Teraz odpaľuje až na úrovni 257 bodov!

Somehow this isn't working.

Táto analógia akosi nefunguje.

But I'm going to ask you a question.

Chcem sa vás teraz niečo spýtať.

What do you think a batting average

Aká by podľa vás mala byť priemerná úspešnosť odpalu

for a cardiac surgeon or a nurse practitioner

u kardiochirurga alebo diplomovaného zdravotníka,

or an orthopedic surgeon,

ortopedickej chirurgičky,

an OBGYN, a paramedic

u pôrodníka

is supposed to be?

či záchranárky?

1,000, very good.

1 000, správne.

Now truth of the matter is,

Pravdou však je, že

nobody knows in all of medicine

nikto v medicínskom odbore nevie,

what a good surgeon

akú priemernú úspešnosť by

or physician or paramedic

lekár alebo záchranárka

is supposed to bat.

mali mať.

What we do though is we send each one of them, including myself,

Každého z nich však, mňa nevynímajúc,

out into the world

posielame do sveta

with the admonition, be perfect.

s požiadavkou, aby boli dokonalí.

Never ever, ever make a mistake,

Ani nech Ti nenapadne, aby si pochybil,

but you worry about the details, about how that's going to happen.

ale to, ako sa s tým vysporiadaš, je na Tvojich pleciach.

And that was the message that I absorbed

Týmto odkazom som nasiakol,

when I was in med school.

keď som študoval medicínu.

I was an obsessive compulsive student.

Ako študent som bol obsesívne kompulzívny.

In high school, a classmate once said

Na strednej škole jeden spolužiak o mne raz povedal,

that Brian Goldman would study for a blood test.

že by som študoval aj na krvnú skúšku.

(Laughter)

(Smiech)

And so I did.

A aj som študoval.

And I studied in my little garret

Študoval som v svojej malej mandzardke

at the nurses' residence at Toronto General Hospital,

v komplexe pre stredný zdravotnícky personál v Torontskej všeobecnej nemocnici

not far from here.

neďaleko odtiaľto.

And I memorized everything.

A neustále som sa bifľoval.

I memorized in my anatomy class

Na hodinách anatómie som sa učil naspamäť

the origins and exertions of every muscle,

pôvod a námahu všetkých svalov,

every branch of every artery that came off the aorta,

všetkých vetiev každej artérie, ktoré vystupuju z aorty,

differential diagnoses obscure and common.

diferenciálne diagnózy, či už obskúrne alebo bežné.

I even knew the differential diagnosis

Dokonca som poznal aj diferenciálnu diagnózu

in how to classify renal tubular acidosis.

ako klasifikovať renálnu tubulárnu acidózu.

And all the while,

Postupom času

I was amassing more and more knowledge.

som zberal viac a viac vedomostí.

And I did well, I graduated with honors,

A počínal som si veľmi dobre, vysokú školu som skončil

cum laude.

s vyznamením.

And I came out of medical school

Z lekárskej fakulty som vyšiel

with the impression

v domnení,

that if I memorized everything and knew everything,

že pokiaľ by som dokázal zapamäť si a vedieť všecičko,

or as much as possible,

alebo aspoň toľko koľko je možné,

as close to everything as possible,

tak blízko k dokonalosti ako sa dá,

that it would immunize me against making mistakes.

že sa zaočkujem voči pochybeniu.

And it worked

Chvíľu to dokonca

for a while,

aj fungovalo.

until I met Mrs. Drucker.

Až kým som nestretol pani Druckerovú.

I was a resident at a teaching hospital here in Toronto

Pôsobil som ako asistujúci lekár

when Mrs. Drucker was brought to the emergency department

v univerzitnej nemocnici tu v Toronte,

of the hospital where I was working.

keď na pohotovosť doviezli pani Druckerovú.

At the time I was assigned to the cardiology service

V tom čase som slúžil

on a cardiology rotation.

na kardiológii.

And it was my job,

Ak z pohotovosti

when the emergency staff called for a cardiology consult,

zavolali so žiadosťou o kardiologické konziliárne vyšetrenie,

to see that patient in emerg.

mal som pacienta vyšetriť a následne

and to report back to my attending.

referovať svojmu nadriadenému sekundárnemu lekárovi.

And I saw Mrs. Drucker, and she was breathless.

Pri vyšetrení bola pani Druckerová dýchavičná.

And when I listened to her, she was making a wheezy sound.

Voľným uchom bolo u nej počuť sipot.

And when I listened to her chest with a stethoscope,

Keď som ju popočúval stetoskopom,

I could hear crackly sounds on both sides

na oboch stranách som počul praskavý zvuk,

that told me that she was in congestive heart failure.

ktorý naznačoval, že išlo o kongestívne zlyhanie srdca.

This is a condition in which the heart fails,

Je to stav, pri ktorom srdce zlyháva,

and instead of being able to pump all the blood forward,

keďže nedokáže prečerpávať všetku krv smerom vpred,

some of the blood backs up into the lung, the lungs fill up with blood,

namiesto čoho istý objem krvi zostáva v pľúcach, ktoré sa ňou postupne napĺňajú.

and that's why you have shortness of breath.

Preto tá dýchavičnosť.

And that wasn't a difficult diagnosis to make.

Nebolo obtiažne dopracovať sa k tejto diagnóze.

I made it and I set to work treating her.

Čo sa aj stalo, a nasadil som liečbu.

I gave her aspirin. I gave her medications to relieve the strain on her heart.

Podal som jej aspirín a lieky na zmiernenie záťaže na srdce.

I gave her medications that we call diuretics, water pills,

Podal som jej diuretiká,

to get her to pee out the access fluid.

a teda tablety na vymočenie nadbytočnej tekutiny.

And over the course of the next hour and a half or two,

A počas ďalšej jeden a pol hodiny až dvoch hodín

she started to feel better.

sa začala cítiť lepšie.

And I felt really good.

A ja s ňou.

And that's when I made my first mistake;

Vtedy som urobil prvú chybu -

I sent her home.

poslal som ju domov.

Actually, I made two more mistakes.

Vlastne som urobil hneď dve.

I sent her home

Poslal som ju domov

without speaking to my attending.

bez toho, aby som o nej referoval svojmu nadriadenému.

I didn't pick up the phone and do what I was supposed to do,

Nezdvihol som telefón, aj keď som mal,

which was call my attending and run the story by him

nezreferoval mu, a nedal mu šancu

so he would have a chance to see her for himself.

aby ju mohol prezrieť aj on.

And he knew her,

On ju dokonca poznal,

he would have been able to furnish additional information about her.

a bol by vedel o nej ďalšie informácie.

Maybe I did it for a good reason.

Možno som na to mal dobrý dôvod.

Maybe I didn't want to be a high-maintenance resident.

Možno som mu nechcel byť na obtiaž.

Maybe I wanted to be so successful

Možno som si chcel byť tak dobrý

and so able to take responsibility

v preberaní zodpovednosti,

that I would do so

že som to chcel dokázať

and I would be able to take care of my attending's patients

starostlivosťou o pacientov svojho nadriadeného,

without even having to contact him.

a to dokonca bez toho, aby som ho kontaktoval.

The second mistake that I made was worse.

Druhá chyba, ktorej som sa dopustil, bola horšia.

In sending her home,

Tým, že som ju poslal domov

I disregarded a little voice deep down inside

nedbal som na svoj vnútorný hlas,

that was trying to tell me,

ktorý sa ma snažil upozorniť slovami

"Goldman, not a good idea. Don't do this."

„Goldman, to nie je dobrý nápad. Nerob to."

In fact, so lacking in confidence was I

Neveril som si až natoľko,

that I actually asked the nurse

že som sa dokonca opýtal sestry,

who was looking after Mrs. Drucker,

ktorá sa o ňu starala:

"Do you think it's okay if she goes home?"

„Myslíte, že bude v poriadku, ak pôjde domov?"

And the nurse thought about it

Sestra sa zamyslela

and said very matter-of-factly, "Yeah, I think she'll do okay."

a veľmi vecne odvetila, Hej, myslím, že bude v poriadku."

I can remember that like it was yesterday.

Pamätám si to, akoby to bolo včera.

So I signed the discharge papers,

A tak som podpísal prepúšťaciu správu,

and an ambulance came, paramedics came to take her home.

došla sanitka a odviezla ju domov.

And I went back to my work on the wards.

Ja som sa vrátil k práci na oddeleniach.

All the rest of that day,

Po zvyšok dňa,

that afternoon,

celé popoludnie,

I had this kind of gnawing feeling inside my stomach.

mi žalúdok zvieral ťaživý pocit.

But I carried on with my work.

Pokračoval som však v práci.

And at the end of the day, I packed up to leave the hospital

Na konci dňa som sa zbalil a kráčal som z nemocnice

and walked to the parking lot

k parkovisku,

to take my car and drive home

kde som chcel nastúpiť do auta a odísť domov,

when I did something that I don't usually do.

keď som zrazu urobil niečo, čo som zvyčajne nerobil.

I walked through the emergency department on my way home.

Na ceste domov som sa prešiel cez pohotovosť.

And it was there that another nurse,

Sestra, ktorá tam slúžila,

not the nurse who was looking after Mrs. Drucker before, but another nurse,

a nebola to sestra, ktorá sa starala o pani Druckerovú,

said three words to me

mi položila otázku,

that are the three words

presne tú otázku,

that most emergency physicians I know dread.

ktorej sa väčšina pohotovostných lekárov desí.

Others in medicine dread them as well,

Aj iní v medicíne pri nej tuhnú hrôzou,

but there's something particular about emergency medicine

ale pri pohotovostnej medicíne má trochu inú váhu,

because we see patients so fleetingly.

lebo tu sa stretávame s pacientmi len na kratučkú chvíľu.

The three words are:

Tá otázka znie:

Do you remember?

„Pamätáte si?"

"Do you remember that patient you sent home?"

„Pamätáte si tú pacientku, ktorú ste poslali domov?,"

the other nurse asked matter-of-factly.

spýtala sa táto sestra akoby mimochodom.

"Well she's back,"

"Nuž, je späť,"

in just that tone of voice.

presne týmto tónom hlasu.

Well she was back all right.

Nielenže bola späť,

She was back and near death.

ale bola tiež na pokraji smrti.

About an hour after she had arrived home,

Asi po hodine na to, ako došla domov,

after I'd sent her home,

po tom, čo som ju tam poslal,

she collapsed and her family called 911

skolabovala a jej rodina zavolala záchranku,

and the paramedics brought her back to the emergency department

ktorá ju dopravila späť na pohotovosť.

where she had a blood pressure of 50,

Jej krvný tlak bol na 50-tke,

which is in severe shock.

čo znamená, že bola vo vážnom šoku.

And she was barely breathing and she was blue.

Ledva dýchala a bola namodralá.

And the emerg. staff pulled out all the stops.

Pohotovostný personál urobil všetko, čo sa dalo.

They gave her medications to raise her blood pressure.

Podali jej liečivá na zvýšenie krvného tlaku.

They put her on a ventilator.

Dali ju na ventilátor.

And I was shocked

Ja som zostal v šoku

and shaken to the core.

a hlboko otrasený.

And I went through this roller coaster,

Bol som citovo rozorvaný,

because after they stabilized her,

kedže po tom ako ju stabilizovali,

she went to the intensive care unit,

presunuli ju do jednotky intenzívnej starostlivosti

and I hoped against hope that she would recover.

a ja som si nadovšetko prial, aby sa zotavila.

And over the next two or three days,

O dva alebo tri dni

it was clear that she was never going to wake up.

bolo zjavné, že sa už neprebudí.

She had irreversible brain damage.

Mala totiž nezvratné poškodenie mozgu.

And the family gathered.

Zišla sa jej rodina.

And over the course of the next eight or nine days,

V priebehu osmi alebo deviatich dní

they resigned themselves to what was happening.

sa zmierili s tým, čo sa deje.

And at about the nine day mark, they let her go --

Zhruba na deviaty deň ju nechali v pokoji odísť.

Mrs. Drucker,

Pani Druckerová,

a wife, a mother

manželka, matka,

and a grandmother.

a stará mama.

They say you never forget the names

Vraví sa, že nikdy nezabudnete na mená tých,

of those who die.

ktorí zomrú.

And that was my first time to be acquainted with that.

Vtedy som to okúsil po prvý raz.

Over the next few weeks,

Ďalších niekoľko týždňov

I beat myself up

som sa obviňoval

and I experienced for the first time

a po prvý raz okúsil

the unhealthy shame that exists

škodlivý pocit hanby, ktorá pretrváva

in our culture of medicine --

v našej medicínskej kultúre -

where I felt alone, isolated,

cítil som sa tu osamotený a izolovaný.

not feeling the healthy kind of shame that you feel,

Nebol to pocit zdravej hanby,

because you can't talk about it with your colleagues.

o ktorej sa človek môže porozprávať s kolegami,

You know that healthy kind,

tak ako keď vytárate tajomstvo,

when you betray a secret that a best friend made you promise never to reveal

pri ktorom Vás najlepší priateľ zaprisahal, aby ste ho neprezradili

and then you get busted

a vyjde to najavo.

and then your best friend confronts you

Zídete sa zoči-voči,

and you have terrible discussions,

prebehnú strašlivé debaty,

but at the end of it all that sick feeling guides you

a na konci celej tejto peripetie Vás ten žieravý pocit privedie k tomu,

and you say, I'll never make that mistake again.

že si poviete - „ Tak túto chybu už nikdy neurobím."

And you make amends and you never make that mistake again.

Urobíte nápravu a danú chybu už nikdy nezopakujete.

That's the kind of shame that is a teacher.

Tento druh pocitu hanby pôsobí v roli učiteľa.

The unhealthy shame I'm talking about

Ja mám však namysli hanbu, ktorá

is the one that makes you so sick inside.

Vás zviera vo vnútri.

It's the one that says,

Tú hanbu, pri ktorej sa nepresvedčite o tom,

not that what you did was bad,

že to, čo ste urobili, bolo zlé,

but that you are bad.

ale že ste zlý Vy.

And it was what I was feeling.

Presne tak som sa cítil.

And it wasn't because of my attending; he was a doll.

Nebolo to mojím nadriadením, ten bol skvelý.

He talked to the family, and I'm quite sure that he smoothed things over

Pohovoril si s dotknutou rodinou. Iste sa mu podarilo veci utriasť

and made sure that I didn't get sued.

a ja sa vyhol žalobe.

And I kept asking myself these questions.

Dokola som sa sám seba spytoval:

Why didn't I ask my attending? Why did I send her home?

„Prečo som sa nespýtal svojho nadriadeného? Prečo som ju len poslal domov?"

And then at my worst moments:

A v najhorších chvíľach dokonca:

Why did I make such a stupid mistake?

„Prečo som urobil tak hlúpu chybu?"

Why did I go into medicine?

„Prečo som sa dal na medicínu?"

Slowly but surely,

Pomaly ale isto

it lifted.

tento stav pominul.

I began to feel a bit better.

Začal som sa cítiť lepšie.

And on a cloudy day,

V deň, keď bolo nebo zamračené,

there was a crack in the clouds and the sun started to come out

sa zrazu mraky pohli a keď ich preťal lúč slnka

a ja som si pripustil,

and I wondered,

maybe I could feel better again.

že sa možno opäť raz budem cítiť dobre.

And I made myself a bargain

Urobil som dohodu sám so sebou.

that if only I redouble my efforts to be perfect

Znásobím svoju snahu zdokonaliť sa

and never make another mistake again,

a už nikdy neurobím žiadnu chybu.

please make the voices stop.

Len nech tie vnútorné hlasy stíchnu.

And they did.

A oni stíchli

And I went back to work.

a ja som sa vrátil k práci.

And then it happened again.

Lenže jedného dňa sa to stalo opäť.

Two years later I was an attending in the emergency department

O dva roky neskôr som ako sekundárny lekár slúžil na pohotovosti

at a community hospital just north of Toronto,

v komunitnej nemocnici severne od Toronta,

and I saw a 25 year-old man with a sore throat.

kde som vyšetroval 25-ročného muža s bolesťami hrdla.

It was busy, I was in a bit of a hurry.

Mal som nabitý deň a trochu som sa ponáhľal.

He kept pointing here.

Stále mi ukazoval prstom sem.

I looked at his throat, it was a little bit pink.

Prezrel som mu hrdlo. Bolo trochu naružovelé.

And I gave him a prescription for penicillin

Dal som mu recept na penicilín

and sent him on his way.

a vyprevadil som ho.

And even as he was walking out the door,

Ešte aj keď kráčal k dverám

he was still sort of pointing to his throat.

mimovoľne poukazoval na to hrdlo.

And two days later I came to do my next emergency shift,

O dva dni na to som došiel do ďalšej pohovostnej zmeny,

and that's when my chief asked to speak to me quietly in her office.

kedy si ma môja šéfka zavolala na rozhovor medzi štyrmi očami.

And she said the three words:

Z jej úst zazneli opäť tie známe slová:

Do you remember?

„Pamätáte sa?"

"Do you remember that patient you saw with the sore throat?"

„Pamätáte sa na pacienta, ktorý k Vám prišiel s boľavým hrdlom?"

Well it turns out, he didn't have a strep throat.

Ukázalo sa, že nemal streptokovovú angínu.

He had a potentially life-threatening condition

Trpel na potenciálne smrteľné ochorenie

called epiglottitis.

zvané epiglotitída.

You can Google it,

Vygooglite si to ak chcete.

but it's an infection, not of the throat, but of the upper airway,

Každopádne ide o infekciu horných dýchacích ciest, nie hrdla,

and it can actually cause the airway to close.

ktorá môže spôsobiť uzáver dýchacej cesty.

And fortunately he didn't die.

Našťastie nezomrel.

He was placed on intravenous antibiotics

Nasadili mu infúzne antibiotiká

and he recovered after a few days.

a v priebehu pár dní sa zotavil.

And I went through the same period of shame and recriminations

Ja som si opäť prešiel obdobím plným hanby a sebaobviňovania,

and felt cleansed and went back to work,

čo ma očistilo a vrátilo späť k práci.

until it happened again and again and again.

Ale stalo sa to opäť a znovu..

Twice in one emergency shift, I missed appendicitis.

Dvakrát v priebehu jednej zmeny som nezaregistroval apendicídu.

Now that takes some doing,

To už je čo povedať,

especially when you work in a hospital

najmä ak pracujete v nemocnici,

that at the time saw but 14 people a night.

kde sme vtedy vyšetrili celkom 14 pacientov za noc.

Now in both cases, I didn't send them home

Ani v jednom z týchto dvoch prípadov som ich neposlal domov

and I don't think there was any gap in their care.

a nemyslím, že pri ich starostlivosti došlo k akémukoľvek zanedbaniu.

One I thought had a kidney stone.

V prvom prípade som sa domnieval, že ide o obličkový kameň.

I ordered a kidney X-ray. When it turned out to be normal,

Požiadal som o RTG. Keď sa vrátili výsledky a boli v norme,

my colleague who was doing a reassessment of the patient

môj kolega, ktorý robil druhé vyšetrenie pacienta,

noticed some tenderness in the right lower quadrant and called the surgeons.

si všimol niečo v pravom dolnom kvadrante a zavolal chirurgov.

The other one had a lot of diarrhea.

V druhom prípade pacient trpel úpornou hnačkou

I ordered some fluids to rehydrate him

a tak som nasadil tekutiny na rehydratáciu

and asked my colleague to reassess him.

a požiadal som kolegu o druhé vyšetrenie.

And he did

Keď ho robil,

and when he noticed some tenderness in the right lower quadrant, called the surgeons.

všimol si istú mieru citlivosti v pravom dolnom kvadrante a prizval k nemu chirurgov.

In both cases,

V oboch prípadoch

they had their operations and they did okay.

sa im dostalo operácie a boli v poriadku.

But each time,

Ale v oboch prípadoch

they were gnawing at me, eating at me.

ma tieto prípady gniavili, zožierali ma.

And I'd like to be able to say to you

Najradšej by som vám povedal,

that my worst mistakes only happened in the first five years of practice

že k mojim najvážnejším chybám došlo v prvých piatich rokoch praxe,

as many of my colleagues say, which is total B.S.

podobne ako to tvrdia o sebe aj moji kolegovia, ale to je úplná sprosťosť.

(Laughter)

(Smiech)

Some of my doozies have been in the last five years.

K poniektorým z mojich prešľapov došlo v uplynulých piatich rokoch.

Alone, ashamed and unsupported.

V osamotení, zahanbení a bez opory.

Here's the problem:

V tom je koreň problému.

If I can't come clean

Ak nemôžem vyjsť s pravdou von

and talk about my mistakes,

a hovoriť o svojich omyloch,

if I can't find the still-small voice

ak nemôžem nasledovať ten zatiaľ nerozvinutý vnútorný hlas,

that tells me what really happened,

ktorý svedčí o tom, čo sa skutočne stalo,

how can I share it with my colleagues?

ako potom môžem ísť za svojimi kolegami a podeliť sa s nimi o to?

How can I teach them about what I did

Ako ich môžem poučiť o tom, čo som urobil ja,

so that they don't do the same thing?

aby nevstúpili do tej istej rieky?

If I were to walk into a room --

Ak by som práve vstúpil do miestnosti,

like right now, I have no idea what you think of me.

práve v tej chvíli, vôbec netuším, čo by ste si o mne pomysleli.

When was the last time you heard somebody talk

Kedy naposledy ste počuli hovoriť niekoho

about failure after failure after failure?

o jednom zlyhaní za druhým?

Oh yeah, you go to a cocktail party

Jasné, počujete o tom napríklad na večierku,

and you might hear about some other doctor,

kde ktosi rozpráva historky o akomsi druhom lekárovi,

but you're not going to hear somebody

ale určite nezačujete nikoho hovoriť

talking about their own mistakes.

o svojich vlastných chybách.

If I were to walk into a room filled with my colleages

Ak by som medzi svojími kolegami

and ask for their support right now

začal vykladať to, o čom som práve rozprával vám,

and start to tell what I've just told you right now,

dúfajúc, že ma pochopia,

I probably wouldn't get through two of those stories

už pri druhom príbehu by sa

before they would start to get really uncomfortable,

prestali cítiť vo svojej koži,

somebody would crack a joke,

niekto by nadhodil vtip

they'd change the subject and we would move on.

a prešlo by sa na inú tému.

And in fact, if I knew and my colleagues knew

Vlastne, ak by sme s kolegami vedeli,

that one of my orthopedic colleagues took off the wrong leg in my hospital,

že jeden náš kolega na ortopédii odoperoval nesprávnu nohu,

believe me, I'd have trouble

verte mi, robilo by mi problém

making eye contact with that person.

pozrieť sa mu do očí.

That's the system that we have.

V takomto systéme žijeme.

It's a complete denial of mistakes.

V úplnom popieraní omylov.

It's a system

V systéme,

in which there are two kinds of physicians --

ktorý sa delí na dva svety -

those who make mistakes

na tých, ktorí chybujú

and those who don't,

a na tých, ktorí sú neomylní;

those who can't handle sleep deprivation and those who can,

na tých, ktorí zvládnu nedostatok spánku a tých, ktorí to nedokážu;

those who have lousy outcomes

na tých, ktorí majú mizerné výsledky

and those who have great outcomes.

a na tých, ktorých oslňujú.

And it's almost like an ideological reaction,

Akoby išlo o ideologickú reakciu,

like the antibodies begin to attack that person.

pri ktorej protilátky začnú takéhoto človeka napádať.

And we have this idea

Trpíme tiež predstavou,

that if we drive the people who make mistakes

že ak z lekárskej paxe vytlačíme ľudí

out of medicine,

ktorí robia chyby,

what will we be left with, but a safe system.

dopracujeme sa k bezpečnému systému.

But there are two problems with that.

Tu vnimam dva základné problémy.

In my 20 years or so

Za 20 rokov v

of medical broadcasting and journalism,

lekárskej mediálnej oblasti,

I've made a personal study of medical malpractice and medical errors

som skúmal fenomén zanedbania pochybeniav rámci lekárskej starostlivosti.

to learn everything I can,

v rámci osobnej prípravy

from one of the first articles I wrote for the Toronto Star

na základe článku, ktorý som napísal pre Toronto Star

pre reláciu pod názvom „Biely plášť, čierne umenie."

to my show "White Coat, Black Art."

And what I've learned

Zistil som,

is that errors are absolutely ubiquitous.

že omyly sú všadeprítomné.

We work in a system

Pracujeme v systéme,

where errors happen every day,

kde k pochybeniam dochádza každý deň.

where one in 10 medications

V 10 percentách prípadov je výber

are either the wrong medication given in hospital

lieku alebo dávky v nemocnici

or at the wrong dosage,

nesprávny.

where hospital-acquired infections are getting more and more numerous,

Stále častejšie dochádza k prenosu infekciíí práve v nemocnici

causing havoc and death.

a šíria skazu a smrť.

In this country,

Podľa odhadov ročne

as many as 24,000 Canadians die

zomrie na pochybenie, ktorému bolo možné predísť

of preventable medical errors.

až 24 tisíc Kanaďanov.

In the United States, the Institute of Medicine pegged it at 100,000.

V USA, Inštitút Medicíny hovorí o čísle 100 tisíc.

In both cases, these are gross underestimates,

V oboch prípadoch sú odhady hlboko podhodnotené,

because we really aren't ferreting out the problem

pretože nejdeme dôsledne po koreni problému.

as we should.

Ale mali by sme.

And here's the thing.

Akoby toho nebolo dosť,

In a hospital system

v systéme nemocničnej starostivosti,

where medical knowledge is doubling

sa medicínske vedomosti znásobujú

every two or three years, we can't keep up with it.

každé dva alebo tri roky, čo je nemysliteľné.

Sleep deprivation is absolutely pervasive.

O nedostatku spánku ani nehovorím.

We can't get rid of it.

Nevieme sa ho zbaviť.

We have our cognitive biases,

Ďalej, každý z nás má sklon k predpojatosti.

so that I can take a perfect history on a patient with chest pain.

ale urobiť anamnézu u pacienta s bolesťami na hrudi zvládnem dokonale.

Now take the same patient with chest pain,

Ak by sme ale vzali obdobného pacienta s bolesťami na hrudi,

make them moist and garrulous

ktorý by bol záreoveň spotený a utáraný

and put a little bit of alcohol on their breath,

a mierne by ho bolo cítiť po alkohole,

and suddenly my history is laced with contempt.

moja anamnéza by zrazu nasiakla pohŕdaním.

I don't take the same history.

Anamnézy nerobím podľa šablóny.

I'm not a robot;

Nie som robot;

I don't do things the same way each time.

nerobím veci zakaždým rovnako.

And my patients aren't cars;

Moji pacienti nie sú autá;

they don't tell me their symptoms in the same way each time.

ani oni mi nehovoria o svojich symptómoch zakaždým rovnako.

Given all of that, mistakes are inevitable.

Spočítané a zrátané, chybám sa nedá vyhnúť.

So if you take the system, as I was taught,

Ak použijem logiku, ktorú ma naučili,

and weed out all the error-prone health professionals,

a chystám sa odstrániť zo systému všetkých zdravotníkov so sklonom k pochybeniu,

well there won't be anybody left.

nikto by v ňom potom nezostal.

And you know that business

Poznáte to,

about people not wanting

ako nikto nechce hovoriť

to talk about their worst cases?

o svojich najhorších pochybeniach?

On my show, on "White Coat, Black Art,"

Vo svojej relácii „Biely plášť, čierne umenie",

I made it a habit of saying, "Here's my worst mistake,"

som si zaužíval hovoriť o najhoršej chybe svojej praxe.

I would say to everybody

Počnúc záchranármi

from paramedics to the chief of cardiac surgery,

až po primára kardiochirurgie, všetkým som povedal

"Here's my worst mistake," blah, blah, blah, blah, blah,

"Najhoršou chybou,ktorú som kedy urobil bolo x, y,

"What about yours?" and I would point the microphone towards them.

aká bola tá Vaša?" a posunul som pred nich mikrofón.

And their pupils would dilate,

Zreničky sa mi rozšírili,

they would recoil,

myklo nimi,

then they would look down and swallow hard

oči spustili nadol, ťažko prehltli,

and start to tell me their stories.

a začali rozprávať.

They want to tell their stories. They want to share their stories.

Oni o tom chcú prehovoriť. Podeliť sa o to.

They want to be able to say,

Radi by povedali,

"Look, don't make the same mistake I did."

„Len prosím neurob rovnakú chybu, akú som urobil ja."

What they need is an environment to be able to do that.

Potrebujú prostredie, ktoré im to umožní.

What they need is a redefined medical culture.

Potrebujú medicínsku kultúru, ktorá sa predefinuje.

And it starts with one physician at a time.

Tá vznikne jedným zdravotníkom po druhom.

The redefined physician is human,

Predefinovaný zdravotník alebo zdravotníčka je len človek,

knows she's human,

vie, že len človekom,

accepts it, isn't proud of making mistakes,

prijíma tento fakt a nie je hrdá na svoje chyby,

but strives to learn one thing

ale usiluje sa o to.

from what happened

aby na základe toho, čo sa stalo,

that she can teach to somebody else.

mohla naučiť niekoho iného, ako sa tomu vyvarovať.

She shares her experience with others.

Delí sa o svoju skúsenosť s inými.

She's supportive when other people talk about their mistakes.

Chápavo pristupuje k tým, ktorí hovoria o svojich chybách.

And she points out other people's mistakes,

Upovedomí na chyby iných,

not in a gotcha way,

bez zbytočného chytráctva,

but in a loving, supportive way

láskavým, chápavým spôsobom,

so that everybody can benefit.

tak aby mal z toho prospech každý.

And she works in a culture of medicine

Funguje v kultúre medicíny,

that acknowledges

ktorá priznáva skutočnosť,

that human beings run the system,

že ho spravujú ľudské bytosti,

and when human beings run the system, they will make mistakes from time to time.

a tak z času nas čas robia chyby.

Aby sa systém vyvíjal

So the system is evolving

to create backups

tvorbou zálohových mechanizmov,

that make it easier to detect those mistakes

ktoré uľahčia registráciu chýb,

that humans inevitably make

ktoré sa ľudia nezvratne vo svojej podstate dopúšťajú,

and also fosters in a loving, supportive way

a závoreň láskavo a chápavo vytváral

places where everybody who is observing

priestor na to, aby každý kto

in the health care system

systém zdravotnej starostlivosti pozoruje

can actually point out things that could be potential mistakes

mohol na potenciálne chyby nielen poukázať

and is rewarded for doing so,

ale mohol byť za to aj ocenený.

and especially people like me, when we do make mistakes,

A pre ľudí mne podobných by bolo obzvlášť podstatné, že ak pochybíme,

we're rewarded for coming clean.

a chybu si priznáme, systém to bude vedieť oceniť.

My name is Brian Goldman.

Volám sa Brian Goldman.

I am a redefined physician.

Som predefinovaný zdravotník.

I'm human. I make mistakes.

Som len človek. Robím chyby.

I'm sorry about that,

Mrzí ma to,

but I strive to learn one thing

ale usilujem sa,

that I can pass on to other people.

aby som svoje ponaučenie odovzdal iným.

I still don't know what you think of me,

Ani v tejto chvíli neviem, čo si o mne myslíte

but I can live with that.

ale svet sa mi nezrúti.

And let me close with three words of my own:

Dovoľte mi uzavrieť tromi vlastnými slovami:

I do remember.

Áno, pamätám si.

(Applause)

(Potlesk)