TED演讲：未确诊的慢性疼痛背后的偏见
字幕摘录
| 时间 | 英文 | 中文 |
|---|---|---|
| 0:04 | As a doctor in the field of pain management, I work in a world where you bring us your | 作为治疗疼痛的医生,我在一个你带给我们你 |
| 0:10 | pain and we treat it. | 痛苦和我们治疗它。 |
| 0:13 | We ask questions. | 我们问问题。 |
| 0:15 | We take the symptoms you present. | 我们接受你的症状 |
| 0:17 | We decide what tests to run. | 我们决定进行什么测试。 |
| 0:20 | We listen with compassion and wisdom and choose the best course of action based on our knowledge | 我们以同情和智慧倾听,并根据我们的知识选择最佳行动方针 |
| 0:26 | and experience combined with science, and sometimes in a very small window of time. | 经验与科学相结合, 有时在一个很小的时间窗口。 |
| 0:34 | As physicians, we took a sacred oath to do no harm, and the system has gone a great length | 作为医生,我们发了神圣的誓言,不作任何伤害, 而这个制度已经走了很长一段时间 |
| 0:39 | to teach us and set up guidelines to make sure that we treat every patient equally and | 教导我们,制定指导方针,以确保我们平等对待每个病人 |
| 0:45 | without judgment. | 没有判断力。 |
展开字幕全文（165 条）
| 序号 | 英文 | 中文 |
|---|---|---|
| 1 | As a doctor in the field of pain management, I work in a world where you bring us your | 作为治疗疼痛的医生,我在一个你带给我们你 |
| 2 | pain and we treat it. | 痛苦和我们治疗它。 |
| 3 | We ask questions. | 我们问问题。 |
| 4 | We take the symptoms you present. | 我们接受你的症状 |
| 5 | We decide what tests to run. | 我们决定进行什么测试。 |
| 6 | We listen with compassion and wisdom and choose the best course of action based on our knowledge | 我们以同情和智慧倾听,并根据我们的知识选择最佳行动方针 |
| 7 | and experience combined with science, and sometimes in a very small window of time. | 经验与科学相结合, 有时在一个很小的时间窗口。 |
| 8 | As physicians, we took a sacred oath to do no harm, and the system has gone a great length | 作为医生,我们发了神圣的誓言,不作任何伤害, 而这个制度已经走了很长一段时间 |
| 9 | to teach us and set up guidelines to make sure that we treat every patient equally and | 教导我们,制定指导方针,以确保我们平等对待每个病人 |
| 10 | without judgment. | 没有判断力。 |
| 11 | As we stand there in your moment of pain, we run your situation through every filter | 当我们站在你痛苦的时刻, 我们检查你的处境 每一个过滤器 |
| 12 | we have to give you the best care. | 我们得好好照顾你 |
| 13 | And for most of us, this is more than just a job, it's a calling. | 对我们大多数人来说,这不仅仅是一项工作,而是一项呼吁。 |
| 14 | But as we stand there in your moment, looking at your story from all the different angles | 但当我们站在你的时刻 从不同的角度看待你的故事 |
| 15 | and all the different rational voices in our head run through the decision making process, | 我们头脑中所有不同的理性声音 都贯穿了决策过程 |
| 16 | there's another voice in the mix. | 混音里还有一个声音 |
| 17 | And this voice, while it isn't rational or informed, yet it often dictates our decisions. | 这个声音,虽然既不合理,也不知情, 但是它常常决定我们的决定。 |
| 18 | And we don't give it a second thought, because you see, this voice existed long before we | 我们不给它一个第二个想法, 因为你看到,这个声音存在 很久以前,我们 |
| 19 | began studying medicine, and so we accept it as truth. | 开始学习医学, 所以我们接受它为真理。 |
| 20 | And this voice sometimes calls the shots. | 而这个声音有时会发出响亮的声音. |
| 21 | It's what I refer to as the undiagnosed bias, and it's causing suffering and death for | 我称之为"未诊断的偏见" 它造成了痛苦和死亡 |
| 22 | many with chronic pain. | 许多人都患有慢性疼痛。 |
| 23 | I have spent the last 15 years studying pain, its cause, its treatment, and its management. | 过去15年里,我一直在研究疼痛、其原因、治疗以及管理。 |
| 24 | But it wasn't until I found myself sitting on the other side of the exam room that I | 但直到我发现自己坐在考试室的另一边 |
| 25 | noticed the crack in the foundation of pain management, when I discovered that hidden | 当我发现疼痛管理的基础有裂缝时 |
| 26 | voice that exists in all of us. | 声音存在于我们所有人。 |
| 27 | That hidden voice, which I termed the undiagnosed bias, is more commonly known as implicit bias, | 这个隐蔽的声音,我称之为未诊断的偏差, 更常被称为隐含偏差, |
| 28 | which is a bias that exists based on our unconscious beliefs and associations. | 这是一种基于我们无意识的信仰和协会的偏见。 |
| 29 | Implicit bias in healthcare was brought to light in 2003, when the Institute of Medicine | 2003年,医学研究所揭露了在保健方面的隐含偏见。 |
| 30 | published a report titled Unequal Treatment. | 发表题为《不平等待遇》的报告。 |
| 31 | They found that regardless of insurance and income status, racial and ethnic minorities | 他们发现,无论保险和收入状况如何,种族和族裔少数群体都存在。 |
| 32 | received worse care. | 得到了更好的照顾。 |
| 33 | And when it comes to pain, research shows that bias extends beyond minorities to also | 在痛苦方面,研究表明,偏见超越了少数群体,也超越了少数群体。 |
| 34 | include women and even children. | 包括妇女甚至儿童。 |
| 35 | Dr. Susan Moore was a Black female physician whose story was heard around the world in | 苏珊·摩尔博士是一位黑人女性医生 他的故事在世界各地都听到 |
| 36 | 2020. | 2020 (中文(简体) ). |
| 37 | The story of a doctor who struggled to receive the care she knew she needed. | 一个医生为了得到她知道需要的护理而挣扎的故事. |
| 38 | Her pain was due to a health issue that she fully understood and described in medical | 她的疼痛是由于她完全理解和描述的健康问题 |
| 39 | lingo to her doctors, yet her pain was dismissed. | 对她医生的语气, 但她的痛苦被解除。 |
| 40 | When she posted her experience to a group of thousands of fellow physicians, there was | 当她将她的经验张贴给 数千名同仁医生时, |
| 41 | an uproar of support. | 支持的愤怒。 |
| 42 | I mean, no one could accept that a doctor would treat a patient, let alone a fellow | 我的意思是,没有人可以接受 医生会治疗病人, 更不用说一个家伙。 |
| 43 | colleague like this, simply based on how they look. | 像这样的同事, 仅仅基于他们的样子。 |
| 44 | But that's the problem with implicit bias. | 但这就是隐含偏见的问题。 |
| 45 | Most of the time, you are unaware you even have it. | 大部分时间,你不知道 你甚至拥有它。 |
| 46 | I remember the year I went from doctor to patient. | 我记得我从医生到病人的那一年 |
| 47 | It started off as a small pain in my foot that just wouldn't go away. | 一开始我脚上有点痛,不会消失 |
| 48 | Well, it grew worse, to the point that it overshadowed my life. | 情况变得更糟了 以至于我的生命被蒙上了阴影 |
| 49 | It was this constant companion affecting my work and my family life. | 是这个不断的同伴影响我的工作和家庭生活。 |
| 50 | I finally went to go see a foot surgeon and was told, | 我终于去看了个脚科医生 然后被告知 |
| 51 | source not clear. | 来源不明。 |
| 52 | Probably tendons were inflamed, he said. | 他说,可能是病发作 |
| 53 | And he prescribed a boot and some physical therapy. | 他开了一个靴子和一些物理治疗。 |
| 54 | But the pain worsened and it spread to my hip and my back. | 但痛苦恶化了 扩散到我的臀部和背部 |
| 55 | I sought out more medical specialists, even holistic practitioners, all with different | 我找了更多的医学专家 甚至全方位的医生 都有不同的 |
| 56 | theories, but no clear diagnosis or source of pain. | 理论,但没有明确的诊断 或疼痛的来源。 |
| 57 | I began to feel like I was going to have to live with this forever. | 我开始感觉我不得不永远忍受这一切 |
| 58 | And as the pain kept progressing with no clear diagnosis, I even thought to myself, | 由于疼痛没有经过明确的诊断,我甚至想, |
| 59 | wait, am I making this up? | 等等,是我编的吗? |
| 60 | Is my pain even real? | 我的痛苦是真的吗? |
| 61 | In an online survey of 2,400 American women with a variety of chronic pain conditions, | 在对2400名患有各种慢性疼痛的美国女性进行的在线调查中, |
| 62 | 91% felt that the health care system discriminated against them. | 91%的人认为保健系统歧视她们。 |
| 63 | And nearly half were told that the pain was all in their heads. | 近一半的人被告知 痛苦都在他们头上 |
| 64 | So let's go ahead and dispel that pain myth right away. | 所以,让我们继续去消除 痛苦的神话立即。 |
| 65 | If you're worried that your pain is in your head, you're right. | 若烦恼烦恼烦恼于头目中即得正法. |
| 66 | Because pain is in everyone's heads. | 因为痛苦存在于每个人的头上. |
| 67 | You see, pain can't take place without our brains. | 没有我们的大脑,痛苦是不会发生的 |
| 68 | When you step on a nail, for example, you stimulate nociceptors or specialized nerve | 例如你踩到钉子时,会刺激鼻孔或专用神经 |
| 69 | cells that send a message through your spinal cord to your brain. | 细胞通过脊髓向大脑传递信息. |
| 70 | Well, your brain then decides what it's going to do with that signal. | 那么,你的大脑决定它与信号有什么关系。 |
| 71 | If it senses something dangerous, it will process that experience as painful to prevent | 如果感觉危险,它会处理 经历痛苦的防止 |
| 72 | you from further injury. | 继续伤害你 |
| 73 | And the decision by the brain to process it as painful is based on environmental and social | 而大脑决定 处理它的痛苦 是基于环境和社会 |
| 74 | cues, as well as by culture and one's past experiences. | 以及文化和过去的经历 |
| 75 | Now, contrary to popular belief, not all pain is related to tissue damage. | 现在,与大众看法相反,并不是所有的疼痛都与组织损伤有关. |
| 76 | Pain is actually defined as an unpleasant sensory and emotional experience that can | 痛苦实际上被定义为一种不愉快的感官和情感体验,可以 |
| 77 | be associated with actual or potential tissue damage. | 与实际或潜在的组织损害有关。 |
| 78 | You can have real pain with no physical injury or source. | 没有身体伤害或来源,你可以有真正的痛苦。 |
| 79 | Pain is the one thing that can't be measured by a monitor or lab test. | 疼痛是无法通过监视器或实验室测试来衡量的一件事. |
| 80 | It's hard to quantify or qualify. | 难以量化或定性. |
| 81 | It's measured on a scale of zero to 10 that is based on one's own perception of what | 它的测量尺度为0到10, 这基于一个人对什么的看法 |
| 82 | they're experiencing. | 他们正在经历。 |
| 83 | Pain then is subjective. | 痛苦是主观的 |
| 84 | And as doctors, our process of treating pain begins with identifying its source, which | 作为医生,我们治疗疼痛的过程 始于找出其来源 |
| 85 | presents a problem when there is no source. | 当没有来源时,就会出现问题。 |
| 86 | For when there's no source, it becomes open to interpretation. | 因为当没有来源时,它就会变成开放的解释. |
| 87 | And interpretation becomes open to that undiagnosed bias. | 而这种未经诊断的偏见,解释就变得开放。 |
| 88 | Did you know that the different sexes experience pain differently? | 你知道不同性别的人会经历不同的痛苦吗? |
| 89 | Now, for the sake of this talk, when I say female versus male, I'm referencing sex assigned | 现在,为了这个话题,当我说 女性对男性,我引用 性别分配 |
| 90 | at birth. | 在出生时。 |
| 91 | And when I say woman versus man or non-binary, then gender identity is at the core of the | 当我说女人对男人或非二进制, 那么性别认同是核心 |
| 92 | point. | 点。 |
| 93 | Females have more nerve fibers than men, and there's a hormonal influence to a variety | 雌性的神经纤维比男人要多 荷尔蒙对多种动物都有影响 |
| 94 | of chronic pain conditions. | 慢性疼痛状况。 |
| 95 | At puberty, rates of chronic pain rise faster in girls than boys. | 在青春期,女孩慢性疼痛率的上升速度比男孩快。 |
| 96 | And as females approach menopause, sex differences in chronic pain begin to disappear. | 而随着雌性接近绝经期,慢性疼痛的性别差异开始消失. |
| 97 | Females experience more recurrent pain, longer lasting pain, and higher overall levels of | 女性遭受更多的反复性疼痛、更长的持久痛苦和更高的总体水平 |
| 98 | chronic pain than men, yet the majority of studies on the treatment of chronic pain have | 慢性疼痛比男性还要严重,然而大多数关于慢性疼痛治疗的研究 |
| 99 | only been conducted in men. | 只用男人来做 |
| 100 | Did you know that women are more likely than men to be given anti-anxiety medications instead | 你知道女人比男人更可能 得到抗焦虑的药物 |
| 101 | of painkillers when they present to the emergency department complaining of severe abdominal | 止痛药,当他们在急诊部门抱怨腹部严重 |
| 102 | pain? | 痛苦吗? |
| 103 | Even for extremely urgent conditions, such as chest pain from a heart attack, women experience | 即使是在非常紧急的条件下,如心脏病发作导致胸部疼痛,妇女也会经历 |
| 104 | delays in life-saving interventions that can prevent death. | 拖延采取能够防止死亡的救生措施。 |
| 105 | Research shows that clinicians more often suggest psychosocial causes, such as stress | 研究表明,临床医生更经常提出心理社会原因,如压力。 |
| 106 | or family problems, to women patients in pain when they would more often order lab | 或家庭问题,对于疼痛的女病人,当她们更经常地订购实验室时 |
| 107 | tests for a male patient with the exact same symptoms. | 对症状完全相同的男性患者进行检测。 |
| 108 | For black women, such as Dr. Moore, they suffer two blows. | 对于黑人妇女来说,比如摩尔博士,她们会遭受两次打击. |
| 109 | The insulting notion that they are over-dramatic due to their gender, along with the erroneous | 侮辱性观念,即她们因其性别而过于戏剧性,以及错误的 |
| 110 | view that because their skin is black, they are impervious to pain. | 因为他们的皮肤是黑色的, 他们无法忍受痛苦。 |
| 111 | A 2016 study of a group of medical students found that nearly half believed black people | 2016年对一群医科学生的研究发现,近半数相信黑人. |
| 112 | have thicker skin than white people, less sensitive nerve endings, or that their blood | 皮肤比白人更厚 神经末梢更敏感 或是血液 |
| 113 | clots more quickly. | 血块更快。 |
| 114 | The origin of these outrageous claims dates back to slavery and the 19th century experiments | 这些令人发指的说法起源于奴隶制和19世纪的实验 |
| 115 | by Dr. Thomas Hamilton, who tortured black slaves to prove that black skin was deeper | 托马斯・汉密尔顿医生 拷问黑人奴隶 证明黑皮肤更深 |
| 116 | than white skin. | 比白皮肤。 |
| 117 | And Dr. James Sims, a gynecologist, conducted experimental surgeries on enslaved black women | 妇科医生James Sims 对被奴役的黑人妇女做了实验手术 |
| 118 | without anesthesia, contributing further to false beliefs that black women experience | 导致黑人女性的错觉 |
| 119 | less pain. | 少一点痛苦 |
| 120 | There were times that I found it ironic that as an anesthesiologist whose livelihood is | 有几次我发现讽刺的是 作为一个麻醉师,他的生计是 |
| 121 | centered around managing pain, that I would suffer from chronic pain myself. | 以治疗疼痛为中心, 我将遭受慢性疼痛我自己。 |
| 122 | And so, like Dr. Moore, I became my own advocate and dove deep into the root causes of my | 所以,和摩尔博士一样, 我成了我自己的倡导者, 并深深地潜入我的根本原因 |
| 123 | own pain. | 他自己的痛苦。 |
| 124 | After five years, thousands of dollars and many hours spent in pain, I finally found | 5年后,我花了几千美元 和许多小时痛苦,我终于发现 |
| 125 | the cause by diving into integrative and functional medicine. | 通过潜入综合和功能医学的事业。 |
| 126 | Now, my pain was due to physical imbalances triggered by childbirth, years of stress and | 现在,我的痛苦是由于 分娩引起的身体失衡, 多年的压力和 |
| 127 | sleep deprivation, and a dietary sensitivity that had been triggering inflammation. | 睡眠被剥夺 饮食敏感 一直引发炎症 |
| 128 | Over time, I healed myself, and finally the pain began to ease. | 随着时间的推移,我治愈了自己,最终痛苦开始缓解. |
| 129 | But while my own pain did fade, my passion for other people with chronic pain grew stronger. | 但虽然我自己的痛苦确实消退了, 我对长期痛苦的其他人的热情却变得更加强烈。 |
| 130 | Now, doctors aren't the enemy. | 医生不是敌人 |
| 131 | If you asked physicians why they went into medicine, you would hear, to help people. | 如果你问医生 为什么他们去医学, 你会听到,帮助人们。 |
| 132 | So much so that during disasters and global pandemics, healthcare workers kissed their | 因此,在灾害和全球流行病期间,保健工作者亲吻了他们 |
| 133 | own families goodbye to go take care of yours. | 自己的家人再见了 去照顾你的家人 |
| 134 | They worked tirelessly during codes to resuscitate your loved ones and shed tears when they lose | 他们在密码中不懈地工作 以恢复你的亲人 并在失去亲人时流泪 |
| 135 | them. | 他们。 |
| 136 | But with exhaustion, time pressures and overcrowded emergency rooms comes the ability for that | 但随着时间的耗尽 和过度拥挤的急诊室 有了这个能力 |
| 137 | hidden voice to take over our rational one. | 隐藏的声音接管我们理性的声音 |
| 138 | Now, the healthcare system has been teaching bias training, and studies show little to | 现在,卫生保健系统一直在教授偏见培训,研究显示, |
| 139 | no explicit bias in healthcare, which is great, but we continue to see implicit bias in a | 在保健方面没有明显的偏见,这是伟大的,但我们继续看到隐含的偏见, |
| 140 | percentage of healthcare practitioners. | 保健从业人员的百分比。 |
| 141 | Because it operates in an unintentional and unconscious manner, implicit bias begins outside | 因为它以无意和无意识的方式运作, 隐含的偏见从外面开始 |
| 142 | the walls of the hospital and is brought in unknowingly. | 医院的墙壁被不知不觉地带入 |
| 143 | And it's not just doctors. | 而且不只是医生 |
| 144 | Bias exists in all of us. | 我们所有人都有偏见 |
| 145 | We can all do better. | 我们都做得更好。 |
| 146 | How? | 怎么会? |
| 147 | Well, the first step is awareness. | 第一步是认识 |
| 148 | We need to begin by identifying our stereotypes and then rewrite the stories of the people | 我们首先要找出我们的陈规旧习 然后重写人民的故事 |
| 149 | we meet. | 我们见面。 |
| 150 | When a woman sits down next to us, asks ourselves, what would we say if this were a man? | 当一个女人坐在我们旁边, 问我们自己, 如果这是个男人,我们会怎么说? |
| 151 | Would our answer change? | 我们的答案会改变吗? |
| 152 | And for those whose pain has been dismissed, fight to be heard. | 且痛已除者,争以听之. |
| 153 | Finding the right doctor can feel a little bit like dating. | 找到合适的医生 感觉有点像约会 |
| 154 | You may need to swipe through a few to find the right one for you. | 你也许需要刷几张 帮你找到合适的 |
| 155 | But don't give up and don't delay seeking treatment. | 但是不要放弃 不要拖延寻求治疗 |
| 156 | The sooner you are properly diagnosed, the greater chance you have of breaking your pain | 你越早被正确诊断 越有可能解开你的痛苦 |
| 157 | cycle. | 循环。 |
| 158 | As physicians, we took an oath at our White Coat Ceremonies to first do no harm. | 作为医生,我们宣誓 在我们的白衣仪式上 首先不伤害。 |
| 159 | And most of us live by that sacred oath. | 我们大多数人都以那个神圣的誓言为生。 |
| 160 | But part of that vow needs to include staying in check with that inner voice to make sure | 但誓言的一部分需要包括 保持与内在的声音 以确保 |
| 161 | that we aren't writing a story that our patients haven't told us yet. | 我们没有写一个病人还没有告诉我们的故事 |
| 162 | Because it is our duty as physicians to replace the undiagnosed bias with empathy. | 因为我们作为医生有责任用同情来代替未诊断的偏见。 |
| 163 | And to all of you out there who are suffering with chronic pain, we hear you. | 对于所有长期遭受痛苦的人,我们听到了。 |
| 164 | And we're ready to listen. | 我们准备听 |
| 165 | Thank you. | 谢谢 |
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