Jeg begyndte på skrivning og forskning som kirurgisk praktikant, som én, der var lang vej fra at blive ekspert inden for noget som helst. Det spørgsmål du helt naturligt så vil stille er, hvordan bliver jeg godt til det, jeg forsøger at gøre? Og det blev til et et spørgsmål om hvordan bliver vi alle gode til det vi prøver at gøre?
I got my start in writing and research as a surgical trainee, as someone who was a long ways away from becoming any kind of an expert at anything. So the natural question you ask then at that point is, how do I get good at what I'm trying to do? And it became a question of, how do we all get good at what we're trying to do?
Det er svært nok at lære færdighederne, prøve at lære alt det materiale, du skal læse inden for en hvilken som helst opgave. Jeg skulle tænke over, hvordan jeg syede og skar, men derudover også hvordan jeg skal vælge den rette person til at være på en operationsstue. Og så, midt i alt dette, kom denne nye kontekst med at tænke over, hvad det vil sige at være dygtig.
It's hard enough to learn to get the skills, try to learn all the material you have to absorb at any task you're taking on. I had to think about how I sew and how I cut, but then also how I pick the right person to come to an operating room. And then in the midst of all this came this new context for thinking about what it meant to be good.
Inden for de sidste par år har vi indset, at vi befinder os i den største krise lægekunsten har oplevet, på grund af noget, du normalt ikke tænker over når du er en læge, som bekymrer sig om at gøre godt for andre mennesker, og det er prisen på sundhedssystemet. Der er ikke det land i verden som i dag ikke spørger sig om vi kan betaler for det som lægerne gør. Den politiske kamp som har udviklet sig handler om hvorvidt det er regeringen som er problemet eller det er forsikringsselskaberne som er problemet. Svaret er ja og nej. Det ligger dybere end alt dette.
In the last few years we realized we were in the deepest crisis of medicine's existence due to something you don't normally think about when you're a doctor concerned with how you do good for people, which is the cost of health care. There's not a country in the world that now is not asking whether we can afford what doctors do. The political fight that we've developed has become one around whether it's the government that's the problem or is it insurance companies that are the problem. And the answer is yes and no; it's deeper than all of that.
Grunden til vores besvær er faktisk kompleksiteten som videnskaben har givet os. Og for at forstå dette, Vil jeg tage jer et par generationer tilbage i tiden. Jeg vil tage jer tilbage til en tid hvor Lewis Thomas skrev sin bog: "Den yngste videnskab." Lewis Thomas var en læge-forfatter, en af mine favorit forfattere. Og har skrev denne bog for at forklare, blandt mange ting, hvordan det var at være intern mediciner på Boston City Hospital i årene før penicillinen i 1937. Det var en tid hvor medicin var billig og meget ineffektiv. Hvis du var på et hospital, skrev han, ville det gøre dig godt men kun fordi det tilbød dig noget varme, noget mad, ly, og måske medfølende opmærksomhed fra en sygeplejerske. Læger og medicin gjorde ingen forskel overhovedet. Dette forhindrede ikke lægerne fra at være afsindigt travle i deres arbejde som han forklarede.
The cause of our troubles is actually the complexity that science has given us. And in order to understand this, I'm going to take you back a couple of generations. I want to take you back to a time when Lewis Thomas was writing in his book, "The Youngest Science." Lewis Thomas was a physician-writer, one of my favorite writers. And he wrote this book to explain, among other things, what it was like to be a medical intern at the Boston City Hospital in the pre-penicillin year of 1937. It was a time when medicine was cheap and very ineffective. If you were in a hospital, he said, it was going to do you good only because it offered you some warmth, some food, shelter, and maybe the caring attention of a nurse. Doctors and medicine made no difference at all. That didn't seem to prevent the doctors from being frantically busy in their days, as he explained.
Hvad de prøvede at gøre var at finde ud af om du havde en af de diagnoser som man kunne gøre noget ved. Og der var få. Du kunne for eksempel have lungebetændelse og de kunne give dig et antiserum, og injektioner af kanin antistoffer mod bakterien streptococcus hvis lægen kunne bestemme undertypen rigtigt. Hvis du havde akut hjertesvigt, kunne de tape en halv liter blod fra dig, ved at åbne en pulsåre på armen og give dig knuste blade fra planten fingerbøl og lægge dig i et ilttelt. Hvis du havde tidlige tegn på lammelse og var du virkelig god til at spørge om personlige spørgsmål, kunne du finde ud af at lammelsen skyldes syfilis, hvorefter du kunne ordinere en hyggelig blanding af kviksølv og arsenik -- så længe de ikke overdoserede og slog patienten ihjel. Udover denne slags ting var der ikke meget en læge kunne gøre.
What they were trying to do was figure out whether you might have one of the diagnoses for which they could do something. And there were a few. You might have a lobar pneumonia, for example, and they could give you an antiserum, an injection of rabid antibodies to the bacterium streptococcus, if the intern sub-typed it correctly. If you had an acute congestive heart failure, they could bleed a pint of blood from you by opening up an arm vein, giving you a crude leaf preparation of digitalis and then giving you oxygen by tent. If you had early signs of paralysis and you were really good at asking personal questions, you might figure out that this paralysis someone has is from syphilis, in which case you could give this nice concoction of mercury and arsenic -- as long as you didn't overdose them and kill them. Beyond these sorts of things, a medical doctor didn't have a lot that they could do.
Det var dengang kernestrukturen af lægeverden blev skabt -- hvad det var at være god til, hvad vi ville og hvad vi ønskede hvad lægekunsten skulle udvikle sig til. Det var en tid hvor hvad der var kendt vidste du, du kunne have det hele i dit hovede og du kunne det hele. Hvis du havde en receptblok, hvis du havde en sygeplejerske, hvis du havde et hospital kunne det give dig et sted hvor folk kunne komme sig, måske nogle simple redskaber, Så kunne du gøre det hele. Du rettede benbruddet, du tappede blodet, præparerede det og kiggede på det under mikroskopet, du dyrkede kulturer, du indsprøjtede antiserum. Det var en håndværkers liv.
This was when the core structure of medicine was created -- what it meant to be good at what we did and how we wanted to build medicine to be. It was at a time when what was known you could know, you could hold it all in your head, and you could do it all. If you had a prescription pad, if you had a nurse, if you had a hospital that would give you a place to convalesce, maybe some basic tools, you really could do it all. You set the fracture, you drew the blood, you spun the blood, looked at it under the microscope, you plated the culture, you injected the antiserum. This was a life as a craftsman.
Som resultat, opbyggede vi en kultur og et sæt af værdier som siger hvad du var god til var at at være dristig, at være modig, at være uafhængig og selvtilstrækkelig. Autonomi var vores højeste værdi. Gå et par generationer frem til hvor vi er nu og det ligner en fuldstændig anden verden. Vi har nu fundet behandlinger for næsten alle de titusinder af tilstande som et menneske kan have. Vi kan ikke kurere alt. Vi kan ikke garantere at alle vil leve et langt og sundt liv. Men vi kan gøre det muligt for de fleste.
As a result, we built it around a culture and set of values that said what you were good at was being daring, at being courageous, at being independent and self-sufficient. Autonomy was our highest value. Go a couple generations forward to where we are, though, and it looks like a completely different world. We have now found treatments for nearly all of the tens of thousands of conditions that a human being can have. We can't cure it all. We can't guarantee that everybody will live a long and healthy life. But we can make it possible for most.
Hvordan er det muligt? Vi har nu udformet 4.000 medicinske og kirurgiske procedure. Vi har opfundet 6.000 medikamenter som jeg nu har tilladelse til at ordinere. Vi prøver at udbrede denne formåen, by efter by, til alle personer i live -- i vores eget land, samt i resten af verden. Og vi har nået det punkt hvor vi har erkendt, som læger, at vi ikke kan vide det hele. Vi kan ikke selv gøre alt.
But what does it take? Well, we've now discovered 4,000 medical and surgical procedures. We've discovered 6,000 drugs that I'm now licensed to prescribe. And we're trying to deploy this capability, town by town, to every person alive -- in our own country, let alone around the world. And we've reached the point where we've realized, as doctors, we can't know it all. We can't do it all by ourselves.
Det var en undersøgelse hvor de kiggede på hvor mange klinikere som skulle til at tage sig af dig hvis du kom på hospitalet, som det har ændret sig over tid. Og i året 1970 tog det hvad der svarer til to fuldtidsklinikere. Det vil sige at det tog noget tid til pleje og så en lille smule tid for lægen som kom forbi dig en gang om dagen. I slutningen af det 20'ende århundrede kræver det nu mere end 15 klinikere for den samme type hospitalspatient -- specialister, fysioterapeuter, sygeplejerskerne.
There was a study where they looked at how many clinicians it took to take care of you if you came into a hospital, as it changed over time. And in the year 1970, it took just over two full-time equivalents of clinicians. That is to say, it took basically the nursing time and then just a little bit of time for a doctor who more or less checked in on you once a day. By the end of the 20th century, it had become more than 15 clinicians for the same typical hospital patient -- specialists, physical therapists, the nurses.
Vi er alle specialister nu selv de praktiserende læger. Alle har kun en lille del af plejen. Men at holde fast i strukturen vi byggede omkring den frygtløshed, uafhængighed, selvtilstrækkelighed hos hver at disse mennesker er blevet en katastrofe. Vi har uddannet, ansat og belønnet folk til at være cowboys. Men det er mekanikere, vi har brug for, mekanikere for patienter.
We're all specialists now, even the primary care physicians. Everyone just has a piece of the care. But holding onto that structure we built around the daring, independence, self-sufficiency of each of those people has become a disaster. We have trained, hired and rewarded people to be cowboys. But it's pit crews that we need, pit crews for patients.
Der er beviser nok omkring os: 40 procent af patienter med blodpropper i kranspulsåren i vores samfund modtager mangelfuld eller forkert behandling. 60 procent af vores astma- og hjerteslagspatienter modtager mangelfuld eller forkert behandling. to millioner kommer på hospitalet og pådrager sig en infektion som de ikke havde før fordi nogle ikke fulgte de basal principper for hygiejne. Vores erfaring med folk som bliver syge, har behov for hjælp fra andre folk, er at vi har forbløffende klinikere som vi kan henvende os til -- hårdtarbejdende, utroligt veltrænede og meget kloge -- at vi har adgang til fantastiske teknologier som giver os meget håb. Men lidt fornemmelse for at det forenes på pålidelig vis for dig fra start til slut på en succesfuld måde.
There's evidence all around us: 40 percent of our coronary artery disease patients in our communities receive incomplete or inappropriate care. 60 percent of our asthma, stroke patients receive incomplete or inappropriate care. Two million people come into hospitals and pick up an infection they didn't have because someone failed to follow the basic practices of hygiene. Our experience as people who get sick, need help from other people, is that we have amazing clinicians that we can turn to -- hardworking, incredibly well-trained and very smart -- that we have access to incredible technologies that give us great hope, but little sense that it consistently all comes together for you from start to finish in a successful way.
Det er et andet tegn på at vi skal bruge mekanikere, og det er de uhåndterlige udgifter for sundhedsvæsnet. Vi indenfor lægevidenskab, tror jeg, er ligeglade med dette spørgsmål om pris. Vi ønsker bare at sige: "Sådan er det bare. Det er hvad behandling koster." Når du går fra en verden hvor du behandlede gigt med aspirin, som sjældent virkede, til en hvor, hvis det er slemt nok, kan erstatte hofter eller knæ. Hvilket giver dig år, måske årtier uden funktionsnedsættelse, en dramatisk forandring, men er det en overraskelse at en hofteoperation til $40.000 som erstatning til en 10 cents aspirin er meget dyrere? Sådan er det bare.
There's another sign that we need pit crews, and that's the unmanageable cost of our care. Now we in medicine, I think, are baffled by this question of cost. We want to say, "This is just the way it is. This is just what medicine requires." When you go from a world where you treated arthritis with aspirin, that mostly didn't do the job, to one where, if it gets bad enough, we can do a hip replacement, a knee replacement that gives you years, maybe decades, without disability, a dramatic change, well is it any surprise that that $40,000 hip replacement replacing the 10-cent aspirin is more expensive? It's just the way it is.
Men jeg tror at vi ikke kan ignorere nogle sandheder, som fortæller os noget om hvad vi kan gøre. Da vi kiggede på data for at finde resultater der er kommet efter kompleksiteten er steget fandt vi at de dyreste behandlinger ikke nødvendigvis er de bedste. Og omvendt, den bedste behandling viser sig ofte at være den billigste -- har færre komplikationer, og folk er mere effektive med hvad de gør. Hvilket betyder at der er håb. Hvis man for at få de bedste resultater virkeligt havde behov for den mest kostbare behandling i landet, i verden, så havde vi virkeligt behov for at tale om rationering af hvem som skal dækkes af Medicare. Det ville være vores eneste valg.
But I think we're ignoring certain facts that tell us something about what we can do. As we've looked at the data about the results that have come as the complexity has increased, we found that the most expensive care is not necessarily the best care. And vice versa, the best care often turns out to be the least expensive -- has fewer complications, the people get more efficient at what they do. And what that means is there's hope. Because [if] to have the best results, you really needed the most expensive care in the country, or in the world, well then we really would be talking about rationing who we're going to cut off from Medicare. That would be really our only choice.
Men når vi kigger på de positive afvigelser -- dem som får de bedste resultater til den laveste pris -- så opdager vi at dem som minder mest om systemer er de mest succesfulde. Hvilket vil sige, at de fandt veje for at få alle de forskellige dele, alle de forskellige komponenter, samlet til en helhed. At have fantastiske komponenter er ikke nok, og stadigvæk syntes vi at være besat af komponenter indenfor medicin. Vi vil have de bedste medikamenter, de bedste teknologier, de bedste specialister, men vi tænker ikke meget på hvordan det hele skal fungere sammen. Det er faktisk en forfærdelig designstrategi.
But when we look at the positive deviants -- the ones who are getting the best results at the lowest costs -- we find the ones that look the most like systems are the most successful. That is to say, they found ways to get all of the different pieces, all of the different components, to come together into a whole. Having great components is not enough, and yet we've been obsessed in medicine with components. We want the best drugs, the best technologies, the best specialists, but we don't think too much about how it all comes together. It's a terrible design strategy actually.
Her er et berømt tankeeksperiment, som rammer plet, som siger: "Hvad hvis du byggede en bil af alle de bedste bildele?" Du starter med at bruge Porche bremser, en Ferrari motor, et Volvo karrosseri, et BMW chassis. Og du samle det hele og hvad vil du få ud af det? En meget dyr bunke skrot, som ikke kører nogen steder. Og det er hvad lægeverden nogen gange føles som. Det er ikke et system.
There's a famous thought experiment that touches exactly on this that said, what if you built a car from the very best car parts? Well it would lead you to put in Porsche brakes, a Ferrari engine, a Volvo body, a BMW chassis. And you put it all together and what do you get? A very expensive pile of junk that does not go anywhere. And that is what medicine can feel like sometimes. It's not a system.
Nu med systemer, når ting fungere sammen, så opdager du at bestemte færdigheder for at betragte det sådan. Færdighed nummer et er evnen til at genkende en succes og evnen til at genkende en fiasko. Når du er specialist, kan du ikke se slutresultatet sårligt godt. Du skal blive virkeligt interesseret i data, lige så usexet som det lyder.
Now a system, however, when things start to come together, you realize it has certain skills for acting and looking that way. Skill number one is the ability to recognize success and the ability to recognize failure. When you are a specialist, you can't see the end result very well. You have to become really interested in data, unsexy as that sounds.
En af mine kollegaer er kirurg i Cedar Rapids, Iowa, og han blev interesseret i spørgsmålet om hvor mange CT- skanninger de lavede for deres distrikt i Cedar Rapids. Han blev interesseret i dette fordi der havde været regeringsrapporter, avisartikler og tidsskriftartikler som sagde at der havde været alt for mange CT-skanninger. Han så det ikke med sine egne patienter. Så han stillede spørgsmålet: "Hvor mange udfører vi?" Og han ønskede at få fat i data. Det tog ham tre måneder. Ingen havde spurgt om dette i hans distrikt før. Og hvad han fandt var at for de 300.000 mennesker i deres distrikt, var der i det forrige år udført 52.000 CT-skanninger. De havde fundet et problem.
One of my colleagues is a surgeon in Cedar Rapids, Iowa, and he got interested in the question of, well how many CT scans did they do for their community in Cedar Rapids? He got interested in this because there had been government reports, newspaper reports, journal articles saying that there had been too many CT scans done. He didn't see it in his own patients. And so he asked the question, "How many did we do?" and he wanted to get the data. It took him three months. No one had asked this question in his community before. And what he found was that, for the 300,000 people in their community, in the previous year they had done 52,000 CT scans. They had found a problem.
Hvilket bringer os til færdighed nummer to som et system har. Færdighed et, find ud af hvor dine fiaskoer er. Færdighed nummer to er at finde løsninger. Jeg blev interesseret i dette da WHO kom til mit team og spurgte om vi kunne hjælpe med et projekt for at reducere dødsfald i kirurgi. Mængden af kirurgi har spredt sig rundt i verdenen, men sikkerheden i kirurgi har ikke. Nu er vores sædvanlige taktik med at takle problemer som disse at lave mere træning, give vores folk mere specialisering eller bruge mere teknologi.
Which brings us to skill number two a system has. Skill one, find where your failures are. Skill two is devise solutions. I got interested in this when the World Health Organization came to my team asking if we could help with a project to reduce deaths in surgery. The volume of surgery had spread around the world, but the safety of surgery had not. Now our usual tactics for tackling problems like these are to do more training, give people more specialization or bring in more technology.
Med kirurgi kan du bare ikke finde folk som er mere specialiserede og du kan ikke finde folk som er bedre trænnet. Og stadigvæk ser vi disse uforståelige niveauer af dødsfald, bivirkninger som kunne være undgået. Så vi kiggede på hvad andre høj-risiko industrier gør. Vi kiggede på skyskraber konstruktion, vi kiggede på luftfartsindustrien, og vi fandt at de havde teknologi, de havde træning og de havde endnu en ting: De havde checklister. Jeg forventede ikke at jeg skulle bruge en væsentlig del af min tid som en Harvard kirurg med at bekymre mig om checklister. Men dog fandt vi at disse var redskabet til at gøre eksperter bedre. Vi fik en sikkerhedsingeniør fra Boing til at hjælpe os.
Well in surgery, you couldn't have people who are more specialized and you couldn't have people who are better trained. And yet we see unconscionable levels of death, disability that could be avoided. And so we looked at what other high-risk industries do. We looked at skyscraper construction, we looked at the aviation world, and we found that they have technology, they have training, and then they have one other thing: They have checklists. I did not expect to be spending a significant part of my time as a Harvard surgeon worrying about checklists. And yet, what we found were that these were tools to help make experts better. We got the lead safety engineer for Boeing to help us.
Kunne vi designe en checkliste for kirurger? Ikke for de nederste folk på totempælen, men for folkene fra top til bund, hele holdet inklusiv kirurgerne. Og hvad de lærte os var at, det at designe en checkliste som skal hjælp folk at håndtere kompleksitet faktisk indeholder flere vanskeligheder end jeg havde forestillet mig. Du må forestille dig disse ting som pauser. Du har behov for at identificerer øjeblikke i processen hvor du kan fange et problem før det udvikler sig til en fare og gøre noget ved det. Du må identificere at dette er en før-start-checkliste. Og du skal fokusere på det vigtige. En fly checkliste, som denne for et enmotorsfly, er ikke en opskrift på hvordan man flyver et fly, det er en huskeliste over de nøgle punkter, som kan glemmes eller tabes hvis de ikke er checkede.
Could we design a checklist for surgery? Not for the lowest people on the totem pole, but for the folks who were all the way around the chain, the entire team including the surgeons. And what they taught us was that designing a checklist to help people handle complexity actually involves more difficulty than I had understood. You have to think about things like pause points. You need to identify the moments in a process when you can actually catch a problem before it's a danger and do something about it. You have to identify that this is a before-takeoff checklist. And then you need to focus on the killer items. An aviation checklist, like this one for a single-engine plane, isn't a recipe for how to fly a plane, it's a reminder of the key things that get forgotten or missed if they're not checked.
Så vi gjorde dette. Vi lavede en 19 punkts tominutters checkliste for kirurgiske teams. Vi havde pauser lige inden bedøvelsen blev givet, lige inden skalpelen rammer huden, lige inden patienten forlader operationsstuen. Og vi havde en blanding af banale ting her -- At være sikker på at antibiotika bliver givet indenfor de rigtige tidsramme, fordi det halvere antallet af infektioner -- og så det interessante, fordi du ikke kan lave en opskrift på noget så kompliceret som kirurgi. I stedet for kan du lave en opskrift på hvordan holdet skal være forberedt på det uforudsete. Og vi havde ting som at være sikker på at alle i rummet havde introduceret dem selv med navn ved dagen start, fordi du har et halvt dusin folk eller mere hvor nogen sommetider er sammen som et hold for den første gang den dag hvor du kommer ind.
So we did this. We created a 19-item two-minute checklist for surgical teams. We had the pause points immediately before anesthesia is given, immediately before the knife hits the skin, immediately before the patient leaves the room. And we had a mix of dumb stuff on there -- making sure an antibiotic is given in the right time frame because that cuts the infection rate by half -- and then interesting stuff, because you can't make a recipe for something as complicated as surgery. Instead, you can make a recipe for how to have a team that's prepared for the unexpected. And we had items like making sure everyone in the room had introduced themselves by name at the start of the day, because you get half a dozen people or more who are sometimes coming together as a team for the very first time that day that you're coming in.
Vi indførte denne checkliste på otte hospitaler rund om i verden, spændende fra landlige områder i Tanzania til University of Washington i Seattle. Vi fandt at efter de indførte den faldt raten af komplikationer med 35 procent. Den faldt på samtlige hospitaler hvor den blev indført. Dødsraten faldt med 47 procent. Dette var meget mere end med et medikament.
We implemented this checklist in eight hospitals around the world, deliberately in places from rural Tanzania to the University of Washington in Seattle. We found that after they adopted it the complication rates fell 35 percent. It fell in every hospital it went into. The death rates fell 47 percent. This was bigger than a drug.
(Bifald)
(Applause)
Og det bringer os til færdighed nummer tre, evnen til at indføre dette, at få kollegaer fra top til bund til rent faktisk at gøre disse ting. Og det har været langsomt til at spredes. Det er ikke vores norm i kirurgi -- at lave checklister fora t gå i gang med fødsler eller andre områder Det er en stor modstand fordi at bruge disse redskaber tvinger os til at indse at vi er ikke et system, tvinger os til at agere ud fra et andet sæt af værdier. Bare det at bruge en checkliste kræver at du omfavner nogle andre værdier end dem vi havde, som ydmyghed, disciplin, holdarbejde. Det er det modsatte af hvad vi er opflasket med: Uafhængighed, selvtilstrækkelighed, autonomi.
And that brings us to skill number three, the ability to implement this, to get colleagues across the entire chain to actually do these things. And it's been slow to spread. This is not yet our norm in surgery -- let alone making checklists to go onto childbirth and other areas. There's a deep resistance because using these tools forces us to confront that we're not a system, forces us to behave with a different set of values. Just using a checklist requires you to embrace different values from the ones we've had, like humility, discipline, teamwork. This is the opposite of what we were built on: independence, self-sufficiency, autonomy.
Jeg mødte forresten en rigtig cowboy. Jeg spurgte ham hvordan det var at drive tusinde stykker kvæg gennem hundrede af miles? Hvordan gør du? Og han sagde:"Vi har cowboys placeret på bestemte steder hele vejen rundt." De kommunikere konstant elektronisk, de har protokoller og checklister for hvordan de håndtere alt -- (Latter) -- fra dårligt vejr til nødsituationer eller vaccineringer af kvæget. Selv cowboys er mekanikere ne. og det ser ud til at være på tide at vi også selv bliver det.
I met an actual cowboy, by the way. I asked him, what was it like to actually herd a thousand cattle across hundreds of miles? How did you do that? And he said, "We have the cowboys stationed at distinct places all around." They communicate electronically constantly, and they have protocols and checklists for how they handle everything -- (Laughter) -- from bad weather to emergencies or inoculations for the cattle. Even the cowboys are pit crews now. And it seemed like time that we become that way ourselves.
At få systemer til at virke er den store opgave for min generation af læger og videnskabsfolk. Men jeg vil gå længere og sige at få systemer til at virke hvad enten der er indenfor sundhed, uddannelse, klimaforandringer, finde vej ud af fattigdom, er den store udfordring for vores generation som helhed. Indenfor hvert eneste område er viden eksploderet men det har medført kompleksitet, det har medført specialisering. Og vi er kommet dertil hvor vi ikke har noget valg end at erkende, som de individualister vi gerne vil være, kompleksitet kræver gruppesucces. Vi bliver nødt til at at være mekanikere nu.
Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work, whether in health care, education, climate change, making a pathway out of poverty, is the great task of our generation as a whole. In every field, knowledge has exploded, but it has brought complexity, it has brought specialization. And we've come to a place where we have no choice but to recognize, as individualistic as we want to be, complexity requires group success. We all need to be pit crews now.
Mange tak.
Thank you.
(Bifald)
(Applause)