TED演講者：Sheetal DeCaria / 希塔·德卡里亞

演講標(biāo)題：The bias behind your undiagnosed chronic pain / 未確診的慢性疼痛背后的偏見(jiàn)

內(nèi)容概要：While doctors take an oath to do no harm, there's a good chance their unconscious biases can seep into how seriously they take your pain. Physician Sheetal DeCaria explains how perception impacts medical care and treatment -- and calls for health care professionals to check in with how they do their patient checkups.

雖然醫(yī)生發(fā)下誓言“絕不傷害他人”，但他們無(wú)意識(shí)的偏見(jiàn)很有可能滲入到他們對(duì)你的疼痛的重視程度。醫(yī)生希塔·德卡里亞解釋了主觀想法是如何影響醫(yī)療護(hù)理和治療的——并呼吁醫(yī)療行業(yè)從業(yè)者審視他們是如何對(duì)病人進(jìn)行檢查和評(píng)估的。

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【1】As a doctor in the field of pain management, I work in a world where you bring us your pain and we treat it.

作為疼痛管理領(lǐng)域 （麻醉科）的醫(yī)生, 在我的世界里,你作為患者來(lái)到 我們的診室,陳述你的疼痛癥狀, 然后我們給你治療。

【2】We ask questions, we take the symptoms you present, we decide what tests to run.

我們提出問(wèn)題, 我們了解你出現(xiàn)的癥狀, 我們決定進(jìn)行哪些檢查。

【3】We listen with compassion and wisdom and choose the best course of action based on our knowledge and experience combined with science.

我們帶著同情和智慧傾聽(tīng)你, 并基于我們的知識(shí)和經(jīng)驗(yàn), 結(jié)合科學(xué)考量, 為你選擇最佳的治療方案。

【4】And sometimes in a very small window of time.

有時(shí)這一切都發(fā)生在很短的時(shí)間里。

【5】As physicians, we took a sacred oath to do no harm.

作為醫(yī)生,我們發(fā)下神圣誓言: 絕不傷害他人。

【6】And the system has gone to great lengths to teach us and set up guidelines to make sure that we treat every patient equally and without judgment.

這個(gè)制度不遺余力地 教育和指導(dǎo)我們, 以確保我們平等地對(duì)待每一位患者, 不摻雜個(gè)人情感。

【7】As we stand there in your moment of pain, we run your situation through every filter we have to give you the best care.

我們直面你的痛苦, 針對(duì)你的病情考慮 每一個(gè)可能的治療手段 來(lái)給你最好的治療。

【8】And for most of us, this is more than just a job.

對(duì)于我們中的大多數(shù)來(lái)說(shuō), 這不僅僅是一份工作,

【9】It's a calling.

這是一種使命感。

【10】But as we stand there in your moment, looking at your story from all the different angles and all the different rational voices in our head run through the decision making process, there's another voice in the mix.

但當(dāng)我們?cè)O(shè)身處地地為患者著想時(shí), 我們會(huì)從各個(gè)角度了解你的情況, 各種合理的方案 從我們的腦海中涌現(xiàn)出來(lái), 幫助我們最終做出決策, 但在這一過(guò)程中, 另一種觀念也參與了進(jìn)來(lái)。

【11】And this voice, well, it isn't rational or informed.

而這種觀念, 它既不理性也不明智,

【12】Yet, it often dictates our decisions.

然而,它常常影響著我們的決策。

【13】And we don't give it a second thought because you see, this voice existed long before we began studying medicine.

我們從來(lái)沒(méi)有考慮過(guò)這個(gè)問(wèn)題, 因?yàn)槟憧?這個(gè)觀念早在我們 開(kāi)始學(xué)習(xí)醫(yī)學(xué)之前就存在了,

【14】And so we accept it as truth.

所以我們已經(jīng)把它當(dāng)作事實(shí)接受了,

【15】And this voice sometimes calls the shots.

而且這種觀念 有時(shí)會(huì)主宰我們的決策。

【16】It's what I refer to as the undiagnosed bias.

這就是我所說(shuō)的“未確診的偏見(jiàn)”。

【17】And it's causing suffering and death for many with chronic pain.

它導(dǎo)致了許多慢性 疼痛患者的痛苦和死亡。

【18】I have spent the last 15 years studying pain.

在過(guò)去的 15 年里, 我一直在研究疼痛:

【19】Its cause, its treatment and its management.

它的成因、治療方法和控制手段。

【20】But it wasn't until I found myself sitting on the other side of the exam room that I noticed the crack in the foundation of pain management.

但直到我自己 坐在檢查室的另一端時(shí), 我才意識(shí)到疼痛管理領(lǐng)域 存在的根本性的問(wèn)題,

【21】When I discovered that hidden voice that exists in all of us.

我才第一次發(fā)現(xiàn)了那個(gè)存在于 我們每個(gè)人心中的固有觀念。

【22】That hidden voice, which I termed the undiagnosed bias, is more commonly known as implicit bias, which is a bias that exists based on our unconscious beliefs and associations.

我將這個(gè)固有觀念 稱(chēng)為“未確診的偏見(jiàn)”, 通常它也被稱(chēng)作固有偏見(jiàn), 這是一種基于 我們無(wú)意識(shí)的看法和聯(lián)想而產(chǎn)生的偏見(jiàn)。

【23】Implicit bias in health care was brought to light in 2003, when the Institute of Medicine published a report titled "Unequal Treatment."

2003 年,當(dāng)醫(yī)學(xué)研究所發(fā)表了一份 題為“不平等的治療”的報(bào)告時(shí), 醫(yī)療行業(yè)中的 固有偏見(jiàn)被暴露了出來(lái)。

【24】They found that regardless of insurance and income status, racial and ethnic minorities received worse care.

他們發(fā)現(xiàn),無(wú)論患者的醫(yī)療保險(xiǎn) 和收入狀況如何, 少數(shù)種族和少數(shù)族裔 得到的護(hù)理都更差。

【25】And when it comes to pain, research shows that bias extends beyond minorities to also include women and even children.

當(dāng)涉及疼痛時(shí), 研究表明這一偏見(jiàn) 并不局限于少數(shù)族裔, 還包括婦女甚至兒童。

【26】Dr. Susan Moore was a Black female physician whose story was heard around the world in 2020.

蘇珊·摩爾博士是一位黑人女醫(yī)生, 她的故事在 2020 年 傳遍了世界各地。

【27】The story of a doctor who struggled to receive the care she knew she needed.

作為一名醫(yī)生,她知道自己需要何種治療, 但她卻要拼盡全力才能獲取這一治療。

【28】Her pain was due to a health issue that she fully understood and described in medical lingo to her doctors.

她清楚地知道 是什么健康問(wèn)題導(dǎo)致了她的疼痛, 并用醫(yī)學(xué)術(shù)語(yǔ)向她的醫(yī)生描述了,

【29】Yet her pain was dismissed.

但她的疼痛卻被忽視了。

【30】When she posted her experience to a group of thousands of fellow physicians, there was an uproar of support.

當(dāng)她把她的經(jīng)歷發(fā)布到一個(gè) 有著數(shù)千名醫(yī)生同行的群組中時(shí), 響起了一片支持之聲。

【31】I mean, no one could accept that a doctor would treat a patient, let alone a fellow colleague like this, simply based on how they look.

你懂的,沒(méi)有人能夠 接受一名醫(yī)生基于患者的相貌, 就這樣去對(duì)待一名患者, 更不用說(shuō)這樣 去對(duì)待一名醫(yī)生同行了。

【32】But that's the problem with implicit bias.

但這就是固有偏見(jiàn)帶來(lái)的問(wèn)題。

【33】Most of the time you are unaware you even have it.

大多數(shù)時(shí)候, 你甚至都意識(shí)不到你也有著這種偏見(jiàn)。

【34】I remember the year I went from doctor to patient.

我記得我從醫(yī)生 變成了患者的那一年。

【35】It started off as a small pain in my foot that just wouldn't go away.

一開(kāi)始我只是感到腳上有點(diǎn)痛, 怎么都不能緩解,

【36】Well, it grew worse, to the point that it overshadowed my life.

接著,疼痛變嚴(yán)重了, 甚至使我的生活都變得暗淡了。

【37】It was this constant companion affecting my work and my family life.

這個(gè)無(wú)時(shí)無(wú)刻存在著的“伙伴” 影響了我的工作和家庭生活。

【38】I finally went to go see a foot surgeon and was told, "Source not clear.

最終我決定去看一位足外科醫(yī)生, 他告訴我:“疼痛原因不明,

【39】Probably tendons were inflamed," he said.

可能是肌腱發(fā)炎了?！?/p>

【40】And he prescribed a boot and some physical therapy.

他推薦我使用一種 治療用的靴子和一些物理療法。

【41】But the pain worsened, and it spread to my hip and my back.

但疼痛依舊在加劇, 并擴(kuò)散到了我的臀部和背部。

【42】I sought out more medical specialists, even holistic practitioners, all with different theories, but no clear diagnosis or source of pain.

我向更多的醫(yī)學(xué)專(zhuān)家, 甚至是整體治療師求助, 他們都有不同的理論, 但沒(méi)有人能給出明確的診斷 或指出疼痛的來(lái)源。

【43】I began to feel like I was going to have to live with this forever.

我開(kāi)始覺(jué)得 我將不得不永遠(yuǎn)忍受這種疼痛。

【44】And as the pain kept progressing with no clear diagnosis, I even thought to myself, "Wait.

在沒(méi)有明確診斷而疼痛 仍不斷加劇的情況下, 我甚至開(kāi)始反問(wèn)自己: “等等,

【45】Am I making this up?

這是我編造的嗎？

【46】Is my pain even real?"

我的疼痛是真的嗎？”

【47】In an online survey of 2,400 American women with a variety of chronic pain conditions, 91 percent felt that the health care system discriminated against them.

在對(duì) 2400 名有著各種慢性疼痛疾病的 美國(guó)女性進(jìn)行的在線調(diào)查中, 91% 的人認(rèn)為醫(yī)療系統(tǒng)歧視她們,

【48】And nearly half were told that the pain was all in their heads.

近一半的人被告知, 這些疼痛都是她們腦海中的幻覺(jué)。

【49】So let's go ahead and dispel that pain myth right away.

那么,讓我們現(xiàn)在 就去消除這個(gè)有關(guān)疼痛的錯(cuò)誤觀點(diǎn)。

【50】If you're worried that your pain is in your head, you're right.

如果你擔(dān)心你的疼痛 是在你的腦子里, 你是對(duì)的,

【51】Because pain is in everyone's heads.

因?yàn)樘弁词窃诿總€(gè)人的腦子里。

【52】You see, pain can't take place without our brains.

你看,沒(méi)有我們的大腦, 我們不會(huì)感覺(jué)到疼痛。

【53】When you step on a nail, for example, you stimulate nociceptors, or specialized nerve cells, that send a message through your spinal cord to your brain.

例如,當(dāng)你踩到釘子時(shí), 你的傷害感受器 或?qū)ｉT(mén)的神經(jīng)細(xì)胞被激活, 它們會(huì)通過(guò)脊髓向大腦發(fā)送信息,

【54】Well, your brain then decides what it's going to do with that signal.

然后你的大腦 會(huì)決定如何去處理這個(gè)信號(hào)。

【55】If it senses something dangerous, it will process that experience as painful to prevent you from further injury.

如果它感覺(jué)到有危險(xiǎn), 它會(huì)將這個(gè)經(jīng)歷編碼為疼痛, 以防你受到進(jìn)一步的傷害。

【56】And the decision by the brain to process it as painful is based on environmental and social cues as well as by culture and one's past experiences.

大腦是否決定將其編碼為疼痛, 取決于很多因素: 環(huán)境和社會(huì)暗示、文化、 以及一個(gè)人過(guò)往的經(jīng)歷。

【57】Now, contrary to popular belief, not all pain is related to tissue damage.

現(xiàn)在,與流行的看法相反, 并非所有的疼痛 都與身體組織的損傷有關(guān)。

【58】Pain is actually defined as an unpleasant sensory and emotional experience that can be associated with actual or potential tissue damage.

疼痛實(shí)際上被定義為 一種不愉快的感官和情緒體驗(yàn), 這可能與實(shí)際的 或潛在的組織損傷有關(guān)。

【59】You can have real pain with no physical injury or source.

你可以在沒(méi)有身體傷害或誘因的 情況下感受到真正的疼痛。

【60】Pain is the one thing that can't be measured by a monitor or lab test.

疼痛是一個(gè)無(wú)法 用儀器或化驗(yàn)測(cè)量的東西,

【61】It's hard to quantify or qualify.

也很難被量化或限定。

【62】It's measured on a scale of zero to 10 that is based on one's own perception of what they're experiencing.

我們通常用一個(gè) 從 0 到 10 的等級(jí)衡量疼痛, 而這基于人們 對(duì)他們經(jīng)歷的事情的主觀感知。

【63】Pain, then, is subjective.

所以,疼痛是主觀的。

【64】And as doctors, our process of treating pain begins with identifying its source.

作為醫(yī)生, 我們治療疼痛的過(guò)程 從確定疼痛的來(lái)源開(kāi)始。

【65】Which presents a problem when there is no source.

當(dāng)沒(méi)有來(lái)源時(shí), 就會(huì)出現(xiàn)如下的問(wèn)題。

【66】For when there's no source, it becomes open to interpretation.

因?yàn)楫?dāng)沒(méi)有來(lái)源的時(shí)候, 疼痛就可以被任意解釋,

【67】And interpretation becomes open to that undiagnosed bias.

而我們的解釋 就會(huì)被“未確診的偏見(jiàn)”所影響。

【68】Did you know that the different sexes experience pain differently?

你知道不同性別 對(duì)疼痛的體驗(yàn)是不同的嗎？

【69】Now, for the sake of this talk, when I say female versus male, I'm referencing sex assigned at birth.

在這個(gè)演講中,當(dāng)我說(shuō)女性或男性時(shí), 我指的是人出生時(shí)的性別;

【70】And when I say woman versus man or non-binary, then gender identity is at the core of the point.

而當(dāng)我說(shuō)女人、男人或非二元性別時(shí), 我指的是那個(gè)人的性別認(rèn)同。

【71】Females have more nerve fibers than men, and there's a hormonal influence to a variety of chronic pain conditions.

女性比男性擁有更多的神經(jīng)纖維, 而且荷爾蒙 會(huì)影響各種慢性疼痛病癥。

【72】At puberty, rates of chronic pain rise faster in girls than boys.

在青春期,女孩的慢性疼痛概率 比男孩上升得更快。

【73】And as females approach menopause, sex differences in chronic pain begin to disappear.

隨著女性接近更年期, 慢性疼痛的性別差異開(kāi)始消失。

【74】Females experience more recurrent pain, longer-lasting pain and higher overall levels of chronic pain than men.

與男性相比,女性經(jīng)歷了更多的 復(fù)發(fā)性疼痛和更持久的疼痛, 以及更高的慢性疼痛總體水平。

【75】Yet the majority of studies on the treatment of chronic pain have only been conducted in men.

然而,大多數(shù) 關(guān)于慢性疼痛治療的研究 只在男性身上進(jìn)行過(guò)。

【76】Did you know that women are more likely than men to be given anti-anxiety medications instead of painkillers when they present to the emergency department complaining of severe abdominal pain?

你知道嗎, 當(dāng)人們來(lái)到急診科陳述劇烈腹痛時(shí), 女性比男性更有可能 被給予抗焦慮藥物而不是止痛藥？

【77】Even for extremely urgent conditions such as chest pain from a heart attack, women experience delays in life saving-interventions that can prevent death.

即使對(duì)于極其緊急的狀況, 如心臟病發(fā)作引起的胸痛, 女性也會(huì)更遲地得到 能夠預(yù)防死亡的急救干預(yù)。

【78】Research shows that clinicians more often suggest psychosocial causes such as stress or family problems to women patients in pain when they would more often order lab tests for a male patient with the exact same symptoms.

研究表明, 對(duì)于感到疼痛的女性患者, 臨床醫(yī)生更經(jīng)常將疼痛歸因于 社會(huì)心理因素,例如壓力或家庭問(wèn)題; 而對(duì)于有著 完全相同的癥狀的男性患者, 他們經(jīng)常會(huì)進(jìn)行更多的化驗(yàn)。

【79】For Black women such as Dr. Moore, they suffer two blows.

對(duì)于像摩爾醫(yī)生這樣的黑人女性, 她們?cè)馐艿搅穗p重打擊。

【80】The insulting notion that they are overdramatic due to their gender, along with the erroneous view that because their skin is Black, they are impervious to pain.

因?yàn)樗桥?人們頗具 侮辱性地認(rèn)為她反應(yīng)過(guò)于夸張; 與此同時(shí),因?yàn)樗兄谏钠つw, 人們錯(cuò)誤地認(rèn)為她并不會(huì)感受到疼痛。

【81】A 2016 study of a group of medical students found that nearly half believed Black people have thicker skin than white people, less sensitive nerve endings, or that their blood clots more quickly.

2016 年的一項(xiàng)研究發(fā)現(xiàn), 近一半的醫(yī)學(xué)生 認(rèn)為黑人的皮膚比白人更厚, 神經(jīng)末梢敏感性較低, 或者他們的血液凝結(jié)得更快。

【82】The origin of these outrageous claims dates back to slavery and the 19th century experiments by Dr. Thomas Hamilton, who tortured Black slaves to prove that Black skin was deeper than white skin.

這些駭人說(shuō)法的起源 可以追溯到奴隸制 和 19 世紀(jì) 托馬斯·漢密爾頓博士的實(shí)驗(yàn): 他折磨黑人奴隸, 以此來(lái)證明黑人的皮膚比白人的更厚。

【83】And Dr. James Sims, a gynecologist, conducted experimental surgeries on enslaved Black women without anesthesia, contributing further to false beliefs that Black women experience less pain.

婦科醫(yī)生詹姆斯·西姆斯 在沒(méi)有麻醉的情況下對(duì) 女性黑人奴隸進(jìn)行了實(shí)驗(yàn)性手術(shù)—— 這進(jìn)一步助長(zhǎng)了錯(cuò)誤的觀念, 即黑人女性會(huì)感受到較少的疼痛。

【84】There were times that I found it ironic that as an anesthesiologist, whose livelihood is centered around managing pain, that I would suffer from chronic pain myself.

有時(shí)我會(huì)發(fā)現(xiàn)這一切很有諷刺意味: 作為一名麻醉科醫(yī)生, 一個(gè)將畢生精力 投入疼痛管理領(lǐng)域的人, 我自己也會(huì)受到慢性疼痛的困擾。

【85】And so, like Dr. Moore, I became my own advocate and dove deep into the root causes of my own pain.

于是,像摩爾醫(yī)生一樣, 我成為了我自己的擁護(hù)者, 并深入研究了我的疼痛的根源。

【86】After five years, thousands of dollars and many hours spent in pain, I finally found the cause by diving into integrative and functional medicine.

花費(fèi)了五年時(shí)間, 數(shù)千美元和許多小時(shí)的疼痛, 我通過(guò)深入了解綜合和機(jī)能醫(yī)學(xué), 終于找到了我的疼痛的原因。

【87】Now my pain was due to physical imbalances triggered by childbirth, years of stress and sleep deprivation, and a dietary sensitivity that had been triggering inflammation.

我的疼痛來(lái)源于分娩引發(fā)的身體失衡, 多年的壓力和睡眠短缺, 以及飲食敏感性引發(fā)的炎癥。

【88】Over time, I healed myself.

隨著時(shí)間的推移, 我走上了自愈之路,

【89】And finally, the pain began to ease.

最后,疼痛開(kāi)始減輕。

【90】But while my own pain did fade, my passion for other people with chronic pain grew stronger.

但是,雖然我自己的疼痛確實(shí)消退了, 但我對(duì)其他慢性疼痛患者 的熱情卻越來(lái)越強(qiáng)烈。

【91】Now doctors aren't the enemy.

我們知道,醫(yī)生不是敵人。

【92】If you ask physicians why they went into medicine, you would hear "to help people."

如果你問(wèn)醫(yī)生他們?yōu)槭裁磳W(xué)醫(yī), 你總會(huì)聽(tīng)到“為了幫助別人”。

【93】So much so, that during disasters and global pandemics, health care workers kiss their own families goodbye to go take care of yours.

在災(zāi)難和全球流行病期間, 我們一次又一次地目睹, 醫(yī)護(hù)人員與自己的家人深情告別, 全心全意地去照顧你的家人。

【94】They work tirelessly during codes to resuscitate your loved ones and shed tears when they lose them.

他們?cè)诩本葧r(shí)刻不知疲倦地工作, 盡力使你愛(ài)的人蘇醒過(guò)來(lái), 也在患者去世時(shí)傷心流淚。

【95】But with exhaustion, time pressures and overcrowded emergency rooms comes the ability for that hidden voice to take over our rational one.

但由于疲憊、 時(shí)間壓力和人滿(mǎn)為患的急診室, 那種固有觀念 就可能會(huì)取代我們理性的決策。

【96】Now the health care system has been teaching bias training, and studies show little to no explicit bias in health care, which is great, but we continue to see implicit bias in a percentage of health care practitioners.

現(xiàn)在,醫(yī)療系統(tǒng)一直 在對(duì)我們進(jìn)行反偏見(jiàn)的培訓(xùn), 令人欣慰的是,研究表明 在醫(yī)療領(lǐng)域幾乎沒(méi)有明顯的偏見(jiàn), 但我們依然看到一定比例的 醫(yī)療行業(yè)從業(yè)者有著固有偏見(jiàn)。

【97】Because it operates in an unintentional and unconscious manner, implicit bias begins outside the walls of the hospital and is brought in unknowingly.

因?yàn)樗砸环N無(wú)意 和無(wú)意識(shí)的方式存在, 固有偏見(jiàn)在醫(yī)院之外產(chǎn)生, 并在不知不覺(jué)中蔓延到醫(yī)院內(nèi)部。

【98】And it's not just doctors.

不僅僅是醫(yī)生,

【99】Bias exists in all of us.

我們每個(gè)人都有偏見(jiàn),

【100】We can all do better.

而我們都可以做得更好。

【101】How?

要怎么做呢？

【102】Well, the first step is awareness.

首先是要意識(shí)到偏見(jiàn)的存在。

【103】We need to begin by identifying our stereotypes.

我們需要從發(fā)現(xiàn) 我們心中的刻板印象開(kāi)始,

【104】And then rewrite the stories of the people we meet.

然后重新書(shū)寫(xiě)我們遇到的人們的故事。

【105】When a woman sits down next to us, ask ourselves: What would we say if this were a man?

當(dāng)一個(gè)女人坐在我們旁邊時(shí), 問(wèn)問(wèn)自己: 如果這是一個(gè)男人,我們會(huì)說(shuō)什么？

【106】Would our answer change?

我們的答案會(huì)改變嗎？

【107】And for those whose pain has been dismissed, fight to be heard.

對(duì)于有些患者來(lái)說(shuō), 他們的疼痛總是被忽視,

【108】Finding the right doctor can feel a little bit like dating.

他們找到合適的醫(yī)生 就有點(diǎn)像是在約會(huì)。

【109】You may need to swipe through a few to find the right one for you.

你可能需要嘗試 好幾個(gè)才能找到適合你的那個(gè)。

【110】(Laughter) But don't give up.

（笑聲） 但不要放棄,

【111】And don't delay seeking treatment.

也不要拖延尋求治療。

【112】The sooner you are properly diagnosed, the greater chance you have of breaking your pain cycle.

你越早得到正確的診斷, 你越有可能結(jié)束這個(gè)痛苦的循環(huán)。

【113】As physicians, we took an oath at our white coat ceremonies to first do no harm.

作為醫(yī)生, 我們?cè)诎状蠊邮谟鑳x式上宣誓: 首先絕不傷害他人。

【114】And most of us live by that sacred oath.

我們中的大多數(shù) 都信守著那神圣的誓言。

【115】But part of that vow needs to include staying in check with that inner voice to make sure that we aren't writing a story that our patients haven't told us yet.

但是,為了堅(jiān)守誓言, 我們需要時(shí)時(shí)審視自己內(nèi)心的聲音, 以確保我們不會(huì) 在患者還沒(méi)有告知我們病情之前, 就擅自為他們寫(xiě)好了劇本。

【116】Because it is our duty as physicians to replace the undiagnosed bias with empathy.

因?yàn)樽鳛獒t(yī)生, 我們有責(zé)任用同理心取代 “未確診的偏見(jiàn)”。

【117】And to all of you out there who are suffering with chronic pain, we hear you.

對(duì)于所有的慢性疼痛患者, 我們聽(tīng)見(jiàn)了你們的聲音,

【118】And we're ready to listen.

而我們也會(huì)繼續(xù)傾聽(tīng)。

【119】Thank you.

謝謝各位。

【120】(Applause)