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

386,956 views ・ 2012-01-25

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Please double-click on the English subtitles below to play the video.

Prevodilac: Jelena Nedjic Lektor: Mateja Nenadovic
00:15
I think we have to do something
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Mislim da je neophodno da promenimo
00:17
about a piece of the culture of medicine that has to change.
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jedan aspekt medicinske kulture.
00:20
And I think it starts with one physician, and that's me.
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Mislim da jedan lekar može da pokrene to, to sam ja.
00:23
And maybe I've been around long enough
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Mislim da sam već dovoljno dugo u tome
00:25
that I can afford to give away some of my false prestige
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da mogu da priuštim da se odreknem dela lažnog prestiža
00:27
to be able to do that.
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da bih to uradio.
00:29
Before I actually begin the meat of my talk,
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Pre nego što zadrem u suštinu mog predavanja,
00:31
let's begin with a bit of baseball.
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počeo bih sa pričom o bejzbolu.
00:33
Hey, why not?
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Ha, a što da ne?
00:35
We're near the end, we're getting close to the World Series.
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Sezona se uskoro završava, uskoro će i veliko finale.
00:38
We all love baseball, don't we?
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Svi volimo bejzbol, zar ne?
00:41
(Laughter)
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(smeh)
00:43
Baseball is filled with some amazing statistics.
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U bejzbolu nailazite na neverovatne statističke podatke.
00:46
And there's hundreds of them.
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Ima ih na hiljade.
00:49
"Moneyball" is about to come out, and it's all about statistics
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Uskoro će izaći i film "Moneyball", tu se radi o statistici,
00:52
and using statistics to build a great baseball team.
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upotreba statistike kako biste napravili odličan bejzbol tim.
00:54
I'm going to focus on one stat
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Fokusiraću se na jedan podatak,
00:57
that I hope a lot of you have heard of.
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a nadam se da ste svi čuli o tome.
00:59
It's called batting average.
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To nazivamo prosečan uspeh.
01:01
So we talk about a 300, a batter who bats 300.
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Ako pričamo o broju 300, o udaraču koji udara 300.
01:04
That means that ballplayer batted safely, hit safely
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To znači da je igrač sigurno udario loptu
01:08
three times out of 10 at bats.
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3 puta od 10 pokušaja.
01:11
That means hit the ball into the outfield,
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To znači da je plasirao loptu van terena,
01:13
it dropped, it didn't get caught,
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pala je, niko je nije uhvatio,
01:15
and whoever tried to throw it to first base didn't get there in time
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i ko god da je pokušao da dobaci loptu do prve baze nije to na vreme uradio
01:18
and the runner was safe.
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i trkač je osvojio bazu.
01:20
Three times out of 10.
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U 3 od 10 pokušaja.
01:23
Do you know what they call a 300 hitter
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Znate li kako zovu udarača koji ima prosek 300
01:26
in Major League Baseball?
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u glavnoj bejzbol ligi?
01:28
Good, really good,
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Dobar, veoma dobar,
01:31
maybe an all-star.
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možda super zvezda.
01:34
Do you know what they call
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Da li znate kako zovu onoga
01:36
a 400 baseball hitter?
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ko ima prosek udaraca 400?
01:38
That's somebody who hit, by the way,
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To je neko ko udari lopticu, uzgred budi rečeno,
01:40
four times safely out of every 10.
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4 puta u 10 pokušaja.
01:42
Legendary --
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Legendarni,
01:45
as in Ted Williams legendary --
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kao legendarni Ted Vilijams,
01:47
the last Major League Baseball player
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poslednji igrač glavne bejzbol lige
01:49
to hit over 400 during a regular season.
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koji je premašio prosek od 400 tokom redovne sezone.
01:52
Now let's take this back into my world of medicine
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Sada bih ove podatke preslikao u svet medicine,
01:54
where I'm a lot more comfortable,
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o tome mnogo više znam,
01:56
or perhaps a bit less comfortable
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a možda će mi biti manje prijatno
01:58
after what I'm going to talk to you about.
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kada vam ispričam ono što želim da kažem.
02:01
Suppose you have appendicitis
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Zamislite da imate upalu slepog creva
02:03
and you're referred to a surgeon
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i da su vas uputili na hirurga
02:05
who's batting 400 on appendectomies.
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čiji je prosek uspešnosti 400 u apendiktomijama.
02:07
(Laughter)
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(smeh)
02:10
Somehow this isn't working out, is it?
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Nekako ovo baš i ne funkcioniše, zar ne?
02:13
Now suppose you live
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Zamisilite sada da živite
02:15
in a certain part of a certain remote place
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u veoma udaljenom delu sveta,
02:18
and you have a loved one
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a vaša voljena osoba
02:20
who has blockages in two coronary arteries
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pati od zakrčenja dve koronarne arterije,
02:23
and your family doctor refers that loved one to a cardiologist
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a vaš porodični lekar preporuči vašoj voljenoj osobi kardiologa
02:26
who's batting 200 on angioplasties.
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čiji je prosek oko 200 u angioplastičnoj hirurgiji.
02:30
But, but, you know what?
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Ali, ali, znate šta?
02:32
She's doing a lot better this year. She's on the comeback trail.
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Mnogo je bolja ove godine. Vraća se u formu.
02:34
And she's hitting a 257.
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Tako da je njen prosek sada 257.
02:37
Somehow this isn't working.
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To nekako ne funkcioniše.
02:39
But I'm going to ask you a question.
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Pitaću vas sada nešto.
02:41
What do you think a batting average
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Šta vi mislite kolika treba da bude
02:43
for a cardiac surgeon or a nurse practitioner
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prosečna uspešnost kardiologa
02:45
or an orthopedic surgeon,
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ili medicinske sestre,
02:47
an OBGYN, a paramedic
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ortopeda, ginekologa,
02:49
is supposed to be?
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hitne službe?
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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Istina je da niko u svetu
02:57
nobody knows in all of medicine
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medicine ne zna
02:59
what a good surgeon
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koliki prosek treba da ima
03:01
or physician or paramedic
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dobar hirurg
03:03
is supposed to bat.
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ili lekar ili služba za spašavanje.
03:05
What we do though is we send each one of them, including myself,
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Ono što mi ustvari sistemski radimo lekarima, pa i meni,
03:07
out into the world
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mi im ugraviramo zahtev da budu perfektni
03:09
with the admonition, be perfect.
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u svom poslu.
03:11
Never ever, ever make a mistake,
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Nikada, nikada nemoj napraviti grešku,
03:13
but you worry about the details, about how that's going to happen.
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ali ti se brini o detaljima kako da to sprovedeš u delo.
03:16
And that was the message that I absorbed
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To je poruka koju sam poneo sa sobom
03:18
when I was in med school.
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sa studija medicine.
03:20
I was an obsessive compulsive student.
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Bio sam opsesivno kompulsivan student.
03:23
In high school, a classmate once said
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U srednjoj školi je moj drugar iz razreda
03:26
that Brian Goldman would study for a blood test.
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govorio kako Brajan Goldman uči za test analize krvi.
03:28
(Laughter)
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(smeh)
03:31
And so I did.
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I to je tačno.
03:33
And I studied in my little garret
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Učio sam u mom malom potkrovlju
03:35
at the nurses' residence at Toronto General Hospital,
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u rezidenciji za medicinske sestre Opšte bolnice u Torontu,
03:37
not far from here.
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nedaleko odavde.
03:39
And I memorized everything.
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Sve sam pamtio.
03:41
I memorized in my anatomy class
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Na časovima anatomije sam pamtio
03:43
the origins and exertions of every muscle,
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početak i kraj svakog mišića,
03:45
every branch of every artery that came off the aorta,
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granu svake arterije koja se račva od aorte,
03:48
differential diagnoses obscure and common.
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čudne i uobičajene diferencijalne dijagnoze.
03:51
I even knew the differential diagnosis
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Znao sam čak i diferencijalnu dijagnozu
03:53
in how to classify renal tubular acidosis.
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po kojoj se klasifikuju tipovi acidoze bubrežnih kanala.
03:55
And all the while,
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Sve to vreme,
03:57
I was amassing more and more knowledge.
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skladištio sam sve više i više znanja.
03:59
And I did well, I graduated with honors,
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Dobro mi je išlo, diplomirao sam sa posebnim pohvalama,
04:01
cum laude.
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sa desetkom.
04:03
And I came out of medical school
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Završio sam medicinski fakulet
04:06
with the impression
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i imao sam utisak
04:08
that if I memorized everything and knew everything,
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da ukoliko zapamtim sve i znam sve,
04:10
or as much as possible,
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ili barem što je moguće više,
04:12
as close to everything as possible,
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što bliže sveobuhvatnom znanju,
04:14
that it would immunize me against making mistakes.
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da će me to znanje osposobiti da ne pravim greške.
04:17
And it worked
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To je i bilo tako
04:19
for a while,
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neko vreme,
04:22
until I met Mrs. Drucker.
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dok nisam upoznao gospođu Druker.
04:25
I was a resident at a teaching hospital here in Toronto
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Bio sam na specijalizaciji u bolnici ovde u Torontu,
04:27
when Mrs. Drucker was brought to the emergency department
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kada su gospođu Druker doveli u urgentni centar
04:30
of the hospital where I was working.
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bolnice u kojoj sam radio.
04:32
At the time I was assigned to the cardiology service
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U tom periodu sam vršio dužnosti kardiologa,
04:34
on a cardiology rotation.
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bio sam na specijalizaciji iz kardiologije.
04:36
And it was my job,
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Moj zadatak je bio da pomognem
04:38
when the emergency staff called for a cardiology consult,
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u urgentnom centru kada im je potreban savet kardiologa,
04:40
to see that patient in emerg.
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da obiđem pacijenta u urgentnom centru,
04:43
and to report back to my attending.
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i da podnesem izveštaj svom nadređenom.
04:45
And I saw Mrs. Drucker, and she was breathless.
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Obišao sam g-đu Druker, bila je bez daha.
04:48
And when I listened to her, she was making a wheezy sound.
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Kada sam je oslušnuo, pravila je zviždukav zvuk.
04:51
And when I listened to her chest with a stethoscope,
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Kada sam joj poslušao pluća stetoskopom,
04:53
I could hear crackly sounds on both sides
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čuo sam razarajući zvuk sa obe strane
04:55
that told me that she was in congestive heart failure.
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što mi je ukazalo da je u pitanju srčani napad.
04:58
This is a condition in which the heart fails,
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U tom stanju srce prestane da radi,
05:01
and instead of being able to pump all the blood forward,
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i umesto da ispumpava krv u sistemski krvotok,
05:03
some of the blood backs up into the lung, the lungs fill up with blood,
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deo krvi se vraća u pluća koja se pune krvlju,
05:06
and that's why you have shortness of breath.
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i zato imate kratak udisaj.
05:08
And that wasn't a difficult diagnosis to make.
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To nije bilo teško dijganostifikovati.
05:11
I made it and I set to work treating her.
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Učinio sam to i počeo sa terapijom.
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 i lekove koji smanjuju pritisak u srcu.
05:17
I gave her medications that we call diuretics, water pills,
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Dao sam joj lekove koje nazivamo dijureticima, vodene pilule,
05:20
to get her to pee out the access fluid.
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kako bi ispiškila višak tečnosti.
05:23
And over the course of the next hour and a half or two,
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U toku narednih sat i po ili dva vremena,
05:25
she started to feel better.
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počela je da se oporavlja.
05:27
And I felt really good.
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Dobro sam se osećao.
05:30
And that's when I made my first mistake;
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Tada sam učinio prvu grešku:
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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U stvari, napravio sam još dve 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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a nisam razgovarao sa nadređenim lekarem.
05:42
I didn't pick up the phone and do what I was supposed to do,
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Nisam telefonirao i nisam uradio ono što je trebalo da uradim,
05:45
which was call my attending and run the story by him
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a to je da pozovem dežurnog i prepričam mu detalje
05:47
so he would have a chance to see her for himself.
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kako bi on bio u prilici da je i sam pregleda.
05:50
And he knew her,
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On ju je poznavao,
05:52
he would have been able to furnish additional information about her.
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bio bi u stanju da dođe do dodatnih informacija o njoj.
05:55
Maybe I did it for a good reason.
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Možda sam to uradio iz dobrog razloga.
05:57
Maybe I didn't want to be a high-maintenance resident.
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Možda nisam želeo da budem neko kome treba puno supervizije.
06:00
Maybe I wanted to be so successful
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Možda sam želeo da budem toliko uspešan
06:02
and so able to take responsibility
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i sposoban da preuzmem odgovornost,
06:04
that I would do so
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a da bih to uradio
06:06
and I would be able to take care of my attending's patients
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trebalo je da se postaram o pacijentima nadređenog,
06:08
without even having to contact him.
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a da ga uopšte ne kontaktiram.
06:10
The second mistake that I made was worse.
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Druga greška je bila još gora.
06:14
In sending her home,
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Kada sam je poslao kući,
06:16
I disregarded a little voice deep down inside
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zanemario sam glasić u sebi
06:18
that was trying to tell me,
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koji je pokušavao da mi kaže:
06:20
"Goldman, not a good idea. Don't do this."
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"Goldmane, to nije dobra ideja. Ne čini to."
06:23
In fact, so lacking in confidence was I
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Toliko sam bio nesiguran
06:26
that I actually asked the nurse
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da sam na kraju pitao sestru
06:28
who was looking after Mrs. Drucker,
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koja je pazila g-đu Druker:
06:30
"Do you think it's okay if she goes home?"
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"Da li je OK da je pustimo kući?"
06:33
And the nurse thought about it
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Sestra se zamislila,
06:35
and said very matter-of-factly, "Yeah, I think she'll do okay."
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a onda odlučno rekla: "Da, mislim da će biti okej."
06:37
I can remember that like it was yesterday.
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Sećam se toga kao da je juče bilo.
06:40
So I signed the discharge papers,
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Potpisao sam otpusnu listu,
06:42
and an ambulance came, paramedics came to take her home.
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došla su kola hitne pomoći i odvela je kući.
06:45
And I went back to my work on the wards.
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Vratio sam se svojim dužnostima.
06:48
All the rest of that day,
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Tokom celog dana,
06:50
that afternoon,
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tog popodeva,
06:52
I had this kind of gnawing feeling inside my stomach.
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sam osećao grčeve u stomaku.
06:55
But I carried on with my work.
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Ali sam nastavio sa poslom.
06:58
And at the end of the day, I packed up to leave the hospital
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Na kraju dana, spremio sam se da napustim bolnicu,
07:00
and walked to the parking lot
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i otišao sam do parkinga
07:02
to take my car and drive home
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kako bih se odvezao kući,
07:04
when I did something that I don't usually do.
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ali sam tada uradio nešto što inače ne radim.
07:08
I walked through the emergency department on my way home.
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Prošao sam kroz urgentni centar na svom putu ka kući.
07:11
And it was there that another nurse,
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Tamo mi je druga sestra,
07:13
not the nurse who was looking after Mrs. Drucker before, but another nurse,
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ne ona sestra koja je negovala g-đu Druker, već druga sestra,
07:16
said three words to me
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rekla tri reči,
07:19
that are the three words
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to su tri reči kojih se
07:21
that most emergency physicians I know dread.
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svi lekari u uregentnom plaše.
07:24
Others in medicine dread them as well,
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Ostali medicinari ih se takođe plaše,
07:26
but there's something particular about emergency medicine
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ali urgentni centar karakteriše nešto posebno
07:28
because we see patients so fleetingly.
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jer sa pacijentima provodimo kratko vreme.
07:32
The three words are:
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Te tri reči su"
07:34
Do you remember?
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"Sećaš li se?"
07:38
"Do you remember that patient you sent home?"
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"Sećaš li se onog pacijenta kog si poslao kući?",
07:41
the other nurse asked matter-of-factly.
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ta druga sestra me je odvažno pitala.
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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baš tim tonom glasa.
07:47
Well she was back all right.
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Pa, ona se vratila, u redu.
07:49
She was back and near death.
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Ona se vratila i gotovo da je mrtva.
07:52
About an hour after she had arrived home,
188
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Sat vremena nakon što je stigla kući,
07:54
after I'd sent her home,
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nakon što sam je ja poslao kući
07:56
she collapsed and her family called 911
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ona je kolabirala i njena porodica je pozvala 94,
07:59
and the paramedics brought her back to the emergency department
191
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i ekipa paramedika ju je vratila u urgentni centar
08:01
where she had a blood pressure of 50,
192
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imala je krvni pritisak 50,
08:03
which is in severe shock.
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što znači da je u teškom šoku.
08:05
And she was barely breathing and she was blue.
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Jedva je disala i bila je plava.
08:08
And the emerg. staff pulled out all the stops.
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Osoblje iz urgentnog centra je uradilo sve što je moglo.
08:11
They gave her medications to raise her blood pressure.
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Dobila je lekove za povišenje krvnog pritiska.
08:14
They put her on a ventilator.
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Prikačili su je na veštačka pluća.
08:16
And I was shocked
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Bio sam šokiran
08:19
and shaken to the core.
199
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i potpuno potresen.
08:21
And I went through this roller coaster,
200
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1976
Sve se u mojoj glavi vrtelo,
08:23
because after they stabilized her,
201
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kada su stabilizovali njeno stanje
08:25
she went to the intensive care unit,
202
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poslali su je na intezivnu negu,
08:27
and I hoped against hope that she would recover.
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i suludo sam se nadao da će se oporaviti.
08:29
And over the next two or three days,
204
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Nakon dva, tri dana
08:31
it was clear that she was never going to wake up.
205
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bilo je jasno da se nikada neće probuditi.
08:33
She had irreversible brain damage.
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Došlo je do nepovratnog oštećenja mozga.
08:36
And the family gathered.
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Porodica se okupila.
08:38
And over the course of the next eight or nine days,
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U narednih osam ili devet dana
08:41
they resigned themselves to what was happening.
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su prihvatili neminovnost koja je pred njima.
08:43
And at about the nine day mark, they let her go --
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Devetog dana su se oprostili od nje,
08:46
Mrs. Drucker,
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g-đa Druker,
08:48
a wife, a mother
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žena, majka
08:50
and a grandmother.
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i baka.
08:53
They say you never forget the names
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1976
Kažu da se imena onih koji umru
08:55
of those who die.
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1976
nikada ne zaborave.
08:57
And that was my first time to be acquainted with that.
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A tada sam se ja prvi put suočio sa tim.
09:00
Over the next few weeks,
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1976
U toku narednih nekoliko nedelja
09:02
I beat myself up
218
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2976
sam mučio samog sebe,
09:05
and I experienced for the first time
219
545260
1976
i po prvi put doživeo
09:07
the unhealthy shame that exists
220
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1976
tu nezdravu sramotu koja
09:09
in our culture of medicine --
221
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1976
karakteriše kulturu medicine.
09:11
where I felt alone, isolated,
222
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Osećao sam se usamljeno, izolovano,
09:14
not feeling the healthy kind of shame that you feel,
223
554260
1976
nisam doživljavao kao vi zdravu sramotu,
09:16
because you can't talk about it with your colleagues.
224
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2524
jer nisam mogao da pričam o tome sa kolegama.
09:18
You know that healthy kind,
225
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Znate onaj zdrav tip sramote,
09:20
when you betray a secret that a best friend made you promise never to reveal
226
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otkriješ tajnu za koju si najboljem prijatelju obećao da je nikome nećeš reći,
09:23
and then you get busted
227
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1332
a onda budeš provaljen,
09:25
and then your best friend confronts you
228
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1976
pa te tvoj najbolji prijatelj suoči sa tim
09:27
and you have terrible discussions,
229
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1976
i obavite žučnu diskusiju,
09:29
but at the end of it all that sick feeling guides you
230
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ali na kraju svega toga taj nezdrav osećaj te usmerava
09:32
and you say, I'll never make that mistake again.
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i kažeš kako nikada nećeš ponoviti tu grešku.
09:34
And you make amends and you never make that mistake again.
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Iskupiš se i nikada ne ponoviš tu grešku.
09:37
That's the kind of shame that is a teacher.
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Ovakav vid sramote je učitelj.
09:40
The unhealthy shame I'm talking about
234
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1976
Nezdrav osećaj sramote o kom pričam
09:42
is the one that makes you so sick inside.
235
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je onaj tip koji te čini bolesnim iznutra.
09:45
It's the one that says,
236
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1976
Taj tip prosto kaže
09:47
not that what you did was bad,
237
587260
1976
ne da je loše to što si uradio,
09:49
but that you are bad.
238
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1976
već da si ti sam loš.
09:51
And it was what I was feeling.
239
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2976
Upravo sam to osećao.
09:54
And it wasn't because of my attending; he was a doll.
240
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To nije uzrokovao moj mentor, on je bio odličan.
09:57
He talked to the family, and I'm quite sure that he smoothed things over
241
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3429
Razgovarao je sa familijom i siguran sam da je izgladio stvari
10:00
and made sure that I didn't get sued.
242
600713
2523
i pobrinuo se da me ne sude.
10:03
And I kept asking myself these questions.
243
603260
2976
Ponavljao sam sebi ova pitanja.
10:06
Why didn't I ask my attending? Why did I send her home?
244
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Zašto nisam pitao ništa svog mentora? Zašto sam je otpustio?
10:09
And then at my worst moments:
245
609260
1976
A u najgorim momentima:
10:11
Why did I make such a stupid mistake?
246
611260
2976
Zašto sam napravio tako glupavu grešku?
10:14
Why did I go into medicine?
247
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1976
Zašto sam studirao medicinu?
10:16
Slowly but surely,
248
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1976
Polako, ali sigurno
10:18
it lifted.
249
618260
1976
osećaj je nestao.
10:20
I began to feel a bit better.
250
620260
1976
Osećao sam se bolje.
10:22
And on a cloudy day,
251
622260
1976
Jednog oblačnog dana
10:24
there was a crack in the clouds and the sun started to come out
252
624260
2953
je sunce počelo da se pomalja između oblaka
i ja sam se pitao
10:27
and I wondered,
253
627237
999
10:28
maybe I could feel better again.
254
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1976
da li ću se osećati bolje ponovo.
10:30
And I made myself a bargain
255
630260
2976
Napravio sam dogovor da ako
10:33
that if only I redouble my efforts to be perfect
256
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4976
udvostručim svoje napore da dosegnem savršenstvo
10:38
and never make another mistake again,
257
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1976
i nikada ne napravim novu grešku,
10:40
please make the voices stop.
258
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1976
ti glasovi nestanu.
10:42
And they did.
259
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1976
Nestali su.
10:44
And I went back to work.
260
644260
1976
Vratio sam se poslu.
10:46
And then it happened again.
261
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2976
A onda se ponovo desilo.
10:49
Two years later I was an attending in the emergency department
262
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2976
Dve godine kasnije bio sam dežurni u urgentnom centru,
10:52
at a community hospital just north of Toronto,
263
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2191
u državnoj bolnici severno od Toronta,
10:54
and I saw a 25 year-old man with a sore throat.
264
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2761
i pregledao sam 25-ogodišnjaka sa upaljenim grlom.
10:57
It was busy, I was in a bit of a hurry.
265
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1976
Bila je gužva, ja sam bio u žurbi.
10:59
He kept pointing here.
266
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1976
Non-stop je pokazivao ovde.
11:01
I looked at his throat, it was a little bit pink.
267
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2334
Pogledao sam mu grlo, bilo je ružičasto.
11:03
And I gave him a prescription for penicillin
268
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2096
Prepisao sam mu penicilin,
11:05
and sent him on his way.
269
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1498
i poslao ga kući.
11:07
And even as he was walking out the door,
270
667260
1976
Čak i dok je izlazio kroz vrata,
11:09
he was still sort of pointing to his throat.
271
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pokazivao je ka svom grlu.
11:12
And two days later I came to do my next emergency shift,
272
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2976
Nakon dva dana, došao sam da odradim novu smenu na urgentnom,
11:15
and that's when my chief asked to speak to me quietly in her office.
273
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3239
i tada me je šefica pozvala da porazgovaramo u kancelariji.
11:18
And she said the three words:
274
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3713
Izgovorili je tri reči:
11:22
Do you remember?
275
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2976
Sećaš li se?
11:25
"Do you remember that patient you saw with the sore throat?"
276
685260
2976
"Sećaš li se tog pacijenta koji boluje od upale grla?"
11:28
Well it turns out, he didn't have a strep throat.
277
688260
2334
Pa, ispostavilo se da nije patio od upale grla.
11:30
He had a potentially life-threatening condition
278
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Bolovao je od veoma ozbiljnog problema
11:32
called epiglottitis.
279
692881
1355
koji nazivamo epiglotitis.
11:34
You can Google it,
280
694260
1976
Možete proveriti na Guglu,
11:36
but it's an infection, not of the throat, but of the upper airway,
281
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3143
to je infekcija, ali ne grla, već gornjih disajnih puteva,
11:39
and it can actually cause the airway to close.
282
699427
2809
i može dovesti do zatvaranja disajnih puteva.
11:42
And fortunately he didn't die.
283
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2976
Srećom, nije umro.
11:45
He was placed on intravenous antibiotics
284
705260
2976
Nakon intravenozne terapije antibioticima,
11:48
and he recovered after a few days.
285
708260
1976
oporavio se nakon dva dana.
11:50
And I went through the same period of shame and recriminations
286
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3976
Prošao sam kroz isti period osećaja srama, osude,
11:54
and felt cleansed and went back to work,
287
714260
3976
onda sam se pročistio i vratio poslu,
11:58
until it happened again and again and again.
288
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4976
i ponovilo se opet, i opet, i opet.
12:03
Twice in one emergency shift, I missed appendicitis.
289
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2976
Dva puta sam u jednoj smeni promašio upalu slepog creva.
12:06
Now that takes some doing,
290
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2976
E pa, to nije lako uraditi,
12:09
especially when you work in a hospital
291
729260
1976
a naročito kada radite u bolnici koja
12:11
that at the time saw but 14 people a night.
292
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2976
je tada primala četrnaest ljudi u noćnoj smeni.
12:14
Now in both cases, I didn't send them home
293
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2976
Nisam poslao ljude kući u oba slučaja,
12:17
and I don't think there was any gap in their care.
294
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2334
i smatram da nije došlo do propusta u lečenju.
12:19
One I thought had a kidney stone.
295
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U prvom slučaju sam pomislio da je u pitanju kamen u bubregu.
12:21
I ordered a kidney X-ray. When it turned out to be normal,
296
741260
1976
Snimili smo mu bubrege. Ničega čudnog nije bilo,
12:23
my colleague who was doing a reassessment of the patient
297
743260
2976
moj kolega koji je nakon toga pregledao pacijenta
12:26
noticed some tenderness in the right lower quadrant and called the surgeons.
298
746260
2976
je osetio meko tkivo u donjem desnom delu abdomena i pozvao je hirurge.
12:29
The other one had a lot of diarrhea.
299
749260
1976
Drugi je patio od dijareje.
12:31
I ordered some fluids to rehydrate him
300
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2976
Pokušao sam da ga rehidriram,
12:34
and asked my colleague to reassess him.
301
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2976
i zamolio kolegu da ga i on pregleda.
12:37
And he did
302
757260
1976
Kada je osetio
12:39
and when he noticed some tenderness in the right lower quadrant, called the surgeons.
303
759260
1976
meko tkivo u donjem desnom delu adbomena, pozvao je hirurge.
12:41
In both cases,
304
761260
1976
U oba slučaja,
12:43
they had their operations and they did okay.
305
763260
2976
pacijenti su operisni i sve je prošlo dobro.
12:46
But each time,
306
766260
1976
Ali svaki put bi me
12:48
they were gnawing at me, eating at me.
307
768260
1976
oni proždirali, izjedali.
12:50
And I'd like to be able to say to you
308
770260
1976
Voleo bih da mogu da vam kažem
12:52
that my worst mistakes only happened in the first five years of practice
309
772260
3429
kako sam najgore greške napravio u toku prvih pet godina rada
12:55
as many of my colleagues say, which is total B.S.
310
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2523
kao što to kažu mnoge moje kolege, a to je potpuna laž.
12:58
(Laughter)
311
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1976
(smeh)
13:00
Some of my doozies have been in the last five years.
312
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3000
Neki od mojih bisera su se desili u poslednjih pet godina.
13:06
Alone, ashamed and unsupported.
313
786260
1976
Usamljen, osramoćen i bez podrške.
13:08
Here's the problem:
314
788260
1976
U ovome je problem:
13:10
If I can't come clean
315
790260
1976
Ukoliko ne mogu otvoreno
13:12
and talk about my mistakes,
316
792260
3976
da pričam o svojim greškama,
13:16
if I can't find the still-small voice
317
796260
1976
ukoliko ne mogu da čujem glas razuma
13:18
that tells me what really happened,
318
798260
1976
koji mi govori šta se zaista desilo,
13:20
how can I share it with my colleagues?
319
800260
1976
kako onda mogu to da podelim sa kolegama?
13:22
How can I teach them about what I did
320
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2976
Kako mogu da im prenesem to znanje
13:25
so that they don't do the same thing?
321
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3976
kako oni ne bi napravili istu grešku?
13:29
If I were to walk into a room --
322
809260
1976
Kada bih ušetao u sobu,
13:31
like right now, I have no idea what you think of me.
323
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2976
kao sada, ja nemam predstavu šta mislite o meni.
13:34
When was the last time you heard somebody talk
324
814260
1976
Kada ste poslednji put slušali nekog ko priča
13:36
about failure after failure after failure?
325
816260
2000
o neuspehu, za neuspehom, za neuspehom?
13:38
Oh yeah, you go to a cocktail party
326
818284
1952
A da, odete na koktel prijem
13:40
and you might hear about some other doctor,
327
820260
2048
verovatno biste čuli o nekom drugom lekaru,
13:42
but you're not going to hear somebody
328
822332
1904
ali nećete čuti nikoga
13:44
talking about their own mistakes.
329
824260
1976
ko priča o sopstvenim greškama.
13:46
If I were to walk into a room filled with my colleages
330
826260
2976
Ukoliko bih ušetao u sobu gde su moje kolege,
13:49
and ask for their support right now
331
829260
1976
i zamolio ih baš sada za podršku
13:51
and start to tell what I've just told you right now,
332
831260
2429
i kada bih im ispričao ovo što sam vama upravo rekao,
13:53
I probably wouldn't get through two of those stories
333
833713
2523
verovatno bi počeli da se osećaju nelagodno
13:56
before they would start to get really uncomfortable,
334
836260
2477
pre završetka druge priče
13:58
somebody would crack a joke,
335
838761
1475
neko bi se našalio,
14:00
they'd change the subject and we would move on.
336
840260
3000
promenili bi temu i nastavili.
14:05
And in fact, if I knew and my colleagues knew
337
845260
2976
Ukoliko bih znao i ukoliko bi moje kolege znale
14:08
that one of my orthopedic colleagues took off the wrong leg in my hospital,
338
848260
3976
da je jedan od mojih kolega ortopeda uklonio pogrešnu nogu u bolnici,
14:12
believe me, I'd have trouble
339
852260
1976
verujte mi, bilo bi mi teško
14:14
making eye contact with that person.
340
854260
1976
da uspostavim kontakt sa tom osobom.
14:16
That's the system that we have.
341
856260
1976
To je naš sistem.
14:18
It's a complete denial of mistakes.
342
858260
2976
Potpuno nepriznavanje grešaka.
14:21
It's a system
343
861260
1976
To je sistem
14:23
in which there are two kinds of physicians --
344
863260
3976
koji priznaje dva tipa doktora:
14:27
those who make mistakes
345
867260
1976
oni koji prave greške
14:29
and those who don't,
346
869260
1976
i oni koji ne prave,
14:31
those who can't handle sleep deprivation and those who can,
347
871260
2976
oni koji ne mogu da podnesu nespavanje i oni koji mogu,
14:34
those who have lousy outcomes
348
874260
1976
oni koji imaju loše rezultate
14:36
and those who have great outcomes.
349
876260
2976
i oni koji imaju odlične.
14:39
And it's almost like an ideological reaction,
350
879260
2143
To je skoro kao ideološka reakcija,
14:41
like the antibodies begin to attack that person.
351
881427
3809
kao da antitela počnu da napadaju tu osobu.
14:45
And we have this idea
352
885260
1976
Nosimo se idejom
14:47
that if we drive the people who make mistakes
353
887260
2143
da ukoliko bismo izbacili ljude koji čine greške
14:49
out of medicine,
354
889427
1809
iz medicine,
14:51
what will we be left with, but a safe system.
355
891260
3976
dobili bismo siguran sistem.
14:55
But there are two problems with that.
356
895260
2976
Ali susrećemo se tu sa dva problema.
14:58
In my 20 years or so
357
898260
1976
Izveo sam studiju o greškama u medicini i lošoj praksi
15:00
of medical broadcasting and journalism,
358
900260
2976
koja obuhvata moj dvadesetogodišnji rad
15:03
I've made a personal study of medical malpractice and medical errors
359
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3239
izučavanja loše prakse i medicinskog žurnalizma,
15:06
to learn everything I can,
360
906523
1713
kako bih naučio sve što mogu,
15:08
from one of the first articles I wrote for the Toronto Star
361
908260
2810
od prvog članka koji sam napisao za "Toronto Star"
do moje emisije "Beli mantil, crna umetnost".
15:11
to my show "White Coat, Black Art."
362
911094
2142
15:13
And what I've learned
363
913260
1976
Shvatio sam da su
15:15
is that errors are absolutely ubiquitous.
364
915260
2976
greške široko rasprostranjene.
15:18
We work in a system
365
918260
1976
Radimo u sistemu gde
15:20
where errors happen every day,
366
920260
1976
se greške dešavaju svakog dana,
15:22
where one in 10 medications
367
922260
1976
u kom je jedan od 10 prepisanih lekova
15:24
are either the wrong medication given in hospital
368
924260
2334
ili pogrešan lek
15:26
or at the wrong dosage,
369
926618
1618
ili je primenjen u pogrešnoj dozi,
15:28
where hospital-acquired infections are getting more and more numerous,
370
928260
3334
u sistemu gde su sve češće dešavaju zaraze u bolnicama,
15:31
causing havoc and death.
371
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2618
i dovode do opšte propasti i smrti.
15:34
In this country,
372
934260
1976
U ovoj zemlji umre
15:36
as many as 24,000 Canadians die
373
936260
1976
24.000 Kanađana usled grešaka medicinara
15:38
of preventable medical errors.
374
938260
1976
koje se mogu sprečiti.
15:40
In the United States, the Institute of Medicine pegged it at 100,000.
375
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U Sjedinjenim Državama je Institut za medicinu procenio taj broj na 100.000.
15:44
In both cases, these are gross underestimates,
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U oba slučaju su to podcenjene procene,
15:47
because we really aren't ferreting out the problem
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obzirom da se ne bavimo problemom onako
15:49
as we should.
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kako bi trebalo.
15:51
And here's the thing.
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U ovome je stvar.
15:54
In a hospital system
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U bolničkom sistemu u kom
15:57
where medical knowledge is doubling
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se znanja iz medicine udvostručavaju
15:59
every two or three years, we can't keep up with it.
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svake dve ili tri godine, ne možemo sve da znamo.
16:02
Sleep deprivation is absolutely pervasive.
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Nedostatak sna je sveprisutan.
16:05
We can't get rid of it.
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Ne možemo ga se otarasiti.
16:07
We have our cognitive biases,
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Zatim pravimo greške u rasuđivanju,
16:09
so that I can take a perfect history on a patient with chest pain.
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da bih došao do odlične medicinske istorije pacijenta koji oseća bol u grudima.
16:12
Now take the same patient with chest pain,
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Ukoliko biste pregledali istog pacijenta,
16:14
make them moist and garrulous
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a da je sada mokar i pričljiv,
16:16
and put a little bit of alcohol on their breath,
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i oseća se na alkohol,
16:18
and suddenly my history is laced with contempt.
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tada bi istorija bolesti bila povezana sa predrasudom.
16:20
I don't take the same history.
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Ne dođem do iste istorije bolesti,
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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ne ponavljam svaki put stvari na isti način.
16:26
And my patients aren't cars;
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Moji pacijenti nisu kola,
16:28
they don't tell me their symptoms in the same way each time.
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ne izlažu mi svoje simptome na isti način svaki put.
16:31
Given all of that, mistakes are inevitable.
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Uzimajući sve to u obzir, greške su neizbežne.
16:34
So if you take the system, as I was taught,
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Ukoliko prihvatite sistem na način koji je meni predstavljen
16:37
and weed out all the error-prone health professionals,
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i uklonite sve medicinare koji prave greške,
16:41
well there won't be anybody left.
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pa niko u njemu ne bi ostao.
16:46
And you know that business
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1976
Znate čitavu tu ujdurmu
16:48
about people not wanting
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o tome kako ljudi ne žele
16:50
to talk about their worst cases?
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da pričaju o svojim najgorim slučajevima?
16:53
On my show, on "White Coat, Black Art,"
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1976
U svojoj emisiji "Beli mantil, crna umetnost",
16:55
I made it a habit of saying, "Here's my worst mistake,"
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imam običaj da kažem: "Ovo je moja najgora greška",
16:57
I would say to everybody
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rekao bih to svima,
16:59
from paramedics to the chief of cardiac surgery,
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ljudima iz hitne službe i šefu kardiologije:
17:02
"Here's my worst mistake," blah, blah, blah, blah, blah,
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1976
"Ovo je moja najveća greška", bla,bla,bla.
17:04
"What about yours?" and I would point the microphone towards them.
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"A koja je tvoja?", usmerio bi mikrofon ka njima.
17:07
And their pupils would dilate,
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1809
Zenice bi im se raširile,
17:09
they would recoil,
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trgli bi se,
17:11
then they would look down and swallow hard
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a potom bi spustili pogled, zagrcnuli bi se
17:14
and start to tell me their stories.
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i počeli bi da pričaju svoje priče.
17:17
They want to tell their stories. They want to share their stories.
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Oni žele da ispričaju svoje priče. Oni to žele.
17:20
They want to be able to say,
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Žele priliku da kažu:
17:22
"Look, don't make the same mistake I did."
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"Slušaj, ne ponavljaj moju grešku."
17:24
What they need is an environment to be able to do that.
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Neophodna im je sredina koja bi to omogućila.
17:26
What they need is a redefined medical culture.
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Neophodna im je promena u kulturi medicine.
17:30
And it starts with one physician at a time.
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To počinje sa jednim lekarom.
17:33
The redefined physician is human,
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Novodefinisani lekar je ljudsko biće,
17:36
knows she's human,
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zna da je ljudsko biće,
17:38
accepts it, isn't proud of making mistakes,
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prihvata to, ne ponosi se greškama,
17:40
but strives to learn one thing
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1905
ali se trudi da nauči nešto
17:42
from what happened
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iz onoga što se desilo
17:44
that she can teach to somebody else.
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i poduči kolegu.
17:46
She shares her experience with others.
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Ona deli svoje iskustvo sa drugima.
17:48
She's supportive when other people talk about their mistakes.
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Pruža podršku ljudima koji pričaju o svojim greškama.
17:51
And she points out other people's mistakes,
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Ukazuje na greške drugih ljudi,
17:53
not in a gotcha way,
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1904
ne u pogrdnom smislu,
17:55
but in a loving, supportive way
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već sa puno ljubavi i poštovanja,
17:58
so that everybody can benefit.
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kako bi svi imali koristi od toga.
18:00
And she works in a culture of medicine
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Radi u takvoj kulturi
18:02
that acknowledges
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1976
koja prihvata činjenicu
18:04
that human beings run the system,
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da su ljudi zaposleni u tom sistemu,
18:06
and when human beings run the system, they will make mistakes from time to time.
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i kada je takav slučaj, s vremena na vreme će se dešavati greške.
Sistem evoluira na način
18:10
So the system is evolving
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18:13
to create backups
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da stvara podršku
18:17
that make it easier to detect those mistakes
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koja omogućava lakše uočavanje tih grešaka
18:20
that humans inevitably make
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koje ljudi bespogovorno čine,
18:23
and also fosters in a loving, supportive way
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i takođe razvija na način pun ljubavi i podrške
18:26
places where everybody who is observing
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mesta gde svako ko se bavi analizom
18:29
in the health care system
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sistema zdravstva
18:31
can actually point out things that could be potential mistakes
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može da dođe i ukaže na moguće greške i
18:34
and is rewarded for doing so,
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biva nagrađen za to,
18:36
and especially people like me, when we do make mistakes,
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a naročito kada ljudi kao ja prave greške,
18:38
we're rewarded for coming clean.
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mi treba da dobijemo nagradu kada ih priznamo.
18:42
My name is Brian Goldman.
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Zovem se Brajan Goldman.
18:45
I am a redefined physician.
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Ja sam nova vrsta lekara.
18:48
I'm human. I make mistakes.
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Ja sam ljudsko biće. Grešim.
18:50
I'm sorry about that,
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Žao mi je zbog toga,
18:52
but I strive to learn one thing
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ali trudim se da naučim nešto
18:54
that I can pass on to other people.
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što mogu da prenesem drugim ljudima.
18:57
I still don't know what you think of me,
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Ja i dalje ne znam šta mislite o meni,
19:00
but I can live with that.
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ali mogu da živim sa tim.
19:02
And let me close with three words of my own:
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Zaključio bih sa svoje tri reči:
19:05
I do remember.
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Da, sećam se.
19:09
(Applause)
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(aplauz)
About this website

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