[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.91,0:00:03.11,Default,,0000,0000,0000,,I am a neurosurgeon,
Dialogue: 0,0:00:03.13,0:00:07.46,Default,,0000,0000,0000,,and I'm here to tell you today\Nthat people like me need your help.
Dialogue: 0,0:00:08.12,0:00:10.14,Default,,0000,0000,0000,,And in a few moments, I will tell you how.
Dialogue: 0,0:00:10.17,0:00:14.29,Default,,0000,0000,0000,,But first, let me start off by telling you\Nabout a patient of mine.
Dialogue: 0,0:00:14.31,0:00:16.95,Default,,0000,0000,0000,,This was a woman in her 50s,
Dialogue: 0,0:00:16.98,0:00:19.02,Default,,0000,0000,0000,,she was in generally good shape,
Dialogue: 0,0:00:19.05,0:00:21.44,Default,,0000,0000,0000,,but she had been in and out\Nof hospital a few times
Dialogue: 0,0:00:21.46,0:00:24.69,Default,,0000,0000,0000,,due to curative breast cancer treatment.
Dialogue: 0,0:00:25.77,0:00:28.64,Default,,0000,0000,0000,,Now she had gotten a prolapse\Nfrom a cervical disc,
Dialogue: 0,0:00:28.66,0:00:32.34,Default,,0000,0000,0000,,giving her radiating pain of a tense kind,
Dialogue: 0,0:00:32.36,0:00:34.31,Default,,0000,0000,0000,,out into the right arm.
Dialogue: 0,0:00:35.06,0:00:37.82,Default,,0000,0000,0000,,Looking at her MRI\Nbefore the consultation,
Dialogue: 0,0:00:37.85,0:00:39.62,Default,,0000,0000,0000,,I decided to suggest an operation.
Dialogue: 0,0:00:40.41,0:00:44.85,Default,,0000,0000,0000,,Now, neck operations like these\Nare standardized, and they're quick.
Dialogue: 0,0:00:45.28,0:00:46.89,Default,,0000,0000,0000,,But they carry a certain risk.
Dialogue: 0,0:00:46.91,0:00:49.06,Default,,0000,0000,0000,,You make an incision right here,
Dialogue: 0,0:00:49.09,0:00:51.94,Default,,0000,0000,0000,,and you dissect carefully\Npast the trachea,
Dialogue: 0,0:00:51.97,0:00:53.31,Default,,0000,0000,0000,,the esophagus,
Dialogue: 0,0:00:53.33,0:00:56.57,Default,,0000,0000,0000,,and you try not to cut\Ninto the internal carotid artery.
Dialogue: 0,0:00:56.59,0:00:57.86,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:00:57.88,0:01:00.12,Default,,0000,0000,0000,,Then you bring in the microscope,
Dialogue: 0,0:01:00.14,0:01:02.51,Default,,0000,0000,0000,,and you carefully remove\Nthe disc and the prolapse
Dialogue: 0,0:01:02.54,0:01:03.73,Default,,0000,0000,0000,,in the nerve root canal,
Dialogue: 0,0:01:03.75,0:01:05.87,Default,,0000,0000,0000,,without damaging the cord\Nand the nerve root
Dialogue: 0,0:01:05.90,0:01:08.21,Default,,0000,0000,0000,,lying only millimeters underneath.
Dialogue: 0,0:01:08.62,0:01:11.08,Default,,0000,0000,0000,,The worst case scenario\Nis the damage to the cord,
Dialogue: 0,0:01:11.11,0:01:15.27,Default,,0000,0000,0000,,which can result in paralysis\Nfrom the neck down.
Dialogue: 0,0:01:16.67,0:01:19.20,Default,,0000,0000,0000,,Explaining this to the patient,\Nshe fell silent.
Dialogue: 0,0:01:19.23,0:01:20.44,Default,,0000,0000,0000,,And after a few moments,
Dialogue: 0,0:01:20.46,0:01:24.24,Default,,0000,0000,0000,,she uttered a few very decisive words\Nfor me and for her.
Dialogue: 0,0:01:25.89,0:01:29.37,Default,,0000,0000,0000,,"Doctor, is this really necessary?"
Dialogue: 0,0:01:29.40,0:01:30.88,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:01:32.10,0:01:35.03,Default,,0000,0000,0000,,And you know what I realized,\Nright there and then?
Dialogue: 0,0:01:35.42,0:01:36.57,Default,,0000,0000,0000,,It was not.
Dialogue: 0,0:01:37.56,0:01:40.58,Default,,0000,0000,0000,,In fact, when I get patients\Nlike this woman,
Dialogue: 0,0:01:40.61,0:01:43.08,Default,,0000,0000,0000,,I tend to advise not to operate.
Dialogue: 0,0:01:43.66,0:01:45.80,Default,,0000,0000,0000,,So what made me do it this time?
Dialogue: 0,0:01:47.15,0:01:48.80,Default,,0000,0000,0000,,Well, you see,
Dialogue: 0,0:01:48.83,0:01:51.06,Default,,0000,0000,0000,,this prolapse was so delicate,
Dialogue: 0,0:01:51.09,0:01:54.78,Default,,0000,0000,0000,,I could practically see myself\Npulling it out of the nerve root canal
Dialogue: 0,0:01:54.80,0:01:57.28,Default,,0000,0000,0000,,before she entered the consultation room.
Dialogue: 0,0:01:57.91,0:02:00.91,Default,,0000,0000,0000,,I have to admit it,\NI wanted to operate on her.
Dialogue: 0,0:02:01.36,0:02:03.23,Default,,0000,0000,0000,,I'd love to operate on her.
Dialogue: 0,0:02:03.26,0:02:06.87,Default,,0000,0000,0000,,Operating, after all,\Nis the most fun part of my job.
Dialogue: 0,0:02:06.90,0:02:09.53,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:02:10.54,0:02:12.73,Default,,0000,0000,0000,,I think you can relate to this feeling.
Dialogue: 0,0:02:12.75,0:02:16.63,Default,,0000,0000,0000,,My architect neighbor says\Nhe loves to just sit and draw
Dialogue: 0,0:02:16.66,0:02:18.09,Default,,0000,0000,0000,,and design houses.
Dialogue: 0,0:02:18.12,0:02:19.49,Default,,0000,0000,0000,,He'd rather do that all day
Dialogue: 0,0:02:19.51,0:02:23.41,Default,,0000,0000,0000,,than talk to the client\Npaying for the house
Dialogue: 0,0:02:23.43,0:02:26.37,Default,,0000,0000,0000,,that might even give him\Nrestrictions on what to do.
Dialogue: 0,0:02:27.07,0:02:28.35,Default,,0000,0000,0000,,But like every architect,
Dialogue: 0,0:02:28.37,0:02:31.36,Default,,0000,0000,0000,,every surgeon needs\Nto look their patient in the eye
Dialogue: 0,0:02:31.38,0:02:32.85,Default,,0000,0000,0000,,and together with the patient,
Dialogue: 0,0:02:32.87,0:02:36.86,Default,,0000,0000,0000,,they need to decide on what is best\Nfor the person having the operation.
Dialogue: 0,0:02:38.26,0:02:39.68,Default,,0000,0000,0000,,And that might sound easy.
Dialogue: 0,0:02:39.71,0:02:42.33,Default,,0000,0000,0000,,But let's look at some statistics.
Dialogue: 0,0:02:44.01,0:02:47.11,Default,,0000,0000,0000,,The tonsils are the two lumps\Nin the back of your throat.
Dialogue: 0,0:02:47.42,0:02:49.57,Default,,0000,0000,0000,,They can be removed surgically,
Dialogue: 0,0:02:49.59,0:02:51.65,Default,,0000,0000,0000,,and that's called a tonsillectomy.
Dialogue: 0,0:02:51.67,0:02:55.97,Default,,0000,0000,0000,,This chart shows the operation rate\Nof tonsillectomies in Norway
Dialogue: 0,0:02:55.100,0:02:57.43,Default,,0000,0000,0000,,in different regions.
Dialogue: 0,0:02:57.45,0:03:01.13,Default,,0000,0000,0000,,What might strike you\Nis that there is twice the chance
Dialogue: 0,0:03:01.16,0:03:04.69,Default,,0000,0000,0000,,that your kid --\Nbecause this is for children --
Dialogue: 0,0:03:04.71,0:03:08.25,Default,,0000,0000,0000,,will get a tonsillectomy in Finnmark\Nthan in Trondheim.
Dialogue: 0,0:03:08.86,0:03:11.61,Default,,0000,0000,0000,,The indications\Nin both regions are the same.
Dialogue: 0,0:03:12.20,0:03:14.45,Default,,0000,0000,0000,,There should be\Nno difference, but there is.
Dialogue: 0,0:03:14.76,0:03:16.21,Default,,0000,0000,0000,,Here's another chart.
Dialogue: 0,0:03:16.24,0:03:18.40,Default,,0000,0000,0000,,The meniscus helps stabilize the knee
Dialogue: 0,0:03:18.43,0:03:20.68,Default,,0000,0000,0000,,and can be torn or fragmented acutely,
Dialogue: 0,0:03:20.71,0:03:23.11,Default,,0000,0000,0000,,topically during sports like soccer.
Dialogue: 0,0:03:23.62,0:03:26.86,Default,,0000,0000,0000,,What you see here is the operation rate\Nfor this condition.
Dialogue: 0,0:03:27.35,0:03:31.12,Default,,0000,0000,0000,,And you see that the operation\Nrate in Møre og Romsdal
Dialogue: 0,0:03:31.15,0:03:34.83,Default,,0000,0000,0000,,is five times the operation\Nrate in Stavanger.
Dialogue: 0,0:03:35.43,0:03:36.78,Default,,0000,0000,0000,,Five times.
Dialogue: 0,0:03:37.13,0:03:38.42,Default,,0000,0000,0000,,How can this be?
Dialogue: 0,0:03:38.44,0:03:40.42,Default,,0000,0000,0000,,Did the soccer players in Møre og Romsdal
Dialogue: 0,0:03:40.45,0:03:42.60,Default,,0000,0000,0000,,play more dirty\Nthan elsewhere in the country?
Dialogue: 0,0:03:42.62,0:03:44.26,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:03:44.82,0:03:45.96,Default,,0000,0000,0000,,Probably not.
Dialogue: 0,0:03:47.11,0:03:49.27,Default,,0000,0000,0000,,I added some information now.
Dialogue: 0,0:03:49.29,0:03:51.44,Default,,0000,0000,0000,,What you see now\Nis the procedures performed
Dialogue: 0,0:03:51.47,0:03:53.50,Default,,0000,0000,0000,,in public hospitals, in light blue,
Dialogue: 0,0:03:53.52,0:03:56.51,Default,,0000,0000,0000,,the ones in private clinics\Nare light green.
Dialogue: 0,0:03:56.53,0:03:59.88,Default,,0000,0000,0000,,There is a lot of activity\Nin the private clinics
Dialogue: 0,0:03:59.90,0:04:01.84,Default,,0000,0000,0000,,in Møre og Romsdal, isn't there?
Dialogue: 0,0:04:02.36,0:04:03.74,Default,,0000,0000,0000,,What does this indicate?
Dialogue: 0,0:04:03.76,0:04:07.70,Default,,0000,0000,0000,,A possible economic motivation\Nto treat the patients.
Dialogue: 0,0:04:08.52,0:04:09.67,Default,,0000,0000,0000,,And there's more.
Dialogue: 0,0:04:11.58,0:04:15.34,Default,,0000,0000,0000,,Recent research has shown\Nthat the difference of treatment effect
Dialogue: 0,0:04:15.36,0:04:18.82,Default,,0000,0000,0000,,between regular physical therapy\Nand operations for the knee --
Dialogue: 0,0:04:18.84,0:04:20.36,Default,,0000,0000,0000,,there is no difference.
Dialogue: 0,0:04:20.39,0:04:24.14,Default,,0000,0000,0000,,Meaning that most\Nof the procedures performed
Dialogue: 0,0:04:24.17,0:04:26.37,Default,,0000,0000,0000,,on the chart I've just shown
Dialogue: 0,0:04:26.40,0:04:29.05,Default,,0000,0000,0000,,could have been avoided,\Neven in Stavanger.
Dialogue: 0,0:04:29.78,0:04:32.22,Default,,0000,0000,0000,,So what am I trying to tell you here?
Dialogue: 0,0:04:32.25,0:04:37.37,Default,,0000,0000,0000,,Even though most indications\Nfor treatments in the world
Dialogue: 0,0:04:37.40,0:04:38.56,Default,,0000,0000,0000,,are standardized,
Dialogue: 0,0:04:38.58,0:04:42.88,Default,,0000,0000,0000,,there is a lot of unnecessary variation\Nof treatment decisions,
Dialogue: 0,0:04:42.90,0:04:44.74,Default,,0000,0000,0000,,especially in the Western world.
Dialogue: 0,0:04:45.57,0:04:48.75,Default,,0000,0000,0000,,Some people are not getting\Nthe treatment that they need,
Dialogue: 0,0:04:49.49,0:04:52.56,Default,,0000,0000,0000,,but an even greater portion of you
Dialogue: 0,0:04:52.58,0:04:54.17,Default,,0000,0000,0000,,are being overtreated.
Dialogue: 0,0:04:56.65,0:04:59.43,Default,,0000,0000,0000,,"Doctor, is this really necessary?"
Dialogue: 0,0:04:59.46,0:05:02.45,Default,,0000,0000,0000,,I've only heard that question\Nonce in my career.
Dialogue: 0,0:05:02.47,0:05:06.33,Default,,0000,0000,0000,,My colleagues say they never heard\Nthese words from a patient.
Dialogue: 0,0:05:07.43,0:05:09.18,Default,,0000,0000,0000,,And to turn it the other way around,
Dialogue: 0,0:05:09.21,0:05:11.76,Default,,0000,0000,0000,,how often do you think\Nyou'll get a "no" from a doctor
Dialogue: 0,0:05:11.79,0:05:13.59,Default,,0000,0000,0000,,if you ask such a question?
Dialogue: 0,0:05:14.49,0:05:16.20,Default,,0000,0000,0000,,Researchers have investigated this,
Dialogue: 0,0:05:16.22,0:05:18.97,Default,,0000,0000,0000,,and they come up\Nwith about the same "no" rate
Dialogue: 0,0:05:18.100,0:05:20.16,Default,,0000,0000,0000,,wherever they go.
Dialogue: 0,0:05:20.19,0:05:21.90,Default,,0000,0000,0000,,And that is 30 percent.
Dialogue: 0,0:05:21.92,0:05:25.89,Default,,0000,0000,0000,,Meaning, three out of 10 times,
Dialogue: 0,0:05:25.91,0:05:29.45,Default,,0000,0000,0000,,your doctor prescribes\Nor suggests something
Dialogue: 0,0:05:29.47,0:05:32.15,Default,,0000,0000,0000,,that is completely unnecessary.
Dialogue: 0,0:05:34.54,0:05:37.43,Default,,0000,0000,0000,,And you know what they claim\Nthe reason for this is?
Dialogue: 0,0:05:38.12,0:05:39.27,Default,,0000,0000,0000,,Patient pressure.
Dialogue: 0,0:05:40.83,0:05:42.16,Default,,0000,0000,0000,,In other words, you.
Dialogue: 0,0:05:42.94,0:05:44.94,Default,,0000,0000,0000,,You want something to be done.
Dialogue: 0,0:05:46.66,0:05:49.06,Default,,0000,0000,0000,,A friend of mine came to me\Nfor medical advice.
Dialogue: 0,0:05:49.08,0:05:50.24,Default,,0000,0000,0000,,This is a sporty guy,
Dialogue: 0,0:05:50.26,0:05:53.82,Default,,0000,0000,0000,,he does a lot of cross-country skiing\Nin the winter time,
Dialogue: 0,0:05:53.84,0:05:55.54,Default,,0000,0000,0000,,he runs in the summer time.
Dialogue: 0,0:05:55.57,0:05:59.57,Default,,0000,0000,0000,,And this time, he'd gotten a bad back ache\Nwhenever he went jogging.
Dialogue: 0,0:05:59.59,0:06:01.79,Default,,0000,0000,0000,,So much that he had to stop doing it.
Dialogue: 0,0:06:03.05,0:06:06.36,Default,,0000,0000,0000,,I did an examination,\NI questioned him thoroughly,
Dialogue: 0,0:06:06.38,0:06:09.52,Default,,0000,0000,0000,,and what I found out is\Nthat he probably had a degenerated disc
Dialogue: 0,0:06:09.54,0:06:11.61,Default,,0000,0000,0000,,in the lower part of his spine.
Dialogue: 0,0:06:12.09,0:06:14.45,Default,,0000,0000,0000,,Whenever it got strained, it hurt.
Dialogue: 0,0:06:16.16,0:06:18.51,Default,,0000,0000,0000,,He'd already taken up\Nswimming instead of jogging,
Dialogue: 0,0:06:18.54,0:06:20.04,Default,,0000,0000,0000,,there was really nothing to do,
Dialogue: 0,0:06:20.06,0:06:22.20,Default,,0000,0000,0000,,so I told him, "You need\Nto be more selective
Dialogue: 0,0:06:22.22,0:06:23.54,Default,,0000,0000,0000,,when it comes to training.
Dialogue: 0,0:06:23.56,0:06:25.16,Default,,0000,0000,0000,,Some activities are good for you,
Dialogue: 0,0:06:25.19,0:06:26.42,Default,,0000,0000,0000,,some are not."
Dialogue: 0,0:06:27.66,0:06:28.96,Default,,0000,0000,0000,,His reply was,
Dialogue: 0,0:06:29.92,0:06:31.72,Default,,0000,0000,0000,,"I want an MRI of my back."
Dialogue: 0,0:06:33.78,0:06:35.16,Default,,0000,0000,0000,,"Why do you want an MRI?"
Dialogue: 0,0:06:36.24,0:06:39.04,Default,,0000,0000,0000,,"I can get it for free\Nthrough my insurance at work."
Dialogue: 0,0:06:39.81,0:06:42.93,Default,,0000,0000,0000,,"Come on," I said --\Nhe was also, after all, my friend.
Dialogue: 0,0:06:42.95,0:06:44.83,Default,,0000,0000,0000,,"That's not the real reason."
Dialogue: 0,0:06:44.86,0:06:49.36,Default,,0000,0000,0000,,"Well, I think it's going to be good\Nto see how bad it looks back there."
Dialogue: 0,0:06:51.09,0:06:54.04,Default,,0000,0000,0000,,"When did you start interpreting\NMRI scans?" I said.
Dialogue: 0,0:06:54.06,0:06:56.11,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:06:56.14,0:06:57.59,Default,,0000,0000,0000,,"Trust me on this.
Dialogue: 0,0:06:58.03,0:07:00.09,Default,,0000,0000,0000,,You're not going to need the scan."
Dialogue: 0,0:07:00.78,0:07:02.53,Default,,0000,0000,0000,,"Well," he said,
Dialogue: 0,0:07:02.56,0:07:05.48,Default,,0000,0000,0000,,and after a while, he continued,\N"It could be cancer."
Dialogue: 0,0:07:05.87,0:07:08.07,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:07:08.10,0:07:09.90,Default,,0000,0000,0000,,He got the scan, obviously.
Dialogue: 0,0:07:10.91,0:07:12.54,Default,,0000,0000,0000,,And through his insurance at work,
Dialogue: 0,0:07:12.56,0:07:14.60,Default,,0000,0000,0000,,he got to see one\Nof my colleagues at work,
Dialogue: 0,0:07:14.63,0:07:16.76,Default,,0000,0000,0000,,telling him about the degenerated disc,
Dialogue: 0,0:07:16.78,0:07:18.20,Default,,0000,0000,0000,,that there was nothing to do,
Dialogue: 0,0:07:18.22,0:07:21.60,Default,,0000,0000,0000,,and that he should keep on swimming\Nand quit the jogging.
Dialogue: 0,0:07:24.20,0:07:26.26,Default,,0000,0000,0000,,After a while,\NI met him again and he said,
Dialogue: 0,0:07:26.28,0:07:28.24,Default,,0000,0000,0000,,"At least now I know what this is."
Dialogue: 0,0:07:28.71,0:07:30.33,Default,,0000,0000,0000,,But let me ask you a question.
Dialogue: 0,0:07:30.36,0:07:34.47,Default,,0000,0000,0000,,What if all of you in this room\Nwith the same symptoms had an MRI?
Dialogue: 0,0:07:34.50,0:07:37.19,Default,,0000,0000,0000,,And what if all the people in Norway
Dialogue: 0,0:07:37.21,0:07:40.82,Default,,0000,0000,0000,,had an MRI due to occasional back pain?
Dialogue: 0,0:07:42.06,0:07:45.67,Default,,0000,0000,0000,,The waiting list for an MRI\Nwould quadruple, maybe even more.
Dialogue: 0,0:07:46.18,0:07:48.94,Default,,0000,0000,0000,,And you would all take\Nthe spot on that list
Dialogue: 0,0:07:48.97,0:07:51.30,Default,,0000,0000,0000,,from someone who really had cancer.
Dialogue: 0,0:07:51.92,0:07:55.49,Default,,0000,0000,0000,,So a good doctor sometimes says no,
Dialogue: 0,0:07:55.52,0:07:59.86,Default,,0000,0000,0000,,but the sensible patient\Nalso turns down, sometimes,
Dialogue: 0,0:07:59.89,0:08:02.54,Default,,0000,0000,0000,,an opportunity\Nto get diagnosed or treated.
Dialogue: 0,0:08:04.78,0:08:08.08,Default,,0000,0000,0000,,"Doctor, is this really necessary?"
Dialogue: 0,0:08:08.47,0:08:11.79,Default,,0000,0000,0000,,I know this can be\Na difficult question to ask.
Dialogue: 0,0:08:12.38,0:08:14.28,Default,,0000,0000,0000,,In fact, if you go back 50 years,
Dialogue: 0,0:08:14.30,0:08:16.65,Default,,0000,0000,0000,,this was even considered rude.
Dialogue: 0,0:08:16.68,0:08:17.80,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:08:17.82,0:08:20.27,Default,,0000,0000,0000,,If the doctor had decided\Nwhat to do with you,
Dialogue: 0,0:08:20.29,0:08:21.63,Default,,0000,0000,0000,,that's what you did.
Dialogue: 0,0:08:23.57,0:08:25.82,Default,,0000,0000,0000,,A colleague of mine,\Nnow a general practitioner,
Dialogue: 0,0:08:25.84,0:08:30.18,Default,,0000,0000,0000,,was sent away to a tuberculosis\Nsanatorium as a little girl,
Dialogue: 0,0:08:30.21,0:08:31.37,Default,,0000,0000,0000,,for six months.
Dialogue: 0,0:08:31.39,0:08:33.25,Default,,0000,0000,0000,,It was a terrible trauma for her.
Dialogue: 0,0:08:33.70,0:08:36.04,Default,,0000,0000,0000,,She later found out, as a grown-up,
Dialogue: 0,0:08:36.07,0:08:39.61,Default,,0000,0000,0000,,that her tests on tuberculosis\Nhad been negative all along.
Dialogue: 0,0:08:40.40,0:08:43.94,Default,,0000,0000,0000,,The doctor had sent her away\Non nothing but wrong suspicion.
Dialogue: 0,0:08:44.42,0:08:48.82,Default,,0000,0000,0000,,No one had dared or even considered\Nconfronting him about it.
Dialogue: 0,0:08:49.27,0:08:50.67,Default,,0000,0000,0000,,Not even her parents.
Dialogue: 0,0:08:51.51,0:08:54.75,Default,,0000,0000,0000,,Today, the Norwegian health minister
Dialogue: 0,0:08:54.78,0:08:58.16,Default,,0000,0000,0000,,talks about the patient\Nhealth care service.
Dialogue: 0,0:08:58.68,0:09:03.09,Default,,0000,0000,0000,,The patient is supposed to get advice\Nfrom the doctor about what to do.
Dialogue: 0,0:09:04.34,0:09:06.18,Default,,0000,0000,0000,,This is great progress.
Dialogue: 0,0:09:06.20,0:09:09.59,Default,,0000,0000,0000,,But it also puts more\Nresponsibility on you.
Dialogue: 0,0:09:09.92,0:09:12.84,Default,,0000,0000,0000,,You need to get in the front seat\Nwith your doctor
Dialogue: 0,0:09:12.86,0:09:15.01,Default,,0000,0000,0000,,and start sharing\Ndecisions on where to go.
Dialogue: 0,0:09:15.42,0:09:18.98,Default,,0000,0000,0000,,So, the next time\Nyou're in a doctor's office,
Dialogue: 0,0:09:19.01,0:09:20.90,Default,,0000,0000,0000,,I want you to ask,
Dialogue: 0,0:09:20.92,0:09:23.98,Default,,0000,0000,0000,,"Doctor, is this really necessary?"
Dialogue: 0,0:09:24.32,0:09:26.62,Default,,0000,0000,0000,,And in my female patient's case,
Dialogue: 0,0:09:26.65,0:09:28.96,Default,,0000,0000,0000,,the answer would be no,
Dialogue: 0,0:09:28.98,0:09:31.65,Default,,0000,0000,0000,,but an operation could also be justified.
Dialogue: 0,0:09:32.16,0:09:36.89,Default,,0000,0000,0000,,"So doctors, what are the risks\Nattached to this operation?"
Dialogue: 0,0:09:37.49,0:09:42.94,Default,,0000,0000,0000,,Well, five to ten percent of patients\Nwill have worsening of pain symptoms.
Dialogue: 0,0:09:43.43,0:09:45.14,Default,,0000,0000,0000,,One to two percent of patients
Dialogue: 0,0:09:45.16,0:09:48.18,Default,,0000,0000,0000,,will have an infection in the wound\Nor even a rehemorrhage
Dialogue: 0,0:09:48.20,0:09:50.60,Default,,0000,0000,0000,,that might end up in a re-operation.
Dialogue: 0,0:09:52.07,0:09:55.66,Default,,0000,0000,0000,,0.5 percent of patients\Nalso experience permanent hoarseness
Dialogue: 0,0:09:55.68,0:09:57.47,Default,,0000,0000,0000,,and a few, but still a few,
Dialogue: 0,0:09:57.50,0:10:01.87,Default,,0000,0000,0000,,will experience reduced function\Nin the arms or even legs.
Dialogue: 0,0:10:03.16,0:10:05.62,Default,,0000,0000,0000,,"Doctor, are there other options?"
Dialogue: 0,0:10:06.13,0:10:09.51,Default,,0000,0000,0000,,Yes, rest and physical therapy\Nover some time
Dialogue: 0,0:10:09.53,0:10:11.56,Default,,0000,0000,0000,,might get you perfectly well.
Dialogue: 0,0:10:13.10,0:10:15.84,Default,,0000,0000,0000,,"And what happens if I don't do anything?"
Dialogue: 0,0:10:15.86,0:10:17.03,Default,,0000,0000,0000,,It's not recommended,
Dialogue: 0,0:10:17.06,0:10:20.09,Default,,0000,0000,0000,,but even then, there's a slight chance\Nthat you will get well.
Dialogue: 0,0:10:21.00,0:10:22.15,Default,,0000,0000,0000,,Four questions.
Dialogue: 0,0:10:22.78,0:10:24.30,Default,,0000,0000,0000,,Simple questions.
Dialogue: 0,0:10:24.32,0:10:28.68,Default,,0000,0000,0000,,Consider them your new toolbox to help us.
Dialogue: 0,0:10:28.70,0:10:30.31,Default,,0000,0000,0000,,Is this really necessary?
Dialogue: 0,0:10:30.34,0:10:32.13,Default,,0000,0000,0000,,What are the risks?
Dialogue: 0,0:10:32.15,0:10:33.71,Default,,0000,0000,0000,,Are there other options?
Dialogue: 0,0:10:33.73,0:10:36.89,Default,,0000,0000,0000,,And what happens if I don't do anything?
Dialogue: 0,0:10:37.33,0:10:41.38,Default,,0000,0000,0000,,Ask them when your doctor\Nwants to send you to an MRI,
Dialogue: 0,0:10:41.40,0:10:43.70,Default,,0000,0000,0000,,when he prescribes antibiotics
Dialogue: 0,0:10:43.72,0:10:45.82,Default,,0000,0000,0000,,or suggests an operation.
Dialogue: 0,0:10:46.28,0:10:47.99,Default,,0000,0000,0000,,What we know from research
Dialogue: 0,0:10:48.01,0:10:51.20,Default,,0000,0000,0000,,is that one out of five\Nof you, 20 percent,
Dialogue: 0,0:10:51.23,0:10:53.76,Default,,0000,0000,0000,,will change your opinion on what to do.
Dialogue: 0,0:10:54.62,0:10:57.97,Default,,0000,0000,0000,,And by doing that, you will\Nnot only have made your life
Dialogue: 0,0:10:57.99,0:11:01.55,Default,,0000,0000,0000,,a whole lot easier,\Nand probably even better,
Dialogue: 0,0:11:01.58,0:11:03.53,Default,,0000,0000,0000,,but the whole health care sector
Dialogue: 0,0:11:03.56,0:11:06.62,Default,,0000,0000,0000,,will have benefited from your decision.
Dialogue: 0,0:11:07.35,0:11:08.54,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:11:08.56,0:11:12.25,Default,,0000,0000,0000,,(Applause)