翻译：Omnia Mohamed审计员：Shimaa Nabil Transcriber: Viviane P. Reviewer: Peter van de Ven
我向你坦白。
I have a confession to make.
多年来，我有一个深层的秘密- For years now, I've had this deep, dark secret -
事实上，我一生都在 my whole life, really -
我没告诉任何人 that I've never told anybody.
但是现在和现在 But here and now,
我想我已经准备好告诉世界了。 I think I'm ready to tell the world.
所以这里是： So here goes:
我的自白是 My confession is that I am
来自千禧一代。 a millennial.
我知道，这太可怕了。 I know, it's terrible.
即使是最糟糕的事情。 That's the worst.
当我决定成为千禧一代时，我在想什么？ What was I thinking when I decided to become a millennial, right?
（笑声） (Laughter)
我告诉你们之后，我真的感觉好多了。 I feel better already just having told you guys that.
你知道千禧一代是一群人 You know, millennials were a cohort of people
他们出生于八十年代初期或二十世纪初，直到第二个千年开始， born from the early or middle 1980s up until about the early 2000s,
但是这个定义基本上是唯一达成共识的东西 but that definition is pretty much the only thing that's agreed upon
为了我们这一代。 for our generation.
但是，我想你们听到了 Nevertheless, you guys have probably heard
关于我们的许多负面想法和成见。 a lot of negative thoughts and stereotypes about us.
您可能听说过我们自恋， You might have heard we're narcissistic or entitled,
懒散的 that we're lazy and unfocused,
沉迷于我们的手机并痴迷于Instagram过滤器。 that we're addicted to our telephones and obsessed with Instagram filters.
现在，其中一些可能是正确的， Now, some of that may be true,
但是您并没有真正听到太多积极的消息。 but you don't really hear about the positives too much.
众所周知，刻板印象并不能说明某人的整个故事， As we all know, stereotypes don't tell a whole story about a person,
更不用说整整一代的人了。 let alone a whole generation of millions.
所以，说完之后，让我真正地自我介绍一下。 So, that being said, allow me to actually introduce myself formally.
我叫Daniel Vozneska博士。 My name is Dr. Daniel Wozniczka.
我的病人只叫我丹医生。 My patients just call me Dr. Dan.
当您的波兰姓氏很难发音时，就会发生这种情况。 That's what happens when you have a hard-to-pronounce Polish last name.
我今年29岁， I'm 29 years old,
再过几天，我将完成内科学习。 and in a few days, I'll be finishing my internal medicine residency.
另外，我将完成两个硕士学位 I'm also finishing two master's degrees,
一位工商管理专业的 one in business, my MBA,
另一个是公共卫生。 and one in public health, my MPH.
我也是医学研究员。 I'm also a medical researcher.
它已在一些科学期刊上发表。 I've published in some peer-reviewed journals.
除了医学，我还从事一些创业。 And outside of medicine, I do a little bit as an entrepreneur.
I'm either the founder or expert advisor
对于一些新兴的卫生保健项目。 for a couple different healthcare start-ups.
最后但并非最不重要的一点是，我在国会当过游说者， Last but not least, I've worked as a congressional lobbyist,
这几乎就是您的想法， which is pretty much exactly what you think it is,
代表ACP， on behalf of ACP,
美国医师学院。 the American College of Physicians.
他们把我送到华盛顿特区。 They've sent me down to Washington, DC,
我曾与国会议员或参议院议员交谈 They've sent me down to Washington, DC,
我曾与国会议员或参议院议员交谈 and I've chatted with congressmen or senators
关于不同的医疗保健问题。 about different healthcare issues.
我记得所有这些，因为我做过一些事情， I bring all this up because some of what I'm doing,
突出了我们这一代人的积极因素。 it really brings to light the positives of our generation as a whole.
例如千禧一代 For example, the millennials
这是我们在美国受过高等教育的一代。 are the most educated generation we've ever had in America.
我们也是有史以来最多样化的国家。 We're also the most diverse that this nation's ever seen.
同样，我们也是技术上最聪明的人。 Unsurprisingly, we're the most tech-savvy, also.
但是，有一定的积极特征 But there's one particular positive attribute
没人真正谈论它。 that no one really talks about.
与劳动力有关。 It pertains to the workforce.
您可以向千禧一代问一个非常简单的问题： You can ask millennials a very simple question:
“您想在职业生涯中完成什么？” "What do you want to accomplish in your career?"
它会给您一个看似简单的答案， They'll give you an answer that may seem simple,
但这很深。 but it's profound.
他们会告诉大家他们想如何产生影响。 They'll all tell you how they want to make an impact.
他们想要改变世界，他们想要创新。 They want to change the world, they want to innovate.
当您开始职业生涯时，这是多么美妙的想法。 And what a beautiful mentality that is when you start your career.
所以当我们前进时， So as we go forward,
这种效应将推动千禧一代的前进。 this impact will drive forward the millennials.
人们总是问我 People always ask me,
“你觉得自己像医生吗？” "What's it like to be a doctor?"
我总是给他们完全相同的答案： I always give them the same exact answer:
我喜欢药！ I love medicine!
我别无选择 Couldn't do anything else.
我是幼儿园的那个男孩，他知道他会当医生。 I was that guy in kindergarten who knew he was going to be a doctor.
我想告诉大家一个关于我为何如此热爱医学的故事。 I want to tell you guys a story about why I love medicine so much.
几周前 A few weeks ago,
病人来我医院 a patient comes into my hospital,
病得很重 really sick.
他的双肺都有感染。 He's got an infection in both of his lungs.
感染已扩散到血液中， That infection has spread to his bloodstream,
因此他到处生病。 so he's sick all over.
他患有脓毒性休克。 He has something called septic shock.
他的呼吸太糟糕了，是唯一获得氧气的方法 His breathing is so bad that the only way he can get oxygen
如果我们将一根管子从他的嘴里穿过他的喉咙，再到他的肺部 is if we put a tube down his mouth, through his throat, into his lungs
因此，设备可以呼吸。 so a machine can breathe for him.
他的血压开始下降。 His blood pressure starts to plummet.
健康人的血压约为120/80； A healthy blood pressure is like 120/80;
这个家伙是50/30下跌更多。 this guy is 50/30 and dropping further.
我不得不给涩 I have to put a medicine called a vasopressor
再次提高他的压力。 to bring his pressure back up.
因此，我不得不将导管插入他的颈静脉， For that, I've got to put a catheter into his jugular vein,
在锁骨下激励她更多 push it further into his subclavian
并更多地靠近他的心。 and even further towards the edge of his heart.
但是，进展并不顺利，他的压力持续下降。 Doesn't work that well, though; his pressure keeps on dropping.
在我眼前，他的心脏停止跳动。 Before my very eyes, his heart stops beating.
快死了。 He passes away.
但是，我们没有停止， We don't stop, though.
我的一位护士从字面上跳过了那个男人 One of my nurses literally jumps on top of the guy
然后我开始挤压他的胸部。 and starts pressing onto his chest.
我们带来了救援车， We get a crash cart,
我们拍了桨， we take these two paddles,
我们给他们充电了600伏特的电， charge them up to 600 volts of electricity,
我们把它们放在他的胸口， put it on his chest,
正如您在电视上看到的 and just like you see on television,
我们震惊了他。 we shock him.
奏效了。 It works.
他的心又开始跳动。 His heart starts to beat again.
我们从字面上把他带离了死者世界。 We literally brought him back from the dead.
几周后，这个家伙？ A few weeks after that, this same guy?
嫁给他最小的女儿， His youngest daughter is getting married,
在她结婚那天，他能够陪着她到祭坛前。 and he's able to walk her down the aisle on her wedding day.
我喜欢这种药。 I love medicine for things like that.
我只当了三年医生 I've only been a doctor for three years,
但是我确实有数百个这样的故事。 but I've got hundreds of those stories already.
但是即使我喜欢医学 But even though I love medicine,
我真的不喜欢我的工作。 I don't really love my job.
我知道这听起来很矛盾， I know that sounds like a contradiction,
但事实并非如此。 but it's not.
没有人真正谈论医生的日常工作中发生了什么 No one really talks about what really goes into the day-to-day work of a doctor
多少与医学无关。 and how much of it has absolutely nothing to do with medicine.
例如 For example,
我每天花费数小时，填写纸张和表格。 I spend hours a day, any given day, filling out paperwork and forms.
我每小时都会照顾一个病人， For every hour I'll take care of a patient,
我花了两个小时填写表格。 I'll spend two hours filling out forms.
原因很简单： The reason for that is pretty simple:
这些表格会寄给保险公司， those forms get submitted to an insurance company,
基于这些模型 and it's based on those forms
保险公司将支付医院费用， that the insurance company will reimburse the hospital,
你会付钱的 will pay them.
我对这个病人做得有多好，并不重要。 And it doesn't really matter how great of a job you did on that patient;
如果未正确填写该表格， if that form isn't filled out meticulously,
加上所有必要的细节， with all the details needed,
医院赔偿少了 the hospital gets reimbursed less,
它可能根本不会得到补偿。 if at all.
它可能根本不会得到补偿。
我每天在表格上的时间。 Hours of my day on forms.
但是，这是我工作的最后一部分，这可能是有史以来最糟糕的。 But then there's that last part of my job that's probably the worst.
我诊断并治疗了病人之后 After I've diagnosed my patient, after I treat them,
我必须在保险公司之间移动 then I have to navigate insurance companies
为确保我的患者获得所需的药物。 to make sure that my patients get the medicine they need.
众所周知，一个负担不起药物费用的患者， As we all know, patients that can't afford their medicine,
他是个不会吃药的病人。 that's a patient that's not going to take his medicine.
伙计们，这伤了我的心。 It breaks my heart, guys.
我有病人在医院来找我 I've got patients coming to me in the hospital
第二次，第三次，第四次，第五次和第六次 for a second, third, fourth, fifth, sixth time
完全一样的原因 for the same exact thing
仅仅因为他们无法获得药物。 simply because they can't get their pills.
不只是药物 And it's not just pills, too;
我必须花几个小时才能找到可以将患者转送给哪个医生的方法， I have to spend hours figuring out which surgeon I can send my patient to,
或任何透析中心或疗养院。 or which dialysis center, which nursing home.
我一天的时间。 Hours of my day.
这几天的医生就是这样。 That's what it's really like to be a doctor these days, guys.
在国家一级，情况变得更加复杂。 On the national level, things get even more complicated, though.
我们将从Kaiser家庭基金会那里看到所有这些幻灯片。 All these slides we're about to see are from the Kaiser Family Foundation.
我们作为国民生产总值（GDP）的国家所支付的医疗保健费用是天文数字， The amount that we as a nation pay per GDP for all healthcare is astronomical,
higher than any other country.
高于任何其他国家。 higher than any other country.
而且我们得到的不是更好， And what we get from it, not only is it not better,
有时更糟。 it's sometimes worse.
您可能会对自己说，情况总是如此，对吗？ You might be saying to yourself that this has always been this way, right?
这是美国的制度。 That's the American system.
不，不是。 No, not really.
如您所见，因为就像1980年代之前， Because, you see, as late as the 1980s,
我们所支付的价格与加拿大，英国，欧洲相当。 what we were paying was on par with Canada, with the UK, with Europe.
直到最近，人类开发的这些系统才改变。 It's only recently that these man-made systems have changed it.
不幸的是，您可以在这里看到未来- The future, sadly, as you can see here -
更暗 even more bleak.
在未来几十年， In the decades to come,
我们国家将支付的医疗费用 what our nation will pay for Medicare expenditures
它会飞涨。 is going to skyrocket.
它实际上可能使整个国家破产。 It could virtually bankrupt the entire nation.
现在，所有这些东西，所有这些压力， Now, all of these things, all of these pressures,
作为医生的日常个人水平， both on the day-to-day, personal-level doctor
而且在国家一级， as well as on the national,
它使医生感到压力更大 they make things more stressful for doctors
在一项压力很大的工作中- in a job that's already stressful -
您从字面上决定是生是死。 you're literally doing life-and-death decisions.
所以这些最近的压力， So these new pressures,
两种新的质量标准 whether it be new quality metrics
或者要求医生在更短的时间内检查更多的患者， or doctors being told to see more patients in less time,
花更多时间填写表格- spending more time to fill out forms -
据说对外科医生来说 surgeons are being told,
“我的朋友，您必须加快这些操作， "Hey buddy, you've got to hurry up those operations,
他还带来了其他一些案件。” squeeze in a few more cases."
所有这些事情都是有代价的， All these things come at a cost,
我不是说财务成本。 and I don't mean financial.
目前，我们有自杀医生的流行病。 Right now, we have an epidemic of physicians committing suicide.
在美国，每年我们损失300至400名医生 Every single year in America, we lose between 300 to 400 doctors
谁用双手结束生命。 who take their own life.
以每天看医生的速度。 That's a doctor a day, on average.
一大批医学院毕业生消失了， That's an entire graduating medical school class gone,
每年。 every year.
但是，没有人在谈论这一点。 No one talks about this, though.
谁受到的威胁最大？ Who's most at risk?
他们是女医生。 It's the female doctor.
医生自杀的可能性高2.3倍 A female doctor is 2.3 times more likely to commit suicide
来自一般人口的妇女。 than a female in the general population.
这几天是药。 That's medicine these days, guys.
2012年，midscape发表了一项很棒的研究。 There was a great, great study published in Medscape in 2012.
他们问了24,000位医生一个简单的问题： They asked 24,000 doctors a simple question:
“如果您能回到过去并改变职业， "If you could go back in time and change careers,
你知道你现在知道的 knowing then what you know now,
您还要选择药吗？ would you still choose medicine?
还是您会选择其他东西？” Or would you do something else?"
你知道结果吗？ You guys know the results?
54％的医生说他们会继续吃药。 Fifty-four percent of doctors said they would stick with medicine.
我们一半的人不能或不想这样做。 Half of us either can't or don't want to do this anymore.
这是没人谈论的可悲的事实。 That's the sad truth that no one talks about.
那么，这能使我们得到什么呢？ So, where do we go from here?
什么是千禧一代 What are the millennials,
芝加哥现年29岁的医生 what's a 29-year-old doctor in Chicago, just starting out,
他会怎么做？ going to do?
我为您提供的答案非常简单，而且也非常复杂。 The answer I have for you is both incredibly simple and very complex.
我们正在与系统作斗争。 We fight the system.
我们努力为自己，家人，患者订购， We fight the system for ourselves, for our families, for our patients,
为子孙后代。 for the generations yet to come.
我想告诉大家我们将如何做到这一点。 And I want to tell you guys exactly how we're going to be doing this.
我们在这个房间里 We here in this room,
我们在这个房间里 we probably wouldn't think of a hospital as a business, right?
我们可能不会将医院视为一家公司，对吧？ we probably wouldn't think of a hospital as a business, right?
好吧，放心 Well, rest assured,
在我们的资本主义社会中，许多人就是这样做的。 in our capitalistic society, there's a lot of people who do just that.
每个企业都需要一位总裁，需要一位首席执行官。 Every business needs a boss, needs a CEO.
你们如何看待篮球教练 What would you guys think of a basketball coach
他一生有没有回来？ that never took a jump shot in his life?
从未上过课的校长怎么办？ What about a principal that never taught a classroom?
不知道如何开车的汽车公司CEO呢？ What about an automobile CEO that doesn't know how to drive a car?
我的意思是，我对所有这些人的期望都不高，对吧？ I mean, I'd have low expectations for all of these people, right?
但这就是我们几十年来一直在做的事情。 But that's what we've been doing for decades.
经营我们医院的人对医学一无所知。 The people who are running our hospitals know nothing about medicine.
他们将它们作为老式项目运行， They run it as an old-fashioned business,
他们查看Excel电子表格，以最大限度地提高利润。 looking at Excel spreadsheets, maximizing profits.
他们查看Excel电子表格，以最大限度地提高利润。
有一项研究对此进行了比较， There was a study that compared this,
发表在《社会科学与医学杂志》，2011年。 published in the journal Social Science & Medicine, 2011.
他们比较了所有正规商人经营的医院 They compared all the hospitals that were run by a normal businessman
换取医生实际管理的少数几个 as opposed to the couple that were actually run by doctors
他们接受了一些商业培训。 who had some business training.
由医生经营的医院 The hospitals that were run by doctors,
我们几乎拥有所有质量等级， in almost every single quality metric we had,
无论是护理费用，医疗失误，住院时间， whether it be cost of care, medical errors, length of stay,
或任何你拥有的。 what have you,
在几乎所有指标中 in almost all the metrics,
她的表现比另一家医院高出25％或更多。 they outperformed the other hospital by 25 percent or more.
震惊吧？ Shocking, right?
不，不是真的，但这就是我们几十年来一直在做的事情。 No, not really, but that's what we've been doing for decades.
在国家一级，情况正在恶化。 On the national level, it gets even worse.
制定我们的医疗保健法律和政策的人也不是医生。 The people writing our healthcare laws, our policy, they're not doctors either.
众议院有435人， We've got 435 people in the House of Representatives,
我们有100名参议员。 and we've got 100 in the Senate.
共有535个。 535 total.
如果我告诉你，你会相信我吗 Would you believe me if I told you
只有3％的当选官员是医生或科学家？ that only 3% of our elected officials are doctors or scientists?
但是这些是制定我们法律的人， But these are the people making our laws,
尽管我们知道医疗保健的争议性， despite the fact that we know how contentious a thing healthcare is,
在过去的几十年中。 the past few decades.
您提到的这种效果是由千禧一代产生的， That impact that I mentioned the millennials making,
这种改变世界的野心？ that aspiration to change the world?
它不会随药物本身一起提供。 It's not going to be coming with medicine itself.
它将随我们拥有的系统一起提供。 It's going to be coming in the system that we have.
目前，我们经历了接受业务培训的医生的革命， Right now, we have the revolution of the business-trained doctor,
医学博士/工商管理学的出现。 the rise of the MD/MBA.
15年前 Fifteen years ago,
我们拥有30所医学院，并获得医学/工商管理博士学位。 we had 30 medical schools who offered a joint MD/MBA degree.
目前呢？ Nowadays?
它已经翻了一番，达到65。 It's doubled to 65.
原因很明显： The reason is obvious:
医学院知道 medical schools know
我们不仅必须训练新士兵进入战es， that we don't have to just train new soldiers to be in the trenches;
我们必须训练新的将军。 we have to train brand-new generals.
展望未来，千禧一代将产生这种影响 Going forward, that impact the millennials will be making
将会接管医院的管理， will be to take over hospital administration,
要开医院 to run hospitals,
要从事医疗创业， to go into medical entrepreneurship,
参政并制定对我国真正有意义的法律 to go into politics and make laws that actually make sense for our country
并且不要破产。 and don't bankrupt us.
这就是下一代医生将如何改变医疗保健的方式。 That is how the upcoming generation of doctors will change healthcare.
他们将挽救生命，并挽救医疗保健本身。 They'll be saving lives and saving healthcare itself.
我想直接与一些千禧一代联系 I want to end by talking to some of the younger millennials directly
因为是的，我来自29岁的千禧一代， because yeah, I'm a millennial, I'm 29,
但是我的立场比较老。 but I'm on the older side.
如您所知，我将在几天内完成学业 And, you know, I'm finishing residency in a few days
我完成了工商管理和公共卫生学位。 and I'm finishing my MBA and my MPH.
很多千禧一代可能正在关注这一点， A lot of the millennials that might be watching this,
也许他们仍然是18、19、20。 they're probably 18, 19, 20 still.
如果你还那么年轻，想当医生， And if you're that young and you want to be a doctor,
您仍然面临着多年的培训和教育。 you've still got a lot of years of training and education ahead of you.
大学四年，医学院四年， Four years of college, four years of medical school,
并且至少居住三年。 and at least three years of residency.
我想直接和你谈谈。 I want to speak directly to you for a second.
因为您会听到老一辈告诉您， Because you're going to hear the older generation tell you,
“医学是不值得的。 "Medicine's not worth it.
不要成为医生。 Don't become a doctor.
伙计们，医学已经改变了。” Medicine's changed, guys."
您会听到的。 You're going to hear that.
我在这里告诉你相反。 I'm here to tell you the opposite.
药太好了，好吗？ Medicine is freaking awesome, alright?
没有人能找到更好的工作 Nobody has a better gig
从一个献身于拯救人类同事生命的人开始， than the guy who devotes his life to saving the life of his fellow man,
我向你保证 I promise you.
我不在乎你是否爬上山 I don't care if you're climbing to the top of mountains
或潜入海洋深处， or diving to the bottom of the ocean,
我不在乎您是否是摇滚明星，您的派对在各个海岸之间都卖不出去。 I don't care if you're a rockstar selling out concerts coast to coast.
即使您是宇航员，我也不在乎。 I don't even care if you're an astronaut going to outer space.
没有人比奉献者更好的工作。 Nobody has a better job than the person devoted to saving lives.
我们需要年轻，有才华，启发性和创造力的思想来涉足医学， We need young, talented, inspired, creative minds to come into medicine,
不要气that。 not to be dissuaded away from it.
多么美好的时光。 And what a beautiful time it is to come in,
因为我们将是这一代变化的一代， because we will be that generation that changes it,
系统得到改善。 that improves the system.
我们在医学上遇到的问题并非患者护理固有的； The problems we have in medicine are not intrinsic to patient care;
它们是后代的人造系统。 they're man-made systems from past generations.
不要让任何人阻止您成为医生。 Don't let anyone dissuade you away from your dream of becoming a doctor.
我想结束这句话。 I want to end with this quote.
这句话启发了我 This is a quote that's inspired me
在医学院的许多漫长的夜晚 through a lot of all-nighters in med school.
在我整整24小时的班次中，这启发了我， It's inspired me through a lot of 24-hour shifts in my residency,
我希望你继续激励我 and I hope it'll continue to inspire me
在努力产生这种影响的同时，我们这一代人也在努力。 as I strive to make that impact that my generation so hopes to make.
俗话是： The quote is this:
“那些疯狂到认为自己可以改变世界的人， "Those of us that are crazy enough to think we can change the world,
只有他们实际上有机会实现这一目标。” we're the only ones that stand a chance of actually doing it."
谢谢你们 Thanks so much, guys.
（鼓掌） (Applause)