Eric Dishman: Health care should be a team sport

Translator: Joseph Geni Reviewer: Morton Bast

翻译人员: Bighead Ge 校对人员: Shengwei Cai

I want to share some personal friends and stories with you

我要分享一些我的朋友和故事

that I've actually never talked about in public before

我从来没有公开谈过

to help illustrate the idea

我的目的是要说明一种想法、

and the need and the hope

一种需求、一种希望

for us to reinvent our health care system around the world.

以重塑全球的医疗照护系统

Twenty-four years ago, I had -- a sophomore in college,

24年前，我还是个大二学生

I had a series of fainting spells. No alcohol was involved.

我昏迷了好几次，不是因为酒醉

And I ended up in student health,

我被送到学生健康中心

and they ran some labwork and came back right away,

做了一些检验后，立刻得知

and said, "Kidney problems."

是肾脏问题

And before I knew it, I was involved and thrown into

我还没搞清楚状况，就开始了

this six months of tests and trials and tribulations

六个月的检验、考验和折磨

with six doctors across two hospitals

由2家医院的6位医生诊治

in this clash of medical titans

这些医界权威互相争执

to figure out which one of them was right

想厘清谁才正确

about what was wrong with me.

诊断出我的病情

And I'm sitting in a waiting room some time later for an ultrasound,

做完超音波后，我坐在候诊室

and all six of these doctors actually show up in the room at once,

6位医生同时出现

and I'm like, "Uh oh, this is bad news."

我想：「糟了，一定是坏消息！」

And their diagnosis was this:

医生诊断说：

They said, "You have two rare kidney diseases

「你得了两种罕见的肾脏疾病，

that are going to actually destroy your kidneys eventually,

最终会让你的肾脏坏死，

you have cancer-like cells in your immune system

你的免疫系统中有类似癌症细胞，

that we need to start treatment right away,

必须立即治疗。

and you'll never be eligible for a kidney transplant,

你永远不可能符合换肾资格，

and you're not likely to live more than two or three years."

最多还能活2到3年。」

Now, with the gravity of this doomsday diagnosis,

这项诊断好像世界末日

it just sucked me in immediately,

让我立刻认定

as if I began preparing myself as a patient

自己就是病人

to die according to the schedule that they had just given to me,

将在医生宣判的日期死亡

until I met a patient named Verna in a waiting room,

我在候诊室遇到另一位病人薇娜 (Verna)

who became a dear friend, and she grabbed me one day

她成了我的好友，有天她拉着我

and took me off to the medical library

带我到医学图书馆

and did a bunch of research on these diagnoses and these diseases,

仔细研究我的疾病和诊断

and said, "Eric, these people who get this

然后说：「得到这些疾病的人，

are normally in their '70s and '80s.

通常都是七、八十岁，

They don't know anything about you. Wake up.

他们根本不了解你，醒醒吧，

Take control of your health and get on with your life."

掌握自己的健康、好好的生活！」

And I did.

我真的这么做了

Now, these people making these proclamations to me

宣告我病症的人

were not bad people.

都不是坏人

In fact, these professionals were miracle workers,

他们都是仁心仁术的专科医师

but they're working in a flawed, expensive system that's set up the wrong way.

但他们在有缺陷、昂贵、错误 的系统下工作

It's dependent on hospitals and clinics for our every care need.

所有的照护都依赖医院与诊所

It's dependent on specialists who just look at parts of us.

依赖只看我们部分身体的专科医师

It's dependent on guesswork of diagnoses and drug cocktails,

依赖基于猜测的诊断 以及乱枪打鸟的用药

and so something either works or you die.

他不成功，你就成仁

And it's dependent on passive patients

这系统也依赖消极的病人

who just take it and don't ask any questions.

默默承受、不问问题

Now the problem with this model

以上这种模式是有问题的

is that it's unsustainable globally.

以全球来说，是无法永续的

It's unaffordable globally.

也是无法负担的

We need to invent what I call a personal health system.

我们要发展「个人化健康系统」

So what does this personal health system look like,

个人化健康系统是什么？

and what new technologies and roles is it going to entail?

有哪些新技术、新角色？

Now, I'm going to start by actually sharing with you

我现在要与各位分享

a new friend of mine, Libby,

我的新朋友「利比」(Libby)

somebody I've become quite attached to over the last six months.

过去半年我们关系密切

This is Libby, or actually, this is an ultrasound image of Libby.

这就是利比 也可说是利比的超音波影像

This is the kidney transplant I was never supposed to have.

是我本来永远等不到的移植肾脏

Now, this is an image that we shot a couple of weeks ago for today,

这是几周前照的影像

and you'll notice, on the edge of this image,

请注意角落

there's some dark spots there, which was really concerning to me.

那里有些阴影，我很担心

So we're going to actually do a live exam

我要在现场进行检验

to sort of see how Libby's doing.

看看利比的状况好不好

This is not a wardrobe malfunction. I have to take my belt off here.

不是衣服有问题，我要脱掉皮带

Don't you in the front row worry or anything.

前排的请不要担心

(Laughter)

(笑声)

I'm going to use a device from a company called Mobisante.

我要开始使用行动检测公司 (Mobisante) 所开发的仪器

This is a portable ultrasound.

叫做行动超音波

It can plug into a smartphone. It can plug into a tablet.

可连接手机或平板计算机

Mobisante is up in Redmond, Washington,

行动检测公司在华盛顿州雷德蒙市

and they kindly trained me to actually do this on myself.

他们好心训练我自助使用

They're not approved to do this. Patients are not approved to do this.

他们没有获准这么做 病人也没获准这么用

This is a concept demo, so I want to make that clear.

先讲清楚，这只是概念的展示

All right, I gotta gel up.

涂上凝胶

Now the people in the front row are very nervous. (Laughter)

现在前排观众很紧张了 (笑声)

And I want to actually introduce you to Dr. Batiuk,

我要介绍贝谢克医师 (Dr. Thomas Batiuk)

who's another friend of mine.

他是我的另一位朋友

He's up in Legacy Good Samaritan Hospital in Portland, Oregon.

在奥勒冈州波特兰市的撒马里亚 慈善医院 (Legacy Good Samaritan)

So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay?

先确认一下，贝医生，听得到吗？

And actually, can you see Libby?

还有，你看得到「利比」吗？

Thomas Batuik: Hi there, Eric.

贝医师：嗨！艾瑞克，你好 (即演讲者 Eric Dishman)

You look busy. How are you?

你看起来好忙啊！你好！

Eric Dishman: I'm good. I'm just taking my clothes off

艾瑞克：我很好，我刚脱了衣服

in front of a few hundred people. It's wonderful.

有几百位观众在看，感觉真好！

So I just wanted to see, is this the image you need to get?

我想知道这是不是你要看的影像？

And I know you want to look and see if those spots are still there.

请帮我检查那些阴影还在不在？

TB: Okay. Well let's scan around a little bit here,

贝医师：请往周围扫描一下

give me a lay of the land.

我先看一下整体状况

ED: All right.TB: Okay. Turn it a little bit inside,

艾瑞克：好的 贝医师：往里面一点

a little bit toward the middle for me.

往中间一点点

Okay, that's good. How about up a little bit?

好，很好，往上一点点

Okay, freeze that image. That's a good one for me.

停，这个影像正是我要的

ED: All right. Now last week, when I did this,

艾瑞克：上周停住时

you had me measure that spot to the right.

你要我量阴影的大小

Should I do that again?

现在要做吗?

TB: Yeah, let's do that.

贝医师：没错，量一下

ED: All right. This is kind of hard to do

艾瑞克：这有点难

with one hand on your belly and one hand on measuring,

一手在腹部，另一手还要操作

but I've got it, I think,

我想我做到了

and I'll save that image and send it to you.

我把影像存盘，再寄给你

So tell me a little bit about what this dark spot means.

请告诉我那个阴影是什么

It's not something I was very happy about.

我不太安心

TB: Many people after a kidney transplant

贝医师：很多人在肾脏移植后

will develop a little fluid collection around the kidney.

肾脏周围会积水

Most of the time it doesn't create any kind of mischief,

大部分不会造成伤害

but it does warrant looking at,

但是需要注意

so I'm happy we've got an opportunity to look at it today,

很高兴今天有机会检查

make sure that it's not growing, it's not creating any problems.

确认没有变大、不会造成问题

Based on the other images we have,

与先前影像比较

I'm really happy how it looks today.

我很满意今天的状况

ED: All right. Well, I guess we'll double check it when I come in.

艾瑞克：我去看诊时请再检查一次

I've got my six month biopsy in a couple of weeks,

再几周就要做6个月的切片检查

and I'm going to let you do that in the clinic,

我会请你帮忙

because I don't think I can do that one on myself.

因为我没办法自己作切片

TB: Good choice.ED: All right, thanks, Dr. Batiuk.

贝医师：没错 艾瑞克：谢谢你，贝医师

All right. So what you're sort of seeing here

好的，各位刚才看到的

is an example of disruptive technologies,

是革命性的创新技术

of mobile, social and analytic technologies.

包括行动装置、社群、分析技术

These are the foundations of what's going to make personal health possible.

是未来个人化健康照护的基础

Now there's really three pillars

有三大支柱支撑着…

of this personal health I want to talk to you about now,

接下来要谈的个人化健康照护

and it's care anywhere, care networking and care customization.

就是照护行动化、网络化、客制化

And you just saw a little bit of the first two

刚才只匆匆一瞥前两项

with my interaction with Dr. Batiuk.

看到我和贝医生的互动

So let's start with care anywhere.

现在从第一点开始，照护行动化

Humans invented the idea of hospitals and clinics

建立医院和诊所的构想，起源自

in the 1780s. It is time to update our thinking.

1780年，现在该重新思考了

We have got to untether clinicians and patients

我们该将医生和病人

from the notion of traveling to a special

都要走到一栋专用

bricks-and-mortar place for all of our care,

建筑物进行医疗的做法中 释放出来

because these places are often the wrong tool,

对医疗目的而言，这往往是错误的

and the most expensive tool, for the job.

而且昂贵的

And these are sometimes unsafe places to send our sickest patients,

对重病患者有时并不安全

especially in an era of superbugs

尤其是这个超级细菌、

and hospital-acquired infections.

及院内感染横行的时代

And many countries are going to go brickless from the start

许多国家想直接跳过实体医院

because they're never going to be able to afford

因为太贵了，永远负担不起…

the mega-medicalplexes that a lot of the rest of the world has built.

已开发国家的这种大型医学中心

Now I personally learned that hospitals

我个人的经验是，医院

can be a very dangerous place at a young age.

对小孩来说，是个很危险的地方

This was me in third grade.

这是小学三年级的我

I broke my elbow very seriously, had to have surgery,

手肘严重骨折，需要动手术

worried that they were going to actually lose the arm.

我很怕会失去整只手臂

Recovering from the surgery in the hospital, I get bedsores.

手术后的住院期间，我得了褥疮

Those bedsores become infected,

褥疮受到感染

and they give me an antibiotic which I end up being allergic to,

抗生素治疗造成严重过敏

and now my whole body breaks out,

最后全身爆发…

and now all of those become infected.

全面性的感染

The longer I stayed in the hospital, the sicker I became,

住院越久，我病得越重

and the more expensive it became,

医药费也越高

and this happens to millions of people around the world every year.

全球每年数百万人都是相同情形

The future of personal health that I'm talking about

我讲的未来个人化健康照护

says care must occur at home as the default model,

是以居家照护为优先

not in a hospital or clinic.

不是目前的医院或诊所

You have to earn your way into those places

你想进医院或诊所

by being sick enough to use that tool for the job.

要病到有必要的程度才行

Now the smartphones that we're already carrying

现在我们用的智能型手机

can clearly have diagnostic devices like ultrasounds plugged into them,

已可外接各种诊断装置，如超音波

and a whole array of others, today,

及其他许多装置

and as sensing is built into these,

智能型手机还内建多种传感器

we'll be able to do vital signs monitor

可进行生命迹像监测

and behavioral monitoring like we've never had before.

及过去没听过的行为监测

Many of us will have implantables that will actually look

未来我们之中许多人可能会植入

real-time at what's going on with our blood chemistry

实时监控血液中化学物质

and in our proteins right now.

及蛋白质的装置

Now the software is also getting smarter, right?

软件越来越聪明，对吧？

Think about a coach, an agent online,

就像是在线的教练或经纪人

that's going to help me do safe self-care.

可帮我们安全的自我照顾

That same interaction that we just did with the ultrasound

像我刚才展示超音波的互动

will likely have real-time image processing,

未来可能会有实时图像处理

and the device will say, "Up, down, left, right,

机器会指挥我上下左右

ah, Eric, that's the perfect spot to send that image

说：「就是这个位置，影像存盘，

off to your doctor."

传给你的医生吧！」

Now, if we've got all these networked devices

如果我们有了这些网络装置

that are helping us to do care anywhere,

照护行动化就可以达成

it stands to reason that we also need a team

当然，我们需要一个团队

to be able to interact with all of that stuff,

来进行相关互动

and that leads to the second pillar I want to talk about,

这就需要我说的第二根支柱

care networking.

照护网络化

We have got to go beyond this paradigm

我们要突破传统模式

of isolated specialists doing parts care

也就是独立专科医师 分别进行部分看护

to multidisciplinary teams doing person care.

进而由多科别团队进行个人化照护

Uncoordinated care today is expensive at best,

今日缺乏协调的照护，不仅昂贵

and it is deadly at worst.

还可能致命

Eighty percent of medical errors are actually caused

80%的医疗错误是因为

by communication and coordination problems

沟通协调问题

amongst medical team members.

存在医疗团队成员间

I had my own heart scare years ago in graduate school,

在念研究所时我有心惊胆颤的经验

when we're under treatment for the kidney,

那时在治疗肾脏

and suddenly, they're like, "Oh, we think you have a heart problem."

突然有人说：「你得了心脏病！」

And I have these palpitations that are showing up.

接着我出现了心悸

They put me through five weeks of tests --

进行了5个星期检验

very expensive, very scary -- before the nurse finally notices

又贵又可怕－ 最后有位护士注意到

the piece of the paper, my meds list

一张纸，我的药单

that I've been carrying to every single appointment,

我每次约诊都带的单子

and says, "Oh my gosh."

他说：「天哪！」

Three different specialists had prescribed

有三位专科医师开了

three different versions of the same drug to me.

三种同等药效的不同处方药

I did not have a heart problem. I had an overdose problem.

我心脏没病，是用药过量

I had a care coordination problem.

是看护缺乏协调的问题

And this happens to millions of people every year.

这每年发生在数百万人身上

I want to use technology that we're all working on and making happen

我想用现有的科技

to make health care a coordinated team sport.

使健康照护成为合作的团队运动

Now this is the most frightening thing to me.

才能解决这件让我最害怕的事

Out of all the care I've had in hospitals and clinics around the world,

我曾在世界各地的医院及诊所诊治

the first time I've ever had a true team-based care experience

我第一次感受到 真正的医疗团队照护

was at Legacy Good Sam these last six months

就是过去半年在撒马里亚慈善医院 (Legacy Good Samaritan)

for me to go get this.

让我有此感受

And this is a picture of my graduation team from Legacy.

这是我在医院的毕业团队照片

There's a couple of the folks here. You'll recognize Dr. Batiuk.

有好几位，这位是贝医师

We just talked to him. Here's Jenny, one of the nurses,

刚和他通电话 这是珍妮，其中一位护士

Allison, who helped manage the transplant list,

这是艾利森，他帮忙处理移植清单

and a dozen other people who aren't pictured,

还有十几位不在相片中

a pharmacist, a psychologist, a nutritionist,

有药师、心理医师、营养师

even a financial counselor, Lisa,

甚至还有财务顾问，莉萨

who helped us deal with all the insurance hassles.

她帮我们处理所有保险事务

I wept the day I graduated.

我毕业那天哭了

I should have been happy, because I was so well

我应该要高兴，因为病已好到

that I could go back to my normal doctors,

可以回去看一般的医师了

but I wept because I was so actually connected to this team.

我哭是因为和团队感情深厚

And here's the most important part.

这才是最重要的部份

The other people in this picture are me and my wife, Ashley.

照片上还有我，以及我太太艾希莉

Legacy trained us on how to do care for me at home

医院训练我们在家自行照护

so that they could offload the hospitals and clinics.

医院和诊所就不必那么忙碌

That's the only way that the model works.

这是这种模式成功的唯一方式

My team is actually working in China

我的团队其实在中国工作

on one of these self-care models

从事自助看护模式

for a project we called Age-Friendly Cities.

称为「年龄友善城市」计划

We're trying to help build a social network

我们尝试建立社群网络

that can help track and train the care of seniors

以帮助追踪并且训练年长者

caring for themselves

能自已照顾自己

as well as the care provided by their family members

以及由家人提供看护

or volunteer community health workers,

还有小区的健康看护志愿者

as well as have an exchange network online,

另外还有在线照护交换网站

where, for example, I can donate three hours of care a day to your mom,

例如我每天照顾你妈三小时

if somebody else can help me with transportation to meals,

而有人可以帮我送餐点

and we exchange all of that online.

大家在网络上交换工作

The most important point I want to make to you about this

我要强调的重点是

is the sacred and somewhat over-romanticized

神圣而又太理想化的

doctor-patient one-on-one

一对一医病关系

is a relic of the past.

是过去的遗留

The future of health care is smart teams,

健康照护的未来是智慧团队

and you'd better be on that team for yourself.

而你自己最好就是团队的一员

Now, the last thing that I want to talk to you about

我要谈的最后一件事是

is care customization,

通行证个性化

because if you've got care anywhere and you've got care networking,

因为通行证行动化与通行证网络化

those are going to go a long way towards improving our health care system,

要改善医疗系统，无法一蹴而就

but there's still too much guesswork.

但现有医疗存在太多猜测

Randomized clinical trials were actually invented in 1948

随机临床实验是在1948年发明的

to help invent the drugs that cured tuberculosis,

用来发明治疗结核病的药

and those are important things, don't get me wrong.

那是很重要的事，别误会

These population studies that we've done have created

这些全民研究帮忙创造了

tons of miracle drugs that have saved millions of lives,

许多新药，救治了数百万的生命

but the problem is that health care

问题是，这种医疗通行证

is treating us as averages, not unique individuals,

把我们当成平均数 而不是独立的个人

because at the end of the day,

终究来说

the patient is not the same thing as the population

病人和研究的平均数并不相同

who are studied. That's what's leading to the guesswork.

所以必须要用猜的

The technologies that are coming,

新科技已经来临

high-performance computing, analytics,

计算机的高速运算、分析

big data that everyone's talking about,

大家都在讲的大数据运算 (big data)

will allow us to build predictive models for each of us

可针对每个人建立预测模型

as individual patients.

把每个人当作个别病人

And the magic here is, experiment on my avatar

更神奇的是可拿我的计算机分身实验

in software, not my body in suffering.

不必让我身体受苦

Now, I've had two examples I want to quickly share with you

我有两个案例很快和各位分享

of this kind of care customization on my own journey.

关于我亲身经历的照护客制化

The first was quite simple. I finally realized some years ago

第一个很简单，我几年前才了解

that all my medical teams were optimizing my treatment for longevity.

我的整个医疗团队都在为 延长我的寿命而精进治疗

It's like a badge of honor to see how long they can get the patient to live.

能让病人活得更久 他们就像得到荣誉徽章一样

I was optimizing my life for quality of life,

那时我想改善生活质量

and quality of life for me means time in snow.

对我来说，生活质量就是 在雪地的时光

So on my chart, I forced them to put, "Patient goal:

我强迫他们在病历上写： 「病人的目标为，

low doses of drugs over longer periods of time,

长时间低剂量的用药，

side effects friendly to skiing."

副作用不影响滑雪。」

And I think that's why I achieved longevity.

我想这就是我活得较久的原因

I think that time-in-snow therapy was as important

「雪地的时光」这项治疗很重要

as the pharmaceuticals that I had.

跟其他药品一样重要

Now the second example of customization -- and by the way,

第二样个体化的案例是…顺道一提

you can't customize care if you don't know your own goals,

如果你没有目标，是无法个体化的

so health care can't know those until you know your own health care goals.

你要先有目标，医疗小组才会知道

But the second example I want to give you is,

但我要说的第二个案例

I happened to be an early guinea pig,

我刚好是个早期的白老鼠

and I got very lucky to have my whole genome sequenced.

我很幸运拥有完整的基因体定序

Now it took about two weeks of processing

目前大约要花两星期

on Intel's highest-end servers to make this happen,

用英特尔最高速的服务器定序

and another six months of human and computing labor

再加上6个月的人工与计算机运算

to make sense of all of that data.

以解读所有数据

And at the end of all of that, they said, "Yes,

最后他们说：「成功了，

those diagnoses of that clash of medical titans

医界权威争执多年的诊断

all of those years ago were wrong,

全都错了，

and we have a better path forward."

现在有更好的方向可以迈进。」

The future that Intel's working on now is to figure out

英特尔正努力，希望能找出方法

how to make that computing for personalized medicine

让个人化医疗的运算

go from months and weeks to even hours,

由几个月缩短到几周，甚至几小时

and make this kind of tool available,

让更多人可使用

not just in the mainframes of tier-one research hospitals around the world,

不仅限于全球一流的教学医院

but in the mainstream -- every patient, every clinic

而能成为主流－ 让每个病人、每间诊所都可使用

with access to whole genome sequencing.

这种完整的基因体定序

And I tell you, this kind of care customization

这种通行证个体化

for everything from your goals to your genetics

从个人目标到基因体定序

will be the most game-changing transformation

将是改变游戏规则的大革命

that we witness in health care during our lifetime.

我们有生之年就可见证到

So these three pillars of personal health,

健康照护的三大支柱

care anywhere, care networking, care customization,

通行证行动化、网络化、客制化

are happening in pieces now,

正逐步发生

but this vision will completely fail if we don't step up

但这个愿景可能完全失败，如果

as caregivers and as patients to take on new roles.

医护人员和患者不愿扮演新的角色

It's what my friend Verna said:

我朋友薇娜说得好：

Wake up and take control of your health.

醒醒吧！你要主导自己的健康，

Because at the end of the day these technologies

有了这些科技

are simply about people caring for other people

最后还是「人」在照顾别人与自己

and ourselves in some powerful new ways.

只是运用更好更新的方法

And it's in that spirit that I want to introduce you

这正是接下来我要很快介绍的

to one last friend, very quickly.

最后一位朋友的精神

Tracey Gamley stepped up to give me the impossible kidney

翠西甘姆利(Tracey Gamley) 挺身而出，她捐出了

that I was never supposed to have.

我本来不可能得到的肾脏

(Applause)

(掌声)

So Tracey, just tell us a little bit quickly about what the donor experience was like with you.

翠西，请很快分享一下 作为捐赠者的体会

Tracey Gamley: For me, it was really easy.

翠西：对我来说，真的很简单

I only had one night in the hospital.

我只在医院住了一夜

The surgery was done laparoscopically,

手术是以腹腔镜进行的

so I have just five very small scars on my abdomen,

我的腹部只留下5个很小的疤痕

and I had four weeks away from work

我有4个星期不能工作

and went back to doing everything I'd done before

之后就完全回复到我原来的生活

without any changes.

没有任何改变

ED: Well, I probably will never get a chance to say this to you

艾瑞克：我可能再也没有机会

in such a large audience ever again.

在这么多人面前对你说…

So "thank you" feel likes a really trite word,

「谢谢你！」 感觉上好像老掉牙了

but thank you from the bottom of my heart for saving my life.

但我打从心底感谢你救了我一命

(Applause)

(掌声)

This TED stage and all of the TED stages

在 TED 讲台上

are often about celebrating innovation

大多都是赞扬创新发明

and celebrating new technologies,

以及新科技

and I've done that here today,

这正是我刚才所做的

and I've seen amazing things coming from TED speakers,

我也目睹了其他演讲者的惊人成就

I mean, my gosh, artificial kidneys, even printable kidneys, that are coming.

天啊！人工肾脏、打印肾脏 可能都不再是梦想

But until such time that these amazing technologies

但在那些惊人科技实现

are available to all of us, and even when they are,

还有普及之前，甚至于之后

it's up to us to care for, and even save, one another.

都要靠我们彼此关爱，互相救助

I hope you will go out and make personal health happen

希望各位今后能够让 个人化健康照护实现

for yourselves and for everyone. Thanks so much.

为了你，也为了每个人。 非常感谢！

(Applause)

(掌声)