4 questions you should always ask your doctor | Christer Mjåset

Prevodilac: Kristina Radosavljević Lektor: Ivana Krivokuća

I am a neurosurgeon,

Ja sam neurohirurg,

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

i ovde sam danas kako bih vam rekao da ljudi kao ja trebaju vašu pomoć.

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

Kroz nekoliko sekundi ću vam reći i kako.

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

Pre svega, dozvolite mi da počnem sa pričom o jednom mom pacijentu.

This was a woman in her 50s,

Reč je o ženi u šestoj deceniji života,

she was in generally good shape,

generalno dobrog zdravlja,

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

ali je nekoliko puta dolazila u bolnicu

due to curative breast cancer treatment.

zbog lečenja raka dojke.

Now she had gotten a prolapse from a cervical disc,

Sada je imala vratnu diskus herniju

giving her radiating pain of a tense kind,

koja je izazivala intenzivan bol koji se širio

out into the right arm.

kroz njenu desnu ruku.

Looking at her MRI before the consultation,

Gledajući njenu magnetnu rezonancu, pre konsultacija,

I decided to suggest an operation.

odlučio sam da joj predložim operaciju.

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

Operacije vrata kao što je ova su standardizovane i brze,

But they carry a certain risk.

ali nose određeni rizik.

You make an incision right here,

Napravite rez ovde,

and you dissect carefully past the trachea,

secirate pažljivo pored dušnika,

the esophagus,

jednjaka,

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

i pokušate da ne razrežete unutrašnju karotidnu arteriju.

(Laughter)

(Smeh)

Then you bring in the microscope,

Onda uzmete mikroskop,

and you carefully remove the disc and the prolapse

i pažljivo uklonite disk i prolaps

in the nerve root canal,

kanala nervnog korena,

without damaging the cord and the nerve root

bez oštećenja živca i nervnog korena

lying only millimeters underneath.

koji leži samo nekoliko milimetara ispod.

The worst case scenario is the damage to the cord,

Najgori scenario je da se ošteti nerv,

which can result in paralysis from the neck down.

što može dovesti do paralize od vrata nadole.

Explaining this to the patient, she fell silent.

Dok sam objašnjavao ovo pacijentkinji, ona je zaćutala.

And after a few moments,

Nakon nekoliko trenutaka,

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

izgovorila je nekoliko veoma presudnih reči i za mene i za nju:

"Doctor, is this really necessary?"

„Doktore, da li je to stvarno neophodno?”

(Laughter)

(Smeh)

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

Znate šta sam shvatio, upravo tu i tada?

It was not.

Nije bilo neophodno.

In fact, when I get patients like this woman,

U stvari, kad primim pacijenta kao što je ova žena,

I tend to advise not to operate.

obično ne savetujem operaciju.

So what made me do it this time?

Šta me je nateralo da to učinim tada?

Well, you see,

Vidite,

this prolapse was so delicate,

ova hernija je bila tako delikatna,

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

da sam bukvalno mogao da vidim sebe kako je izvlačim iz korena nervnog kanala,

before she entered the consultation room.

pre nego što je ušla u ordinaciju.

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

Priznajem, želeo sam da je operišem.

I'd love to operate on her.

Želeo sam da izvršim operaciju na njoj.

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

Operacija je, na kraju krajeva, najzabavniji deo mog posla.

(Laughter)

(Smeh)

I think you can relate to this feeling.

Mislim da možete da shvatite to osećanje.

My architect neighbor says he loves to just sit and draw

Moj komšija arhitekta kaže da on voli samo da sedi, crta

and design houses.

i dizajnira kuće.

He'd rather do that all day

On bi radije to radio po ceo dan,

than talk to the client paying for the house

nego da razgovara sa klijentom koji plaća za kuću,

that might even give him restrictions on what to do.

koji bi mogao čak da mu stavi ograničenja na to šta da uradi.

But like every architect,

Ali kao i svaki arhitekta,

every surgeon needs to look their patient in the eye

svaki hirurg treba da pogleda svog pacijenta u oči

and together with the patient,

i da zajedno sa pacijentom

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

odluči šta je najbolje za osobu koja se operiše.

And that might sound easy.

To možda zvuči lako.

But let's look at some statistics.

Ali pogledajmo neke statističke podatke.

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

Krajnici su dva ispupčenja u pozadini vašeg grla.

They can be removed surgically,

Mogu se hirurški odstraniti,

and that's called a tonsillectomy.

i to se zove tonzilektomija.

This chart shows the operation rate of tonsillectomies in Norway

Ovaj grafikon pokazuje stopu operacija krajnika u Norveškoj,

in different regions.

u različitim regionima.

What might strike you is that there is twice the chance

Ono što vas može iznenaditi je da su duplo veće šanse

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

da vaše dete - zato što je reč o deci -

will get a tonsillectomy in Finnmark than in Trondheim.

ima operaciju krajnika u Finmarku nego u Trondhajmu.

The indications in both regions are the same.

Indikacije su iste u oba regiona.

There should be no difference, but there is.

Ne bi trebalo da bude razlike, ali ona postoji.

Here's another chart.

Evo još jednog grafikona.

The meniscus helps stabilize the knee

Meniskus pomaže da se učvrsti koleno

and can be torn or fragmented acutely,

i može biti pokidan ili izrazito izlomljen,

topically during sports like soccer.

obično tokom bavljenja sportom kao što je fudbal.

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

Ono što vidite ovde je stopa operacija tog stanja.

And you see that the operation rate in Møre og Romsdal

Vidite da je stopa operacije u Mere og Romsdalu

is five times the operation rate in Stavanger.

pet puta veća od stope operacije u Stavangeru.

Five times.

Pet puta.

How can this be?

Kako je to moguće?

Did the soccer players in Møre og Romsdal

Da li igrači u Mere og Romsdalu

play more dirty than elsewhere in the country?

igraju prljavije nego igde u zemlji?

(Laughter)

(Smeh)

Probably not.

Verovatno ne.

I added some information now.

Sada sam dodao neke informacije.

What you see now is the procedures performed

Ovo što vidite su procedure izvedene

in public hospitals, in light blue,

u državnim bolnicama, svetlo plavo,

the ones in private clinics are light green.

i u privatnim klinikama, svetlo zeleno.

There is a lot of activity in the private clinics

Dosta je aktivnosti na privatnim klinikama

in Møre og Romsdal, isn't there?

u Mere og Romsdalu, zar ne?

What does this indicate?

Šta nam to govori?

A possible economic motivation to treat the patients.

Moguća ekonomska motivacija da se pacijent leči.

And there's more.

Ima tu još toga.

Recent research has shown that the difference of treatment effect

Nedavno istraživanje je pokazalo da razlika u efektu lečenja

between regular physical therapy and operations for the knee --

između obične fizikalne terapije i operacije kolena

there is no difference.

ne postoji.

Meaning that most of the procedures performed

Što znači da se većina izvedenih operacija

on the chart I've just shown

sa grafikona koji sam pokazao

could have been avoided, even in Stavanger.

mogla izbeći, čak i u Stavangeru.

So what am I trying to tell you here?

Šta pokušavam da vam kažem ovim?

Even though most indications for treatments in the world

Iako je, širom sveta, većina simptoma za lečenje

are standardized,

standardizovana,

there is a lot of unnecessary variation of treatment decisions,

postoje brojne nepotrebne varijacije u odlukama lečenja,

especially in the Western world.

posebno na zapadu.

Some people are not getting the treatment that they need,

Neki ljudi ne dobijaju lečenje koje im je potrebno,

but an even greater portion of you

ali još veći deo vas

are being overtreated.

dobija i previše lečenja.

"Doctor, is this really necessary?"

„Doktore, da li je to stvarno neophodno?”

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

Samo sam jednom čuo to pitanje u celoj svojoj karijeri.

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

Moje kolege kažu da nikada nisu čuli te reči od pacijenta.

And to turn it the other way around,

Ako to pogledamo sa druge strane,

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

koliko često mislite da ćete od doktora dobiti „ne” kao odgovor,

if you ask such a question?

kada postavite ovakvo pitanje?

Researchers have investigated this,

Istraživači su se bavili ovim,

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

i došli do iste stope „ne”

wherever they go.

gde god bi otišli.

And that is 30 percent.

A to iznosi oko 30 procenata.

Meaning, three out of 10 times,

Što znači, tri od deset puta,

your doctor prescribes or suggests something

vaš doktor vam prepiše ili predloži nešto

that is completely unnecessary.

što je potpuno nepotrebno.

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

Znate šta navode kao razlog za to?

Patient pressure.

Pritisak pacijenata.

In other words, you.

Drugim rečima, vas.

You want something to be done.

Vi želite da se nešto uradi.

A friend of mine came to me for medical advice.

Prijatelj mi se obratio radi medicinskog saveta.

This is a sporty guy,

On je sportista,

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

dosta praktikuje skijaško trčanje u zimskom periodu,

he runs in the summer time.

a u letnjem periodu trči.

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

Sada je imao jak bol u leđima kad god bi otišao na trčanje.

So much that he had to stop doing it.

Toliko da je morao da prestane da trči.

I did an examination, I questioned him thoroughly,

Pregledao sam ga, temeljno ispitao,

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

i otkrio sam da verovatno ima degenerisan disk

in the lower part of his spine.

u donjem delu kičme.

Whenever it got strained, it hurt.

Kada god bi se izvio, bolelo je.

He'd already taken up swimming instead of jogging,

Već je počeo sa plivanjem umesto trčanja,

there was really nothing to do,

ništa se tu nije moglo raditi,

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

pa sam mu rekao: „Moraš biti izbirljiviji

when it comes to training.

kada je reč o vežbanju.

Some activities are good for you,

Neke aktivnosti su dobre za tebe,

some are not."

a neke nisu.”

His reply was,

Njegov odgovor je bio:

"I want an MRI of my back."

„Želim da mi se uradi MR leđa.”

"Why do you want an MRI?"

„Zašto bi želeo MR?”

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

„Mogu ga dobiti besplatno kroz osiguranje sa posla.”

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

„Ma, hajde,” rekao sam - ipak je on bio moj prijatelj.

"That's not the real reason."

„To nije stvarni razlog.”

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

„Mislim da će biti dobro da se vidi koliko loše izgleda.”

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

„Kad si ti to počeo da tumačiš MR snimke?”, pitao sam.

(Laughter)

(Smeh)

"Trust me on this.

„Veruj mi.

You're not going to need the scan."

Neće ti trebati skeniranje.”

"Well," he said,

„Pa,” rekao je,

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

i nakon pauze nastavio: „mogao bi biti rak.”

(Laughter)

(Smeh)

He got the scan, obviously.

Dobio je skeniranje, naravno.

And through his insurance at work,

Kroz osiguranje sa posla,

he got to see one of my colleagues at work,

otišao je do jednog mog kolege,

telling him about the degenerated disc,

koji mu je rekao za degenerisani disk,

that there was nothing to do,

da tu nema šta da se radi,

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

da treba da nastavi sa plivanjem i da prestane da trči.

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

Nakon određenog vremena, ponovo sam ga sreo i on mi je rekao:

"At least now I know what this is."

„Bar sad znam šta mi je.”

But let me ask you a question.

Da vas pitam nešto.

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

Šta bi bilo da ste svi vi ovde sa istim simptomima išli na MR?

And what if all the people in Norway

Šta bi bilo kada bi svi ljudi u Norveškoj

had an MRI due to occasional back pain?

išli na magnetnu rezonancu zbog povremenih bolova u leđima?

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

Lista čekanja za MR bi bila četiri puta duža, možda čak i više.

And you would all take the spot on that list

Vi biste zauzeli mesto na toj listi

from someone who really had cancer.

nekome ko stvarno ima rak.

So a good doctor sometimes says no,

Dobar doktor nekad kaže „ne”,

but the sensible patient also turns down, sometimes,

ali i razuman pacijent takođe nekada odbije

an opportunity to get diagnosed or treated.

mogućnost dijagnostikovanja ili lečenja.

"Doctor, is this really necessary?"

„Doktore, da li je to stvarno potrebno?”

I know this can be a difficult question to ask.

Znam da to može biti teško pitanje.

In fact, if you go back 50 years,

U stvari, ako se vratite 50 godina unazad,

this was even considered rude.

to se čak smatralo nepristojnim.

(Laughter)

(Smeh)

If the doctor had decided what to do with you,

Ako je doktor odlučio šta će raditi sa vama,

that's what you did.

to ste i radili.

A colleague of mine, now a general practitioner,

Moja koleginica, sada lekar opšte prakse,

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

je kao dete poslata u lečilište za tuberkulozu,

for six months.

na šest meseci.

It was a terrible trauma for her.

To je bila grozna trauma za nju.

She later found out, as a grown-up,

Kasnije je, kao odrasla, saznala

that her tests on tuberculosis had been negative all along.

da su njeni testovi na tuberkolozu bili sve vreme negativni.

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

Doktor ju je poslao tamo samo na osnovu pogrešne sumnje.

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

Niko nije smeo, niti čak pomislio, da mu se suprotstavi.

Not even her parents.

Čak ni njeni roditelji.

Today, the Norwegian health minister

Danas, norveški ministar zdravlja

talks about the patient health care service.

govori o zdravstvenoj usluzi pacijenata.

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

Pacijent bi trebalo da dobije savet od doktora šta treba da radi.

This is great progress.

Ovo je veliki napredak.

But it also puts more responsibility on you.

U isto vreme prebacuje više odgovornosti na vas.

You need to get in the front seat with your doctor

Morate da sednete sa svojim doktorom

and start sharing decisions on where to go.

i da počnete deliti odluke o tome šta raditi.

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

Dakle, sledeći put kada se budete našli u doktorskoj ordinaciji,

I want you to ask,

želim da pitate:

"Doctor, is this really necessary?"

„Doktore, da li je to stvarno neophodno?”

And in my female patient's case,

U slučaju moje pacijentkinje,

the answer would be no,

odgovor bi bio „ne”,

but an operation could also be justified.

ali operacija bi takođe mogla biti opravdana.

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

„Doktore, koji su rizici vezani za ovu operaciju?”

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

Pa, pet od deset procenata pacijenata će imati povećane simptome bola.

One to two percent of patients

Jedan do dva procenta pacijenata

will have an infection in the wound or even a rehemorrhage

imaće infekciju rane ili čak ponovno krvarenje,

that might end up in a re-operation.

koje može dovesti do ponovne operacije.

0.5 percent of patients also experience permanent hoarseness

Takođe, 0,5 procenata pacijenata ima trajnu promuklost,

and a few, but still a few,

a nekolicina, ali ipak nekoliko njih,

will experience reduced function in the arms or even legs.

će imati smanjenu pokretljivost u rukama, pa čak i nogama.

"Doctor, are there other options?"

„Doktore, ima li drugih opcija?”

Yes, rest and physical therapy over some time

Da, odmor i fizikalna terapija nakon određenog vremena

might get you perfectly well.

mogu dovesti do potpunog ozdravljenja.

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

„Šta će se desiti ako ništa ne uradim?”

It's not recommended,

To nije preporučljivo,

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

ali čak i tad, postoji mala šansa da ćete ozdraviti.

Four questions.

Četiri pitanja.

Simple questions.

Jednostavna pitanja.

Consider them your new toolbox to help us.

Razmišljajte o njima kao o vašem novom setu za pomoć doktorima.

Is this really necessary?

Da li je to stvarno neophodno?

What are the risks?

Koji su rizici?

Are there other options?

Da li postoje druge opcije?

And what happens if I don't do anything?

Šta će se desiti ako ništa ne preduzmem?

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

Postavite ih kada doktor želi da vas pošalje na MR,

when he prescribes antibiotics

kada vam prepiše antibiotik

or suggests an operation.

ili predloži operaciju.

What we know from research

Ono što znamo na osnovu istraživanja

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

je da će jedno od vas pet, znači, 20 procenata,

will change your opinion on what to do.

promeniti svoje mišljenje o pitanju toga šta će učiniti.

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

Time ne samo da ćete svoj život učiniti lakšim,

a whole lot easier, and probably even better,

i verovatno boljim,

but the whole health care sector

nego će i ceo zdravstveni sistem

will have benefited from your decision.

imati koristi od vaše odluke.

Thank you.

Hvala vam.

(Applause)

(Aplauz)