By Adem Lewis /


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)


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