TED演讲:医生们可以互相学习(3)
You flip a coin. Fifty percent risk. That's quite a lot.
这和掷硬币的几率一样。 50％的风险，不是一般的高。
If he instead would go to Hamburg,
如果他换而选择去汉堡，
and to a clinic called the Martini-Klinik,
去一个叫Martini的医院，
the risk would be only one in 20.
风险几率则减少到5%。
Either you a flip a coin,
一边是像掷硬币一样的50%的风险，
or you have a one in 20 risk.
另一边是仅有的5%。
That's a huge difference, a seven-fold difference.
这是个巨大的差别，有7倍之多。
When we look at many hospitals for many different diseases,
我们调查过很多医院，和很多不同的疾病，
we see these huge differences.
我们都发现了这样巨大的差别。
But you and I don't know. We don't have the data.
但是你我不一定都知道，因为我们没有数据。
And often, the data actually doesn't exist.
而通常，这些数据根本不存在。
Nobody knows.
没人知道。
So going the hospital is a lottery.
于是，去医院看病变成了买乐透。
Now, it doesn't have to be that way. There is hope.
但是，其实不一定得这样。我们还是有希望的。
In the late '70s, there were a group of Swedish orthopedic surgeons who met at their annual meeting,
在70年代后期，有这么一群瑞士外科整形医生，在年会上，
and they were discussing the different procedures they used to operate hip surgery.
他们讨论到目前众多的用于髋关节手术的方法。
To the left of this slide, you see a variety of metal pieces, artificial hips that you would use for somebody who needs a new hip.
在幻灯片的左边，是各种各样的金属配件和髋关节假体，用于治疗需要髋关节置换手术的病人。
They all realized they had their individual way of operating.
他们意识到他们每个人的方法都不同。
They all argued that, My technique is the best,
而且他们都认为我的方法最好。
but none of them actually knew, and they admitted that.
但其实，没人知道哪个办法最好，他们也承认这一点。
So they said, We probably need to measure quality so we know and can learn from what's best.
所以他们说，我们可能需要做质量评估来得知哪个是最好的方法，并学习它。
So they in fact spent two years debating,
事实上，他们花了两年时间来辩论,
So what is quality in hip surgery?
该如何评价髋关节手术的质量。
Oh, we should measure this. No, we should measure that.
有的说应该评价这个指标，有的说那个。
And they finally agreed.
最终他们达成了共识。
And once they had agreed, they started measuring,
之后，他们便开始（给手术结果）做评估，
and started sharing the data.
也开始共享数据。
Very quickly, they found that if you put cement in the bone of the patient before you put the metal shaft in,
很快，他们发现如果在把金属轴插入大腿骨之前先打入粘合剂，
it actually lasted a lot longer,
这能使手术结果保持更长时间，
and most patients would never have to be re-operated on in their lifetime.
而且绝大多数病人终身不用再做手术。
不同医院的不同手术有着不同的结果。但是病人不知道数据, 所以使得选外科医生成为了一个高风险的猜测游戏。史帝芬·拉森（Stefan Larsson）研究了当医生开始衡量并分享他们的髋关节手术的结果时（比如说什么是最有效的方法）会发生的情况。如果医生们可以相互学习并形成一个反馈循环，医疗保健会不会变得更好、更便宜？
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