下載App 希平方
攻其不背
App 開放下載中
下載App 希平方
攻其不背
App 開放下載中
IE版本不足
您的瀏覽器停止支援了😢使用最新 Edge 瀏覽器或點選連結下載 Google Chrome 瀏覽器 前往下載

免費註冊
! 這組帳號已經註冊過了
Email 帳號
密碼請填入 6 位數以上密碼
已經有帳號了?
忘記密碼
! 這組帳號已經註冊過了
您的 Email
請輸入您註冊時填寫的 Email,
我們將會寄送設定新密碼的連結給您。
寄信了!請到信箱打開密碼連結信
密碼信已寄至
沒有收到信嗎?
如果您尚未收到信,請前往垃圾郵件查看,謝謝!

恭喜您註冊成功!

查看會員功能

註冊未完成

《HOPE English 希平方》服務條款關於個人資料收集與使用之規定

隱私權政策
上次更新日期:2014-12-30

希平方 為一英文學習平台,我們每天固定上傳優質且豐富的影片內容,讓您不但能以有趣的方式學習英文,還能增加內涵,豐富知識。我們非常注重您的隱私,以下說明為當您使用我們平台時,我們如何收集、使用、揭露、轉移及儲存你的資料。請您花一些時間熟讀我們的隱私權做法,我們歡迎您的任何疑問或意見,提供我們將產品、服務、內容、廣告做得更好。

本政策涵蓋的內容包括:希平方學英文 如何處理蒐集或收到的個人資料。
本隱私權保護政策只適用於: 希平方學英文 平台,不適用於非 希平方學英文 平台所有或控制的公司,也不適用於非 希平方學英文 僱用或管理之人。

個人資料的收集與使用
當您註冊 希平方學英文 平台時,我們會詢問您姓名、電子郵件、出生日期、職位、行業及個人興趣等資料。在您註冊完 希平方學英文 帳號並登入我們的服務後,我們就能辨認您的身分,讓您使用更完整的服務,或參加相關宣傳、優惠及贈獎活動。希平方學英文 也可能從商業夥伴或其他公司處取得您的個人資料,並將這些資料與 希平方學英文 所擁有的您的個人資料相結合。

我們所收集的個人資料, 將用於通知您有關 希平方學英文 最新產品公告、軟體更新,以及即將發生的事件,也可用以協助改進我們的服務。

我們也可能使用個人資料為內部用途。例如:稽核、資料分析、研究等,以改進 希平方公司 產品、服務及客戶溝通。

瀏覽資料的收集與使用
希平方學英文 自動接收並記錄您電腦和瀏覽器上的資料,包括 IP 位址、希平方學英文 cookie 中的資料、軟體和硬體屬性以及您瀏覽的網頁紀錄。

隱私權政策修訂
我們會不定時修正與變更《隱私權政策》,不會在未經您明確同意的情況下,縮減本《隱私權政策》賦予您的權利。隱私權政策變更時一律會在本頁發佈;如果屬於重大變更,我們會提供更明顯的通知 (包括某些服務會以電子郵件通知隱私權政策的變更)。我們還會將本《隱私權政策》的舊版加以封存,方便您回顧。

服務條款
歡迎您加入看 ”希平方學英文”
上次更新日期:2013-09-09

歡迎您加入看 ”希平方學英文”
感謝您使用我們的產品和服務(以下簡稱「本服務」),本服務是由 希平方學英文 所提供。
本服務條款訂立的目的,是為了保護會員以及所有使用者(以下稱會員)的權益,並構成會員與本服務提供者之間的契約,在使用者完成註冊手續前,應詳細閱讀本服務條款之全部條文,一旦您按下「註冊」按鈕,即表示您已知悉、並完全同意本服務條款的所有約定。如您是法律上之無行為能力人或限制行為能力人(如未滿二十歲之未成年人),則您在加入會員前,請將本服務條款交由您的法定代理人(如父母、輔助人或監護人)閱讀,並得到其同意,您才可註冊及使用 希平方學英文 所提供之會員服務。當您開始使用 希平方學英文 所提供之會員服務時,則表示您的法定代理人(如父母、輔助人或監護人)已經閱讀、了解並同意本服務條款。 我們可能會修改本條款或適用於本服務之任何額外條款,以(例如)反映法律之變更或本服務之變動。您應定期查閱本條款內容。這些條款如有修訂,我們會在本網頁發佈通知。變更不會回溯適用,並將於公布變更起十四天或更長時間後方始生效。不過,針對本服務新功能的變更,或基於法律理由而為之變更,將立即生效。如果您不同意本服務之修訂條款,則請停止使用該本服務。

第三人網站的連結 本服務或協力廠商可能會提供連結至其他網站或網路資源的連結。您可能會因此連結至其他業者經營的網站,但不表示希平方學英文與該等業者有任何關係。其他業者經營的網站均由各該業者自行負責,不屬希平方學英文控制及負責範圍之內。

兒童及青少年之保護 兒童及青少年上網已經成為無可避免之趨勢,使用網際網路獲取知識更可以培養子女的成熟度與競爭能力。然而網路上的確存有不適宜兒童及青少年接受的訊息,例如色情與暴力的訊息,兒童及青少年有可能因此受到心靈與肉體上的傷害。因此,為確保兒童及青少年使用網路的安全,並避免隱私權受到侵犯,家長(或監護人)應先檢閱各該網站是否有保護個人資料的「隱私權政策」,再決定是否同意提出相關的個人資料;並應持續叮嚀兒童及青少年不可洩漏自己或家人的任何資料(包括姓名、地址、電話、電子郵件信箱、照片、信用卡號等)給任何人。

為了維護 希平方學英文 網站安全,我們需要您的協助:

您承諾絕不為任何非法目的或以任何非法方式使用本服務,並承諾遵守中華民國相關法規及一切使用網際網路之國際慣例。您若係中華民國以外之使用者,並同意遵守所屬國家或地域之法令。您同意並保證不得利用本服務從事侵害他人權益或違法之行為,包括但不限於:
A. 侵害他人名譽、隱私權、營業秘密、商標權、著作權、專利權、其他智慧財產權及其他權利;
B. 違反依法律或契約所應負之保密義務;
C. 冒用他人名義使用本服務;
D. 上載、張貼、傳輸或散佈任何含有電腦病毒或任何對電腦軟、硬體產生中斷、破壞或限制功能之程式碼之資料;
E. 干擾或中斷本服務或伺服器或連結本服務之網路,或不遵守連結至本服務之相關需求、程序、政策或規則等,包括但不限於:使用任何設備、軟體或刻意規避看 希平方學英文 - 看 YouTube 學英文 之排除自動搜尋之標頭 (robot exclusion headers);

服務中斷或暫停
本公司將以合理之方式及技術,維護會員服務之正常運作,但有時仍會有無法預期的因素導致服務中斷或故障等現象,可能將造成您使用上的不便、資料喪失、錯誤、遭人篡改或其他經濟上損失等情形。建議您於使用本服務時宜自行採取防護措施。 希平方學英文 對於您因使用(或無法使用)本服務而造成的損害,除故意或重大過失外,不負任何賠償責任。

版權宣告
上次更新日期:2013-09-16

希平方學英文 內所有資料之著作權、所有權與智慧財產權,包括翻譯內容、程式與軟體均為 希平方學英文 所有,須經希平方學英文同意合法才得以使用。
希平方學英文歡迎你分享網站連結、單字、片語、佳句,使用時須標明出處,並遵守下列原則:

  • 禁止用於獲取個人或團體利益,或從事未經 希平方學英文 事前授權的商業行為
  • 禁止用於政黨或政治宣傳,或暗示有支持某位候選人
  • 禁止用於非希平方學英文認可的產品或政策建議
  • 禁止公佈或傳送任何誹謗、侮辱、具威脅性、攻擊性、不雅、猥褻、不實、色情、暴力、違反公共秩序或善良風俗或其他不法之文字、圖片或任何形式的檔案
  • 禁止侵害或毀損希平方學英文或他人名譽、隱私權、營業秘密、商標權、著作權、專利權、其他智慧財產權及其他權利、違反法律或契約所應付支保密義務
  • 嚴禁謊稱希平方學英文辦公室、職員、代理人或發言人的言論背書,或作為募款的用途

網站連結
歡迎您分享 希平方學英文 網站連結,與您的朋友一起學習英文。

抱歉傳送失敗!

不明原因問題造成傳送失敗,請儘速與我們聯繫!
希平方 x ICRT

「Timothy Ihrig:讓人生的最後走得舒適」- What We Can Do to Die Well

觀看次數:1837  • 

框選或點兩下字幕可以直接查字典喔!

I am a palliative care physician and I would like to talk to you today about health care. I'd like to talk to you about the health and care of the most vulnerable population in our country—those people dealing with the most complex serious health issues. I'd like to talk to you about economics as well. And the intersection of these two should scare the hell out of you—it scares the hell out of me.

I'd also like to talk to you about palliative medicine: a paradigm of care for this population, grounded in what they value. Patient-centric care based on their values that helps this population live better and longer. It's a care model that tells the truth and engages one-on-one and meets people where they're at.

I'd like to start by telling the story of my very first patient. It was my first day as a physician, with the long white coat... And I stumbled into the hospital and right away there's a gentleman, Harold, 68 years old, came to the emergency department. He had had headaches for about six weeks that got worse and worse and worse and worse. Evaluation revealed he had cancer that had spread to his brain. The attending physician directed me to go share with Harold and his family the diagnosis, the prognosis and options of care.

Being five hours into my new career, I did the only thing I knew how. I walked in, sat down, took Harold's hand, took his wife's hand and just breathed. He said, "It's not good news is it, sonny?" I said, "No." And so we talked and we listened and we shared. And after a while I said, "Harold, what is it that has meaning to you? What is it that you hold sacred?" And he said, "My family." I said, "What do you want to do?" He slapped me on the knee and said, "I want to go fishing." I said, "That, I know how to do."

Harold went fishing the next day. He died a week later.

As I've gone through my training in my career, I think back to Harold. And I think that this is a conversation that happens far too infrequently. And it's a conversation that had led us to crisis, to the biggest threat to the American way of life today, which is health care expenditures.

So what do we know? We know that this population, the most ill, takes up 15 percent of the gross domestic product—nearly 2.3 trillion dollars. So the sickest 15 percent take up 15 percent of the GDP. If we extrapolate this out over the next two decades with the growth of baby boomers, at this rate, it is 60 percent of the GDP. Sixty percent of the gross domestic product of the United States of America—it has very little to do with health care at that point. It has to do with a gallon of milk, with college tuition. It has to do with everything that we value and everything that we know presently. It has at stake the free-market economy and capitalism of the United States of America.

Let's forget all the statistics for a minute, forget the numbers. Let's talk about the value we get for all these dollars we spend. Well, the Dartmouth Atlas, about six years ago, looked at every dollar spent by Medicare—generally this population. We found that those patients who have the highest per capita expenditures had the highest suffering, pain, depression. And, more often than not, they die sooner.

How can this be? We live in the United States, it has the greatest health care system on the planet. We spend 10 times more on these patients than the second-leading country in the world. That doesn't make sense. But what we know is, out of the top 50 countries on the planet with organized health care systems, we rank 37th. Former Eastern Bloc countries and sub-Saharan African countries rank higher than us as far as quality and value.

Something I experience every day in my practice, and I'm sure, something many of you on your own journeys have experienced: more is not more. Those individuals who had more tests, more bells, more whistles, more chemotherapy, more surgery, more whatever—the more that we do to someone, it decreases the quality of their life. And it shortens it, most often.

So what are we going to do about this? What are we doing about this? And why is this so? You know, the grim reality, ladies and gentlemen, is that we, the health care industry—long white-coat physicians—are stealing from you. Stealing from you the opportunity to choose how you want to live your lives in the context of whatever disease it is. We focus on disease and pathology and surgery and pharmacology. We miss the human being. How can we treat this without understanding this? We do things to this; we need to do things for this.

The triple aim of healthcare: one, improve patient experience. Two, improve the population health. Three, decrease per capita expenditure across a continuum. Our group, palliative care, in 2012, working with the sickest of the sick—cancer, heart disease, lung disease, renal disease, dementia—how did we improve patient experience?

"I want to be at home, Doc."
"Okay, we'll bring the care to you."

Quality of life, enhanced. Think about the human being.

Two: population health. How did we look at this population differently, and engage with them at a different level, a deeper level, and connect to a broader sense of the human condition than my own? How do we manage this group, so that of our outpatient population, 94 percent, in 2012, never had to go to the hospital? Not because they couldn't. But they didn't have to. We brought the care to them. We maintained their value, their quality.

Number three: per capita expenditures. For this population, that today is 2.3 trillion dollars, and in 20 years is 60 percent of the GDP, we reduced health care expenditures by nearly 70 percent. They got more of what they wanted based on their values, lived better and are living longer, for two-thirds less money.

While Harold's time was limited, palliative care's is not. Palliative care is a paradigm from diagnosis through the end of life. The hours, weeks, months, years, across a continuum—with treatment, without treatment.

Meet Christine. Stage III cervical cancer, so, metastatic cancer that started in her cervix, spread throughout her body. She's in her 50s and she is living. This is not about end of life, this is about life. This is not just about the elderly, this is about people.

This is Richard. End-stage lung disease.

"Richard, what is it that you hold sacred?"

"My kids, my wife, and my Harley."

"All right! I can't drive you around on it because I can barely pedal a bicycle, but let's see what we can do."

Richard came to me, and he was in rough shape. He had this little voice telling him that maybe his time was weeks to months. And then we just talked. And I listened and tried to hear—big difference. Use these in proportion to this.

I said, "All right, let's take it one day at a time," like we do in every other chapter of our life. And we have met Richard where Richard's at day-to-day. And it's a phone call or two a week, but he's thriving in the context of end-stage lung disease.

Now, palliative medicine is not just for the elderly, it is not just for the middle-aged. It is for everyone.

Meet my friend Jonathan. We have the honor and pleasure of Jonathan and his father joining us here today. Jonathan is in his 20s, and I met him several years ago. He was dealing with metastatic testicular cancer, spread to his brain. He had a stroke, he had brain surgery, radiation, chemotherapy. Upon meeting him and his family, he was a couple of weeks away from a bone marrow transplant, and in listening and engaging, they said, "Help us understand—what is cancer?"

How did we get this far without understanding what we're dealing with? How did we get this far without empowering somebody to know what it is they're dealing with, and then taking the next step and engaging in who they are as human beings to know if that is what we should do? Lord knows we can do any kind of thing to you. But should we?

And don't take my word for it. All the evidence that is related to palliative care these days demonstrates with absolute certainty people live better and live longer. There was a seminal article out of the New England Journal of Medicine in 2010. A study done at Harvard by friends of mine, colleagues. End-stage lung cancer: one group with palliative care, a similar group without. The group with palliative care reported less pain, less depression. They needed fewer hospitalizations. And, ladies and gentlemen, they lived three to six months longer. If palliative care were a cancer drug, every cancer doctor on the planet would write a prescription for it. Why don't they? Again, because we goofy, long white-coat physicians are trained and of the mantra of dealing with this, not with this.

This is a space that we will all come to at some point. But this conversation today is not about dying, it is about living. Living based on our values, what we find sacred and how we want to write the chapters of our lives, whether it's the last or the last five. What we know, what we have proven, is that this conversation needs to happen today—not next week, not next year. What is at stake is our lives today and the lives of us as we get older and the lives of our children and our grandchildren. Not just in that hospital room or on the couch at home, but everywhere we go and everything we see. Palliative medicine is the answer to engage with human beings, to change the journey that we will all face, and change it for the better.

To my colleagues, to my patients, to my government, to all human beings, I ask that we stand and we shout and we demand the best care possible, so that we can live better today and ensure a better life tomorrow. We need to shift today so that we can live tomorrow.

Thank you very much.

播放本句

登入使用學習功能

使用Email登入

HOPE English 播放器使用小提示

  • 功能簡介

    單句重覆、重複上一句、重複下一句:以句子為單位重覆播放,單句重覆鍵顯示綠色時為重覆播放狀態;顯示白色時為正常播放狀態。按重複上一句、重複下一句時就會自動重覆播放該句。
    收錄佳句:點擊可增減想收藏的句子。

    中、英文字幕開關:中、英文字幕按鍵為綠色為開啟,灰色為關閉。鼓勵大家搞懂每一句的內容以後,關上字幕聽聽看,會發現自己好像在聽中文說故事一樣,會很有成就感喔!
    收錄單字:框選英文單字可以收藏不會的單字。
  • 分享
    如果您有收錄很優秀的句子時,可以分享佳句給大家,一同看佳句學英文!