Translator: Tanya Cushman Reviewer: Rhonda Jacobs
Wow.
Good afternoon, everyone.
I definitely feel that love.
Did you feel the love just now too?
Well, first of all I want to say thank you to the TEDxCortland organizers.
This is such an amazing event,
and I'm so delighted to be here and speak at the first-ever TEDxCortland,
and thank you all for coming
and being part of our inaugural event as well.
So, what if I tell you that in the next 12 minutes,
you will have the secret to transforming your healthcare?
Maybe you'll think that I'll be revealing a new CT scan that takes pictures better
or a blood test that detects diseases earlier,
but what if we find
that the key to saving your life doesn't involve any technology at all,
but is something that each and every person can do today?
I'd like to introduce you to two people.
The first is Gerry, who is a mechanic who lives in South Boston.
He's in his early 40s and is in pretty good health,
says that he's a few pounds overweight
but works out and does basketball and plays soccer with his three kids.
So over the weekend, he was moving some boxes,
and on Monday morning, he wakes up and feels this pull in his chest,
but it's not only in his chest.
He also feels the same sensation in his back and his arms and his legs.
He doesn't think much of it;
he thinks that this is probably just a muscle pull, but he tells his wife.
His wife gets worried and tells him that he better get this checked out.
And so Gerry shows up at the ER,
and he tells someone that he has chest pain
and immediately finds himself hooked up to various machines.
He gets blood drawn, he gets an EKG done,
he goes to get a chest X-ray.
He's told that he has to stay overnight, and so, of course, Gerry stays the night.
The next morning he wakes up,
he gets more blood drawn, more EKGs done,
he goes and runs on a treadmill,
he gets a chest X-ray again, he gets a CT scan of his chest.
Finally, the doctor comes to him and says,
"You can go home.
The good news is you don't have a heart attack, you don't have pneumonia,
you don't have broken ribs.
You have" - get this - "chest pain."
So Gerry says, "But I don't understand.
I came to you saying I have chest pain.
How come I still don't know what it is that I have?"
But his story doesn't quite end yet.
A few weeks later, Gerry goes to see a cardiologist,
who performs a catheterization through his groin
to look at the vessels in his heart.
He also goes to a gastroenterologist,
who does an endoscopy to look at his stomach and his esophagus.
He sees a pulmonologist, who does a lung biopsy
because that CAT scan found a small nodule.
At the end of all this, six months later, he's told that everything is fine.
However, in the process,
he suffers an aneurysm, a blood clot, a kidney infection and pneumonia.
If you ask Gerry today, he will say that he feels lucky that he's alive.
But I ask you,
Is he the recipient of thorough medical care
or is he the victim of overtreatment?
Now, we all know that the cost of healthcare is out of control, right?
wherever we are on the political spectrum,
nobody says that the healthcare system is perfect.
We don't like to talk about rationing to reduce cost,
but what about rational care?
Is it rational to order tests that aren't needed?
Gerry's case may seem like an exception, but it's not.
The Institute of Medicine
estimates that 30% of all tests done are unnecessary,
and all treatments done are unnecessary
to the tune of 750 billion dollars of waste per year.
Now, it's not just about cost, right? But also about unnecessary harm.
So harm, like infection, radiation, aneurysms.
But how often do we talk about these harms?
And instead, why do we continue to invest millions, billions
into developing more tests that are harmful and invasive?
Let me introduce you now to Sandy.
So Sandy is a woman in her early 40s.
She is a schoolteacher and the mother of two.
She lives in Los Angeles.
She's coming to the doctor
because of several weeks of not feeling well.
So, she's feeling run down, she's tired,
she has a cough that wouldn't go away,
she's feeling short of breath.
So her doctor takes one look at her - middle-aged woman, looks pretty good -
and says, "Oh, don't worry. You have a virus. Go home."
Well, Sandy has had viruses before
and thinks that this is nothing like a virus,
but she doesn't know how to speak up to her doctor
and say she thinks it's something else,
and so she goes home.
Several weeks later, she comes back; she's feeling worse,
and the doctor says, "Well, let's run some tests."
There's some blood tests looking for anemia, low thyroid,
maybe a chest X-ray.
And the doctor says to her, "They're normal. You're fine.
Maybe you're depressed. Try some Prozac."
She tries it, doesn't get better.
A month later, goes to see a different doctor.
Now she can't even climb stairs without being very short of breath.
The doctor takes a look at her list of medications, which includes Prozac,
and says, "Aha, I know what's wrong.
You have anxiety. Take some Valium."
This goes on for nearly a year
before she's finally diagnosed with metastatic cancer,
stage 4 breast cancer,
that at that point,
had spread to her lungs, to her bones and to her brain.
In the U.S., 100,000 people die from medical error every year.
That's equivalent to a fully packed Boeing 747
crashing and killing everyone on board
every single day.
The number one cause of fatal medical error is misdiagnosis,
which makes sense, right?
Because if you're diagnosis is wrong, then so is everything else that follows.
Well, amazingly, as we're getting more sophisticated tests
and more advanced treatments,
the rate of misdiagnosis and the rate of medical error
has not decreased.
In fact, the use of more technology
has resulted in doctors spending less time with patients.
A recent study found that resident doctors
spend 12% of time with patients
versus 40% of time with their computers.
So I want to ask you a question.
When you go see your doctor,
your doctor says, "Hi, Mrs. Jones, how are you?
What brings you to see me today?"
How much time do you have to speak before your doctor interrupts you?
Anybody want to take a guess?
Thirty seconds. Any other guesses?
Ten seconds. Wow. All pessimists here.
Well, a study done in the early '90s
showed that the doctors will interrupt in 18 seconds.
A more recent study found that it's exactly what you said,
which is 10 seconds.
Now, how much of your story can you convey in 10 seconds
that allows your doctor to know why it is that you're there?
Well, I have to say - so I'm a practicing emergency physician.
I work in a very busy urban ER in Washington, DC.
This is not what any of us, as providers, want either.
Not what nurses want or doctors want or anybody else, right?
We want to have time to listen to patients,
and so what happens instead when we have more pressure on us
to go faster and faster and see more patients?
Well, we take shortcuts, right?
And so doctors are starting to replace listening with getting tests.
Well, is that a bad thing?
And some of you may be wondering,
Well, isn't Sandy's case the opposite of Gerry's?
What if Sandy had gotten more tests? Wouldn't she have gotten saved?
But let me ask you,
If Sandy had gotten every single test that Gerry got,
what would that have shown?
Absolutely nothing.
If anything,
she would have gotten more reassured, falsely, that everything was fine
because the key to better medical care
isn't about doing more tests or doing fewer tests,
but it's about getting the right tests and about listening and about connecting.
That connection is why I went into medicine.
Growing up in China, I had severe asthma,
and my earliest memories are being shuttled to various doctors,
getting injections and pills and inhalers,
and I even had surgery on my lung, without much improvement.
Then one day my mother took me to see this one doctor who sat down with us.
In a few minutes,
he figured out that my bedroom window was facing the communal kitchen,
and the fumes from our neighbors' cooking was triggering my asthma attacks.
He discovered that my breathing was worst at the end of the day
because I was too afraid and too embarrassed
to use my inhalers at school.
In just a few minutes, just by listening, he understood me,
and as a result, really understood my illness.
Well, that's the kind of doctor that I aspire to become,
but in medical school, in my medical training,
I quickly saw that what we were learning, what the focus was on,
was on things to do to patients,
rather than things for patients.
And I quickly saw, too,
that it's more efficient to just order tests rather than listen,
and it pays better to do tests and to order procedures.
After all, [stories], they're subjective,
they're messy,
they can't be quantified.
So let's forget about them, right?
And yet, that story really matters.
Research across every culture shows that stories are how we connect;
they're how we communicate.
Research also shows that stories are how doctors make diagnoses.
Studies done in the '50s, '60s, '70s - all the way to present day -
show that 80% - eight zero -
80% of diagnoses can be made just based on the story alone,
just based on the history of your illness.
Now, that's better than any test or combination of tests out there -
better than a CT scan or MRI or blood test can show -
and unlike these tests,
telling your story doesn't lead to infection or radiation or other harms.
But when is the last time you heard of millions of dollars
being invested into helping somebody tell a better story?
Why is it that we're spending all of our time and effort and money
into improving the 20%
when we can be improving the 80%,
the 80% that reduces cost and reduces harm?
There is a disconnect between what research shows and what medicine does
and a disconnect between what doctors do and what patients need.
What we have is a high-tech revolution,
but what we need is low-tech innovation.
What doctors focus on is science,
but what patients need is a return to the art of medicine.
Here are three steps that you can take today.
First, tell your story, not your symptoms.
This may sound a little counterintuitive
because we're trained to go to the doctor and say, "I have chest pain"
and then wait for the doctor to ask questions.
Let me give you a thought experiment.
Let's say that you haven't seen an old friend for a while,
and you run into them, maybe here at TEDx.
What do you say to them?
You say, "Hi. How are you? What have you been up to?" Right?
But what if instead you said,
"Are you married? What's your spouse's name?
Are you employed? How long have you been working there?"
You'll get some kind of answers
until this person backs away from you and never talks to you again.
But even if you ask 20, 50 questions,
you're not going to get the depth or nuance
as if you just asked for their story.
Same goes for medicine.
So next time, before you go see your doctor,
instead of googling your symptoms on the internet,
write down your story, practice it and then tell it.
Second, ask for a diagnosis, not for a test.
Remember that tests are a means to an end, and that end is the diagnosis.
So if 80% of diagnoses can be made just by listening,
ask your doctor before you get any tests for what is the most likely diagnosis
and why every test is being done.
If the doctor says, "This needs to be done,"
ask what are are the risks of the test and what to do if that test is negative.
Remember that you have to speak up for yourself.
Third, change begins with each of us.
Some of you may be wondering,
"Well, there are all these other factors at play, right?
There are drug companies and insurance companies and hospitals.
What can I do?
But then I ask you, well, who is the system?
If it's not all of us as patients and caregivers and providers,
then who is it?
Remember that we are the reason why these problems exist too.
Why are there smartphone apps that are replacing seeing your doctor
with having your blood pressure and your heart rate
just sent over to your doctor's office?
Why do hospitals advertise the latest state-of-the-art technology?
It's because it's what we ask for.
We are the ones who idealize the new;
we are the ones who glamorize new technologies.
Well, just as we were all part of the problem,
we all have to be part of the solution.
So ask our legislators
to reimburse doctors for time with patients,
not just for things to do to patients.
And ask our innovators to come up with solutions that further connect us,
rather than make us even more disconnected.
I leave you now with a conclusion of our two stories.
Gerry the mechanic is doing just fine.
Thankfully.
Because he was my patient.
I'm the guilty doctor,
the doctor who ordered unnecessary tests,
who caused avoidable harm,
who didn't listen.
I'm ashamed to admit this because this is not why I went into medicine.
This is not the type of doctor that I wanted to become,
but I think it's important for us to talk about our mistakes
and also this is how I learned.
This is how I learned that the system that we're in is broken,
that we have good people practicing bad medicine.
And this is how I know, too, that there is a better way.
Now, I'm an academic, I'm a researcher, and I'm certainly not against science.
Actually, it's science that shows us why that story is so important.
And so with every patient I see now,
I ask, can I get to the right diagnosis if I just listen?
As for Sandy the schoolteacher, well, I learned a tough lesson too.
You see, Sandy was my mother.
I was a second-year medical student when she was misdiagnosed
and then finally diagnosed with metastatic cancer.
I will always remember her calling me
to tell me that she thought something was wrong.
I would go with her to her doctor's office,
but she would ask me not to speak up.
You see, she was afraid of being the bad patient,
of creating trouble.
My mother died three years ago,
and I think about her every day,
and I wonder,
What if I did speak up?
What would the result have been?
If there's any doubt that one person, one action, one story
can make a difference,
then please let that be my lesson to you.
We know that there's a disconnect
between what research shows and what medicine does
and a disconnect between what doctors do and what patients need.
We must bridge that disconnect.
That's the key to transforming our healthcare.
What will save your life isn't a faster computer or a better test;
it's your story.
You must tell it; it really matters.
Thank you.
(Applause)