TED演讲 | 医生们会犯错误

墨安 TED每日推荐 2023-02-15

| 简介

每个医生都会犯错。但是，医师布莱恩·高德曼提道，医学界的否认（和耻感）文化让医生们无法诉说他们曾经犯过的错误，以至于无法从错误中学习与进步。从讲述自己的故事开始，他号召医生们开始谈论他们曾经犯过的错误。

| 音频 + 视频

| 中英对照演讲稿

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I think we have to do something about a piece of the culture of medicine that has to change.

我觉得在当今的医学文化中，有一部份文化必须要开始改变。

And I think it starts with one physician, and that's me.

而这个改变可以从一个医生开始，那就是我。

And maybe I've been around long enough that I can afford to give away some of my false prestige to be able to do that.

或许是因为我已经行医多年，我可以承受放弃一些虚无的名利来开始这样的改变。

Before I actually begin the meat of my talk, let's begin with a bit of baseball. Hey, why not?

在进入主题之前，让我们先谈谈棒球吧。为什么不呢？

We're near the end, we're getting close to the World Series. We all love baseball, don't we?

常规赛季就快结束，世界职业棒球大赛即将开始。我们都喜爱棒球，不是吗？

Baseball is filled with some amazing statistics. And there's hundreds of them.

棒球的世界中充斥着成千上百种让人咋舌的统计数据。

"Moneyball" is about to come out, and it's all about statistics and using statistics to build a great baseball team.

即将上映的电影《点球成金》，便是完全关于统计数据，以及如何在这些数据的基础上建造一个伟大的球队。

I'm going to focus on one stat that I hope a lot of you have heard of. It's called batting average.

我想讲一个我希望大家都听说过的数据，叫做击球率。

So we talk about a 300, a batter who bats 300.

当我们说一名挥棒球员的击球率为三成的时候，

That means that ballplayer batted safely, hit safely three times out of 10 at bats.

我们是指这位球员的打击非常稳定，每十次种就会有三次安打。

That means hit the ball into the outfield, it dropped, it didn't get caught,

安打意味着球会被击中并被打入外野，而且并不会被立刻接杀，

and whoever tried to throw it to first base didn't get there in time and the runner was safe.

球也不会在跑者成功上到一垒之前被及时的传回。

Three times out of 10. Do you know what they call a 300 hitter in Major League Baseball?

十次中有三次安打。各位知道棒球大联盟如何评论这些击球率上了三成的球员吗？

Good, really good, maybe an all-star.

很棒，非常棒，明星球员一般的棒。

Do you know what they call a 400 baseball hitter?

各位知道他们又是如何称呼一位击球率有着四成，

That's somebody who hit, by the way, four times safely out of every 10.

也就是每十次打击就会打出四个安打的球员吗。

Legendary -- as in Ted Williams legendary -- the last Major League Baseball player to hit over 400 during a regular season.

是传奇--像泰德·威廉斯那样的传奇--他是棒球大联盟里最后一个在常规赛中拥有超过四成击球率的球员。

Now let's take this back into my world of medicine where I'm a lot more comfortable,

现在让我们回到我的世界，医疗领域。这个领域我比较熟悉，

or perhaps a bit less comfortable after what I'm going to talk to you about.

但我接下来要说的却让我有些困扰。

Suppose you have appendicitis and you're referred to a surgeon who's batting 400 on appendectomies.

假设你得了阑尾炎，然后你被推荐给了一位在阑尾移除手术中有着四成“击球率”的外科医生。

Somehow this isn't working out, is it?

这听起来怪怪的，对吧？

Now suppose you live in a certain part of a certain remote place

又假设你住在某一个较为偏远的地区，

and you have a loved one who has blockages in two coronary arteries

而你所爱的人的两条冠状动脉都被堵塞，

and your family doctor refers that loved one to a cardiologist who's batting 200 on angioplasties.

你的家庭医生将她推荐给了一位在血管成形手术上有着两成“击球率”的心脏科医师。

But, but, you know what? She's doing a lot better this year.

但是，等等，你知道吗？她今年的表现有着很大的提高。

She's on the comeback trail. And she's hitting a 257. Somehow this isn't working.

她的水准也在恢复。她的“击球率”达到了两成五。但是这样还是不能被接受。

But I'm going to ask you a question.

而我现在想问各位一个问题。

What do you think a batting average for a cardiac surgeon or a nurse practitioner or an orthopedic surgeon,

你们认为，一位心脏外科医生，或一位职业护理师，一位骨科外科医生，

an OBGYN, a paramedic is supposed to be? 1,000, very good.

妇产科医生或急救人员的“击球率”应该是多少？十成？非常好。

Now truth of the matter is, nobody knows in all of medicine what a good surgeon or physician or paramedic is supposed to bat.

事实上，医学界中没有人知道一个好的外科医生，医师或急救人员应该有多少的“击球率”。

What we do though is we send each one of them, including myself, out into the world with the admonition, be perfect.

我们将他们每个人，包括我自己，送上职业岗位后，便告诫他们以完美来要求自己。

Never ever, ever make a mistake, but you worry about the details, about how that's going to happen.

绝对，绝对不能作出错误的诊断--但我们让他们自己考虑细节，考虑如何达到这样的标准。

And that was the message that I absorbed when I was in med school.

这就是我在医学院时得到的信息。

I was an obsessive compulsive student.

我是一个有着强迫症倾向的学生。

In high school, a classmate once said that Brian Goldman would study for a blood test.

在中学时，有个同学曾经说布莱恩·高德曼会为了血液测验复习。

And so I did. And I studied in my little garret at the nurses' residence at Toronto General Hospital, not far from here.

而我的确这么做了。我在离这不远处的多伦多总医院里护士住宅里的一个小阁楼中，完成了我的学业。

And I memorized everything. I memorized in my anatomy class the origins and exertions of every muscle,

我背下了所有东西。我背下了解剖课中提到的每一块肌肉的起端和伸展方式，

every branch of every artery that came off the aorta, differential diagnoses obscure and common.

每一条从主动脉延伸出来的动脉的分支系统，以及一切鲜为人知的或者常见的鉴别诊断。

I even knew the differential diagnosis in how to classify renal tubular acidosis.

我甚至知道如何鉴别诊断不同的肾小管性酸中毒症。

And all the while, I was amassing more and more knowledge.

在这段时间中，我积累了越来越多的知识。

And I did well, I graduated with honors, cum laude.

我的表现很好，并以优等的成绩毕业。

And I came out of medical school with the impression that if I memorized everything and knew everything,

当我从医学院出来时，我觉得我只要记下和明白了所有的东西，

or as much as possible, as close to everything as possible, that it would immunize me against making mistakes.

或者稍退一步--将近所有的东西，那我犯医疗错误的几率就会微乎其微。

And it worked for a while, until I met Mrs. Drucker.

而我在一段时间之内的确没有犯错。直到我遇到了Drucker女士。

I was a resident at a teaching hospital here in Toronto

我正作为一个实习医生在多伦多工作，

when Mrs. Drucker was brought to the emergency department of the hospital where I was working.

当Drucker女士被带入教学医院的急诊室时。

At the time I was assigned to the cardiology service on a cardiology rotation.

当时我正因心脏科轮调而被指派在心血管诊所。

And it was my job, when the emergency staff called for a cardiology consult,

我的工作是，当紧急救护人员需要有关于心脏的专业会诊时，

to see that patient in emerg. and to report back to my attending.

在急症室诊断病人，并在之后向负责我的主治医生汇报。

And I saw Mrs. Drucker, and she was breathless.

当我见到Drucker女士的时候，她的气息已经很微弱。

And when I listened to her, she was making a wheezy sound.

在我与她交谈时，我听到她的呼吸有喘息的声音。

And when I listened to her chest with a stethoscope,

当我用听诊器聆听她的胸腔时，

I could hear crackly sounds on both sides that told me that she was in congestive heart failure.

两边都传来的爆裂的声音告诉我，这是郁血性心脏衰竭。

This is a condition in which the heart fails, and instead of being able to pump all the blood forward,

这是由于心脏在衰竭后，无法将所有的血液完全的输送出去，

some of the blood backs up into the lung, the lungs fill up with blood, and that's why you have shortness of breath.

而导致部分血液回流入肺脏，肺脏里充满了血液，而造成呼吸短促。

And that wasn't a difficult diagnosis to make.

这不是一个困难的诊断。

I made it and I set to work treating her.

作出诊断后我开始着手帮她治疗。

I gave her aspirin. I gave her medications to relieve the strain on her heart.

我开给了她阿司匹林，并给了她一些可以减轻她心脏负担的药物。

I gave her medications that we call diuretics, water pills, to get her to pee out the access fluid.

我还给了她一些利尿剂，俗称水丸，帮助她将体内多余的水分排出。

And over the course of the next hour and a half or two, she started to feel better.

在接下来的一两个小时里，她开始觉得好转。

And I felt really good. And that's when I made my first mistake; I sent her home.

我也感到高兴。而就在此时我犯了第一个错误：我让她回了家。

Actually, I made two more mistakes. I sent her home without speaking to my attending.

正确的来说，我还犯了两个错误。我在和我的主治汇报之前便让她回了家。

I didn't pick up the phone and do what I was supposed to do,

我没有做我照着我应该做的，

which was call my attending and run the story by him so he would have a chance to see her for himself.

拿起电话打给我的主治并让他看一下这个案例，给他一个亲自见见这名病患的机会。

And he knew her, he would have been able to furnish additional information about her.

我的主治认识她，因此可以提供更详细的病历资料。

Maybe I did it for a good reason. Maybe I didn't want to be a high-maintenance resident.

或许我有这么做的理由。或许我并不想做一个需要经常地指导的实习医生。

Maybe I wanted to be so successful and so able to take responsibility

也许我太想可以独当一面，

that I would do so and I would be able to take care of my attending's patients without even having to contact him.

可以不需要和我的主治沟通便照顾好他的病患。

The second mistake that I made was worse.

而我犯的第二个错误更加严重。

In sending her home, I disregarded a little voice deep down inside that was trying to tell me,

在让她回家时，我忽视了我内心一个微小的声音。这个声音试图告诉我：

"Goldman, not a good idea. Don't do this."

“高德曼，这样不好，不要这么做。”

In fact, so lacking in confidence was I that I actually asked the nurse who was looking after Mrs. Drucker,

其实，当时的我是如此的没有自信，以至于我甚至向照顾Drucker女士的护士寻求了意见：

"Do you think it's okay if she goes home?"

“你觉得让她回家好么？”

And the nurse thought about it and said very matter-of-factly, "Yeah, I think she'll do okay."

那位护士想了想，然后就事论事的说：“嗯，我觉得没有问题。”

I can remember that like it was yesterday.

这一切对我来说，都还像是发生在了昨天。

So I signed the discharge papers, and an ambulance came, paramedics came to take her home.

我在出院单上签了名，一辆救护车来后急救人员将她送回了家。

And I went back to my work on the wards.

之后我回到了我在诊所的工作。

All the rest of that day, that afternoon, I had this kind of gnawing feeling inside my stomach.

在接下来的一天中，那天下午，我的肠胃有着一种翻滚的感觉。

But I carried on with my work.

但我还是照常的继续工作。

And at the end of the day, I packed up to leave the hospital and walked to the parking lot to take my car and drive home when I did something that I don't usually do.

在工作结束后，我整理了下便离开了医院。在我走向停车场去取我的车的路程中，做了一件我平常不会做的事情。

I walked through the emergency department on my way home.

我从急诊室借了道。

And it was there that another nurse, not the nurse who was looking after Mrs. Drucker before,

而就在那里，另外一位护士，不是之前照顾Drucker女士的那位，

but another nurse, said three words to me that are the three words that most emergency physicians I know dread.

对我说了绝大部分急诊医生都害怕听到的三个字。

Others in medicine dread them as well, but there's something particular about emergency medicine because we see patients so fleetingly.

其他科系的医生也害怕这三个字，但因为急诊医生看的病人都来去匆匆，这三个字对我们有着特别的意义。

The three words are: Do you remember?

这三个字是：记得吗？

"Do you remember that patient you sent home?"

“记得吗？你送回家的那个患者？”

The other nurse asked matter-of-factly.

那位护士就事论事的问道。

"Well she's back," in just that tone of voice.

“她又回来了。” 她就用了这样平常的语调。

Well she was back all right.

她的确回来了。

She was back and near death.

回来时已经濒临死亡。

About an hour after she had arrived home, after I'd sent her home, she collapsed and her family called 911 and the paramedics brought her back to the emergency department

在我让她回家后大约一个小时后，她昏倒在了地上，她的家人打了911，急救人员将她重新带回了急诊室。

where she had a blood pressure of 50, which is in severe shock.

此时的她已严重休克，血压只有 50。

And she was barely breathing and she was blue.

她的呼吸极其微弱，面色发青。

And the emerg. staff pulled out all the stops.

急救人员们使出了浑身解数。

They gave her medications to raise her blood pressure.

他们给了她提升血压的药物。

They put her on a ventilator.

并将她连接上了人工呼吸器。

And I was shocked and shaken to the core.

我震惊不已，吓得不得了。

And I went through this roller coaster, because after they stabilized her, she went to the intensive care unit, and I hoped against hope that she would recover.

之后我的心情便像是做着云霄飞车一般，因为当他们将她的情况稳定下来后，便将她送进了加护病房，我在绝望中希望她能够醒过来。

And over the next two or three days, it was clear that she was never going to wake up.

但在接下来的两三天中，她再也不会醒来的可能性越来越大。

She had irreversible brain damage. And the family gathered.

她的脑部已经受到了无法逆转的损伤。

And over the course of the next eight or nine days, they resigned themselves to what was happening.

她的家人聚在了一起。在接下来的八到九天里，他们慢慢的接受了这件事实。

And at about the nine day mark, they let her go -- Mrs. Drucker, a wife, a mother and a grandmother.

在第九天，他们选择让她离开人间 -- Drucker女士，一个家庭的妻子，母亲，和祖母。

They say you never forget the names of those who die.

有人说你永远不会忘记那些 (因你的疏忽而过世的）人的名字，

And that was my first time to be acquainted with that.

而那是我第一次意识到这句话的现实。

Over the next few weeks, I beat myself up and I experienced for the first time the unhealthy shame that exists in our culture of medicine -- where I felt alone, isolated,

在接下来的几个星期内，我无比的沮丧，并第一次经历了那种在医学文化中存在的危险的羞愧感 -- 我觉得孤单无助。

not feeling the healthy kind of shame that you feel, because you can't talk about it with your colleagues.

这不是那种健康的羞愧感，因为你不能和你的同事提起讨论它。

You know that healthy kind, when you betray a secret that a best friend made you promise never to reveal and then you get busted and then your best friend confronts you and you have terrible discussions, but at the end of it all that sick feeling guides you and you say, I'll never make that mistake again.

你知道健康的那种，当你背叛了对挚友的承诺而说出了答应要保守的秘密，并被他知道了以后，你的挚友找你算账时，虽然你们会争执不休，但最后那层罪恶感仍然会主导你，你告诉自己，我绝对不会再犯同样的错误。

And you make amends and you never make that mistake again.

如是，你做了修正的承诺，然后你永不会再犯那样的错。

That's the kind of shame that is a teacher.

这种羞愧有着教导的作用。

The unhealthy shame I'm talking about is the one that makes you so sick inside.

而我所说的那种非良性的羞愧会让你愧对于心。

It's the one that says, not that what you did was bad, but that you are bad.

它会对你说，并非你做的是错的，而是你根本就是坏人。

And it was what I was feeling.

这便是我当时的感觉。

And it wasn't because of my attending; he was a doll.

而这也不是因为我的主治；他人非常好。

He talked to the family, and I'm quite sure that he smoothed things over and made sure that I didn't get sued.

他和那家人好好的谈过。我确定他为了确保我没有被控告而替我打了圆场。

And I kept asking myself these questions. Why didn't I ask my attending?

但我仍然不断问我自己这些问题：为什么当时我没有联系我的主治？

Why did I send her home? And then at my worst moments: Why did I make such a stupid mistake?

为什么我当时会让她回家？更加沮丧时，我会问：我为什么会犯下如此愚蠢的错误？

Why did I go into medicine? Slowly but surely, it lifted.

为什么我会选择进入医学界？慢慢的但稳定地，那糟糕的感觉开始淡化了。

I began to feel a bit better.

我开始觉得缓和了些。

And on a cloudy day, there was a crack in the clouds and the sun started to come out and I wondered, maybe I could feel better again.

然后在一个阴云密布的日子里，当我看到一束阳光从云隙中探出，我觉得，或许我能再次感觉好起来。

And I made myself a bargain that if only I redouble my efforts to be perfect and never make another mistake again, please make the voices stop.

然后我和自己做了一个约定：如果我加倍努力做到完美，不再犯错，请就此让那自责的声音消去。

And they did. And I went back to work. And then it happened again.

那个声音的确停止了。我回到了工作岗位。但错误又发生了。

Two years later I was an attending in the emergency department at a community hospital just north of Toronto, and I saw a 25 year-old man with a sore throat.

两年后，当我在一家多伦多北部一间社区医院的急症室做主治医生时，我看了一位喉咙酸痛的25岁的男人。

It was busy, I was in a bit of a hurry. He kept pointing here.

当时诊所很忙，所以我也有些急。他不停的指着这里。

I looked at his throat, it was a little bit pink.

我看了看，他的喉咙有些红肿。

And I gave him a prescription for penicillin and sent him on his way.

我给他开了盘尼西林的处方后便让他离开了。

And even as he was walking out the door, he was still sort of pointing to his throat.

即便当他走出诊所的大门的时候，他似乎还在指着他的喉咙。

And two days later I came to do my next emergency shift, and that's when my chief asked to speak to me quietly in her office.

两天后，又轮到我在急诊室值班。那时我的主任要我去她的办公室里私下谈谈。

And she said the three words: Do you remember?

她说了那三个字：记得吗？

"Do you remember that patient you saw with the sore throat?"

“记得吗？那位你看过的喉咙酸痛的患者？”

Well it turns out, he didn't have a strep throat.

原来，他并没有得链球菌性咽喉炎。

He had a potentially life-threatening condition called epiglottitis.

得的是一种有可能威胁到生命的病症，叫会厌炎。

You can Google it, but it's an infection, not of the throat, but of the upper airway, and it can actually cause the airway to close.

各位可以在谷歌上查询，但它不是喉咙，而是上呼吸道的感染，并有可能造成呼吸道阻塞。

And fortunately he didn't die.

幸好，他并没有过世。

He was placed on intravenous antibiotics and he recovered after a few days.

在被安排做抗生素静脉注射的几天之后，他便痊愈了。

And I went through the same period of shame and recriminations and felt cleansed and went back to work, until it happened again and again and again.

而我又回到了那个愧疚和自责的时光中，然后等情绪平复后，又回到了工作岗位，直到这些错误再度重复的发生。

Twice in one emergency shift, I missed appendicitis.

在同一个急诊的值班中，我两次没有发现病患得了盲肠炎。

Now that takes some doing, especially when you work in a hospital that at the time saw but 14 people a night.

这是很难想象会发生的事情，尤其是当你在一间一个晚上，只见十四名病患的医院工作。

Now in both cases, I didn't send them home and I don't think there was any gap in their care.

虽然对这两个病例，我都没有让他们回家，而我也不觉得在治疗照顾过程中有任何空隙和差错。

One I thought had a kidney stone.

其中一位我诊断他有肾结石。

I ordered a kidney X-ray.

并安排了肾脏X光，但结果正常。

When it turned out to be normal, my colleague who was doing a reassessment of the patient noticed some tenderness in the right lower quadrant and called the surgeons.

我的同事当时正在对病人的病情做重新的诊断。在他留意到病人右下腹的地方有些柔软时，便联系了外科医生。

The other one had a lot of diarrhea.

另一位病患有严重的腹泻。

I ordered some fluids to rehydrate him and asked my colleague to reassess him.

我给了他一些液体帮助他补充水分，并让我的同事重新看了看。

And he did and when he noticed some tenderness in the right lower quadrant, called the surgeons.

他照做了。当他注意到病人右下腹有些柔软时，也联系了外科医生。

In both cases, they had their operations and they did okay.

这两名病患都做了手术并康复了。

But each time, they were gnawing at me, eating at me.

但每当我想到这两起病例，那种感觉都会折磨啃噬我。

And I'd like to be able to say to you that my worst mistakes only happened in the first five years of practice as many of my colleagues say, which is total B.S.

而我也希望我可以告诉你，我造成的最严重的错误只发生在了我开始行医的前五年，像我众多的同事所称一般。但这完全是扯淡。

Some of my doozies have been in the last five years.

在最近的五年中，我也犯了一些错误。

Alone, ashamed and unsupported.

我依然觉得孤独，羞愧，无助。

Here's the problem: If I can't come clean and talk about my mistakes,

但问题的症结是：如果我不能理清和谈论我所犯过的错误，

if I can't find the still-small voice that tells me what really happened, how can I share it with my colleagues?

如果我无法找到那可以告诉我错误的源头的那仍然微小的声音，我又如何能和我的同事分享我的经验？

How can I teach them about what I did so that they don't do the same thing?

我又如何教导他们，让他们不再重蹈我的覆辙？

If I were to walk into a room -- like right now, I have no idea what you think of me.

当我走入一个场合时 -- 就像现在，我完全不知道各位如何看待我。

When was the last time you heard somebody talk about failure after failure after failure?

你们上一次听到别人谈论自己一次又一次的失败是什么时候的事情？

Oh yeah, you go to a cocktail party and you might hear about some other doctor, but you're not going to hear somebody talking about their own mistakes.

是的，如果你们去参加一场聚会，你或许会听到某些关于其他医生的错误的闲聊，但你不会听到有人谈论自己所犯的错误。

If I were to walk into a room filled with my colleages and ask for their support right now and start to tell what I've just told you right now,

如果我现在走入一间坐满我的同事的房间，向他们寻求帮助并开始和他们说我刚才告诉各位的事情，

I probably wouldn't get through two of those stories before they would start to get really uncomfortable,

或许在我还没讲超过两个故事之前，他们就会开始感到非常的不自在。

somebody would crack a joke, they'd change the subject and we would move on.

有人就会讲个笑话，然后他们会改变话题。

And in fact, if I knew and my colleagues knew that one of my orthopedic colleagues took off the wrong leg in my hospital,

事实上，如果我，或者我的同事，知道医院中一位骨科的同事帮病人截错了腿，

believe me, I'd have trouble making eye contact with that person.

相信我，当我遇到他时，我也无法与他有正常眼神的交汇。

That's the system that we have.

这就是我们所拥有的体系.

It's a complete denial of mistakes.

一个完完全全的否定错误的体系。

It's a system in which there are two kinds of physicians -- those who make mistakes and those who don't,

在这个制度当中，只有两种人 -- 犯错的不犯错的，

可以调适睡眠不足的和不可以忍受的，以及那些有着糟糕的结果和有着优秀的结果的。

And it's almost like an ideological reaction, like the antibodies begin to attack that person.

这几乎就像免疫系统的自我反应，像抗体一般开始攻击那个不一样的人。

And we have this idea that if we drive the people who make mistakes out of medicine, what will we be left with, but a safe system.

我们有着一种想法：当我们将所有的会犯错的人赶出医学界后，我们便会得到一个安全的系统。

But there are two problems with that.

但这种想法会衍生出两个问题。

In my 20 years or so of medical broadcasting and journalism,

在我二十余年的医疗广播和新闻工作中，

I've made a personal study of medical malpractice and medical errors to learn everything I can,

我自行研究了我可以接触到的一切医疗疏失和医疗错误，

from one of the first articles I wrote for the Toronto Star to my show "White Coat, Black Art."

从我为多伦多星报所写的第一篇文章到我的节目《白袍魔艺》。

And what I've learned is that errors are absolutely ubiquitous.

而我所了解到的，便是错误绝对是无处不在。

We work in a system where errors happen every day,

我们工作在一个每天都会发生错误的制度中。

where one in 10 medications are either the wrong medication given in hospital or at the wrong dosage,

医院有十分之一的几率会给错药或者给了错误的剂量，

where hospital-acquired infections are getting more and more numerous, causing havoc and death.

而在医院内被传染的病例正在日渐增多，造成不必要的伤害和死亡。

In this country, as many as 24,000 Canadians die of preventable medical errors.

在这个国家中，有将近2万4千多加拿大人死于可以避免的医疗错误。

In the United States, the Institute of Medicine pegged it at 100,000.

在美国，据医学学院统计，这个人数达到了10万之多。

In both cases, these are gross underestimates, because we really aren't ferreting out the problem as we should.

即使如此，这两项数据也还是过于低估了现实，因为我们从未像我们该做的那般深入地探究这个问题。

What they need is an environment to be able to do that.

他们只是需要一个场合来吐露心声。

What they need is a redefined medical culture.

他们需要的是一个重新定义的医学文化。

And it starts with one physician at a time.

从一位又一位个别的医生开始。

The redefined physician is human, knows she's human, accepts it, isn't proud of making mistakes,

重新定义过的医生也是人类，明白她自己是人，并接受这个事实，她并不觉得犯错误是光荣的，

but strives to learn one thing from what happened that she can teach to somebody else.

却可以从其中学习，并教于他人。

She shares her experience with others.

她会与他人分享她的经验。

She's supportive when other people talk about their mistakes.

并在别人谈论自己过错的时候给于支持。

And she points out other people's mistakes, not in a gotcha way, but in a loving, supportive way so that everybody can benefit.

她不会有一种落井下石的心态，而会以一种可以让每个人都从中受惠的关怀，了解的方式来指出他人的错误。

And she works in a culture of medicine that acknowledges that human beings run the system,

而她所工作的医学文化承认整个体系是由人在运作，

and when human beings run the system, they will make mistakes from time to time.

而当人在运作一个体系的时候，时不时地错误在所难免。

So the system is evolving to create backups that make it easier to detect those mistakes that humans inevitably make and also fosters in a loving,

这样系统才可以不断地进化改革，产生可以让人更加容易察觉这些无法避免的错误的补救方案。

supportive way places where everybody who is observing in the health care system can actually point out things that could be potential mistakes and is rewarded for doing so,

与此同时，我们可以培养一个热心关怀的工作环境，鼓励每一位在观察我们的医疗系统的人，随时指出一些潜在的错误。

and especially people like me, when we do make mistakes, we're rewarded for coming clean.

尤其是鼓励像我一样的人，当我们犯错后，我们可以去正面面对并加以改正。

My name is Brian Goldman. I am a redefined physician. I'm human. I make mistakes.

我是布莱恩.高德曼，我是一位重新定义后的医生。

I'm sorry about that, but I strive to learn one thing that I can pass on to other people.

我是一个人类，我也会犯错。我为此感到抱歉，但我会尽力从中学习，并教于他人。

I still don't know what you think of me, but I can live with that.

我仍然不知各位如何看待我，但我想我对此可以接受。

And let me close with three words of my own: I do remember.

最后让我以我自己的三个字做为结语：我记得。

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