Eric Dishman: Health care should be a team sport

Translator: Joseph Geni Reviewer: Morton Bast

譯者: Maria Liu 審譯者: Allen Li

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

我從來沒有公開談過

to help illustrate the idea

我的目的是要說明一種想法、

and the need and the hope

一種需求、一種希望

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

以重塑全球的醫療照護系統

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

24年前，我還是個大二學生

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

我昏迷了好幾次，不是因為酒醉

And I ended up in student health,

我被送到學生健康中心

and they ran some labwork and came back right away,

做了一些檢驗後，立刻得知

and said, "Kidney problems."

是腎臟問題

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

我還沒搞清楚狀況，就開始了

this six months of tests and trials and tribulations

六個月的檢驗、考驗和折磨

with six doctors across two hospitals

由2家醫院的6位醫生診治

in this clash of medical titans

這些醫界權威互相爭執

to figure out which one of them was right

想釐清誰才正確

about what was wrong with me.

診斷出我的病情

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

做完超音波後，我坐在候診室

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

6位醫生同時出現

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

我想：「糟了，一定是壞消息！」

And their diagnosis was this:

醫生診斷說：

They said, "You have two rare kidney diseases

「你得了兩種罕見的腎臟疾病，

that are going to actually destroy your kidneys eventually,

最終會讓你的腎臟壞死，

you have cancer-like cells in your immune system

你的免疫系統中有類似癌症細胞，

that we need to start treatment right away,

必須立即治療。

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

你永遠不可能符合換腎資格，

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

最多還能活2到3年。」

Now, with the gravity of this doomsday diagnosis,

這項診斷好像世界末日

it just sucked me in immediately,

讓我立刻認定

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,

將在醫生宣判的日期死亡

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

我在候診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，有天她拉著我

and took me off to the medical library

帶我到醫學圖書館

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

仔細研究我的疾病和診斷

and said, "Eric, these people who get this

然後說：「得到這些疾病的人，

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

通常都是七、八十歲，

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

他們根本不了解你，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.

我真的這麼做了

Now, these people making these proclamations to me

宣告我病症的人

were not bad people.

都不是壞人

In fact, these professionals were miracle workers,

他們都是仁心仁術的專科醫師

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

但他們在有缺陷、昂貴、錯誤 的系統下工作

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

所有的照護都依賴醫院與診所

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

依賴只看我們部分身體的專科醫師

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

依賴基於猜測的診斷 以及亂槍打鳥的用藥

and so something either works or you die.

他不成功，你就成仁

And it's dependent on passive patients

這系統也依賴消極的病人

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

默默承受、不問問題

Now the problem with this model

以上這種模式是有問題的

is that it's unsustainable globally.

以全球來說，是無法永續的

It's unaffordable globally.

也是無法負擔的

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

我們要發展「個人化健康系統」

So what does this personal health system look like,

個人化健康系統是什麼？

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

有哪些新技術、新角色？

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

我現在要與各位分享

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.

過去半年我們關係密切

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

這就是利比 也可說是利比的超音波影像

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

是我本來永遠等不到的移植腎臟

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

這是幾週前照的影像

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

請注意角落

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

那裡有些陰影，我很擔心

So we're going to actually do a live exam

我要在現場進行檢驗

to sort of see how Libby's doing.

看看利比的狀況好不好

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

不是衣服有問題，我要脫掉皮帶

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

前排的請不要擔心

(Laughter)

(笑聲)

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

我要開始使用行動檢測公司 (Mobisante) 所開發的儀器

This is a portable ultrasound.

叫做行動超音波

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

可連接手機或平板電腦

Mobisante is up in Redmond, Washington,

行動檢測公司在華盛頓州雷德蒙市

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

他們好心訓練我自助使用

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

他們沒有獲准這麼做 病人也沒獲准這麼用

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

先講清楚，這只是概念的展示

All right, I gotta gel up.

塗上凝膠

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

現在前排觀眾很緊張了 (笑聲)

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

我要介紹貝謝克醫師 (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.

在奧勒岡州波特蘭市的撒馬利亞 慈善醫院 (Legacy Good Samaritan)

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

先確認一下，貝醫生，聽得到嗎？

And actually, can you see Libby?

還有，你看得到「利比」嗎？

Thomas Batuik: Hi there, Eric.

貝醫師：嗨！艾瑞克，你好 (即演講者 Eric Dishman)

You look busy. How are you?

你看起來好忙啊！你好！

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

艾瑞克：我很好，我剛脫了衣服

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

有幾百位觀眾在看，感覺真好！

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

我想知道這是不是你要看的影像？

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

請幫我檢查那些陰影還在不在？

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

貝醫師：請往周圍掃描一下

give me a lay of the land.

我先看一下整體狀況

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

艾瑞克：好的 貝醫師：往裡面一點

a little bit toward the middle for me.

往中間一點點

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

好，很好，往上一點點

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

停，這個影像正是我要的

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

艾瑞克：上週停住時

you had me measure that spot to the right.

你要我量陰影的大小

Should I do that again?

現在要做嗎?

TB: Yeah, let's do that.

貝醫師：沒錯，量一下

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

艾瑞克：這有點難

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

一手在腹部，另一手還要操作

but I've got it, I think,

我想我作到了

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

我把影像存檔，再寄給你

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

請告訴我那個陰影是什麼

It's not something I was very happy about.

我不太安心

TB: Many people after a kidney transplant

貝醫師：很多人在腎臟移植後

will develop a little fluid collection around the kidney.

腎臟周圍會積水

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

大部分不會造成傷害

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,

很高興今天有機會檢查

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

確認沒有變大、不會造成問題

Based on the other images we have,

與先前影像比較

I'm really happy how it looks today.

我很滿意今天的狀況

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

艾瑞克：我去看診時請再檢查一次

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

再幾週就要做6個月的切片檢查

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

我會請你幫忙

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

因為我沒辦法自己作切片

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

貝醫師：沒錯 艾瑞克：謝謝你，貝醫師

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

好的，各位剛才看到的

is an example of disruptive technologies,

是革命性的創新技術

of mobile, social and analytic technologies.

包括行動裝置、社群、分析技術

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

是未來個人化健康照護的基礎

Now there's really three pillars

有三大支柱支撐著…

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

接下來要談的個人化健康照護

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

就是照護行動化、網路化、客製化

And you just saw a little bit of the first two

剛才只匆匆一瞥前兩項

with my interaction with Dr. Batiuk.

看到我和貝醫生的互動

So let's start with care anywhere.

現在從第一點開始，照護行動化

Humans invented the idea of hospitals and clinics

建立醫院和診所的構想，起源自

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

1780年，現在該重新思考了

We have got to untether clinicians and patients

我們該將醫生和病人

from the notion of traveling to a special

都要走到一棟專用

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

建築物進行醫療的做法中 釋放出來

because these places are often the wrong tool,

對醫療目的而言，這往往是錯誤的

and the most expensive tool, for the job.

而且昂貴的

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

對重病患者有時並不安全

especially in an era of superbugs

尤其是這個超級細菌、

and hospital-acquired infections.

及院內感染橫行的時代

And many countries are going to go brickless from the start

許多國家想直接跳過實體醫院

because they're never going to be able to afford

因為太貴了，永遠負擔不起…

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

已開發國家的這種大型醫學中心

Now I personally learned that hospitals

我個人的經驗是，醫院

can be a very dangerous place at a young age.

對小孩來說，是個很危險的地方

This was me in third grade.

這是小學三年級的我

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

手肘嚴重骨折，需要動手術

worried that they were going to actually lose the arm.

我很怕會失去整隻手臂

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

手術後的住院期間，我得了褥瘡

Those bedsores become infected,

褥瘡受到感染

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

抗生素治療造成嚴重過敏

and now my whole body breaks out,

最後全身爆發…

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,

醫藥費也越高

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

全球每年數百萬人都是相同情形

The future of personal health that I'm talking about

我講的未來個人化健康照護

says care must occur at home as the default model,

是以居家照護為優先

not in a hospital or clinic.

不是目前的醫院或診所

You have to earn your way into those places

你想進醫院或診所

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

現在我們用的智慧型手機

can clearly have diagnostic devices like ultrasounds plugged into them,

已可外接各種診斷裝置，如超音波

and a whole array of others, today,

及其他許多裝置

and as sensing is built into these,

智慧型手機還內建多種感測器

we'll be able to do vital signs monitor

可進行生命跡像監測

and behavioral monitoring like we've never had before.

及過去沒聽過的行為監測

Many of us will have implantables that will actually look

未來我們之中許多人可能會植入

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

即時監控血液中化學物質

and in our proteins right now.

及蛋白質的裝置

Now the software is also getting smarter, right?

軟體越來越聰明，對吧？

Think about a coach, an agent online,

就像是線上的教練或經紀人

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

可幫我們安全的自我照顧

That same interaction that we just did with the ultrasound

像我剛才展示超音波的互動

will likely have real-time image processing,

未來可能會有即時影像處理

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

機器會指揮我上下左右

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

說：「就是這個位置，影像存檔，

off to your doctor."

傳給你的醫生吧！」

Now, if we've got all these networked devices

如果我們有了這些網路裝置

that are helping us to do care anywhere,

照護行動化就可以達成

it stands to reason that we also need a team

當然，我們需要一個團隊

to be able to interact with all of that stuff,

來進行相關互動

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

這就需要我說的第二根支柱

care networking.

照護網路化

We have got to go beyond this paradigm

我們要突破傳統模式

of isolated specialists doing parts care

也就是獨立專科醫師 分別進行部分照護

to multidisciplinary teams doing person care.

進而由多科別團隊進行個人化照護

Uncoordinated care today is expensive at best,

今日缺乏協調的照護，不僅昂貴

and it is deadly at worst.

還可能致命

Eighty percent of medical errors are actually caused

80%的醫療錯誤是因為

by communication and coordination problems

溝通協調問題

amongst medical team members.

存在醫療團隊成員間

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

在念研究所時我有心驚膽顫的經驗

when we're under treatment for the kidney,

那時在治療腎臟

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

突然有人說：「你得了心臟病！」

And I have these palpitations that are showing up.

接著我出現了心悸

They put me through five weeks of tests --

進行了5個星期檢驗

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

又貴又可怕－ 最後有位護士注意到

the piece of the paper, my meds list

一張紙，我的藥單

that I've been carrying to every single appointment,

我每次約診都帶的單子

and says, "Oh my gosh."

他說：「天哪！」

Three different specialists had prescribed

有三位專科醫師開了

three different versions of the same drug to me.

相同的處方藥

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

我心臟沒病，是用藥過量

I had a care coordination problem.

是照護缺乏協調的問題

And this happens to millions of people every year.

這每年發生在數百萬人身上

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

我想用現有的科技

to make health care a coordinated team sport.

使健康照護成為合作的團隊運動

Now this is the most frightening thing to me.

才能解決這件讓我最害怕的事

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

我曾在世界各地的醫院及診所診治

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

我第一次感受到 真正的醫療團隊照護

was at Legacy Good Sam these last six months

就是過去半年在撒馬利亞慈善醫院 (Legacy Good Samaritan)

for me to go get this.

讓我有此感受

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

這是我在醫院的畢業團隊照片

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

有好幾位，這位是貝醫師

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

剛和他通電話 這是珍妮，其中一位護士

Allison, who helped manage the transplant list,

這是艾利森，他幫忙處理移植清單

and a dozen other people who aren't pictured,

還有十幾位不在相片中

a pharmacist, a psychologist, a nutritionist,

有藥師、心理醫師、營養師

even a financial counselor, Lisa,

甚至還有財務顧問，麗莎

who helped us deal with all the insurance hassles.

她幫我們處理所有保險事務

I wept the day I graduated.

我畢業那天哭了

I should have been happy, because I was so well

我應該要高興，因為病已好到

that I could go back to my normal doctors,

可以回去看一般的醫師了

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

我哭是因為和團隊感情深厚

And here's the most important part.

這才是最重要的部份

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

照片上還有我，以及我太太艾希莉

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

醫院訓練我們在家自行照護

so that they could offload the hospitals and clinics.

醫院和診所就不必那麼忙碌

That's the only way that the model works.

這是這種模式成功的唯一方式

My team is actually working in China

我的團隊其實在中國工作

on one of these self-care models

從事自助照護模式

for a project we called Age-Friendly Cities.

稱為「年齡友善城市」計畫

We're trying to help build a social network

我們嘗試建立社群網路

that can help track and train the care of seniors

以幫助追蹤並且訓練年長者

caring for themselves

能自已照顧自己

as well as the care provided by their family members

以及由家人提供照護

or volunteer community health workers,

還有社區的健康照護志工

as well as have an exchange network online,

另外還有線上照護交換網站

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

例如我每天照顧你媽三小時

if somebody else can help me with transportation to meals,

而有人可以幫我送餐點

and we exchange all of that online.

大家在網路上交換工作

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

我要強調的重點是

is the sacred and somewhat over-romanticized

可怕而又太理想化的

doctor-patient one-on-one

一對一醫病關係

is a relic of the past.

已成為過去式

The future of health care is smart teams,

健康照護的未來是智慧團隊

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

而你自己最好就是團隊的一員

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

我要談的最後一件事是

is care customization,

照護客製化

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

因為照護行動化與照護網路化

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

要改善醫療系統，並非一蹴可幾

but there's still too much guesswork.

但現有醫療存在太多猜測

Randomized clinical trials were actually invented in 1948

隨機臨床實驗是在1948年發明的

to help invent the drugs that cured tuberculosis,

用來發明治療結核病的藥

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

那是很重要的事，別誤會

These population studies that we've done have created

這些全民研究幫忙創造了

tons of miracle drugs that have saved millions of lives,

許多新藥，救治了數百萬的生命

but the problem is that health care

問題是，這種醫療照護

is treating us as averages, not unique individuals,

把我們當成平均數 而不是獨立的個人

because at the end of the day,

終究來說

the patient is not the same thing as the population

病人和研究的平均數並不相同

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

所以必須要用猜的

The technologies that are coming,

新科技已經來臨

high-performance computing, analytics,

電腦的高速運算、分析

big data that everyone's talking about,

大家都在講的大資料運算 (big data)

will allow us to build predictive models for each of us

可針對每個人建立預測模型

as individual patients.

把每個人當作個別病人

And the magic here is, experiment on my avatar

更神奇的是可拿我的電腦分身實驗

in software, not my body in suffering.

不必讓我身體受苦

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

我有兩個案例很快和各位分享

of this kind of care customization on my own journey.

關於我親身經歷的照護客製化

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

第一個很簡單，我幾年前才瞭解

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

我的整個醫療團隊都在為 延長我的壽命而精進治療

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

能讓病人活得更久 他們就像得到榮譽徽章一樣

I was optimizing my life for quality of life,

那時我想改善生活品質

and quality of life for me means time in snow.

對我來說，生活品質就是 在雪地的時光

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

我強迫他們在病歷上寫： 「病人的目標為，

low doses of drugs over longer periods of time,

長時間低劑量的用藥，

side effects friendly to skiing."

副作用不影響滑雪。」

And I think that's why I achieved longevity.

我想這就是我活得較久的原因

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

「雪地的時光」這項治療很重要

as the pharmaceuticals that I had.

跟其他藥品一樣重要

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

第二個客製化案例是…順道一提

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

如果你沒有目標，是無法客製化的

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

你要先有目標，醫療小組才會知道

But the second example I want to give you is,

但我要說的第二個案例

I happened to be an early guinea pig,

我剛好是個早期的白老鼠

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

我很幸運擁有完整的基因體定序

Now it took about two weeks of processing

目前大約要花兩星期

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

用英特爾最高速的伺服器定序

and another six months of human and computing labor

再加上6個月的人工與電腦運算

to make sense of all of that data.

以解讀所有資料

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

最後他們說：「成功了，

those diagnoses of that clash of medical titans

醫界權威爭執多年的診斷

all of those years ago were wrong,

全都錯了，

and we have a better path forward."

現在有更好的方向可以邁進。」

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

英特爾正努力，希望能找出方法

how to make that computing for personalized medicine

讓個人化醫療的運算

go from months and weeks to even hours,

由幾個月縮短到幾週，甚至幾小時

and make this kind of tool available,

讓更多人可使用

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

不僅限於全球一流的教學醫院

but in the mainstream -- every patient, every clinic

而能成為主流－ 讓每個病人、每間診所都可使用

with access to whole genome sequencing.

這種完整的基因體定序

And I tell you, this kind of care customization

這種照護客製化

for everything from your goals to your genetics

從個人目標到基因體定序

will be the most game-changing transformation

將是改變遊戲規則的大革命

that we witness in health care during our lifetime.

我們有生之年就可見證到

So these three pillars of personal health,

健康照護的三大支柱

care anywhere, care networking, care customization,

照護行動化、網路化、客製化

are happening in pieces now,

正逐步發生

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

但這個願景可能完全失敗，如果

as caregivers and as patients to take on new roles.

醫護人員和患者不願扮演新的角色

It's what my friend Verna said:

我朋友凡恩說得好：

Wake up and take control of your health.

醒醒吧！你要主導自己的健康，

Because at the end of the day these technologies

有了這些科技

are simply about people caring for other people

最後還是「人」在照顧別人與自己

and ourselves in some powerful new ways.

只是運用更好更新的方法

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

這正是接下來我要很快介紹的

to one last friend, very quickly.

最後一位朋友的精神

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.

我本來不可能得到的腎臟

(Applause)

(掌聲)

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

翠西，請很快分享一下 作為捐贈者的經驗

Tracey Gamley: For me, it was really easy.

翠西：對我來說，真的很簡單

I only had one night in the hospital.

我只在醫院住了一夜

The surgery was done laparoscopically,

手術是以腹腔鏡進行的

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

我的腹部只留下5個很小的疤痕

and I had four weeks away from work

我有4個星期不能工作

and went back to doing everything I'd done before

之後就完全回復到我原來的生活

without any changes.

沒有任何改變

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

艾瑞克：我可能再也沒有機會

in such a large audience ever again.

在這麼多人面前對妳說…

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

「謝謝你！」 感覺上好像老掉牙了

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

但我打從心底感謝妳救了我一命

(Applause)

(掌聲)

This TED stage and all of the TED stages

在 TED 講台上

are often about celebrating innovation

大多都是讚揚創新發明

and celebrating new technologies,

以及新科技

and I've done that here today,

這正是我剛才所做的

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

我也目睹了其他演講者的驚人成就

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

天啊！人工腎臟、列印腎臟 可能都不再是夢想

But until such time that these amazing technologies

但在那些驚人科技實現

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

還有普及之前，甚至於之後

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

都要靠我們彼此關愛，互相救助

I hope you will go out and make personal health happen

希望各位今後能夠讓 個人化健康照護實現

for yourselves and for everyone. Thanks so much.

為了你，也為了每個人 非常感謝

(Applause)

(掌聲)