[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:01.39,0:00:02.91,Default,,0000,0000,0000,,I am a palliative care physician
Dialogue: 0,0:00:02.94,0:00:05.93,Default,,0000,0000,0000,,and I would like to talk to you\Ntoday about health care.
Dialogue: 0,0:00:06.39,0:00:10.10,Default,,0000,0000,0000,,I'd like to talk to you\Nabout the health and care
Dialogue: 0,0:00:10.92,0:00:13.76,Default,,0000,0000,0000,,of the most vulnerable\Npopulation in our country --
Dialogue: 0,0:00:13.79,0:00:19.04,Default,,0000,0000,0000,,those people dealing with the most\Ncomplex serious health issues.
Dialogue: 0,0:00:20.20,0:00:23.00,Default,,0000,0000,0000,,I'd like to talk to you\Nabout economics as well.
Dialogue: 0,0:00:23.03,0:00:27.48,Default,,0000,0000,0000,,And the intersection of these two\Nshould scare the hell out of you --
Dialogue: 0,0:00:27.51,0:00:29.28,Default,,0000,0000,0000,,it scares the hell out of me.
Dialogue: 0,0:00:30.20,0:00:32.87,Default,,0000,0000,0000,,I'd also like to talk to you\Nabout palliative medicine:
Dialogue: 0,0:00:33.84,0:00:40.15,Default,,0000,0000,0000,,a paradigm of care for this population,\Ngrounded in what they value.
Dialogue: 0,0:00:40.54,0:00:43.74,Default,,0000,0000,0000,,Patient-centric care based on their values
Dialogue: 0,0:00:43.76,0:00:47.34,Default,,0000,0000,0000,,that helps this population\Nlive better and longer.
Dialogue: 0,0:00:48.46,0:00:50.81,Default,,0000,0000,0000,,It's a care model that tells the truth
Dialogue: 0,0:00:51.74,0:00:52.98,Default,,0000,0000,0000,,and engages one-on-one
Dialogue: 0,0:00:53.01,0:00:54.83,Default,,0000,0000,0000,,and meets people where they're at.
Dialogue: 0,0:00:57.46,0:01:01.22,Default,,0000,0000,0000,,I'd like to start by telling the story\Nof my very first patient.
Dialogue: 0,0:01:01.25,0:01:03.28,Default,,0000,0000,0000,,It was my first day as a physician,
Dialogue: 0,0:01:03.31,0:01:04.80,Default,,0000,0000,0000,,with the long white coat ...
Dialogue: 0,0:01:05.52,0:01:07.00,Default,,0000,0000,0000,,I stumbled into the hospital
Dialogue: 0,0:01:07.02,0:01:09.82,Default,,0000,0000,0000,,and right away there's a gentleman,\NHarold, 68 years old,
Dialogue: 0,0:01:09.85,0:01:11.45,Default,,0000,0000,0000,,came to the emergency department.
Dialogue: 0,0:01:11.47,0:01:13.46,Default,,0000,0000,0000,,He had had headaches for about six weeks
Dialogue: 0,0:01:13.48,0:01:15.63,Default,,0000,0000,0000,,that got worse and worse\Nand worse and worse.
Dialogue: 0,0:01:16.46,0:01:20.09,Default,,0000,0000,0000,,Evaluation revealed he had cancer\Nthat had spread to his brain.
Dialogue: 0,0:01:21.15,0:01:26.44,Default,,0000,0000,0000,,The attending physician directed me\Nto go share with Harold and his family
Dialogue: 0,0:01:27.79,0:01:31.11,Default,,0000,0000,0000,,the diagnosis, the prognosis\Nand options of care.
Dialogue: 0,0:01:32.11,0:01:35.07,Default,,0000,0000,0000,,Five hours into my new career,
Dialogue: 0,0:01:35.09,0:01:37.13,Default,,0000,0000,0000,,I did the only thing I knew how.
Dialogue: 0,0:01:37.92,0:01:39.21,Default,,0000,0000,0000,,I walked in,
Dialogue: 0,0:01:39.79,0:01:41.13,Default,,0000,0000,0000,,sat down,
Dialogue: 0,0:01:41.72,0:01:43.14,Default,,0000,0000,0000,,took Harold's hand,
Dialogue: 0,0:01:43.94,0:01:45.29,Default,,0000,0000,0000,,took his wife's hand
Dialogue: 0,0:01:46.14,0:01:47.42,Default,,0000,0000,0000,,and just breathed.
Dialogue: 0,0:01:48.50,0:01:50.70,Default,,0000,0000,0000,,He said, "It's not good\Nnews is it, sonny?"
Dialogue: 0,0:01:51.13,0:01:52.54,Default,,0000,0000,0000,,I said, "No."
Dialogue: 0,0:01:52.56,0:01:55.92,Default,,0000,0000,0000,,And so we talked\Nand we listened and we shared.
Dialogue: 0,0:01:56.87,0:01:58.10,Default,,0000,0000,0000,,And after a while I said,
Dialogue: 0,0:01:58.12,0:02:01.35,Default,,0000,0000,0000,,"Harold, what is it\Nthat has meaning to you?
Dialogue: 0,0:02:01.37,0:02:03.00,Default,,0000,0000,0000,,What is it that you hold sacred?"
Dialogue: 0,0:02:03.03,0:02:04.34,Default,,0000,0000,0000,,And he said,
Dialogue: 0,0:02:04.36,0:02:05.77,Default,,0000,0000,0000,,"My family."
Dialogue: 0,0:02:06.52,0:02:08.55,Default,,0000,0000,0000,,I said, "What do you want to do?"
Dialogue: 0,0:02:08.57,0:02:11.74,Default,,0000,0000,0000,,He slapped me on the knee\Nand said, "I want to go fishing."
Dialogue: 0,0:02:11.76,0:02:13.63,Default,,0000,0000,0000,,I said, "That, I know how to do."
Dialogue: 0,0:02:14.65,0:02:16.60,Default,,0000,0000,0000,,Harold went fishing the next day.
Dialogue: 0,0:02:17.76,0:02:19.39,Default,,0000,0000,0000,,He died a week later.
Dialogue: 0,0:02:20.46,0:02:23.07,Default,,0000,0000,0000,,As I've gone through\Nmy training in my career,
Dialogue: 0,0:02:23.10,0:02:24.58,Default,,0000,0000,0000,,I think back to Harold.
Dialogue: 0,0:02:24.61,0:02:27.03,Default,,0000,0000,0000,,And I think that this is a conversation
Dialogue: 0,0:02:28.78,0:02:30.97,Default,,0000,0000,0000,,that happens far too infrequently.
Dialogue: 0,0:02:31.74,0:02:35.50,Default,,0000,0000,0000,,And it's a conversation\Nthat had led us to crisis,
Dialogue: 0,0:02:36.17,0:02:38.84,Default,,0000,0000,0000,,to the biggest threat\Nto the American way of life today,
Dialogue: 0,0:02:38.86,0:02:40.97,Default,,0000,0000,0000,,which is health care expenditures.
Dialogue: 0,0:02:41.93,0:02:43.10,Default,,0000,0000,0000,,So what do we know?
Dialogue: 0,0:02:43.13,0:02:46.06,Default,,0000,0000,0000,,We know that\Nthis population, the most ill,
Dialogue: 0,0:02:46.08,0:02:48.66,Default,,0000,0000,0000,,takes up 15 percent\Nof the gross domestic product --
Dialogue: 0,0:02:48.69,0:02:51.48,Default,,0000,0000,0000,,nearly 2.3 trillion dollars.
Dialogue: 0,0:02:52.31,0:02:55.87,Default,,0000,0000,0000,,So the sickest 15 percent\Ntake up 15 percent of the GDP.
Dialogue: 0,0:02:55.89,0:02:59.06,Default,,0000,0000,0000,,If we extrapolate this out\Nover the next two decades
Dialogue: 0,0:02:59.76,0:03:01.75,Default,,0000,0000,0000,,with the growth of baby boomers,
Dialogue: 0,0:03:02.84,0:03:06.75,Default,,0000,0000,0000,,at this rate it is 60 percent of the GDP.
Dialogue: 0,0:03:08.18,0:03:10.46,Default,,0000,0000,0000,,Sixty percent of the gross\Ndomestic product
Dialogue: 0,0:03:10.48,0:03:12.10,Default,,0000,0000,0000,,of the United States of America --
Dialogue: 0,0:03:12.13,0:03:14.82,Default,,0000,0000,0000,,it has very little to do\Nwith health care at that point.
Dialogue: 0,0:03:15.15,0:03:16.96,Default,,0000,0000,0000,,It has to do with a gallon of milk,
Dialogue: 0,0:03:17.54,0:03:19.06,Default,,0000,0000,0000,,with college tuition.
Dialogue: 0,0:03:19.62,0:03:22.09,Default,,0000,0000,0000,,It has to do with\Nevery thing that we value
Dialogue: 0,0:03:22.11,0:03:25.24,Default,,0000,0000,0000,,and every thing that we know presently.
Dialogue: 0,0:03:26.51,0:03:30.70,Default,,0000,0000,0000,,It has at stake the free-market\Neconomy and capitalism
Dialogue: 0,0:03:30.73,0:03:32.48,Default,,0000,0000,0000,,of the United States of America.
Dialogue: 0,0:03:34.96,0:03:38.12,Default,,0000,0000,0000,,Let's forget all the statistics\Nfor a minute, forget the numbers.
Dialogue: 0,0:03:38.14,0:03:41.52,Default,,0000,0000,0000,,Let's talk about the value we get\Nfor all these dollars we spend.
Dialogue: 0,0:03:42.82,0:03:45.42,Default,,0000,0000,0000,,Well, the Dartmouth Atlas,\Nabout six years ago,
Dialogue: 0,0:03:45.44,0:03:48.19,Default,,0000,0000,0000,,looked at every dollar\Nspent by Medicare --
Dialogue: 0,0:03:48.22,0:03:49.83,Default,,0000,0000,0000,,generally this population.
Dialogue: 0,0:03:49.85,0:03:53.79,Default,,0000,0000,0000,,We found that those patients who have\Nthe highest per capita expenditures
Dialogue: 0,0:03:56.05,0:03:59.42,Default,,0000,0000,0000,,had the highest suffering,\Npain, depression.
Dialogue: 0,0:04:00.18,0:04:02.74,Default,,0000,0000,0000,,And, more often than not, they die sooner.
Dialogue: 0,0:04:03.82,0:04:05.35,Default,,0000,0000,0000,,How can this be?
Dialogue: 0,0:04:05.79,0:04:07.19,Default,,0000,0000,0000,,We live in the United States,
Dialogue: 0,0:04:07.22,0:04:09.71,Default,,0000,0000,0000,,it has the greatest health care\Nsystem on the planet.
Dialogue: 0,0:04:09.73,0:04:12.24,Default,,0000,0000,0000,,We spend 10 times more on these patients
Dialogue: 0,0:04:12.26,0:04:14.45,Default,,0000,0000,0000,,than the second-leading\Ncountry in the world.
Dialogue: 0,0:04:15.20,0:04:16.65,Default,,0000,0000,0000,,That doesn't make sense.
Dialogue: 0,0:04:17.76,0:04:19.12,Default,,0000,0000,0000,,But what we know is,
Dialogue: 0,0:04:19.15,0:04:22.32,Default,,0000,0000,0000,,out of the top 50 countries on the planet
Dialogue: 0,0:04:22.34,0:04:25.92,Default,,0000,0000,0000,,with organized health care systems,
Dialogue: 0,0:04:25.95,0:04:28.05,Default,,0000,0000,0000,,we rank 37th.
Dialogue: 0,0:04:30.02,0:04:34.30,Default,,0000,0000,0000,,Former Eastern Bloc countries\Nand sub-Saharan African countries
Dialogue: 0,0:04:34.33,0:04:37.86,Default,,0000,0000,0000,,rank higher than us\Nas far as quality and value.
Dialogue: 0,0:04:40.48,0:04:43.02,Default,,0000,0000,0000,,Something I experience\Nevery day in my practice,
Dialogue: 0,0:04:43.05,0:04:47.10,Default,,0000,0000,0000,,and I'm sure, something many of you\Non your own journeys have experienced:
Dialogue: 0,0:04:47.93,0:04:50.81,Default,,0000,0000,0000,,more is not more.
Dialogue: 0,0:04:52.20,0:04:54.18,Default,,0000,0000,0000,,Those individuals who had more tests,
Dialogue: 0,0:04:54.21,0:04:55.48,Default,,0000,0000,0000,,more bells, more whistles,
Dialogue: 0,0:04:55.50,0:04:57.93,Default,,0000,0000,0000,,more chemotherapy,\Nmore surgery, more whatever --
Dialogue: 0,0:04:57.96,0:05:00.40,Default,,0000,0000,0000,,the more that we do to someone,
Dialogue: 0,0:05:01.28,0:05:03.88,Default,,0000,0000,0000,,it decreases the quality of their life.
Dialogue: 0,0:05:05.42,0:05:07.69,Default,,0000,0000,0000,,And it shortens it, most often.
Dialogue: 0,0:05:09.90,0:05:11.72,Default,,0000,0000,0000,,So what are we going to do about this?
Dialogue: 0,0:05:11.74,0:05:13.15,Default,,0000,0000,0000,,What are we doing about this?
Dialogue: 0,0:05:13.46,0:05:15.07,Default,,0000,0000,0000,,And why is this so?
Dialogue: 0,0:05:15.10,0:05:17.00,Default,,0000,0000,0000,,The grim reality, ladies and gentlemen,
Dialogue: 0,0:05:17.02,0:05:20.42,Default,,0000,0000,0000,,is that we, the health care industry --\Nlong white-coat physicians --
Dialogue: 0,0:05:20.45,0:05:21.86,Default,,0000,0000,0000,,are stealing from you.
Dialogue: 0,0:05:22.88,0:05:25.07,Default,,0000,0000,0000,,Stealing from you the opportunity
Dialogue: 0,0:05:25.97,0:05:28.33,Default,,0000,0000,0000,,to choose how you want to live your lives
Dialogue: 0,0:05:28.36,0:05:30.84,Default,,0000,0000,0000,,in the context of whatever disease it is.
Dialogue: 0,0:05:30.86,0:05:33.63,Default,,0000,0000,0000,,We focus on disease\Nand pathology and surgery
Dialogue: 0,0:05:33.66,0:05:35.04,Default,,0000,0000,0000,,and pharmacology.
Dialogue: 0,0:05:37.32,0:05:39.40,Default,,0000,0000,0000,,We miss the human being.
Dialogue: 0,0:05:41.43,0:05:42.96,Default,,0000,0000,0000,,How can we treat this
Dialogue: 0,0:05:42.98,0:05:44.78,Default,,0000,0000,0000,,without understanding this?
Dialogue: 0,0:05:47.03,0:05:48.97,Default,,0000,0000,0000,,We do things to this;
Dialogue: 0,0:05:50.95,0:05:54.42,Default,,0000,0000,0000,,we need to do things for this.
Dialogue: 0,0:05:56.16,0:05:57.94,Default,,0000,0000,0000,,The triple aim of healthcare:
Dialogue: 0,0:05:57.96,0:06:01.06,Default,,0000,0000,0000,,one, improve patient experience.
Dialogue: 0,0:06:01.08,0:06:04.28,Default,,0000,0000,0000,,Two, improve the population health.
Dialogue: 0,0:06:05.47,0:06:10.25,Default,,0000,0000,0000,,Three, decrease per capita expenditure\Nacross a continuum.
Dialogue: 0,0:06:11.59,0:06:13.33,Default,,0000,0000,0000,,Our group, palliative care,
Dialogue: 0,0:06:13.36,0:06:17.38,Default,,0000,0000,0000,,in 2012, working with\Nthe sickest of the sick --
Dialogue: 0,0:06:19.00,0:06:20.15,Default,,0000,0000,0000,,cancer,
Dialogue: 0,0:06:20.18,0:06:21.52,Default,,0000,0000,0000,,heart disease, lung disease,
Dialogue: 0,0:06:22.02,0:06:23.17,Default,,0000,0000,0000,,renal disease,
Dialogue: 0,0:06:23.19,0:06:24.39,Default,,0000,0000,0000,,dementia --
Dialogue: 0,0:06:25.68,0:06:27.84,Default,,0000,0000,0000,,how did we improve patient experience?
Dialogue: 0,0:06:29.01,0:06:30.61,Default,,0000,0000,0000,,"I want to be at home, Doc."
Dialogue: 0,0:06:30.63,0:06:32.84,Default,,0000,0000,0000,,"OK, we'll bring the care to you."
Dialogue: 0,0:06:32.87,0:06:34.68,Default,,0000,0000,0000,,Quality of life, enhanced.
Dialogue: 0,0:06:35.73,0:06:37.09,Default,,0000,0000,0000,,Think about the human being.
Dialogue: 0,0:06:37.11,0:06:39.04,Default,,0000,0000,0000,,Two: population health.
Dialogue: 0,0:06:39.07,0:06:41.92,Default,,0000,0000,0000,,How did we look\Nat this population differently,
Dialogue: 0,0:06:41.94,0:06:44.79,Default,,0000,0000,0000,,and engage with them\Nat a different level, a deeper level,
Dialogue: 0,0:06:44.82,0:06:48.02,Default,,0000,0000,0000,,and connect to a broader sense\Nof the human condition than my own?
Dialogue: 0,0:06:49.09,0:06:51.68,Default,,0000,0000,0000,,How do we manage this group,
Dialogue: 0,0:06:52.58,0:06:54.35,Default,,0000,0000,0000,,so that of our outpatient population,
Dialogue: 0,0:06:54.38,0:06:59.28,Default,,0000,0000,0000,,94 percent, in 2012,\Nnever had to go to the hospital?
Dialogue: 0,0:06:59.92,0:07:01.55,Default,,0000,0000,0000,,Not because they couldn't.
Dialogue: 0,0:07:03.21,0:07:04.100,Default,,0000,0000,0000,,But they didn't have to.
Dialogue: 0,0:07:05.02,0:07:06.75,Default,,0000,0000,0000,,We brought the care to them.
Dialogue: 0,0:07:07.36,0:07:11.38,Default,,0000,0000,0000,,We maintained their value, their quality.
Dialogue: 0,0:07:13.22,0:07:16.23,Default,,0000,0000,0000,,Number three: per capita expenditures.
Dialogue: 0,0:07:16.75,0:07:18.14,Default,,0000,0000,0000,,For this population,
Dialogue: 0,0:07:18.17,0:07:23.22,Default,,0000,0000,0000,,that today is 2.3 trillion dollars\Nand in 20 years is 60 percent of the GDP,
Dialogue: 0,0:07:23.24,0:07:27.98,Default,,0000,0000,0000,,we reduced health care expenditures\Nby nearly 70 percent.
Dialogue: 0,0:07:28.87,0:07:32.32,Default,,0000,0000,0000,,They got more of what they wanted\Nbased on their values,
Dialogue: 0,0:07:32.35,0:07:34.40,Default,,0000,0000,0000,,lived better and are living longer,
Dialogue: 0,0:07:35.46,0:07:37.23,Default,,0000,0000,0000,,for two-thirds less money.
Dialogue: 0,0:07:42.88,0:07:44.92,Default,,0000,0000,0000,,While Harold's time was limited,
Dialogue: 0,0:07:45.66,0:07:47.56,Default,,0000,0000,0000,,palliative care's is not.
Dialogue: 0,0:07:48.29,0:07:52.96,Default,,0000,0000,0000,,Palliative care is a paradigm\Nfrom diagnosis through the end of life.
Dialogue: 0,0:07:54.68,0:07:55.85,Default,,0000,0000,0000,,The hours,
Dialogue: 0,0:07:56.36,0:07:58.75,Default,,0000,0000,0000,,weeks, months, years,
Dialogue: 0,0:07:59.92,0:08:01.07,Default,,0000,0000,0000,,across a continuum --
Dialogue: 0,0:08:01.10,0:08:02.98,Default,,0000,0000,0000,,with treatment, without treatment.
Dialogue: 0,0:08:03.01,0:08:04.36,Default,,0000,0000,0000,,Meet Christine.
Dialogue: 0,0:08:05.20,0:08:07.13,Default,,0000,0000,0000,,Stage III cervical cancer,
Dialogue: 0,0:08:07.15,0:08:10.17,Default,,0000,0000,0000,,so, metastatic cancer\Nthat started in her cervix,
Dialogue: 0,0:08:10.20,0:08:11.68,Default,,0000,0000,0000,,spread throughout her body.
Dialogue: 0,0:08:12.72,0:08:15.36,Default,,0000,0000,0000,,She's in her 50s and she is living.
Dialogue: 0,0:08:16.74,0:08:18.34,Default,,0000,0000,0000,,This is not about end of life,
Dialogue: 0,0:08:18.36,0:08:19.88,Default,,0000,0000,0000,,this is about life.
Dialogue: 0,0:08:21.18,0:08:23.07,Default,,0000,0000,0000,,This is not just about the elderly,
Dialogue: 0,0:08:23.09,0:08:24.76,Default,,0000,0000,0000,,this is about people.
Dialogue: 0,0:08:25.93,0:08:27.14,Default,,0000,0000,0000,,This is Richard.
Dialogue: 0,0:08:27.71,0:08:29.35,Default,,0000,0000,0000,,End-stage lung disease.
Dialogue: 0,0:08:30.43,0:08:32.85,Default,,0000,0000,0000,,"Richard, what is it\Nthat you hold sacred?"
Dialogue: 0,0:08:33.58,0:08:36.60,Default,,0000,0000,0000,,"My kids, my wife and my Harley."
Dialogue: 0,0:08:37.09,0:08:38.10,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:08:38.13,0:08:39.28,Default,,0000,0000,0000,,"Alright!
Dialogue: 0,0:08:40.54,0:08:43.78,Default,,0000,0000,0000,,I can't drive you around on it\Nbecause I can barely pedal a bicycle,
Dialogue: 0,0:08:43.81,0:08:45.30,Default,,0000,0000,0000,,but let's see what we can do."
Dialogue: 0,0:08:46.38,0:08:48.92,Default,,0000,0000,0000,,Richard came to me,
Dialogue: 0,0:08:48.95,0:08:51.84,Default,,0000,0000,0000,,and he was in rough shape.
Dialogue: 0,0:08:52.44,0:08:54.22,Default,,0000,0000,0000,,He had this little voice telling him
Dialogue: 0,0:08:54.25,0:08:56.65,Default,,0000,0000,0000,,that maybe his time was weeks to months.
Dialogue: 0,0:08:57.49,0:08:58.75,Default,,0000,0000,0000,,And then we just talked.
Dialogue: 0,0:08:58.78,0:09:02.87,Default,,0000,0000,0000,,And I listened and tried to hear --
Dialogue: 0,0:09:02.89,0:09:04.18,Default,,0000,0000,0000,,big difference.
Dialogue: 0,0:09:04.20,0:09:06.37,Default,,0000,0000,0000,,Use these in proportion to this.
Dialogue: 0,0:09:08.48,0:09:11.00,Default,,0000,0000,0000,,I said, "Alright, let's take it\None day at a time,"
Dialogue: 0,0:09:11.03,0:09:13.56,Default,,0000,0000,0000,,like we do in every\Nother chapter of our life.
Dialogue: 0,0:09:14.57,0:09:18.98,Default,,0000,0000,0000,,And we have met Richard\Nwhere Richard's at day-to-day.
Dialogue: 0,0:09:19.01,0:09:22.03,Default,,0000,0000,0000,,And it's a phone call or two a week,
Dialogue: 0,0:09:23.06,0:09:27.22,Default,,0000,0000,0000,,but he's thriving in the context\Nof end-stage lung disease.
Dialogue: 0,0:09:31.04,0:09:33.53,Default,,0000,0000,0000,,Now, palliative medicine is not\Njust for the elderly,
Dialogue: 0,0:09:33.56,0:09:36.16,Default,,0000,0000,0000,,it is not just for the middle-aged.
Dialogue: 0,0:09:37.54,0:09:39.07,Default,,0000,0000,0000,,It is for everyone.
Dialogue: 0,0:09:39.09,0:09:40.63,Default,,0000,0000,0000,,Meet my friend Jonathan.
Dialogue: 0,0:09:41.90,0:09:43.38,Default,,0000,0000,0000,,We have the honor and pleasure
Dialogue: 0,0:09:43.41,0:09:45.73,Default,,0000,0000,0000,,of Jonathan and his father\Njoining us here today.
Dialogue: 0,0:09:45.75,0:09:48.58,Default,,0000,0000,0000,,Jonathan is in his 20s,\Nand I met him several years ago.
Dialogue: 0,0:09:48.61,0:09:51.93,Default,,0000,0000,0000,,He was dealing with\Nmetastatic testicular cancer,
Dialogue: 0,0:09:52.70,0:09:53.95,Default,,0000,0000,0000,,spread to his brain.
Dialogue: 0,0:09:54.46,0:09:55.65,Default,,0000,0000,0000,,He had a stroke,
Dialogue: 0,0:09:56.38,0:09:57.92,Default,,0000,0000,0000,,he had brain surgery,
Dialogue: 0,0:09:57.95,0:09:59.96,Default,,0000,0000,0000,,radiation, chemotherapy.
Dialogue: 0,0:10:01.58,0:10:03.38,Default,,0000,0000,0000,,Upon meeting him and his family,
Dialogue: 0,0:10:03.40,0:10:06.23,Default,,0000,0000,0000,,he was a couple of weeks away\Nfrom a bone marrow transplant,
Dialogue: 0,0:10:06.25,0:10:08.52,Default,,0000,0000,0000,,and in listening and engaging,
Dialogue: 0,0:10:08.54,0:10:13.58,Default,,0000,0000,0000,,they said, "Help us\Nunderstand -- what is cancer?"
Dialogue: 0,0:10:15.76,0:10:17.42,Default,,0000,0000,0000,,How did we get this far
Dialogue: 0,0:10:18.51,0:10:20.81,Default,,0000,0000,0000,,without understanding\Nwhat we're dealing with?
Dialogue: 0,0:10:21.28,0:10:23.69,Default,,0000,0000,0000,,How did we get this far\Nwithout empowering somebody
Dialogue: 0,0:10:23.71,0:10:25.63,Default,,0000,0000,0000,,to know what it is they're dealing with,
Dialogue: 0,0:10:25.65,0:10:29.26,Default,,0000,0000,0000,,and then taking the next step and engaging\Nin who they are as human beings
Dialogue: 0,0:10:29.28,0:10:31.38,Default,,0000,0000,0000,,to know if that is what we should do?
Dialogue: 0,0:10:31.40,0:10:34.48,Default,,0000,0000,0000,,Lord knows we can do\Nany kind of thing to you.
Dialogue: 0,0:10:37.13,0:10:38.34,Default,,0000,0000,0000,,But should we?
Dialogue: 0,0:10:41.87,0:10:43.55,Default,,0000,0000,0000,,And don't take my word for it.
Dialogue: 0,0:10:43.58,0:10:48.03,Default,,0000,0000,0000,,All the evidence that is related\Nto palliative care these days
Dialogue: 0,0:10:48.05,0:10:52.18,Default,,0000,0000,0000,,demonstrates with absolute certainty\Npeople live better and live longer.
Dialogue: 0,0:10:52.20,0:10:55.54,Default,,0000,0000,0000,,There was a seminal article\Nout of the New England Journal of Medicine
Dialogue: 0,0:10:55.57,0:10:56.72,Default,,0000,0000,0000,,in 2010.
Dialogue: 0,0:10:57.62,0:11:00.28,Default,,0000,0000,0000,,A study done at Harvard\Nby friends of mine, colleagues.
Dialogue: 0,0:11:00.31,0:11:01.69,Default,,0000,0000,0000,,End-stage lung cancer:
Dialogue: 0,0:11:01.71,0:11:03.83,Default,,0000,0000,0000,,one group with palliative care,
Dialogue: 0,0:11:04.70,0:11:06.38,Default,,0000,0000,0000,,a similar group without.
Dialogue: 0,0:11:07.78,0:11:11.13,Default,,0000,0000,0000,,The group with palliative care\Nreported less pain,
Dialogue: 0,0:11:11.90,0:11:13.12,Default,,0000,0000,0000,,less depression.
Dialogue: 0,0:11:13.56,0:11:16.46,Default,,0000,0000,0000,,They needed fewer hospitalizations.
Dialogue: 0,0:11:16.49,0:11:17.89,Default,,0000,0000,0000,,And, ladies and gentlemen,
Dialogue: 0,0:11:18.64,0:11:22.28,Default,,0000,0000,0000,,they lived three to six months longer.
Dialogue: 0,0:11:23.80,0:11:27.25,Default,,0000,0000,0000,,If palliative care were a cancer drug,
Dialogue: 0,0:11:27.87,0:11:31.28,Default,,0000,0000,0000,,every cancer doctor on the planet\Nwould write a prescription for it.
Dialogue: 0,0:11:32.84,0:11:34.06,Default,,0000,0000,0000,,Why don't they?
Dialogue: 0,0:11:35.57,0:11:38.91,Default,,0000,0000,0000,,Again, because we goofy,\Nlong white-coat physicians
Dialogue: 0,0:11:38.94,0:11:42.98,Default,,0000,0000,0000,,are trained and of the mantra\Nof dealing with this,
Dialogue: 0,0:11:44.40,0:11:45.64,Default,,0000,0000,0000,,not with this.
Dialogue: 0,0:11:50.70,0:11:54.44,Default,,0000,0000,0000,,This is a space that we will\Nall come to at some point.
Dialogue: 0,0:11:55.71,0:11:58.43,Default,,0000,0000,0000,,But this conversation today\Nis not about dying,
Dialogue: 0,0:11:58.46,0:11:59.83,Default,,0000,0000,0000,,it is about living.
Dialogue: 0,0:12:00.29,0:12:01.61,Default,,0000,0000,0000,,Living based on our values,
Dialogue: 0,0:12:01.64,0:12:03.06,Default,,0000,0000,0000,,what we find sacred
Dialogue: 0,0:12:03.08,0:12:05.50,Default,,0000,0000,0000,,and how we want to write\Nthe chapters of our lives,
Dialogue: 0,0:12:05.52,0:12:07.36,Default,,0000,0000,0000,,whether it's the last
Dialogue: 0,0:12:07.38,0:12:08.78,Default,,0000,0000,0000,,or the last five.
Dialogue: 0,0:12:10.26,0:12:11.67,Default,,0000,0000,0000,,What we know,
Dialogue: 0,0:12:12.28,0:12:13.66,Default,,0000,0000,0000,,what we have proven,
Dialogue: 0,0:12:14.48,0:12:17.01,Default,,0000,0000,0000,,is that this conversation\Nneeds to happen today --
Dialogue: 0,0:12:17.95,0:12:20.00,Default,,0000,0000,0000,,not next week, not next year.
Dialogue: 0,0:12:20.03,0:12:22.86,Default,,0000,0000,0000,,What is at stake is our lives today
Dialogue: 0,0:12:22.88,0:12:24.68,Default,,0000,0000,0000,,and the lives of us as we get older
Dialogue: 0,0:12:24.71,0:12:27.25,Default,,0000,0000,0000,,and the lives of our children\Nand our grandchildren.
Dialogue: 0,0:12:28.31,0:12:30.18,Default,,0000,0000,0000,,Not just in that hospital room
Dialogue: 0,0:12:30.21,0:12:32.12,Default,,0000,0000,0000,,or on the couch at home,
Dialogue: 0,0:12:32.14,0:12:34.53,Default,,0000,0000,0000,,but everywhere we go\Nand everything we see.
Dialogue: 0,0:12:36.33,0:12:41.55,Default,,0000,0000,0000,,Palliative medicine is the answer\Nto engage with human beings,
Dialogue: 0,0:12:41.57,0:12:45.02,Default,,0000,0000,0000,,to change the journey\Nthat we will all face,
Dialogue: 0,0:12:46.30,0:12:47.80,Default,,0000,0000,0000,,and change it for the better.
Dialogue: 0,0:12:50.15,0:12:51.56,Default,,0000,0000,0000,,To my colleagues,
Dialogue: 0,0:12:52.82,0:12:54.09,Default,,0000,0000,0000,,to my patients,
Dialogue: 0,0:12:54.70,0:12:55.88,Default,,0000,0000,0000,,to my government,
Dialogue: 0,0:12:56.30,0:12:58.36,Default,,0000,0000,0000,,to all human beings,
Dialogue: 0,0:12:58.39,0:13:01.76,Default,,0000,0000,0000,,I ask that we stand and we\Nshout and we demand
Dialogue: 0,0:13:02.64,0:13:04.23,Default,,0000,0000,0000,,the best care possible,
Dialogue: 0,0:13:05.35,0:13:07.58,Default,,0000,0000,0000,,so that we can live better today
Dialogue: 0,0:13:07.61,0:13:09.29,Default,,0000,0000,0000,,and ensure a better life tomorrow.
Dialogue: 0,0:13:09.31,0:13:11.28,Default,,0000,0000,0000,,We need to shift today
Dialogue: 0,0:13:12.45,0:13:15.33,Default,,0000,0000,0000,,so that we can live tomorrow.
Dialogue: 0,0:13:16.84,0:13:17.99,Default,,0000,0000,0000,,Thank you very much.
Dialogue: 0,0:13:18.01,0:13:19.30,Default,,0000,0000,0000,,(Applause)