Health care should be a team sport
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0:01 - 0:05I want to share some personal friends and stories with you
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0:05 - 0:07that I've actually never talked about in public before
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0:07 - 0:10to help illustrate the idea
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0:10 - 0:12and the need and the hope
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0:12 - 0:15for us to reinvent our health care system around the world.
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0:15 - 0:18Twenty-four years ago, I had -- a sophomore in college,
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0:18 - 0:21I had a series of fainting spells. No alcohol was involved.
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0:21 - 0:24And I ended up in student health,
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0:24 - 0:26and they ran some labwork and came back right away,
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0:26 - 0:28and said, "Kidney problems."
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0:28 - 0:32And before I knew it, I was involved and thrown into
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0:32 - 0:35this six months of tests and trials and tribulations
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0:35 - 0:38with six doctors across two hospitals
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0:38 - 0:40in this clash of medical titans
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0:40 - 0:42to figure out which one of them was right
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0:42 - 0:45about what was wrong with me.
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0:45 - 0:48And I'm sitting in a waiting room some time later for an ultrasound,
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0:48 - 0:51and all six of these doctors actually show up in the room at once,
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0:51 - 0:55and I'm like, "Uh oh, this is bad news."
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0:55 - 0:57And their diagnosis was this:
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0:57 - 0:59They said, "You have two rare kidney diseases
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0:59 - 1:01that are going to actually destroy your kidneys eventually,
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1:01 - 1:04you have cancer-like cells in your immune system
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1:04 - 1:06that we need to start treatment right away,
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1:06 - 1:08and you'll never be eligible for a kidney transplant,
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1:08 - 1:12and you're not likely to live more than two or three years."
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1:12 - 1:15Now, with the gravity of this doomsday diagnosis,
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1:15 - 1:17it just sucked me in immediately,
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1:17 - 1:20as if I began preparing myself as a patient
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1:20 - 1:24to die according to the schedule that they had just given to me,
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1:24 - 1:27until I met a patient named Verna in a waiting room,
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1:27 - 1:29who became a dear friend, and she grabbed me one day
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1:29 - 1:31and took me off to the medical library
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1:31 - 1:33and did a bunch of research on these diagnoses and these diseases,
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1:33 - 1:36and said, "Eric, these people who get this
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1:36 - 1:38are normally in their '70s and '80s.
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1:38 - 1:41They don't know anything about you. Wake up.
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1:41 - 1:44Take control of your health and get on with your life."
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1:44 - 1:46And I did.
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1:46 - 1:48Now, these people making these proclamations to me
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1:48 - 1:49were not bad people.
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1:49 - 1:52In fact, these professionals were miracle workers,
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1:52 - 1:56but they're working in a flawed, expensive system that's set up the wrong way.
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1:56 - 1:59It's dependent on hospitals and clinics for our every care need.
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1:59 - 2:03It's dependent on specialists who just look at parts of us.
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2:03 - 2:07It's dependent on guesswork of diagnoses and drug cocktails,
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2:07 - 2:09and so something either works or you die.
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2:09 - 2:14And it's dependent on passive patients
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2:14 - 2:17who just take it and don't ask any questions.
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2:17 - 2:19Now the problem with this model
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2:19 - 2:22is that it's unsustainable globally.
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2:22 - 2:23It's unaffordable globally.
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2:23 - 2:27We need to invent what I call a personal health system.
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2:27 - 2:29So what does this personal health system look like,
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2:29 - 2:34and what new technologies and roles is it going to entail?
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2:34 - 2:36Now, I'm going to start by actually sharing with you
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2:36 - 2:38a new friend of mine, Libby,
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2:38 - 2:41somebody I've become quite attached to over the last six months.
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2:41 - 2:45This is Libby, or actually, this is an ultrasound image of Libby.
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2:45 - 2:48This is the kidney transplant I was never supposed to have.
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2:48 - 2:52Now, this is an image that we shot a couple of weeks ago for today,
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2:52 - 2:54and you'll notice, on the edge of this image,
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2:54 - 2:57there's some dark spots there, which was really concerning to me.
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2:57 - 2:59So we're going to actually do a live exam
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2:59 - 3:00to sort of see how Libby's doing.
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3:00 - 3:03This is not a wardrobe malfunction. I have to take my belt off here.
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3:03 - 3:05Don't you in the front row worry or anything.
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3:05 - 3:07(Laughter)
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3:07 - 3:10I'm going to use a device from a company called Mobisante.
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3:10 - 3:12This is a portable ultrasound.
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3:12 - 3:14It can plug into a smartphone. It can plug into a tablet.
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3:14 - 3:16Mobisante is up in Redmond, Washington,
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3:16 - 3:20and they kindly trained me to actually do this on myself.
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3:20 - 3:22They're not approved to do this. Patients are not approved to do this.
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3:22 - 3:25This is a concept demo, so I want to make that clear.
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3:25 - 3:26All right, I gotta gel up.
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3:26 - 3:31Now the people in the front row are very nervous. (Laughter)
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3:31 - 3:35And I want to actually introduce you to Dr. Batiuk,
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3:35 - 3:36who's another friend of mine.
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3:36 - 3:40He's up in Legacy Good Samaritan Hospital in Portland, Oregon.
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3:40 - 3:44So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay?
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3:44 - 3:46And actually, can you see Libby?
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3:46 - 3:47Thomas Batuik: Hi there, Eric.
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3:47 - 3:48You look busy. How are you?
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3:48 - 3:51Eric Dishman: I'm good. I'm just taking my clothes off
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3:51 - 3:53in front of a few hundred people. It's wonderful.
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3:53 - 3:58So I just wanted to see, is this the image you need to get?
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3:58 - 4:02And I know you want to look and see if those spots are still there.
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4:02 - 4:05TB: Okay. Well let's scan around a little bit here,
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4:05 - 4:06give me a lay of the land.
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4:06 - 4:09ED: All right.TB: Okay. Turn it a little bit inside,
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4:09 - 4:12a little bit toward the middle for me.
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4:12 - 4:17Okay, that's good. How about up a little bit?
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4:17 - 4:20Okay, freeze that image. That's a good one for me.
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4:20 - 4:22ED: All right. Now last week, when I did this,
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4:22 - 4:25you had me measure that spot to the right.
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4:25 - 4:27Should I do that again?
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4:27 - 4:28TB: Yeah, let's do that.
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4:28 - 4:31ED: All right. This is kind of hard to do
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4:31 - 4:33with one hand on your belly and one hand on measuring,
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4:33 - 4:35but I've got it, I think,
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4:35 - 4:37and I'll save that image and send it to you.
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4:37 - 4:40So tell me a little bit about what this dark spot means.
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4:40 - 4:42It's not something I was very happy about.
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4:42 - 4:44TB: Many people after a kidney transplant
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4:44 - 4:47will develop a little fluid collection around the kidney.
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4:47 - 4:50Most of the time it doesn't create any kind of mischief,
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4:50 - 4:53but it does warrant looking at,
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4:53 - 4:56so I'm happy we've got an opportunity to look at it today,
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4:56 - 4:58make sure that it's not growing, it's not creating any problems.
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4:58 - 5:01Based on the other images we have,
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5:01 - 5:03I'm really happy how it looks today.
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5:03 - 5:05ED: All right. Well, I guess we'll double check it when I come in.
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5:05 - 5:08I've got my six month biopsy in a couple of weeks,
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5:08 - 5:10and I'm going to let you do that in the clinic,
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5:10 - 5:12because I don't think I can do that one on myself.
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5:12 - 5:15TB: Good choice.ED: All right, thanks, Dr. Batiuk.
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5:15 - 5:17All right. So what you're sort of seeing here
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5:17 - 5:19is an example of disruptive technologies,
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5:19 - 5:22of mobile, social and analytic technologies.
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5:22 - 5:25These are the foundations of what's going to make personal health possible.
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5:25 - 5:28Now there's really three pillars
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5:28 - 5:30of this personal health I want to talk to you about now,
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5:30 - 5:33and it's care anywhere, care networking and care customization.
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5:33 - 5:35And you just saw a little bit of the first two
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5:35 - 5:37with my interaction with Dr. Batiuk.
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5:37 - 5:40So let's start with care anywhere.
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5:40 - 5:42Humans invented the idea of hospitals and clinics
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5:42 - 5:46in the 1780s. It is time to update our thinking.
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5:46 - 5:50We have got to untether clinicians and patients
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5:50 - 5:52from the notion of traveling to a special
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5:52 - 5:55bricks-and-mortar place for all of our care,
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5:55 - 5:57because these places are often the wrong tool,
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5:57 - 6:00and the most expensive tool, for the job.
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6:00 - 6:03And these are sometimes unsafe places to send our sickest patients,
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6:03 - 6:05especially in an era of superbugs
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6:05 - 6:07and hospital-acquired infections.
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6:07 - 6:10And many countries are going to go brickless from the start
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6:10 - 6:12because they're never going to be able to afford
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6:12 - 6:17the mega-medicalplexes that a lot of the rest of the world has built.
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6:17 - 6:20Now I personally learned that hospitals
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6:20 - 6:22can be a very dangerous place at a young age.
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6:22 - 6:24This was me in third grade.
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6:24 - 6:26I broke my elbow very seriously, had to have surgery,
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6:26 - 6:29worried that they were going to actually lose the arm.
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6:29 - 6:32Recovering from the surgery in the hospital, I get bedsores.
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6:32 - 6:34Those bedsores become infected,
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6:34 - 6:37and they give me an antibiotic which I end up being allergic to,
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6:37 - 6:39and now my whole body breaks out,
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6:39 - 6:41and now all of those become infected.
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6:41 - 6:44The longer I stayed in the hospital, the sicker I became,
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6:44 - 6:45and the more expensive it became,
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6:45 - 6:49and this happens to millions of people around the world every year.
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6:49 - 6:51The future of personal health that I'm talking about
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6:51 - 6:56says care must occur at home as the default model,
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6:56 - 6:57not in a hospital or clinic.
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6:57 - 6:59You have to earn your way into those places
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6:59 - 7:02by being sick enough to use that tool for the job.
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7:02 - 7:04Now the smartphones that we're already carrying
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7:04 - 7:08can clearly have diagnostic devices like ultrasounds plugged into them,
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7:08 - 7:10and a whole array of others, today,
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7:10 - 7:12and as sensing is built into these,
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7:12 - 7:14we'll be able to do vital signs monitor
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7:14 - 7:17and behavioral monitoring like we've never had before.
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7:17 - 7:19Many of us will have implantables that will actually look
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7:19 - 7:22real-time at what's going on with our blood chemistry
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7:22 - 7:24and in our proteins right now.
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7:24 - 7:27Now the software is also getting smarter, right?
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7:27 - 7:30Think about a coach, an agent online,
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7:30 - 7:32that's going to help me do safe self-care.
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7:32 - 7:34That same interaction that we just did with the ultrasound
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7:34 - 7:37will likely have real-time image processing,
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7:37 - 7:39and the device will say, "Up, down, left, right,
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7:39 - 7:41ah, Eric, that's the perfect spot to send that image
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7:41 - 7:43off to your doctor."
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7:43 - 7:45Now, if we've got all these networked devices
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7:45 - 7:48that are helping us to do care anywhere,
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7:48 - 7:50it stands to reason that we also need a team
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7:50 - 7:52to be able to interact with all of that stuff,
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7:52 - 7:54and that leads to the second pillar I want to talk about,
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7:54 - 7:56care networking.
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7:56 - 7:59We have got to go beyond this paradigm
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7:59 - 8:03of isolated specialists doing parts care
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8:03 - 8:07to multidisciplinary teams doing person care.
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8:07 - 8:10Uncoordinated care today is expensive at best,
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8:10 - 8:12and it is deadly at worst.
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8:12 - 8:15Eighty percent of medical errors are actually caused
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8:15 - 8:17by communication and coordination problems
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8:17 - 8:19amongst medical team members.
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8:19 - 8:21I had my own heart scare years ago in graduate school,
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8:21 - 8:23when we're under treatment for the kidney,
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8:23 - 8:26and suddenly, they're like, "Oh, we think you have a heart problem."
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8:26 - 8:28And I have these palpitations that are showing up.
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8:28 - 8:30They put me through five weeks of tests --
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8:30 - 8:34very expensive, very scary -- before the nurse finally notices
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8:34 - 8:36the piece of the paper, my meds list
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8:36 - 8:37that I've been carrying to every single appointment,
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8:37 - 8:40and says, "Oh my gosh."
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8:40 - 8:42Three different specialists had prescribed
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8:42 - 8:44three different versions of the same drug to me.
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8:44 - 8:48I did not have a heart problem. I had an overdose problem.
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8:48 - 8:51I had a care coordination problem.
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8:51 - 8:53And this happens to millions of people every year.
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8:53 - 8:57I want to use technology that we're all working on and making happen
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8:57 - 9:01to make health care a coordinated team sport.
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9:01 - 9:03Now this is the most frightening thing to me.
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9:03 - 9:07Out of all the care I've had in hospitals and clinics around the world,
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9:07 - 9:11the first time I've ever had a true team-based care experience
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9:11 - 9:13was at Legacy Good Sam these last six months
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9:13 - 9:15for me to go get this.
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9:15 - 9:18And this is a picture of my graduation team from Legacy.
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9:18 - 9:20There's a couple of the folks here. You'll recognize Dr. Batiuk.
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9:20 - 9:23We just talked to him. Here's Jenny, one of the nurses,
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9:23 - 9:25Allison, who helped manage the transplant list,
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9:25 - 9:27and a dozen other people who aren't pictured,
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9:27 - 9:30a pharmacist, a psychologist, a nutritionist,
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9:30 - 9:32even a financial counselor, Lisa,
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9:32 - 9:35who helped us deal with all the insurance hassles.
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9:35 - 9:37I wept the day I graduated.
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9:37 - 9:39I should have been happy, because I was so well
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9:39 - 9:40that I could go back to my normal doctors,
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9:40 - 9:44but I wept because I was so actually connected to this team.
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9:44 - 9:45And here's the most important part.
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9:45 - 9:48The other people in this picture are me and my wife, Ashley.
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9:48 - 9:53Legacy trained us on how to do care for me at home
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9:53 - 9:55so that they could offload the hospitals and clinics.
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9:55 - 9:58That's the only way that the model works.
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9:58 - 10:00My team is actually working in China
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10:00 - 10:01on one of these self-care models
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10:01 - 10:04for a project we called Age-Friendly Cities.
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10:04 - 10:05We're trying to help build a social network
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10:05 - 10:08that can help track and train the care of seniors
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10:08 - 10:09caring for themselves
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10:09 - 10:12as well as the care provided by their family members
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10:12 - 10:14or volunteer community health workers,
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10:14 - 10:17as well as have an exchange network online,
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10:17 - 10:20where, for example, I can donate three hours of care a day to your mom,
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10:20 - 10:23if somebody else can help me with transportation to meals,
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10:23 - 10:25and we exchange all of that online.
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10:25 - 10:28The most important point I want to make to you about this
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10:28 - 10:31is the sacred and somewhat over-romanticized
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10:31 - 10:34doctor-patient one-on-one
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10:34 - 10:36is a relic of the past.
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10:36 - 10:38The future of health care is smart teams,
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10:38 - 10:42and you'd better be on that team for yourself.
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10:42 - 10:44Now, the last thing that I want to talk to you about
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10:44 - 10:46is care customization,
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10:46 - 10:48because if you've got care anywhere and you've got care networking,
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10:48 - 10:51those are going to go a long way towards improving our health care system,
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10:51 - 10:54but there's still too much guesswork.
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10:54 - 10:58Randomized clinical trials were actually invented in 1948
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10:58 - 11:02to help invent the drugs that cured tuberculosis,
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11:02 - 11:04and those are important things, don't get me wrong.
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11:04 - 11:06These population studies that we've done have created
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11:06 - 11:09tons of miracle drugs that have saved millions of lives,
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11:09 - 11:11but the problem is that health care
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11:11 - 11:15is treating us as averages, not unique individuals,
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11:15 - 11:17because at the end of the day,
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11:17 - 11:20the patient is not the same thing as the population
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11:20 - 11:23who are studied. That's what's leading to the guesswork.
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11:23 - 11:25The technologies that are coming,
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11:25 - 11:27high-performance computing, analytics,
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11:27 - 11:29big data that everyone's talking about,
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11:29 - 11:32will allow us to build predictive models for each of us
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11:32 - 11:34as individual patients.
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11:34 - 11:38And the magic here is, experiment on my avatar
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11:38 - 11:43in software, not my body in suffering.
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11:43 - 11:46Now, I've had two examples I want to quickly share with you
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11:46 - 11:48of this kind of care customization on my own journey.
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11:48 - 11:51The first was quite simple. I finally realized some years ago
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11:51 - 11:55that all my medical teams were optimizing my treatment for longevity.
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11:55 - 11:58It's like a badge of honor to see how long they can get the patient to live.
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11:58 - 12:01I was optimizing my life for quality of life,
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12:01 - 12:05and quality of life for me means time in snow.
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12:05 - 12:08So on my chart, I forced them to put, "Patient goal:
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12:08 - 12:12low doses of drugs over longer periods of time,
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12:12 - 12:15side effects friendly to skiing."
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12:15 - 12:18And I think that's why I achieved longevity.
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12:18 - 12:20I think that time-in-snow therapy was as important
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12:20 - 12:22as the pharmaceuticals that I had.
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12:22 - 12:25Now the second example of customization -- and by the way,
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12:25 - 12:26you can't customize care if you don't know your own goals,
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12:26 - 12:30so health care can't know those until you know your own health care goals.
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12:30 - 12:32But the second example I want to give you is,
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12:32 - 12:33I happened to be an early guinea pig,
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12:33 - 12:37and I got very lucky to have my whole genome sequenced.
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12:37 - 12:39Now it took about two weeks of processing
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12:39 - 12:41on Intel's highest-end servers to make this happen,
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12:41 - 12:44and another six months of human and computing labor
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12:44 - 12:47to make sense of all of that data.
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12:47 - 12:50And at the end of all of that, they said, "Yes,
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12:50 - 12:52those diagnoses of that clash of medical titans
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12:52 - 12:55all of those years ago were wrong,
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12:55 - 12:57and we have a better path forward."
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12:57 - 13:00The future that Intel's working on now is to figure out
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13:00 - 13:02how to make that computing for personalized medicine
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13:02 - 13:05go from months and weeks to even hours,
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13:05 - 13:07and make this kind of tool available,
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13:07 - 13:11not just in the mainframes of tier-one research hospitals around the world,
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13:11 - 13:14but in the mainstream -- every patient, every clinic
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13:14 - 13:16with access to whole genome sequencing.
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13:16 - 13:18And I tell you, this kind of care customization
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13:18 - 13:21for everything from your goals to your genetics
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13:21 - 13:23will be the most game-changing transformation
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13:23 - 13:26that we witness in health care during our lifetime.
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13:26 - 13:29So these three pillars of personal health,
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13:29 - 13:32care anywhere, care networking, care customization,
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13:32 - 13:33are happening in pieces now,
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13:33 - 13:37but this vision will completely fail if we don't step up
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13:37 - 13:41as caregivers and as patients to take on new roles.
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13:41 - 13:43It's what my friend Verna said:
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13:43 - 13:45Wake up and take control of your health.
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13:45 - 13:47Because at the end of the day these technologies
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13:47 - 13:51are simply about people caring for other people
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13:51 - 13:54and ourselves in some powerful new ways.
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13:54 - 13:55And it's in that spirit that I want to introduce you
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13:55 - 13:58to one last friend, very quickly.
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13:58 - 14:02Tracey Gamley stepped up to give me the impossible kidney
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14:02 - 14:07that I was never supposed to have.
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14:07 - 14:22(Applause)
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14:23 - 14:27So Tracey, just tell us a little bit quickly about what the donor experience was like with you.
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14:27 - 14:29Tracey Gamley: For me, it was really easy.
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14:29 - 14:31I only had one night in the hospital.
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14:31 - 14:33The surgery was done laparoscopically,
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14:33 - 14:36so I have just five very small scars on my abdomen,
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14:36 - 14:38and I had four weeks away from work
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14:38 - 14:40and went back to doing everything I'd done before
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14:40 - 14:42without any changes.
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14:42 - 14:45ED: Well, I probably will never get a chance to say this to you
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14:45 - 14:47in such a large audience ever again.
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14:47 - 14:50So "thank you" feel likes a really trite word,
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14:50 - 14:52but thank you from the bottom of my heart for saving my life.
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14:52 - 14:58(Applause)
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14:58 - 15:01This TED stage and all of the TED stages
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15:01 - 15:03are often about celebrating innovation
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15:03 - 15:04and celebrating new technologies,
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15:04 - 15:07and I've done that here today,
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15:07 - 15:09and I've seen amazing things coming from TED speakers,
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15:09 - 15:13I mean, my gosh, artificial kidneys, even printable kidneys, that are coming.
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15:13 - 15:16But until such time that these amazing technologies
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15:16 - 15:19are available to all of us, and even when they are,
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15:19 - 15:24it's up to us to care for, and even save, one another.
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15:24 - 15:26I hope you will go out and make personal health happen
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15:26 - 15:30for yourselves and for everyone. Thanks so much.
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15:30 - 15:35(Applause)
- Title:
- Health care should be a team sport
- Speaker:
- Eric Dishman
- Description:
-
When Eric Dishman was in college, doctors told him he had 2 to 3 years to live. That was a long time ago. One rectified diagnosis and a transplant later, Dishman puts his personal experience and his expertise as a leading medical tech specialist together to suggest some bold ideas for reinventing healthcare -- by putting the patient at the center of a treatment team. (Filmed at TED@Intel)
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 15:59
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