4 questions you should always ask your doctor | Christer Mjåset

翻译人员: Nan Yang 校对人员: psjmz mz

I am a neurosurgeon,

我是一个神经外科医生，

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

我今天要告诉你们， 像我一样的人需要你们的帮助。

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

过一会儿，我会告诉你们怎么做。

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

但是首先，让我跟你们 聊一下我的一个病人。

This was a woman in her 50s,

她是一个五十多岁的女士，

she was in generally good shape,

身材基本上保持的不错，

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

但是她已经为了根治乳腺癌

due to curative breast cancer treatment.

多次进出医院。

Now she had gotten a prolapse from a cervical disc,

现在她的颈椎间盘有脱落，

giving her radiating pain of a tense kind,

带给她放射性的疼痛，

一直影响到她的右胳膊。

out into the right arm.

Looking at her MRI before the consultation,

在诊疗之前我看了 她的核磁共振成像，

I decided to suggest an operation.

我决定建议她进行手术。

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

现在这种脖颈手术已经 很标准化，而且手术时间短，

But they carry a certain risk.

但是仍带有一定的风险。

You make an incision right here,

要在这里做一个切口，

and you dissect carefully past the trachea,

然后剖开，小心的穿过气管，

the esophagus,

食道，

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

还要尽量不切到颈内动脉。

(Laughter)

（笑声）

Then you bring in the microscope,

然后要利用显微镜，

and you carefully remove the disc and the prolapse

仔细的在神经根管中

in the nerve root canal,

移除间盘和脱垂，

without damaging the cord and the nerve root

同时不能损害 在下方仅几毫米处的

lying only millimeters underneath.

索状组织和神经根。

The worst case scenario is the damage to the cord,

最坏的情况就是损害了索状组织，

which can result in paralysis from the neck down.

会导致颈部以下的瘫痪。

Explaining this to the patient, she fell silent.

我把这些解释给病人时，她沉默了。

And after a few moments,

然后过了一会，

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

她对我和她自己说了 一句非常果断的话。

"Doctor, is this really necessary?"

”医生，这个手术真的必要吗？“

(Laughter)

（笑声）

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

你们知道那一刻我意识到什么吗？

It was not.

这个手术并不必要。

In fact, when I get patients like this woman,

实际上，当我面对 像这位女士的病人时，

I tend to advise not to operate.

我倾向于建议她们不做手术。

So what made me do it this time?

为什么我这次却建议她做呢？

Well, you see,

是这样的，

this prolapse was so delicate,

这个脱垂非常精巧，

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

在她进入诊疗室之前， 我几乎可以看见自己

before she entered the consultation room.

正在把脱垂从神经根管中取出。

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

我不得不承认， 我想给她做手术。

I'd love to operate on her.

我非常希望给她做手术。

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

毕竟，手术是我工作中 最有趣的部分。

(Laughter)

（笑声）

I think you can relate to this feeling.

我觉得你们可以体会这种感受。

My architect neighbor says he loves to just sit and draw

我的建筑师邻居 说他就喜欢坐在那

and design houses.

设计房子。

He'd rather do that all day

宁可坐在那一天，

than talk to the client paying for the house

他也不想跟客户讨论 付款买房的事项，

that might even give him restrictions on what to do.

这甚至有可能限制他的设计。

But like every architect,

就像每个建筑师，

every surgeon needs to look their patient in the eye

每个外科医生需要 看着病人的眼睛，

and together with the patient,

然后跟病人一起

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

决定对病人来说最好的手术。

And that might sound easy.

这个听起来可能简单。

But let's look at some statistics.

但是让我们来看一些统计数据。

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

扁桃体是 在你喉咙后面的两个肿块。

They can be removed surgically,

它们可以通过手术切除，

and that's called a tonsillectomy.

即扁桃体切除手术。

This chart shows the operation rate of tonsillectomies in Norway

这个儿童数据表展示了 在挪威不同地区

in different regions.

进行扁桃体手术的比例。

What might strike you is that there is twice the chance

可能会吓到你的是， 在芬马克郡的孩子

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

需要做扁桃体切除手术的几率是

will get a tonsillectomy in Finnmark than in Trondheim.

特隆赫姆的孩子的两倍。

The indications in both regions are the same.

在这两个地方 患病的迹象是相同的。

There should be no difference, but there is.

所以不应该有区别，但是现在有。

Here's another chart.

这是另一个表。

The meniscus helps stabilize the knee

半月板有助于稳定膝盖，

and can be torn or fragmented acutely,

但是容易被撕裂或发生急性碎裂，

topically during sports like soccer.

特别是在像足球这种运动过程中。

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

你们会看见的是 这种情况下的手术比例。

And you see that the operation rate in Møre og Romsdal

在默勒市的比例

is five times the operation rate in Stavanger.

是在斯塔万格市的五倍。

Five times.

五倍。

How can this be?

为什么会这样？

Did the soccer players in Møre og Romsdal

是在默勒的足球运动员

play more dirty than elsewhere in the country?

比国家其它地方玩得更野蛮吗？

(Laughter)

（笑声)

Probably not.

可能不是。

I added some information now.

我现在加入一些信息。

What you see now is the procedures performed

现在你们看见的 浅蓝色的是在公立医院

in public hospitals, in light blue,

执行的治疗程序，

the ones in private clinics are light green.

在私人诊所的是浅绿色的。

There is a lot of activity in the private clinics

在默勒的私人诊所治疗记录

in Møre og Romsdal, isn't there?

有很多，对吗？

What does this indicate?

这表明了什么？

A possible economic motivation to treat the patients.

原因可能是治疗病人的经济动机。

And there's more.

不仅如此。

Recent research has shown that the difference of treatment effect

最近的研究展示了常规的物理治疗

between regular physical therapy and operations for the knee --

和膝盖手术的治疗效果

there is no difference.

并没有不同。

Meaning that most of the procedures performed

意思是在这个我刚展示的图表中，

on the chart I've just shown

大部分被执行的手术

could have been avoided, even in Stavanger.

是本可以被避免的， 甚至是在斯塔万格。

So what am I trying to tell you here?

所以我在试图告诉你们什么呢？

Even though most indications for treatments in the world

尽管世界上大部分的治疗指示

are standardized,

已经标准化了，

there is a lot of unnecessary variation of treatment decisions,

但是有很多是没必要的 治疗手段的变形，

especially in the Western world.

特别是在西方国家。

Some people are not getting the treatment that they need,

一些人没有得到他们需要的治疗，

but an even greater portion of you

而你们当中很多人

are being overtreated.

在被过度治疗。

"Doctor, is this really necessary?"

“医生，这个手术真的必要吗？”

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

我在我的职业生涯中 只听见过一次这个问题。

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

我的同事们说他们从未 听过病人这样问。

And to turn it the other way around,

换一种方式说，

如果你问这种问题， 你们觉得有几次

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

if you ask such a question?

会听见一个医生说”没必要“？

Researchers have investigated this,

调查人员对此进行了调查，

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

他们得到了不论在哪里

wherever they go.

都大概相同的比例。

And that is 30 percent.

是30%。

Meaning, three out of 10 times,

意思是，10 次里有 3 次

your doctor prescribes or suggests something

你的医生会给你开出或者建议

that is completely unnecessary.

完全没必要的东西。

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

你们知道他们声称的原因是什么？

Patient pressure.

患者给的压力。

In other words, you.

换句话说，是你们。

You want something to be done.

你们希望我们一定要做点什么。

A friend of mine came to me for medical advice.

我的一个朋友曾经来找我 咨询医疗方面的建议。

This is a sporty guy,

他是一个爱运动的人。

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

他在冬天经常穿梭在 不同国家进行越野滑雪，

he runs in the summer time.

夏天跑步。

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

这次，他在跑步时 感觉到了严重的背疼。

So much that he had to stop doing it.

疼得他不能再跑步。

I did an examination, I questioned him thoroughly,

我做了一个检查， 全面的对他进行问询，

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

我发现很可能在他的脊椎下半部分

in the lower part of his spine.

有椎间盘退变。

Whenever it got strained, it hurt.

每次收紧的时候，都会疼痛。

He'd already taken up swimming instead of jogging,

他已经接受用游泳代替慢跑，

there was really nothing to do,

实际上没有什么可以做的，

所以我告诉他： ”你在训练的时候，

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

必须有选择性的进行。

when it comes to training.

Some activities are good for you,

一些活动对你有好处，

some are not."

另一些没有。”

His reply was,

他的回答是，

"I want an MRI of my back."

“我想做背部的核磁共振成像。”

"Why do you want an MRI?"

“为什么你想做这个?”

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

“我可以用公司保险报销这个花费。”

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

“拜托，”我说 —— 毕竟，他是我的朋友。

"That's not the real reason."

”那不是真正的原因。”

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

“哦，我觉得能看一下 我的后背到底多糟糕比较好。”

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

“你什么时候开始能看懂 核磁共振扫描了？”我说。

(Laughter)

（笑声）

"Trust me on this.

“这件事你要相信我。

You're not going to need the scan."

你不需要这个扫描。”

"Well," he said,

”唔，”他说，

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

过了一会儿，他继续说， “可能是癌症。”

(Laughter)

（笑声）

He got the scan, obviously.

很明显，他还是做了扫描。

And through his insurance at work,

通过他们公司的保险计划，

he got to see one of my colleagues at work,

他找了我的一个同事，

telling him about the degenerated disc,

告诉他椎间盘退化的事，

that there was nothing to do,

还是没什么其它可以做的，

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

他应该继续游泳，停止慢跑。

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

过了一段时间， 我又遇见了他，

他说：“至少我现在知道 是怎么回事了。”

"At least now I know what this is."

But let me ask you a question.

但是让我问你们一个问题。

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

如果这个房间里有同样症状的人 都来做核磁共振成像呢？

And what if all the people in Norway

如果挪威所有人都因为偶尔的背疼

had an MRI due to occasional back pain?

去做核磁共振成像呢？

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

核磁共振成像的排队人数 会增至四倍，甚至更多。

And you would all take the spot on that list

而你们会占用了名单上那些

from someone who really had cancer.

真的有癌症的人的名额。

So a good doctor sometimes says no,

所以一个好的医生有时候会说不，

but the sensible patient also turns down, sometimes,

但敏感的病人有时候也会拒绝掉

an opportunity to get diagnosed or treated.

一个被诊断和治疗的机会。

"Doctor, is this really necessary?"

“医生，这个真的必要吗？”

I know this can be a difficult question to ask.

我知道这是一个 很难启齿的问题。

In fact, if you go back 50 years,

实际上，如果倒退 50 年，

this was even considered rude.

这甚至会被认为粗鲁。

(Laughter)

（笑声）

If the doctor had decided what to do with you,

如果医生已经决定如何治疗你，

that's what you did.

你就要遵医嘱。

A colleague of mine, now a general practitioner,

我的一个同事， 现在是一个全科医生，

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

在还是个小女孩的时候 曾经被送到肺结核疗养院

for six months.

六个月。

It was a terrible trauma for her.

对她来说是可怕的创伤。

She later found out, as a grown-up,

在她成年后发现，

that her tests on tuberculosis had been negative all along.

她的肺结核测试结果 一直都是阴性的。

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

医生只是基于错误的怀疑 就送她去了疗养院。

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

没有人敢或者甚至想过 去反抗他的做法。

Not even her parents.

甚至她的父母都没有。

Today, the Norwegian health minister

如今，挪威卫生部长

talks about the patient health care service.

谈及患者的医疗保健服务。

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

患者应该从医生那 得到治疗建议。

This is great progress.

这是巨大的进步。

But it also puts more responsibility on you.

但是这同样给了你们 更多的责任。

You need to get in the front seat with your doctor

你们需要坐在医生面前

and start sharing decisions on where to go.

一起讨论接下来的决定。

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

所以，下一次 当你在医生办公室里，

I want you to ask,

我希望你们可以问，

"Doctor, is this really necessary?"

“医生，这个真的必要吗？”

And in my female patient's case,

在我那个女性患者的案例中，

the answer would be no,

答案是不，

but an operation could also be justified.

但是有的手术也有可能是合理的。

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

“所以医生， 这个手术有哪些风险？”

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

5 - 10% 的患者疼痛症状会加重。

One to two percent of patients

1-2% 的患者

will have an infection in the wound or even a rehemorrhage

会伤口感染或甚至是出血

that might end up in a re-operation.

这就需要第二次的手术。

0.5 percent of patients also experience permanent hoarseness

0.5% 的患者也会经历 永久性的声音嘶哑，

and a few, but still a few,

还有一些

will experience reduced function in the arms or even legs.

手臂或者腿功能会衰减。

"Doctor, are there other options?"

“医生，有其他的选择吗？”

Yes, rest and physical therapy over some time

是的，一段时间的休息和物理治疗

might get you perfectly well.

可能会让你完全恢复。

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

“如果我什么都不做会怎么样？”

It's not recommended,

不建议这样，

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

但是尽管那样， 也有很小的可能你会康复。

Four questions.

四个问题。

Simple questions.

简单的问题。

Consider them your new toolbox to help us.

把它们当作你的新工具箱 来帮助我们。

Is this really necessary?

“这真的必要吗？”

What are the risks?

“有什么风险？”

Are there other options?

“有没有其它选择？”

And what happens if I don't do anything?

“如果我什么都不做会怎么样？”

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

当医生让你做核磁共振成像时 要问医生，

when he prescribes antibiotics

还有当他给你开抗生素

or suggests an operation.

或者建议手术时也要问。

What we know from research

从研究中我们知道

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

5 个人中有 1 个， 也就是 20%，

will change your opinion on what to do.

在问了之后 会改变你们的想法。

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

做到这样，你不仅会让你的生活

a whole lot easier, and probably even better,

变得更容易，甚至更好，

but the whole health care sector

而且会让整个医疗保健部门

will have benefited from your decision.

受益于你的决定。

Thank you.

谢谢大家。

(Applause)

（掌声）