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I am a neurosurgeon, and I'm here to tell you today that people like me need your help.
我是一个神经外科医生，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, she was in generally good shape,
她是一个五十多岁的女士，身材基本上保持的不错，
but she had been in and out of hospital a few times due to curative breast cancer treatment.
但是她已经为了根治乳腺癌多次进出医院。
Now she had gotten a prolapse from a cervical disc, giving her radiating pain of a tense kind, out into the right arm.
现在她的颈椎间盘有脱落，带给她放射性的疼痛，一直影响到她的右胳膊。
Looking at her MRI before the consultation, I decided to suggest an operation.
在诊疗之前我看了她的核磁共振成像，我决定建议她进行手术。
Now, neck operations like these are standardized, and they're quick. But they carry a certain risk.
现在这种脖颈手术已经很标准化，而且手术时间短，但是仍带有一定的风险。
You make an incision right here, and you dissect carefully past the trachea, the esophagus,
要在这里做一个切口，然后剖开，小心的穿过气管，食道，
and you try not to cut into the internal carotid artery.
还要尽量不切到颈内动脉。
Then you bring in the microscope, and you carefully remove the disc and the prolapse in the nerve root canal,
然后要利用显微镜，仔细的在神经根管中移除间盘和脱垂，
without damaging the cord and the nerve root lying only millimeters underneath.
同时不能损害在下方仅几毫米处的索状组织和神经根。
The worst case scenario is the damage to the cord, which can result in paralysis from the neck down.
最坏的情况就是损害了索状组织，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, she uttered a few very decisive words for me and for her. "Doctor, is this really necessary?"
然后过了一会，她对我和她自己说了一句非常果断的话。“医生，这个手术真的必要吗？”
And you know what I realized, right there and then? It was not.
你们知道那一刻我意识到什么吗？这个手术并不必要。
In fact, when I get patients like this woman, I tend to advise not to operate.
实际上，当我面对像这位女士的病人时，我倾向于建议她们不做手术。
So what made me do it this time? Well, you see, this prolapse was so delicate,
为什么我这次却建议她做呢？是这样的，这个脱垂非常精巧，
I could practically see myself pulling it out of the nerve root canal before she entered the consultation room.
在她进入诊疗室之前，我几乎可以看见自己正在把脱垂从神经根管中取出。
I have to admit it, I wanted to operate on her. I'd love to operate on her.
我不得不承认，我想给她做手术。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。
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 and design houses.
我的建筑师邻居说他就喜欢坐在那设计房子。
He'd rather do that all day than talk to the client paying for the house that might even give him restrictions on what to do.
宁可坐在那一天，他也不想跟客户讨论付款买房的事项，这甚至有可能限制他的设计。
But like every architect, every surgeon needs to look their patient in the eye and together with the patient,
就像每个建筑师，每个外科医生需要看着病人的眼睛，
they need to decide on what is best for the person having the operation.
然后跟病人一起决定对病人来说最好的手术。
And that might sound easy. But let's look at some statistics.
这个听起来可能简单。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, and that's called a tonsillectomy.
它们可以通过手术切除，即扁桃体切除手术。
This chart shows the operation rate of tonsillectomies in Norway in different regions.
这个儿童数据表展示了在挪威不同地区进行扁桃体手术的比例。
What might strike you is that there is twice the chance that your kid -- because this is for children
可能会吓到你的是，你的孩子有两倍的几率，因为这是针对孩子的，
will get a tonsillectomy in Finnmark than in Trondheim.
在芬马克郡的孩子需要做扁桃体切除手术的几率是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. Here's another chart.
所以不应该有区别，但是现在有。这是另一个表。
The meniscus helps stabilize the knee and can be torn or fragmented acutely, topically during sports like soccer.
半月板有助于稳定膝盖，但是容易被撕裂或发生急性碎裂，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 More og Romsdal is five times the operation rate in Stavanger. Five times.
在默勒市的比例是在斯塔万格市的五倍。五倍。
How can this be? Did the soccer players in More og Romsdal play more dirty than elsewhere in the country?
为什么会这样？是在默勒的足球运动员比国家其它地方玩得更野蛮吗？
Probably not. I added some information now.
可能不是。我现在加入一些信息。
What you see now is the procedures performed in public hospitals, in light blue,
现在你们看见的浅蓝色的是在公立医院执行的治疗程序，
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 in More og Romsdal, isn't there? What does this indicate?
在默勒的私人诊所治疗记录有很多，对吗？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. Recent research has shown that
不仅如此。最近的研究展示了
the difference of treatment effect between regular physical therapy and operations for the knee -- there is no difference.
常规的物理治疗和膝盖手术的治疗效果并没有不同。
Meaning that most of the procedures performed on the chart I've just shown could have been avoided, even in Stavanger.
意思是在这个我刚展示的图表中，大部分被执行的手术是本可以被避免的，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 are standardized,
尽管世界上大部分的治疗指示已经标准化了，
there is a lot of unnecessary variation of treatment decisions, especially in the Western world.
但是有很多是没必要的治疗手段的变形，特别是在西方国家。
Some people are not getting the treatment that they need, but an even greater portion of you are being overtreated.
一些人没有得到他们需要的治疗，而你们当中很多人在被过度治疗。
"Doctor, is this really necessary?" I've only heard that question once in my career.
“医生，这个手术真的必要吗？”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, how often do you think you'll get a "no" from a doctor if you ask such a question?
换一种方式说，如果你问这种问题，你们觉得有几次会听见一个医生说“没必要”？
Researchers have investigated this, and they come up with about the same "no" rate wherever they go. And that is 30 percent.
调查人员对此进行了调查，他们得到了不论在哪里都大概相同的比例。是30%。
Meaning, three out of 10 times, your doctor prescribes or suggests something that is completely unnecessary.
意思是，10次里有3次你的医生会给你开出或者建议完全没必要的东西。
And you know what they claim the reason for this is? Patient pressure.
你们知道他们声称的原因是什么？患者给的压力。
In other words, you. You want something to be done.
换句话说，是你们。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, he does a lot of cross-country skiing in the winter time, he runs in the summer time.
他是一个爱运动的人。他在冬天经常穿梭在不同国家进行越野滑雪，夏天跑步。
And this time, he'd gotten a bad back ache whenever he went jogging. So much that he had to stop doing it.
这次，他在跑步时感觉到了严重的背疼。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 in the lower part of his spine.
我发现很可能在他的脊椎下半部分有椎间盘退变。
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, there was really nothing to do,
他已经接受用游泳代替慢跑，实际上没有什么可以做的，
so I told him, "You need to be more selective when it comes to training. Some activities are good for you, some are not."
所以我告诉他：”你在训练的时候，必须有选择性的进行。一些活动对你有好处，另一些没有。”
His reply was, "I want an MRI of my back."
他的回答是，“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. "That's not the real reason."
“拜托，”我说--毕竟，他是我的朋友。“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。
"Trust me on this. You're not going to need the scan."
“这件事你要相信我。你不需要这个扫描。”
"Well," he said, and after a while, he continued, "It could be cancer."
“唔，”他说，过了一会儿，他继续说，“可能是癌症。”
He got the scan, obviously.
很明显，他还是做了扫描。
And through his insurance at work, he got to see one of my colleagues at work, telling him about the degenerated disc,
通过他们公司的保险计划，他找了我的一个同事，告诉他椎间盘退化的事，
that there was nothing to do, and that he should keep on swimming and quit the jogging.
还是没什么其它可以做的，他应该继续游泳，停止慢跑。
After a while, I met him again and he said, "At least now I know what this is."
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。”
But let me ask you a question. What if all of you in this room with the same symptoms had an MRI?
但是让我问你们一个问题。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 had an MRI due to occasional back pain?
如果挪威所有人都因为偶尔的背疼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 from someone who really had cancer.
而你们会占用了名单上那些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, an opportunity to get diagnosed or treated.
但敏感的病人有时候也会拒绝掉一个被诊断和治疗的机会。
"Doctor, is this really necessary?" I know this can be a difficult question to ask.
“医生，这个真的必要吗？”我知道这是一个很难启齿的问题。
In fact, if you go back 50 years, this was even considered rude.
实际上，如果倒退50年，这甚至会被认为粗鲁。
If the doctor had decided what to do with you, that's what you did.
如果医生已经决定如何治疗你，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, for six months. It was a terrible trauma for her.
在还是个小女孩的时候曾经被送到肺结核疗养院六个月。对她来说是可怕的创伤。
She later found out, as a grown-up, that her tests on tuberculosis had been negative all along.
在她成年后发现，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. Not even her parents.
没有人敢或者甚至想过去反抗他的做法。甚至她的父母都没有。
Today, the Norwegian health minister talks about the patient health care service.
如今，挪威卫生部长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. But it also puts more responsibility on you.
这是巨大的进步。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 and start sharing decisions on where to go.
你们需要坐在医生面前一起讨论接下来的决定。
So, the next time you're in a doctor's office, I want you to ask, "Doctor, is this really necessary?"
所以，下一次当你在医生办公室里，我希望你们可以问，“医生，这个真的必要吗？”
And in my female patient's case, the answer would be no, but an operation could also be justified.
在我那个女性患者的案例中，答案是不，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 will have an infection in the wound or even a rehemorrhage that might end up in a re-operation.
1-2%的患者会伤口感染，或者甚至是出血，这就需要第二次的手术。
0.5 percent of patients also experience permanent hoarseness and a few,
0.5%的患者也会经历永久性的声音嘶哑，
but still a few, will experience reduced function in the arms or even legs.
还有一些手臂或者腿功能会衰减。
"Doctor, are there other options?" Yes, rest and physical therapy over some time might get you perfectly well.
“医生，有其他的选择吗？”是的，一段时间的休息和物理治疗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, but even then, there's a slight chance that you will get well.
不建议这样，但是尽管那样，也有很小的可能你会康复。
Four questions. Simple questions. Consider them your new toolbox to help us.
四个问题。简单的问题。把它们当作你的新工具箱来帮助我们。
Is this really necessary? What are the risks? Are there other options? And what happens if I don't do anything?
“这真的必要吗？”“有什么风险？”“有没有其它选择？”“如果我什么都不做会怎么样？”
Ask them when your doctor wants to send you to an MRI, when he prescribes antibiotics or suggests an operation.
当医生让你做核磁共振成像时要问医生，还有当他给你开抗生素或者建议手术时也要问。
What we know from research is that one out of five of you, 20 percent, will change your opinion on what to do.
从研究中我们知道5个人中有1个，也就是20%，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 a whole lot easier, and probably even better,
做到这样，你不仅会让你的生活变得更容易，甚至更好，
but the whole health care sector will have benefited from your decision. Thank you.
而且会让整个医疗保健部门受益于你的决定。谢谢大家。
