Going Under the Knife, With Eyes and Ears Wide Open想看你的肌腱嗎？醒著動手術 醫病關係新紀元
“Do you want to see your tendons?”
Dr. Asif Ilyas, a hand and wrist surgeon, was about to close his patient’s wound. But first he offered her the opportunity to behold the source of her radiating pain: a band of tendons that looked like pale pink ribbon candy. With a slender surgical instrument, he pushed outward to demonstrate their newly liberated flexibility.
“That’s pretty neat,” the patient, Esther Voynow, managed to gasp.
The operation Ilyas performed, called a De Quervain’s release, is usually done with the patient under anesthesia. But Voynow, her medical inquisitiveness piqued and her distaste for anesthesia pronounced, had chosen to remain awake, her forearm rendered numb with only an injection of a local anesthetic.
More surgery is being performed with the patient awake and looking on, for both financial and medical reasons. But as surgical patients are electing to keep their eyes wide open, doctor-patient protocol has not kept pace with the new practice. Patients can become unnerved by a seemingly ominous silence, or put off by what passes for office humor. Doctors are only beginning to realize that when a patient is alert, it is just not OK to say, “Oops!” or “I wasn’t expecting that,” or even “Oh, my God, what are you doing?!”
“For a thousand years, we talked about the operating theater,” said Dr. Mark Siegler, a medical ethicist at the University of Chicago and an author of a recent study on surgeon-patient communication during awake procedures, published in The American Journal of Surgery. “And for the first time, in recent years the patient has joined the cast.”
Choosing to watch your own surgery is one more manifestation of the patient autonomy movement, in which patients, pushing back against physician paternalism, are eager to involve themselves more deeply in their own medical treatment.
A few studies suggest that some patients feel less anxious about staying awake during surgery, despite possible gruesome sights, than they do about being sedated.
Voynow did not need a preoperative physical exam, blood work, an IV drip or even an attending anesthesiologist. As nurses wheeled her on a gurney out of the O.R., she looked pleasantly surprised. “I’ve had root canals that were worse,” she said.
Evidence That Robots Are Winning the Race for American Jobs機器人搶工作 美國人輸定了
文/Claire Cain Miller
Who is winning the race for jobs between robots and humans? Last year, two leading economists described a future in which humans come out ahead. But now they’ve declared a different winner: the robots.
The industry most affected by automation is manufacturing. For every robot per thousand workers, up to six workers lost their jobs and wages fell by as much as three-fourths of a percent, according to a new paper by the economists, Daron Acemoglu of MIT and Pascual Restrepo of Boston University. It appears to be the first study to quantify large, direct, negative effects of robots.
The paper is all the more significant because the researchers, whose work is highly regarded in their field, had been more sanguine about the effect of technology on jobs. In a paper last year, they said it was likely that increased automation would create new, better jobs, so employment and wages would eventually return to their previous levels. Just as cranes replaced dockworkers but created related jobs for engineers and financiers, the theory goes, new technology has created new jobs for software developers and data analysts.
But that paper was a conceptual exercise. The new one uses real-world data — and suggests a more pessimistic future. The researchers said they were surprised to see very little employment increase in other occupations to offset the job losses in manufacturing. That increase could still happen, they said, but for now there are large numbers of people out of work, with no clear path forward — especially blue-collar men without college degrees.
“The conclusion is that even if overall employment and wages recover, there will be losers in the process, and it’s going to take a very long time for these communities to recover,” Acemoglu said.
“If you’ve worked in Detroit for 10 years, you don’t have the skills to go into health care,” he said. “The market economy is not going to create the jobs by itself for these workers who are bearing the brunt of the change.”
The paper’s evidence of job displacement from technology contrasts with a comment from Treasury Secretary Steve Mnuchin, who said at an Axios event that artificial intelligence’s displacement of human jobs was “not even on our radar screen,” and “50 to 100 more years” away.
The study analyzed the effect of industrial robots in local labor markets in the United States. Robots are to blame for up to 670,000 lost manufacturing jobs between 1990 and 2007, it concluded, and that number will rise because industrial robots are expected to quadruple.
美國財政部長米努勤說人工智慧（artificial intelligence） 取代人類工作，「甚至不在我們雷達螢幕上」（not even on our radar screen）， 意為人工智慧取代人類，不是財政部特別關切的當務之急。俚語on （one’s） radar （screen）意為一切都在雷達監視範圍內，都在掌控中，如：This year’s new fashion trend is definitely on my radar.（今年的新時尚趨勢，我毫無疑問瞭若指掌。）如果on換成under/off/beneath ，意為不在注意或重視的範圍中。