0:12I am a palliative care physicia

0:12
I am a palliative care physician and I would like to talk to you today about health care. I'd like to talk to you about the health and care of the most vulnerable population in our country -- those people dealing with the most complex serious health issues. I'd like to talk to you about economics as well. And the intersection of these two should scare the hell out of you -- it scares the hell out of me.
0:41
I'd also like to talk to you about palliative medicine: a paradigm of care for this population, grounded in what they value. Patient-centric care based on their values that helps this population live better and longer. It's a care model that tells the truth and engages one-on-one and meets people where they're at.
1:08
I'd like to start by telling the story of my very first patient. It was my first day as a physician, with the long white coat ... I stumbled into the hospital and right away there's a gentleman, Harold, 68 years old, came to the emergency department. He had had headaches for about six weeks that got worse and worse and worse and worse. Evaluation revealed he had cancer that had spread to his brain. The attending physician directed me to go share with Harold and his family the diagnosis, the prognosis and options of care.
1:43
Five hours into my new career, I did the only thing I knew how. I walked in, sat down, took Harold's hand, took his wife's hand and just breathed.
1:59
He said, "It's not good news is it, sonny?"
2:02
I said, "No."
2:03
And so we talked and we listened and we shared. And after a while I said, "Harold, what is it that has meaning to you? What is it that you hold sacred?"
2:14
And he said, "My family."
2:17
I said, "What do you want to do?"
2:19
He slapped me on the knee and said, "I want to go fishing."
2:22
I said, "That, I know how to do."
2:25
Harold went fishing the next day. He died a week later.
2:31
As I've gone through my training in my career, I think back to Harold. And I think that this is a conversation that happens far too infrequently. And it's a conversation that had led us to crisis, to the biggest threat to the American way of life today, which is health care expenditures.
2:52
So what do we know? We know that this population, the most ill, takes up 15 percent of the gross domestic product -- nearly 2.3 trillion dollars. So the sickest 15 percent take up 15 percent of the GDP. If we extrapolate this out over the next two decades with the growth of baby boomers, at this rate it is 60 percent of the GDP. Sixty percent of the gross domestic product of the United States of America -- it has very little to do with health care at that point. It has to do with a gallon of milk, with college tuition. It has to do with every thing that we value and every thing that we know presently. It has at stake the free-market economy and capitalism of the United States of America.
3:45
Let's forget all the statistics for a minute, forget the numbers. Let's talk about the value we get for all these dollars we spend. Well, the Dartmouth Atlas, about six years ago, looked at every dollar spent by Medicare -- generally this population. We found that those patients who have the highest per capita expenditures had the highest suffering, pain, depression. And, more often than not, they die sooner.
4:14
How can this be? We live in the United States, it has the greatest health care system on the planet. We spend 10 times more on these patients than the second-leading country in the world. That doesn't make sense. But what we know is, out of the top 50 countries on the planet with organized health care systems, we rank 37th. Former Eastern Bloc countries and sub-Saharan African countries rank higher than us as far as quality and value.
4:51
Something I experience every day in my practice, and I'm sure, something many of you on your own journeys have experienced: more is not more. Those individuals who had more tests, more bells, more whistles, more chemotherapy, more surgery, more whatever -- the more that we do to someone, it decreases the quality of their life. And it shortens it, most often.
5:20
So what are we going to do about this? What are we doing about this? And why is this so? The grim reality, ladies and gentlemen, is that we, the health care industry -- long white-coat physicians -- are stealing from you. Stealing from you the opportunity to choose how you want to live your lives in the context of whatever disease it is. We focus on disease and pathology and surgery and pharmacology. We miss the human being. How can we treat this without understanding this? We do things to this; we need to do things for this.
6:07
The triple aim of healthcare: one, improve patient experience. Two, improve the population health. Three, decrease per capita expenditure across a continuum. Our group, palliative care, in 2012, working with the sickest of the sick -- cancer, heart disease, lung disease, renal disease, dementia -- how did we improve p

ผลลัพธ์ (ไทย) 1:

0:12I am a palliative care physician and I would like to talk to you today about health care. I'd like to talk to you about the health and care of the most vulnerable population in our country -- those people dealing with the most complex serious health issues. I'd like to talk to you about economics as well. And the intersection of these two should scare the hell out of you -- it scares the hell out of me.0:41I'd also like to talk to you about palliative medicine: a paradigm of care for this population, grounded in what they value. Patient-centric care based on their values that helps this population live better and longer. It's a care model that tells the truth and engages one-on-one and meets people where they're at.1:08I'd like to start by telling the story of my very first patient. It was my first day as a physician, with the long white coat ... I stumbled into the hospital and right away there's a gentleman, Harold, 68 years old, came to the emergency department. He had had headaches for about six weeks that got worse and worse and worse and worse. Evaluation revealed he had cancer that had spread to his brain. The attending physician directed me to go share with Harold and his family the diagnosis, the prognosis and options of care.1:43Five hours into my new career, I did the only thing I knew how. I walked in, sat down, took Harold's hand, took his wife's hand and just breathed.1:59He said, "It's not good news is it, sonny?"2:02I said, "No."2:03And so we talked and we listened and we shared. And after a while I said, "Harold, what is it that has meaning to you? What is it that you hold sacred?"2:14And he said, "My family."2:17I said, "What do you want to do?"2:19He slapped me on the knee and said, "I want to go fishing."2:22I said, "That, I know how to do."2:25Harold went fishing the next day. He died a week later.2:31As I've gone through my training in my career, I think back to Harold. And I think that this is a conversation that happens far too infrequently. And it's a conversation that had led us to crisis, to the biggest threat to the American way of life today, which is health care expenditures.2:52So what do we know? We know that this population, the most ill, takes up 15 percent of the gross domestic product -- nearly 2.3 trillion dollars. So the sickest 15 percent take up 15 percent of the GDP. If we extrapolate this out over the next two decades with the growth of baby boomers, at this rate it is 60 percent of the GDP. Sixty percent of the gross domestic product of the United States of America -- it has very little to do with health care at that point. It has to do with a gallon of milk, with college tuition. It has to do with every thing that we value and every thing that we know presently. It has at stake the free-market economy and capitalism of the United States of America.3:45ลองลืมสถิติทั้งหมดสำหรับนาที ลืมตัว พูดคุยเกี่ยวกับค่าเรารับเราใช้เหรียญเหล่านี้ , Atlas ดาร์ทเมาท์ ประมาณหกปีที่แล้ว ดูดีที่ทุกดอลลาร์จากเมดิแคร์ - ประชากรโดยทั่วไปนี้ เราพบว่า ผู้ป่วยที่มีรายจ่ายต่อหัวสูงที่สุดมีความสูงที่สุดความทุกข์ เจ็บปวด ภาวะซึมเศร้า และ บ่อยกว่าไม่ พวกเขาตายเร็ว4:14วิธีนี้สามารถ เราอาศัยอยู่ในสหรัฐอเมริกา มีระบบการดูแลสุขภาพมากที่สุดในโลก เราใช้ 10 ครั้งเพิ่มเติมจากผู้ป่วยเหล่านี้มากกว่าประเทศสองชั้นนำของโลก ที่ไม่เป็นเรื่อง แต่เราว่าเรารู้ว่า จากประเทศยอดนิยม 50 โลกกับการจัดระบบดูแลสุขภาพ จัดอันดับ 37 อดีตค่ายตะวันออกประเทศและประเทศในแอฟริกาซาฮารายศสูงกว่าเราเท่าคุณภาพและคุณค่า4:51สิ่งที่ผมพบทุกวันในทางปฏิบัติของฉัน แน่ใจ สิ่งที่หลายท่านในการเดินทางของคุณเองมีประสบการณ์: เพิ่มเติมจะไม่เพิ่มเติม บุคคลผู้ที่มีการทดสอบเพิ่มเติม ระฆังเพิ่มเติม นกหวีดเพิ่มเติม เคมีบำบัดเพิ่มเติม เพิ่มเติม ผ่าตัด เพิ่มเติมคืออะไร - เพิ่มเติมว่า เราทำเพื่อผู้อื่น มันลดคุณภาพของชีวิตของพวกเขา มัน shortens บ่อยที่สุดแล้ว5:20ดังนั้น สิ่งเราจะทำเกี่ยวกับเรื่องนี้ เรากำลังทำอะไรเกี่ยวกับเรื่องนี้ และนี่คือเหตุผลที่เพื่อ ความจริงที่น่ากลัว สุภาพสตรี และสุภาพ บุรุษ คือ ว่า เรา อุตสาหกรรมการดูแลสุขภาพ -แพทย์เสื้อขาวยาว - จะขโมยจากคุณ จากคุณโอกาสที่จะเลือกวิธีการใช้ชีวิตของคุณในบริบทของโรคว่าเป็นขโมย เรามุ่งเน้นในโรค และพยาธิวิทยา และศัลยกรรม และเภสัชวิทยา เราพลาดมนุษย์ การสามารถจัดการกับนี้ไม่เข้าใจนี้ เราทำสิ่งนี้ เราต้องทำสิ่งนี้6:07สามจุดมุ่งหมายของการดูแลสุขภาพ: หนึ่ง ปรับปรุงประสบการณ์ของผู้ป่วย สอง ปรับปรุงสุขภาพของประชากร สาม ลดรายจ่ายต่อหัวในแบบต่อเนื่อง กลุ่ม การดูแลประคับ ใน 2012 การทำงานของเรากับคนป่วย -โรคมะเร็ง โรคหัวใจ โรคปอด โรคไต ภาวะสมองเสื่อม - sickest ไม่เราปรับปรุง p