How do we heal medicine? | Atul Gawande

Prevodilac: Maja Budišin Lukin Lektor: Mile Živković

I got my start

Moj početak je bio

in writing and research

u pisanju i istraživanju

as a surgical trainee,

u svojstvu pripravnika na hirurgiji,

as someone who was a long ways away

nekoga ko je bio veoma daleko

from becoming any kind of an expert at anything.

od postajanja bilo kakvog stručnjaka u bilo čemu.

So the natural question you ask then at that point

Pitanje koje se tu samo nameće je -

is, how do I get good at what I'm trying to do?

kako postajem dobar u tome što pokušavam da uradim?

And it became a question of,

To se pretvorilo u pitanje -

how do we all get good

kako postajemo dobri

at what we're trying to do?

u onom što pokušavamo da uradimo?

It's hard enough to learn to get the skills,

Dovoljno je teško učenje veštine,

try to learn all the material you have to absorb

pokušaj učenja celog gradiva koje morate savladati

at any task you're taking on.

pri bilo čemu čega se latite.

I had to think about how I sew and how I cut,

Morao sam da razmislim kako šijem ​​i kako sečem,

but then also how I pick the right person

ali takođe i kako odaberem pravu osobu

to come to an operating room.

za operacijsku dvoranu.

And then in the midst of all this

I tada, u sred svega toga

came this new context

pojavio se ovaj novi kontekst

for thinking about what it meant to be good.

za razmišljanje o tome šta znači biti dobar.

In the last few years

U poslednjih nekoliko godina

we realized we were in the deepest crisis

shvatili smo da smo u najdubljoj krizi

of medicine's existence

medicinskog postojanja

due to something you don't normally think about

zbog nečega o čemu normalno ne razmišljate

when you're a doctor

kada ste lekar,

concerned with how you do good for people,

obuzet mišlju kako činiti ljudima dobro,

which is the cost

a to su troškovi

of health care.

zdravstvene zaštite.

There's not a country in the world

Nema zemlje na svetu

that now is not asking

koja se danas ne pita

whether we can afford what doctors do.

možemo li priuštiti to što lekari rade.

The political fight that we've developed

Politička borba koju smo razvili

has become one around

se vrti oko toga

whether it's the government that's the problem

da li je problem u vladi

or is it insurance companies that are the problem.

ili u osiguravajućim kompanijama.

And the answer is yes and no;

A odgovor je i da i ne.

it's deeper than all of that.

Dublje je od svega toga.

The cause of our troubles

Uzrok naših nevolja

is actually the complexity that science has given us.

je zapravo u složenosti koju nam je nauka donela.

And in order to understand this,

Da bi to razumeli

I'm going to take you back a couple of generations.

osvrnuću se na par generacija ranije.

I want to take you back

Vratiću vas

to a time when Lewis Thomas was writing in his book, "The Youngest Science."

u vreme kada je Luis Tomas napisao svoju knjigu "Najmlađa nauka."

Lewis Thomas was a physician-writer,

Luis Tomas je lekar-pisac,

one of my favorite writers.

jedan od mojih omiljenih pisaca.

And he wrote this book to explain, among other things,

Napisao je ovu knjigu da objasni, između ostalog,

what it was like to be a medical intern

kakav je osećaj biti medicinski pripravnik

at the Boston City Hospital

u Bostonskoj gradskoj bolnici

in the pre-penicillin year

u pre-penicilinskoj godini

of 1937.

1937.

It was a time when medicine was cheap

Bilo je to vreme kada je lek bio jeftin

and very ineffective.

i vrlo nedelotvoran.

If you were in a hospital, he said,

On je rekao da ako ste bili u bolnici,

it was going to do you good

to vam je činilo dobro

only because it offered you

samo zato što vam je ponudilo

some warmth, some food, shelter,

neku toplinu, hranu, krov nad glavom,

and maybe the caring attention

a možda i brižnu pažnju

of a nurse.

bolničarke.

Doctors and medicine

Lekari i medicina

made no difference at all.

nisu bili od pomoći.

That didn't seem to prevent the doctors

To izgleda lekare nije sprečilo

from being frantically busy in their days,

da budu izbezumljeno zaposleni u svom poslu,

as he explained.

kako je objasnio.

What they were trying to do

Pokušavali su da prepoznaju

was figure out whether you might have one of the diagnoses

da li možda imate jednu od dijagnoza

for which they could do something.

za koju su mogli da učine nešto.

And there were a few.

Bilo ih je nekoliko.

You might have a lobar pneumonia, for example,

Možda imate lobusnu upalu pluća, na primer,

and they could give you an antiserum,

i mogli su vam dati antiserum,

an injection of rabid antibodies

inekciju s antitelima besnila

to the bacterium streptococcus,

protiv bakterija streptokoka,

if the intern sub-typed it correctly.

ako je pripravnik to ispravno upisao.

If you had an acute congestive heart failure,

Ako ste imali akutnu srčanu insufienciju,

they could bleed a pint of blood from you

mogli su da vam puste pola litre krvi

by opening up an arm vein,

otvaranjem vene na ruci,

giving you a crude leaf preparation of digitalis

dajući vam preparat od sirovog lista digitalisa

and then giving you oxygen by tent.

i onda kiseonik, kiseoničkim šatorom.

If you had early signs of paralysis

Ako su postojali rani znaci paralize,

and you were really good at asking personal questions,

a bili ste jako dobri u postavljanju intimnih pitanja

you might figure out

mogli ste da pronađete

that this paralysis someone has is from syphilis,

da je uzrok te paralize sifilis,

in which case you could give this nice concoction

u kom slučaju biste mogli da date ovu lepu mešavinu

of mercury and arsenic --

žive i arsena -

as long as you didn't overdose them and kill them.

sve dok ih ne predozirate i ubijete.

Beyond these sorts of things,

Osim tih stvari,

a medical doctor didn't have a lot that they could do.

lekari nisu mogli mnogo da urade.

This was when the core structure of medicine

Tada je stvoreno

was created --

jezgro medicine -

what it meant to be good at what we did

šta je tada značilo biti dobar u svom radu

and how we wanted to build medicine to be.

i kakvu medicinu smo želeli da izgradimo.

It was at a time

Bilo je to u vreme

when what was known you could know,

kada ste ono što je bilo poznato, mogli da znate,

you could hold it all in your head, and you could do it all.

da sve držite u glavi i da sve uradite.

If you had a prescription pad,

Ako ste imali formular za recept,

if you had a nurse,

medicinsku sestru,

if you had a hospital

bolnicu

that would give you a place to convalesce, maybe some basic tools,

kao mesto za oporavak, možda neke osnovne instrumente,

you really could do it all.

mogli ste da uradite sve.

You set the fracture, you drew the blood,

Popravili ste prelom, pustili krv,

you spun the blood,

centrifugirali krv,

looked at it under the microscope,

pogledali je pod mikroskopom,

you plated the culture, you injected the antiserum.

zasejali kulturu, ubrizgali antiserum.

This was a life as a craftsman.

To je bio život nalik zanatlijskom.

As a result, we built it around

Rezultat je bio da smo to izgradili

a culture and set of values

oko kulture i sklopa vrednosti

that said what you were good at

koje su govorile da si bio dobar

was being daring,

u tome što si odvažan,

at being courageous,

hrabar,

at being independent and self-sufficient.

nezavisan i samodovoljan.

Autonomy was our highest value.

Samostalnost je bila naša najveća vrednost.

Go a couple generations forward

Pomaknimo se par generacija napred

to where we are, though,

do današnjeg vremena

and it looks like a completely different world.

u sasvim drugačiji svet.

We have now found treatments

Pronašli smo terapije

for nearly all of the tens of thousands of conditions

za skoro sve od desetina hiljada bolesti

that a human being can have.

koje ljudsko biće može da ima.

We can't cure it all.

Ne možemo ih sve izlečiti.

We can't guarantee that everybody will live a long and healthy life.

Ne možemo da garantujemo da će svi imati dug i zdrav život,

But we can make it possible

ali ga možemo omogućiti

for most.

većini.

But what does it take?

Šta je za to potrebno?

Well, we've now discovered

Do sada smo pronašli

4,000 medical and surgical procedures.

4.000 medicinskih i hirurških postupaka.

We've discovered 6,000 drugs

Pronašli smo 6000 lekova

that I'm now licensed to prescribe.

koje sada ovlašćeno mogu da propisujem.

And we're trying to deploy this capability,

Pokušavamo te mogućnosti da primenimo

town by town,

u svakom gradu,

to every person alive --

na svakoj živoj osobi -

in our own country,

u našoj zemlji,

let alone around the world.

da i ne spominjem svet.

And we've reached the point where we've realized,

Došli smo do tačke u kojoj smo shvatili,

as doctors,

kao lekari,

we can't know it all.

da ne možemo znati sve.

We can't do it all

Ne možemo učiniti sve

by ourselves.

sami.

There was a study where they looked

U jednom istraživanju su posmatrali

at how many clinicians it took to take care of you

koliko se kliničara brine o vama

if you came into a hospital,

ako ste došli u bolnicu,

as it changed over time.

jer se to vremenom promenilo.

And in the year 1970,

U 1970. godini,

it took just over two full-time equivalents of clinicians.

bilo je potrebno nešto više od dva stalna kliničara.

That is to say,

To govori

it took basically the nursing time

da je vremenski preovladavala bolnička nega

and then just a little bit of time for a doctor

uz nešto malo učešća lekara

who more or less checked in on you

koji je uglavnom obavljao kontrolu

once a day.

jednom dnevno.

By the end of the 20th century,

Krajem 20. veka,

it had become more than 15 clinicians

to je preraslo u više od 15 kliničara

for the same typical hospital patient --

za istog tipičnog pacijenta u bolnici -

specialists, physical therapists,

specijalisti, fizioterapeuti,

the nurses.

sestre.

We're all specialists now,

Svi smo danas specijalisti,

even the primary care physicians.

čak i lekari opšte prakse.

Everyone just has

Svako ima samo

a piece of the care.

deo nege.

But holding onto that structure we built

Ali držeći se čvrsto te strukture koju smo izgradili

around the daring, independence,

oko smelosti, nezavisnosti,

self-sufficiency

samodovoljnosti

of each of those people

svih tih ljudi,

has become a disaster.

postalo je katastrofa.

We have trained, hired and rewarded people

Obučili smo, zaposlili i nagradili ljude

to be cowboys.

da budu kauboji,

But it's pit crews that we need,

a trebaju nam pit posade

pit crews for patients.

za pacijente.

There's evidence all around us:

Svuda oko nas su dokazi:

40 percent of our coronary artery disease patients

40% koronarnih pacijenata

in our communities

u našim zajednicama

receive incomplete or inappropriate care.

dobijaju nepotpunu ili neodgovarajuću negu.

60 percent

60%

of our asthma, stroke patients

naših astmatičara, bolesnika s moždanim udarom

receive incomplete or inappropriate care.

dobija nepotpunu ili neadekvatnu negu.

Two million people come into hospitals

Dva miliona ljudi koji dođu u bolnice

and pick up an infection

pokupe neku infekciju

they didn't have

koju nisu imali

because someone failed to follow

zato što neko nije uspeo da prati

the basic practices of hygiene.

osnovna pravila higijene.

Our experience

Kao ljudi koji se razboljevamo

as people who get sick,

i trebamo pomoć drugih ljudi,

need help from other people,

naše iskustvo je

is that we have amazing clinicians

da imamo neverovatne kliničare

that we can turn to --

kojima se možemo obratiti -

hardworking, incredibly well-trained and very smart --

radne, neverovatno dobro obučene i vrlo pametne -

that we have access to incredible technologies

da imamo pristup neverovatnim tehnologijama

that give us great hope,

koje nam daju veliku nadu,

but little sense

ali premalo smisla

that it consistently all comes together for you

za doslednu primenu svega toga zajedno

from start to finish

od početka do kraja

in a successful way.

na uspešan način.

There's another sign

Postoji još jedan znak

that we need pit crews,

da su nam potrebne pit posade,

and that's the unmanageable cost

a to su nesavladivi troškovi

of our care.

naše nege.

Now we in medicine, I think,

Mislim da smo u medicini

are baffled by this question of cost.

zapanjeni troškovima.

We want to say, "This is just the way it is.

Želimo reći: "To je tako.

This is just what medicine requires."

To medicina zahteva."

When you go from a world

Kad pređete iz sveta

where you treated arthritis with aspirin,

u kome se artritis lečio aspirinom,

that mostly didn't do the job,

koji većinom nije delovao,

to one where, if it gets bad enough,

u svet u kome, pri pogoršanju,

we can do a hip replacement, a knee replacement

možemo da zamenimo kuk, koleno,

that gives you years, maybe decades,

što vam pruža godine, možda i decenije

without disability,

bez invaliditeta,

a dramatic change,

to je dramatična promena.

well is it any surprise

Da li uopšte iznenađuje

that that $40,000 hip replacement

da je 40.000 $ za zamenu kuka

replacing the 10-cent aspirin

umesto 10 centi za aspirin

is more expensive?

skuplje?

It's just the way it is.

To je tako.

But I think we're ignoring certain facts

No, mislim da zanemarujemo određene činjenice

that tell us something about what we can do.

koje nam ponešto govore o tome šta možemo da uradimo.

As we've looked at the data

Kad smo pogledali podatke

about the results that have come

o novijim rezultatima

as the complexity has increased,

kako je složenost rasla,

we found

pronašli smo

that the most expensive care

da nije najskuplja nega

is not necessarily the best care.

nužno i najbolja.

And vice versa,

I obrnuto,

the best care

najbolja nega

often turns out to be the least expensive --

često ispadne najjeftinija -

has fewer complications,

ima manje komplikacija,

the people get more efficient at what they do.

ljudi u svom poslu postanu efikasniji.

And what that means

A to znači

is there's hope.

da ima nade.

Because [if] to have the best results,

Jer ako je za najbolje rezultate,

you really needed the most expensive care

stvarno potrebna najskuplja nega

in the country, or in the world,

u zemlji ili u svetu,

well then we really would be talking about rationing

onda bismo stvarno govorili o racionalizaciji

who we're going to cut off from Medicare.

u smislu kome ćemo uskratiti pružanje medicinske nege.

That would be really our only choice.

To bi nam zaista bio jedini izbor.

But when we look at the positive deviants --

No, kada pogledamo pozitivna odstupanja -

the ones who are getting the best results

onih koji dobijaju najbolje rezultate

at the lowest costs --

po najnižim troškovima -

we find the ones that look the most like systems

pronalazimo da su slučajevi najviše nalik sistemima

are the most successful.

najuspešniji.

That is to say, they found ways

Naime, našli su načine

to get all of the different pieces,

da sve različite delove,

all of the different components,

svih različitih komponenti,

to come together into a whole.

sastave u celinu.

Having great components is not enough,

Imati sjajne delove nije dovoljno,

and yet we've been obsessed in medicine with components.

a ipak smo u medicini bili opsednuti s komponentama.

We want the best drugs, the best technologies,

Želimo najbolje lekove, najbolje tehnologije,

the best specialists,

najbolje specijaliste,

but we don't think too much

ali ne razmišljamo previše

about how it all comes together.

o tome kako to deluje zajedno.

It's a terrible design strategy actually.

To je u stvari očajna dizajnerska strategija.

There's a famous thought experiment

Postoji poznati misaoni eksperiment,

that touches exactly on this

koji govori upravo o tome

that said, what if you built a car

šta se dešava ako sastavite

from the very best car parts?

automobil od najboljih delova?

Well it would lead you to put in Porsche brakes,

Recimo da stavite Poršeove kočnice,

a Ferrari engine,

Ferarijev motor,

a Volvo body, a BMW chassis.

Volvovu karoseriju, BMW-ovu šasiju.

And you put it all together and what do you get?

Spojite sve to i šta dobijete?

A very expensive pile of junk that does not go anywhere.

Vrlo skupu hrpu smeća koja ne može da se vozi.

And that is what medicine can feel like sometimes.

Tako medicina ponekad deluje.

It's not a system.

To nije sistem.

Now a system, however,

Međutim, sistem,

when things start to come together,

kada se stvari počnu objedinjavati,

you realize it has certain skills

pokazuje određena umeća

for acting and looking that way.

u svom delovanju.

Skill number one

Umeće broj jedan

is the ability to recognize success

je sposobnost da prepozna uspeh

and the ability to recognize failure.

i neuspeh.

When you are a specialist,

Kada ste specijalista,

you can't see the end result very well.

ne možete da vidite krajnji rezultat vrlo dobro.

You have to become really interested in data,

Morate biti zaista zainteresovani za podatke,

unsexy as that sounds.

što baš nije privlačno.

One of my colleagues is a surgeon in Cedar Rapids, Iowa,

Jedan moj kolega, hirurg u Sidar Rapidsu u Ajovi,

and he got interested in the question of,

se zainteresovao

well how many CT scans did they do

koliko je CT skeniranja urađeno

for their community in Cedar Rapids?

za zajednicu u Sidar Rapidsu?

He got interested in this

Zainteresovao se zato

because there had been government reports,

što su u vladinim izveštajima,

newspaper reports, journal articles

u novinama i člancima u časopisima

saying that there had been too many CT scans done.

navodili da je bilo previše CT skeniranja.

He didn't see it in his own patients.

Nije to video kod svojih pacijenata.

And so he asked the question, "How many did we do?"

Hteo je da dobije podatke, pa je postavio pitanje:

and he wanted to get the data.

"Koliko smo ih napravili?"

It took him three months.

Trebalo mu je tri meseca.

No one had asked this question in his community before.

Niko u zajednici nije postavio to pitanje ranije.

And what he found was that,

Pronašao je da je

for the 300,000 people in their community,

za 300.000 ljudi u zajednici,

in the previous year

prethodne godine

they had done 52,000 CT scans.

napravljeno 52.000 CT skeniranja.

They had found a problem.

Pronašli su problem.

Which brings us to skill number two a system has.

To nas dovodi do drugog umeća koje ima sistem.

Skill one, find where your failures are.

Prvo umeće je pronaći kvarove.

Skill two is devise solutions.

Drugo je osmisliti rešenja.

I got interested in this

Zainteresovao sam se za to

when the World Health Organization came to my team

kada je Svetska zdravstvena organizacija zatražila

asking if we could help with a project

od mog tima da pomognemo projektu

to reduce deaths in surgery.

u smanjivanju smrtnosti u hirurgiji.

The volume of surgery had spread

Količina operacija se širom sveta

around the world,

proširila,

but the safety of surgery

ali ne i njihova

had not.

bezopasnost.

Now our usual tactics for tackling problems like these

Naše uobičajene taktike za rešavanje takvih problema

are to do more training,

su povećavanje obuke,

give people more specialization

dati ljudima više specijalizacije

or bring in more technology.

ili uvesti više tehnologije.

Well in surgery, you couldn't have people who are more specialized

U hirurgiji, ne možete imati specijalizovanije

and you couldn't have people who are better trained.

i obučenije ljude,

And yet we see unconscionable levels

a ipak vidimo nesavesne slučajeve

of death, disability

smrti, invalidnosti

that could be avoided.

koje bi se mogle izbeći.

And so we looked at what other high-risk industries do.

Obratili smo se drugim visokorizičnim industrijama.

We looked at skyscraper construction,

Pregledali smo gradnju nebodera,

we looked at the aviation world,

vazduhoplovni svet

and we found

i pronašli smo

that they have technology, they have training,

da osim tehnologije i obuke,

and then they have one other thing:

imaju još jednu stvar:

They have checklists.

kontrolne liste.

I did not expect

Nisam očekivao

to be spending a significant part

da ću kao harvardski hirurg

of my time as a Harvard surgeon

provoditi značajan deo svog vremena

worrying about checklists.

brinući se o kontrolnim listama.

And yet, what we found

No ipak smo pronašli

were that these were tools

da su to načini

to help make experts better.

koji pomažu boljem delovanju stručnjaka.

We got the lead safety engineer for Boeing to help us.

Pomoć smo potražili od Boingovog glavnog inženjera za sigurnost.

Could we design a checklist for surgery?

Da li bismo mogli da napravimo kontrolnu listu za operaciju?

Not for the lowest people on the totem pole,

Ne za najniže u hijerarhiji,

but for the folks

već za ljude

who were all the way around the chain,

koji su u celom lancu,

the entire team including the surgeons.

za ceo tim, uključujući hirurge.

And what they taught us

Naučili su nas

was that designing a checklist

da je pravljenje kontrolne liste

to help people handle complexity

za pomoć ljudima pri savladavanju složenosti

actually involves more difficulty than I had understood.

zapravo teže nego što sam mislio.

You have to think about things

Morate razmišljati o stvarima

like pause points.

kao što su pauze.

You need to identify the moments in a process

Morate prepoznati trenutke u procesu

when you can actually catch a problem before it's a danger

pre nego što problem postane opasan

and do something about it.

i kada se još može nešto učiniti.

You have to identify

Morate prepoznati

that this is a before-takeoff checklist.

da je to kontrolna lista pre poletanja.

And then you need to focus on the killer items.

Zatim se morate usredotočiti na smrtonosne stvari.

An aviation checklist,

Vazduhoplovna kontrolna lista,

like this one for a single-engine plane,

kao ova za avion s jednim motorom,

isn't a recipe for how to fly a plane,

nije recept za upravljanje avionom,

it's a reminder of the key things

već je podsetnik za ključne stvari

that get forgotten or missed

koje se zaborave ili propuste

if they're not checked.

ako se ne provere.

So we did this.

To smo uradili.

We created a 19-item two-minute checklist

Sastavili smo dvominutnu kontrolnu listu sa 19 stavki

for surgical teams.

za hirurške ekipe.

We had the pause points

Pauze smo dali

immediately before anesthesia is given,

neposredno pre anestezije,

immediately before the knife hits the skin,

neposredno pre upotrebe noža

immediately before the patient leaves the room.

i neposredno pre nego što pacijent napusti prostoriju.

And we had a mix of dumb stuff on there --

Dobili smo mešavinu nezanimljivih stvari -

making sure an antibiotic is given in the right time frame

proveru da se antibiotik daje u pravom vremenskom okviru,

because that cuts the infection rate by half --

jer to prepolovi stopu infekcije -

and then interesting stuff,

i zanimljivih stvari,

because you can't make a recipe for something as complicated as surgery.

jer ne možete napraviti recept za nešto tako složeno kao operacija.

Instead, you can make a recipe

Umesto toga, možete napraviti recept

for how to have a team that's prepared for the unexpected.

za to kako imati ekipu pripremljenu za neočekivano.

And we had items like making sure everyone in the room

Imali smo stavke kao što je kontrola da li su se svi u sobi

had introduced themselves by name at the start of the day,

predstavili po imenu na početku dana,

because you get half a dozen people or more

jer imate pola tuceta ili više ljudi

who are sometimes coming together as a team

koji su ponekad zajedno kao ekipa

for the very first time that day that you're coming in.

po prvi put toga dana kada se sami priključujete.

We implemented this checklist

Sproveli smo ovu kontrolnu listu

in eight hospitals around the world,

u osam bolnica širom sveta,

deliberately in places from rural Tanzania

namerno u mestima od ruralne Tanzanije

to the University of Washington in Seattle.

do Univerziteta Vašington u Sijetlu.

We found that after they adopted it

Pronašli smo da su se, posle prihvatanja liste,

the complication rates fell

stope komplikacija smanjile

35 percent.

za 35%.

It fell in every hospital it went into.

Smanjile su se u svakoj bolnici u kojoj su je uveli.

The death rates fell

Stope smrtnosti su se smanjile

47 percent.

za 47%.

This was bigger than a drug.

To je više od smanjivanja lekovima.

(Applause)

(Aplauz)

And that brings us

I to nas dovodi

to skill number three,

do trećeg umeća,

the ability to implement this,

mogućnosti sprovođenja liste,

to get colleagues across the entire chain

da bi kolege u čitavom lancu

to actually do these things.

zaista uradile te stvari,

And it's been slow to spread.

a ono se sporo širi.

This is not yet our norm in surgery --

To još nije naš standard u hirurgiji -

let alone making checklists

da i ne spominjem pravljenje kontrolnih lista

to go onto childbirth and other areas.

za porođaje i druga područja.

There's a deep resistance

Postoji dubok otpor

because using these tools

jer nas korišćenje takvog načina

forces us to confront

prisiljava da se suočimo sa tim

that we're not a system,

da nismo sistem,

forces us to behave with a different set of values.

primorava nas da se nosimo s različitim vrednostima.

Just using a checklist

Samo korišćenje kontrolne liste

requires you to embrace different values from the ones we've had,

zahteva prihvatanje različitih vrednosti od dosadašnjih,

like humility,

kao što je poniznost,

discipline,

disciplina,

teamwork.

timski rad.

This is the opposite of what we were built on:

Suprotno onom na čemu smo izgrađeni:

independence, self-sufficiency,

samostalnosti, samodovoljnosti,

autonomy.

autonomiji.

I met an actual cowboy, by the way.

Upoznao sam pravog kauboja.

I asked him, what was it like

Pitao sam ga, kako je

to actually herd a thousand cattle

goniti stado od hiljadu goveda

across hundreds of miles?

stotinama kilometara?

How did you do that?

Kako se to radi?

And he said, "We have the cowboys stationed at distinct places all around."

Rekao je: "Imamo kauboje stacionirane u okolnim udaljenim mestima."

They communicate electronically constantly,

Oni stalno elektronski komuniciraju,

and they have protocols and checklists

imaju protokole i kontrolne liste

for how they handle everything --

kako da se late svega -

(Laughter)

(Smeh)

-- from bad weather

- od nevremena

to emergencies or inoculations for the cattle.

do vanrednih stanja ili vakcina za stoku.

Even the cowboys are pit crews now.

Čak su i kauboji sada pit posade.

And it seemed like time

Čini se da je vreme

that we become that way ourselves.

da i mi postanemo takvi.

Making systems work

Stvaranje sistema koji deluju

is the great task of my generation

je velik zadatak moje generacije

of physicians and scientists.

lekara i naučnika.

But I would go further and say

No, otišao bih dalje i rekao

that making systems work,

da je stvaranje sistema koji deluju,

whether in health care, education,

bilo u zdravstvu, obrazovanju,

climate change,

pri klimatskim promenama,

making a pathway out of poverty,

pri stvaranju puta izlaska iz siromaštva,

is the great task of our generation as a whole.

velik zadatak naše generacije u celini.

In every field, knowledge has exploded,

Na svim poljima je znanje eksplodiralo,

but it has brought complexity,

ali je donelo složenost

it has brought specialization.

i specijalizaciju.

And we've come to a place where we have no choice

Došli smo do tačke na kojoj nemamo izbora

but to recognize,

osim da prepoznamo,

as individualistic as we want to be,

individualni kakvi želimo da smo,

complexity requires

da složenost zahteva

group success.

grupni uspeh.

We all need to be pit crews now.

Svi moramo da smo pit posade danas.

Thank you.

Hvala.

(Applause)

(Aplauz)