WEBVTT

00:00:09.840 --> 00:00:11.040
Science.

00:00:11.760 --> 00:00:15.176
The very word for many of you conjures
unhappy memories of boredom

00:00:15.200 --> 00:00:18.096
in high school biology or physics class.

00:00:18.120 --> 00:00:21.216
But let me assure that what you did there

00:00:21.240 --> 00:00:23.416
had very little to do with science.

00:00:23.440 --> 00:00:25.736
That was really the "what" of science.

00:00:25.760 --> 00:00:28.480
It was the history
of what other people had discovered.

00:00:29.720 --> 00:00:32.055
What I'm most interested in as a scientist

00:00:32.080 --> 00:00:34.216
is the "how" of science.

00:00:34.240 --> 00:00:38.056
Because science is knowledge in process.

00:00:38.080 --> 00:00:41.536
We make an observation,
guess an explanation for that observation,

00:00:41.560 --> 00:00:43.616
and then make a prediction
that we can test

00:00:43.640 --> 00:00:45.560
with an experiment or other observation.

00:00:46.080 --> 00:00:47.416
A couple of examples.

00:00:47.440 --> 00:00:51.016
First of all, people noticed
that the Earth was below, the sky above,

00:00:51.040 --> 00:00:54.920
and both the Sun and the Moon
seemed to go around them.

00:00:55.720 --> 00:00:57.256
Their guessed explanation

00:00:57.280 --> 00:01:00.360
was that the Earth must be
the center of the universe.

00:01:01.240 --> 00:01:04.440
The prediction: everything
should circle around the Earth.

00:01:05.319 --> 00:01:06.976
This was first really tested

00:01:07.000 --> 00:01:09.816
when Galileo got his hands
on one of the first telescopes,

00:01:09.840 --> 00:01:12.216
and as he gazed into the night sky,

00:01:12.240 --> 00:01:15.936
what he found there was a planet, Jupiter,

00:01:15.960 --> 00:01:19.960
with four moons circling around it.

00:01:23.160 --> 00:01:27.536
He then used those moons
to follow the path of Jupiter

00:01:27.560 --> 00:01:31.296
and found that Jupiter
also was not going around the Earth

00:01:31.320 --> 00:01:33.280
but around the Sun.

00:01:35.660 --> 00:01:37.940
So the prediction test failed.

00:01:38.900 --> 00:01:40.996
And this led to
the discarding of the theory

00:01:41.020 --> 00:01:43.196
that the Earth was the center
of the universe.

00:01:43.220 --> 00:01:47.316
Another example: Sir Isaac Newton
noticed that things fall to the Earth.

00:01:47.740 --> 00:01:50.660
The guessed explanation was gravity,

00:01:51.420 --> 00:01:54.556
the prediction that everything
should fall to the Earth.

00:01:54.580 --> 00:01:58.140
But of course, not everything
does fall to the Earth.

00:01:59.800 --> 00:02:01.360
So did we discard gravity?

00:02:02.520 --> 00:02:06.936
No. We revised the theory and said,
gravity pulls things to the Earth

00:02:06.960 --> 00:02:11.160
unless there is an equal
and opposite force in the other direction.

00:02:11.760 --> 00:02:13.920
This led us to learn something new.

00:02:15.220 --> 00:02:18.476
We began to pay more attention
to the bird and the bird's wings,

00:02:18.500 --> 00:02:20.876
and just think of all the discoveries

00:02:20.900 --> 00:02:22.939
that have flown
from that line of thinking.

00:02:23.939 --> 00:02:29.076
So the test failures,
the exceptions, the outliers

00:02:29.100 --> 00:02:34.481
teach us what we don't know
and lead us to something new.

00:02:35.100 --> 00:02:38.300
This is how science moves forward.
This is how science learns.

00:02:38.940 --> 00:02:41.196
Sometimes in the media,
and even more rarely,

00:02:41.220 --> 00:02:43.636
but sometimes even scientists will say

00:02:43.660 --> 00:02:46.420
that something or other
has been scientifically proven.

00:02:47.080 --> 00:02:51.656
But I hope that you understand
that science never proves anything

00:02:51.680 --> 00:02:53.560
definitively forever.

00:02:54.720 --> 00:02:58.536
Hopefully science remains curious enough

00:02:58.560 --> 00:02:59.976
to look for

00:03:00.000 --> 00:03:01.976
and humble enough to recognize

00:03:02.000 --> 00:03:03.496
when we have found

00:03:03.520 --> 00:03:05.216
the next outlier,

00:03:05.240 --> 00:03:06.736
the next exception,

00:03:06.760 --> 00:03:09.056
which, like Jupiter's moons,

00:03:09.080 --> 00:03:11.680
teaches us what we don't actually know.

00:03:12.360 --> 00:03:14.896
We're going to change gears
here for a second.

00:03:14.920 --> 00:03:16.856
The caduceus, or the symbol of medicine,

00:03:16.880 --> 00:03:19.336
means a lot of different things
to different people,

00:03:19.360 --> 00:03:21.616
but most of our
public discourse on medicine

00:03:21.640 --> 00:03:24.416
really turns it into
an engineering problem.

00:03:24.440 --> 00:03:26.176
We have the hallways of Congress,

00:03:26.200 --> 00:03:30.200
and the boardrooms of insurance companies
that try to figure out how to pay for it.

00:03:30.880 --> 00:03:32.496
The ethicists and epidemiologists

00:03:32.520 --> 00:03:35.216
try to figure out
how best to distribute medicine,

00:03:35.240 --> 00:03:37.896
and the hospitals and physicians
are absolutely obsessed

00:03:37.920 --> 00:03:39.856
with their protocols and checklists,

00:03:39.880 --> 00:03:43.416
trying to figure out
how best to safely apply medicine.

00:03:43.440 --> 00:03:45.560
These are all good things.

00:03:46.160 --> 00:03:48.896
However, they also all assume

00:03:48.920 --> 00:03:50.896
at some level

00:03:50.920 --> 00:03:53.440
that the textbook of medicine is closed.

00:03:55.160 --> 00:03:57.656
We start to measure
the quality of our health care

00:03:57.680 --> 00:04:00.216
by how quickly we can access it.

00:04:00.240 --> 00:04:02.336
It doesn't surprise me
that in this climate,

00:04:02.360 --> 00:04:05.176
many of our institutions
for the provision of health care

00:04:05.200 --> 00:04:07.696
start to look a heck of a lot
like Jiffy Lube.

00:04:07.720 --> 00:04:10.296
(Laughter)

00:04:10.320 --> 00:04:14.256
The only problem is that
when I graduated from medical school,

00:04:14.280 --> 00:04:16.336
I didn't get one of those
little doohickeys

00:04:16.360 --> 00:04:18.736
that your mechanic
has to plug into your car

00:04:18.760 --> 00:04:21.136
and find out exactly what's wrong with it,

00:04:21.160 --> 00:04:23.256
because the textbook of medicine

00:04:23.280 --> 00:04:24.800
is not closed.

00:04:25.320 --> 00:04:27.160
Medicine is science.

00:04:27.560 --> 00:04:30.240
Medicine is knowledge in process.

00:04:31.280 --> 00:04:32.656
We make an observation,

00:04:32.680 --> 00:04:34.815
we guess an explanation
of that observation,

00:04:34.839 --> 00:04:37.456
and then we make a prediction
that we can test.

00:04:37.480 --> 00:04:41.056
Now, the testing ground
of most predictions in medicine

00:04:41.080 --> 00:04:42.616
is populations.

00:04:42.640 --> 00:04:46.216
And you may remember
from those boring days in biology class

00:04:46.240 --> 00:04:48.416
that populations tend to distribute

00:04:48.440 --> 00:04:49.656
around a mean

00:04:49.680 --> 00:04:51.536
as a Gaussian or a normal curve.

00:04:52.260 --> 00:04:53.916
Therefore, in medicine,

00:04:53.939 --> 00:04:58.055
after we make a prediction
from a guessed explanation,

00:04:58.080 --> 00:04:59.960
we test it in a population.

00:05:00.920 --> 00:05:03.856
That means that what we know in medicine,

00:05:03.880 --> 00:05:06.136
our knowledge and our know-how,

00:05:06.160 --> 00:05:08.416
comes from populations

00:05:08.440 --> 00:05:11.216
but extends only as far

00:05:11.240 --> 00:05:12.976
as the next outlier,

00:05:13.000 --> 00:05:14.216
the next exception,

00:05:14.240 --> 00:05:15.976
which, like Jupiter's moons,

00:05:16.000 --> 00:05:18.400
will teach us what we don't actually know.

00:05:19.580 --> 00:05:20.916
Now, I am a surgeon

00:05:20.940 --> 00:05:23.356
who looks after patients with sarcoma.

00:05:23.380 --> 00:05:25.580
Sarcoma is a very rare form of cancer.

00:05:26.220 --> 00:05:28.260
It's the cancer of flesh and bones.

00:05:28.740 --> 00:05:33.076
And I would tell you that every one
of my patients is an outlier,

00:05:33.100 --> 00:05:34.300
is an exception.

00:05:35.500 --> 00:05:38.716
There is no surgery I have ever performed
for a sarcoma patient

00:05:38.740 --> 00:05:42.996
that has ever been guided
by a randomized controlled clinical trial,

00:05:43.020 --> 00:05:46.740
what we consider the best kind
of population-based evidence in medicine.

00:05:47.900 --> 00:05:50.196
People talk about thinking
outside the box,

00:05:50.220 --> 00:05:52.956
but we don't even have a box in sarcoma.

00:05:53.580 --> 00:05:56.916
What we do have as we take
a bath in the uncertainty

00:05:56.940 --> 00:06:01.076
and unknowns and exceptions
and outliers that surround us in sarcoma

00:06:01.100 --> 00:06:05.636
is easy access to what I think
are those two most important values

00:06:05.660 --> 00:06:07.196
for any science:

00:06:07.220 --> 00:06:09.420
humility and curiosity.

00:06:10.600 --> 00:06:12.896
Because if I am humble and curious,

00:06:12.920 --> 00:06:15.216
when a patient asks me a question,

00:06:15.240 --> 00:06:16.680
and I don't know the answer,

00:06:17.520 --> 00:06:18.736
I'll ask a colleague

00:06:18.760 --> 00:06:21.776
who may have a similar
albeit distinct patient with sarcoma.

00:06:21.800 --> 00:06:24.496
We'll even establish
international collaborations.

00:06:24.520 --> 00:06:27.656
Those patients will start
to talk to each other through chat rooms

00:06:27.680 --> 00:06:28.880
and support groups.

00:06:29.400 --> 00:06:32.976
It's through this kind
of humbly curious communication

00:06:33.000 --> 00:06:36.560
that we begin to try and learn new things.

00:06:37.840 --> 00:06:39.896
As an example, this is a patient of mine

00:06:39.920 --> 00:06:41.600
who had a cancer near his knee.

00:06:42.080 --> 00:06:44.456
Because of humbly curious communication

00:06:44.480 --> 00:06:46.576
in international collaborations,

00:06:46.600 --> 00:06:51.136
we have learned that we can repurpose
the ankle to serve as the knee

00:06:51.160 --> 00:06:53.416
when we have to remove the knee
with the cancer.

00:06:53.440 --> 00:06:56.280
He can then wear a prosthetic
and run and jump and play.

00:06:56.960 --> 00:06:59.976
This opportunity was available to him

00:07:00.000 --> 00:07:02.776
because of international collaborations.

00:07:02.800 --> 00:07:04.496
It was desirable to him

00:07:04.520 --> 00:07:07.480
because he had contacted other patients
who had experienced it.

00:07:08.520 --> 00:07:12.576
And so exceptions and outliers in medicine

00:07:12.600 --> 00:07:16.560
teach us what we don't know,
but also lead us to new thinking.

00:07:17.680 --> 00:07:19.536
Now, very importantly,

00:07:19.560 --> 00:07:23.416
all the new thinking that outliers
and exceptions lead us to in medicine

00:07:23.440 --> 00:07:26.800
does not only apply
to the outliers and exceptions.

00:07:27.520 --> 00:07:30.696
It is not that we only learn
from sarcoma patients

00:07:30.720 --> 00:07:32.680
ways to manage sarcoma patients.

00:07:33.520 --> 00:07:35.576
Sometimes, the outliers

00:07:35.600 --> 00:07:37.296
and the exceptions

00:07:37.320 --> 00:07:40.560
teach us things that matter quite a lot
to the general population.

00:07:41.960 --> 00:07:43.816
Like a tree standing outside a forest,

00:07:43.840 --> 00:07:47.856
the outliers and the exceptions
draw our attention

00:07:48.680 --> 00:07:53.532
and lead us into a much greater sense
of perhaps what a tree is.

00:07:54.340 --> 00:07:56.836
We often talk about
losing the forests for the trees,

00:07:56.860 --> 00:07:58.676
but one also loses a tree

00:07:58.700 --> 00:08:00.220
within a forest.

00:08:01.700 --> 00:08:03.556
But the tree that stands out by itself

00:08:03.580 --> 00:08:06.476
makes those relationships
that define a tree,

00:08:06.500 --> 00:08:10.316
the relationships between trunk
and roots and branches,

00:08:10.340 --> 00:08:11.580
much more apparent.

00:08:12.060 --> 00:08:13.756
Even if that tree is crooked

00:08:13.780 --> 00:08:16.756
or even if that tree
has very unusual relationships

00:08:16.780 --> 00:08:19.076
between trunk and roots and branches,

00:08:19.100 --> 00:08:21.796
it nonetheless draws our attention

00:08:21.820 --> 00:08:23.716
and allows us to make observations

00:08:23.740 --> 00:08:25.980
that we can then test
in the general population.

00:08:26.700 --> 00:08:28.676
I told you that sarcomas are rare.

00:08:28.700 --> 00:08:31.340
They make up about one percent
of all cancers.

00:08:31.980 --> 00:08:35.940
You also probably know that cancer
is considered a genetic disease.

00:08:36.539 --> 00:08:39.876
By genetic disease we mean
that cancer is caused by oncogenes

00:08:39.900 --> 00:08:41.275
that are turned on in cancer

00:08:41.299 --> 00:08:44.340
and tumor suppressor genes
that are turned off to cause cancer.

00:08:44.860 --> 00:08:47.276
You might think
that we learned about oncogenes

00:08:47.300 --> 00:08:49.516
and tumor suppressor genes
from common cancers

00:08:49.540 --> 00:08:51.516
like breast cancer and prostate cancer

00:08:51.540 --> 00:08:53.036
and lung cancer,

00:08:53.060 --> 00:08:54.259
but you'd be wrong.

00:08:54.700 --> 00:08:57.595
We learned about oncogenes
and tumor suppressor genes

00:08:57.619 --> 00:08:58.835
for the first time

00:08:58.859 --> 00:09:02.300
in that itty-bitty little one percent
of cancers called sarcoma.

00:09:03.460 --> 00:09:06.036
In 1966, Peyton Rous got the Nobel Prize

00:09:06.060 --> 00:09:08.076
for realizing that chickens

00:09:08.100 --> 00:09:11.220
had a transmissible form of sarcoma.

00:09:11.960 --> 00:09:14.796
Thirty years later, Harold Varmus
and Mike Bishop discovered

00:09:14.820 --> 00:09:17.356
what that transmissible element was.

00:09:17.380 --> 00:09:18.956
It was a virus

00:09:18.980 --> 00:09:20.396
carrying a gene,

00:09:20.420 --> 00:09:21.860
the src oncogene.

00:09:22.580 --> 00:09:26.236
Now, I will not tell you
that src is the most important oncogene.

00:09:26.260 --> 00:09:27.476
I will not tell you

00:09:27.500 --> 00:09:30.996
that src is the most frequently
turned on oncogene in all of cancer.

00:09:31.020 --> 00:09:33.460
But it was the first oncogene.

00:09:34.660 --> 00:09:36.996
The exception, the outlier

00:09:37.020 --> 00:09:39.540
drew our attention and led us to something

00:09:40.220 --> 00:09:44.260
that taught us very important things
about the rest of biology.

00:09:45.580 --> 00:09:49.676
Now, TP53 is the most important
tumor suppressor gene.

00:09:49.700 --> 00:09:52.436
It is the most frequently turned off
tumor suppressor gene

00:09:52.460 --> 00:09:54.260
in almost every kind of cancer.

00:09:55.060 --> 00:09:57.356
But we didn't learn about it
from common cancers.

00:09:57.380 --> 00:09:59.796
We learned about it
when doctors Li and Fraumeni

00:09:59.820 --> 00:10:01.396
were looking at families,

00:10:01.420 --> 00:10:03.436
and they realized that these families

00:10:03.460 --> 00:10:05.980
had way too many sarcomas.

00:10:06.620 --> 00:10:08.396
I told you that sarcoma is rare.

00:10:08.420 --> 00:10:11.596
Remember that a one
in a million diagnosis,

00:10:11.620 --> 00:10:13.756
if it happens twice in one family,

00:10:13.780 --> 00:10:16.180
is way too common in that family.

00:10:17.340 --> 00:10:20.036
The very fact that these are rare

00:10:20.060 --> 00:10:21.500
draws our attention

00:10:22.460 --> 00:10:24.700
and leads us to new kinds of thinking.

00:10:26.180 --> 00:10:27.636
Now, many of you may say,

00:10:27.660 --> 00:10:29.196
and may rightly say,

00:10:29.220 --> 00:10:31.116
that yeah, Kevin, that's great,

00:10:31.140 --> 00:10:33.196
but you're not talking
about a bird's wing.

00:10:33.220 --> 00:10:36.700
You're not talking about moons
floating around some planet Jupiter.

00:10:37.220 --> 00:10:38.756
This is a person.

00:10:38.780 --> 00:10:42.036
This outlier, this exception,
may lead to the advancement of science,

00:10:42.060 --> 00:10:43.260
but this is a person.

00:10:44.980 --> 00:10:46.596
And all I can say

00:10:46.620 --> 00:10:48.980
is that I know that all too well.

00:10:50.460 --> 00:10:53.860
I have conversations with these patients
with rare and deadly diseases.

00:10:54.500 --> 00:10:56.436
I write about these conversations.

00:10:56.460 --> 00:10:58.756
These conversations are terribly fraught.

00:10:58.780 --> 00:11:00.596
They're fraught with horrible phrases

00:11:00.620 --> 00:11:03.860
like "I have bad news"
or "There's nothing more we can do."

00:11:04.460 --> 00:11:07.660
Sometimes these conversations
turn on a single word:

00:11:08.460 --> 00:11:09.660
"terminal."

00:11:17.620 --> 00:11:20.540
Silence can also be rather uncomfortable.

00:11:22.060 --> 00:11:24.636
Where the blanks are in medicine

00:11:24.660 --> 00:11:26.516
can be just as important

00:11:26.540 --> 00:11:28.780
as the words that we use
in these conversations.

00:11:29.780 --> 00:11:31.316
What are the unknowns?

00:11:31.340 --> 00:11:33.540
What are the experiments
that are being done?

00:11:34.380 --> 00:11:36.076
Do this little exercise with me.

00:11:36.100 --> 00:11:39.316
Up there on the screen,
you see this phrase, "no where."

00:11:39.340 --> 00:11:40.620
Notice where the blank is.

00:11:41.380 --> 00:11:44.580
If we move that blank one space over

00:11:45.340 --> 00:11:46.916
"no where"

00:11:46.940 --> 00:11:49.636
becomes "now here,"

00:11:49.660 --> 00:11:51.556
the exact opposite meaning,

00:11:51.580 --> 00:11:53.780
just by shifting the blank one space over.

00:11:56.380 --> 00:11:57.956
I'll never forget the night

00:11:57.980 --> 00:12:00.220
that I walked into
one of my patients' rooms.

00:12:00.980 --> 00:12:02.636
I had been operating long that day

00:12:02.660 --> 00:12:04.676
but I still wanted to come and see him.

00:12:04.700 --> 00:12:07.900
He was a boy I had diagnosed
with a bone cancer a few days before.

00:12:08.540 --> 00:12:11.596
He and his mother had been meeting
with the chemotherapy doctors

00:12:11.620 --> 00:12:12.836
earlier that day,

00:12:12.860 --> 00:12:15.836
and he had been admitted
to the hospital to begin chemotherapy.

00:12:15.860 --> 00:12:18.036
It was almost midnight
when I got to his room.

00:12:18.060 --> 00:12:20.236
He was asleep, but I found his mother

00:12:20.260 --> 00:12:21.836
reading by flashlight

00:12:21.860 --> 00:12:23.316
next to his bed.

00:12:23.340 --> 00:12:26.140
She came out in the hall
to chat with me for a few minutes.

00:12:26.980 --> 00:12:29.076
It turned out that
what she had been reading

00:12:29.100 --> 00:12:31.276
was the protocol
that the chemotherapy doctors

00:12:31.300 --> 00:12:32.540
had given her that day.

00:12:32.900 --> 00:12:34.140
She had memorized it.

00:12:35.900 --> 00:12:39.436
She said, "Dr. Jones, you told me

00:12:39.460 --> 00:12:41.636
that we don't always win

00:12:41.660 --> 00:12:42.940
with this type of cancer,

00:12:44.380 --> 00:12:47.860
but I've been studying this protocol,
and I think I can do it.

00:12:48.660 --> 00:12:52.236
I think I can comply
with these very difficult treatments.

00:12:52.260 --> 00:12:55.236
I'm going to quit my job.
I'm going to move in with my parents.

00:12:55.260 --> 00:12:57.220
I'm going to keep my baby safe."

00:13:00.020 --> 00:13:01.220
I didn't tell her.

00:13:02.540 --> 00:13:05.460
I didn't stop to correct her thinking.

00:13:05.864 --> 00:13:08.451
To shift that blank to where it should be.

00:13:09.133 --> 00:13:11.863
The experiment wasn't whether or not
she could comply

00:13:11.888 --> 00:13:13.648
with this very difficult protocol.

00:13:15.380 --> 00:13:17.636
She was trusting in a protocol

00:13:17.660 --> 00:13:20.876
that even if complied with,

00:13:20.900 --> 00:13:23.300
wouldn't necessarily save her son.

00:13:25.660 --> 00:13:26.860
I didn't tell her.

00:13:28.060 --> 00:13:29.460
I didn't fill in that blank.

00:13:30.780 --> 00:13:32.756
But a year and a half later

00:13:32.780 --> 00:13:35.500
her boy nonetheless died of his cancer.

00:13:37.100 --> 00:13:38.420
Should I have told her?

00:13:41.160 --> 00:13:43.416
Now, many of you may say, "So what?

00:13:43.440 --> 00:13:44.696
I don't have sarcoma.

00:13:44.720 --> 00:13:46.616
No one in my family has sarcoma.

00:13:46.640 --> 00:13:48.096
And this is all fine and well,

00:13:48.120 --> 00:13:50.816
but it probably doesn't
matter in my life."

00:13:50.840 --> 00:13:52.096
And you're probably right.

00:13:52.120 --> 00:13:54.800
Sarcoma may not matter
a whole lot in your life.

00:13:56.840 --> 00:13:59.176
But where the blanks are in medicine

00:13:59.200 --> 00:14:00.520
does matter in your life.

00:14:02.320 --> 00:14:04.616
I didn't tell you one dirty little secret.

00:14:04.640 --> 00:14:09.016
I told you that in medicine,
we test predictions in populations,

00:14:09.040 --> 00:14:10.296
but I didn't tell you,

00:14:10.320 --> 00:14:12.536
and so often medicine never tells you

00:14:12.560 --> 00:14:15.416
that every time an individual

00:14:15.440 --> 00:14:17.536
encounters medicine,

00:14:17.560 --> 00:14:21.600
even if that individual is firmly
embedded in the general population,

00:14:24.160 --> 00:14:26.536
neither the individual
nor the physician knows

00:14:26.560 --> 00:14:29.240
where in that population
the individual will land.

00:14:29.840 --> 00:14:32.536
Therefore, every encounter with medicine

00:14:32.560 --> 00:14:34.000
is an experiment.

00:14:34.720 --> 00:14:36.736
You will be a subject

00:14:36.760 --> 00:14:38.440
in an experiment.

00:14:39.470 --> 00:14:44.310
And the outcome will be either
a better or a worse result for you.

00:14:45.720 --> 00:14:47.736
As long as medicine works well,

00:14:47.760 --> 00:14:50.776
we're fine with fast service,

00:14:50.800 --> 00:14:54.240
bravado, brimmingly
confident conversations.

00:14:55.120 --> 00:14:56.776
But when things don't work well,

00:14:56.800 --> 00:14:58.640
sometimes we want something different.

00:14:59.920 --> 00:15:03.200
A colleague of mine
removed a tumor from a patient's limb.

00:15:04.320 --> 00:15:06.136
He was concerned about this tumor.

00:15:06.160 --> 00:15:09.176
In our physician conferences,
he talked about his concern

00:15:09.200 --> 00:15:10.616
that this was a type of tumor

00:15:10.640 --> 00:15:13.200
that had a high risk
for coming back in the same limb.

00:15:14.080 --> 00:15:16.056
But his conversations with the patient

00:15:16.080 --> 00:15:18.176
were exactly what a patient might want:

00:15:18.200 --> 00:15:19.456
brimming with confidence.

00:15:19.480 --> 00:15:22.496
He said, "I got it all
and you're good to go."

00:15:22.520 --> 00:15:24.256
She and her husband were thrilled.

00:15:24.280 --> 00:15:28.360
They went out, celebrated, fancy dinner,
opened a bottle of champagne.

00:15:29.440 --> 00:15:31.736
The only problem was a few weeks later,

00:15:31.760 --> 00:15:34.856
she started to notice
another nodule in the same area.

00:15:34.880 --> 00:15:39.016
It turned out he hadn't gotten it all,
and she wasn't good to go.

00:15:40.340 --> 00:15:43.180
But what happened at this juncture
absolutely fascinates me.

00:15:43.900 --> 00:15:45.516
My colleague came to me and said,

00:15:45.540 --> 00:15:48.260
"Kevin, would you mind
looking after this patient for me?"

00:15:48.940 --> 00:15:52.156
I said, "Why, you know the right thing
to do as well as I do.

00:15:52.180 --> 00:15:53.796
You haven't done anything wrong."

00:15:53.820 --> 00:15:58.300
He said, "Please, just look
after this patient for me."

00:15:59.900 --> 00:16:01.436
He was embarrassed...

00:16:01.460 --> 00:16:02.860
Not by what he had done,

00:16:03.854 --> 00:16:05.780
but by the conversation that he had had,

00:16:06.460 --> 00:16:07.900
by the overconfidence.

00:16:09.300 --> 00:16:11.916
So I performed
a much more invasive surgery

00:16:11.940 --> 00:16:15.076
and had a very different conversation
with the patient afterwards.

00:16:15.100 --> 00:16:17.436
I said, "Most likely I've gotten it all

00:16:17.460 --> 00:16:19.876
and you're most likely good to go,

00:16:19.900 --> 00:16:23.060
but this is the experiment
that we're doing.

00:16:23.740 --> 00:16:25.756
This is what you're going to watch for.

00:16:25.780 --> 00:16:27.676
This is what I'm going to watch for.

00:16:27.700 --> 00:16:31.636
And we're going to work together
to find out if this surgery will work

00:16:31.660 --> 00:16:32.980
to get rid of your cancer."

00:16:33.620 --> 00:16:35.556
I can guarantee you, she and her husband

00:16:35.580 --> 00:16:38.500
did not crack another bottle of champagne
after talking to me.

00:16:40.300 --> 00:16:43.156
But she was now a scientist,

00:16:43.180 --> 00:16:46.540
not only a subject in her experiment.

00:16:48.660 --> 00:16:50.276
And so I encourage you

00:16:50.300 --> 00:16:53.756
to seek humility and curiosity

00:16:53.780 --> 00:16:54.980
in your physicians.

00:16:56.860 --> 00:16:59.836
Almost 20 billion times each year,

00:16:59.860 --> 00:17:03.796
a person walks into a doctor's office,

00:17:03.820 --> 00:17:06.099
and that person becomes a patient.

00:17:07.420 --> 00:17:10.940
You or someone you love
will be that patient sometime very soon.

00:17:11.940 --> 00:17:13.579
How will you talk to your doctors?

00:17:14.740 --> 00:17:15.940
What will you tell them?

00:17:16.859 --> 00:17:18.380
What will they tell you?

00:17:20.700 --> 00:17:22.915
They cannot tell you

00:17:22.940 --> 00:17:24.460
what they do not know,

00:17:25.660 --> 00:17:29.220
but they can tell you when they don't know

00:17:30.380 --> 00:17:31.740
if only you'll ask.

00:17:32.260 --> 00:17:35.100
So please, join the conversation.

00:17:36.300 --> 00:17:37.516
Thank you.

00:17:37.540 --> 00:17:40.408
(Applause)