第七章 过 错
1.I have mistaken, but I have been mistaken less than other surgeons.
—— Guillaume Dupuytren, 1777——1835
【译文】我犯过错误，但我比其他外科医生犯得要少。
2.I have made many mistakes myself … the best surgeon, like the best general, is he who makes the fewest mistakes.
—— Astley Paston Cooper, 1768——1841
【译文】我自己也犯过许多错误……最好的外科医生就像最好的将军一样，是犯错最少的人。
3.In the art of surgery, error is more likely to occur than in almost any other line of human endeavor.
—— Max Thorek, 1880——1960
【译文】相较于人类的其他大多数行业，外科手术这门艺术更容易发生错误。
4.We have our faults and virtues; we meet with failures and achieve successes.Many of our faults are entirely unavoidable, and arise from the fact that medicine is not an exact science … some things are quite impossible, and our work is carried out upon a living, breathing, complexity called a man, and not upon a jar, a chemical mixture in a retort, or a wooden Indian from the front of a cigar store.
—— J.Chalmers Da Costa, 1863——1933
【译文】我们医生会犯错，也常积德，遭遇失败也收获成功。许多过错完全不可避免，原因在于医学实际上还不是一门精确的科学……有些事情完全不可能。因为我们面对的是一个个活生生的、会喘气、错综复杂的人，而不是一只实验瓶，一个装有化学混合物的反应罐，也不是雪茄店门口摆的那种印第安木偶。
5.From the time of Hippocrates surgery has ever been the salvation of inner medicine.In inner medicine physicians have dwelt too much on dogmas, opinions and speculations; and too often their errors passed undiscovered to the grave.The surgeon, for his good, has had a sharper training; his errors hit him promptly in the face.
—— Thomas Clifford Allbutt, 1836——1933
【译文】从希波克拉底时代以来，外科手术就一直是内科的救赎。内科医生过分强调教条、己见和推测；被掩盖的错误经常直到患者死亡还没能发现；外科医生则不然，一旦犯错，事实将立刻给他以迎面痛击。所以，为了做一个好的外科医生，必须经过更为严苛的培训。
【点评】外科医生最大的福利或许就是比其他专科医生更容易发现自己的错误。
6.The pilot is by circumstance allowed only one serious mistake, while the surgeon may commit many and not even recognize his own errors as such.
—— John Homans, 1877——1954
【译文】因处境不同，飞行员只能犯一次严重的错误，但外科医生可能会多次犯错，甚至都还没意识到自己的错误。
【点评】不能及时发现自己的错误，是最可怕的！
7.Most "avoidable" surgical mortalities are not caused by one-sentinelhorrendous, clearly evident-error which cries "I am malpractice".Instead, most such "avoidable" deaths result from a chain of allegedly "minor" hesitations,ignorance, greed, inattention, overconfidence, arrogance, stupidity-which together drive the nails into the coffin.Taken together they may whisper: "we are negligence…"
—— Moshe Schein
【译文】大多数“可避免的”手术死亡都不曾有过可怕的征兆，也不会高喊着“医疗事故了”这种有明确错误证据的预警。相反，大多数这种“可避免的”死亡都是由一连串所谓的“些许”犹豫、无知、贪心、疏忽、过度自信、傲慢、愚蠢造成的，这些因素累加在一起把钉子钉进了棺材。最后他们会弱弱地说：“是我们疏忽了……”
【点评】大的错误往往是许多小的失误不断累积、一步一步酿成的。
8.The two unforgivable sins of surgery.The first great error in surgery is to operate unnecessarily; the second, to undertake an operation for which the surgeon is not sufficiently skilled technically.
—— Max Thorek, 1880——1960
【译文】手术中不可饶恕的两大罪过是：一是做不必要做的手术，二是做技术上不能胜任的手术。
9.While it is human to err, it is inhuman not to try, if possible, to protect those who entrust their lives into our hands from avoidable failures and danger.
—— Max Thorek, 1880——1960
【译文】虽然犯错误是人之常情，如有可能，但不去设法保护那些把生命托付给我们的人，让他们免受本可避免的失败和危险，则是不人道的。
10.Most patients will survive the surgeon's shortcomings but some will not.
—— P.O.Nystrom
【译文】 多数患者能从外科医生的缺陷中幸存下来，但有些没那么幸运。
11.Surgeons faults are covered with earth, and rich men's with money.
【译文】外科医生的过失用泥土掩盖，富人的过失则用金钱掩盖。
【点评】所以，外科医生的过失是不能承受之重。
12.(There is) a tendency always to attribute fatalities … to sins of omissions,whereas the many evil results of the sins of commission are given much less consideration.
—— J.L.Yates, ?——1905
【译文】 （有）一种倾向总是把灾祸……归因于不作为之罪，而乱作为之罪所带来的许多恶果却很少被关注。
【点评】其实在外科，乱作为所导致的不良后果并不少见，有时甚至多过不作为之罪。
13.We tend to remember best those patients we almost killed; we never forget those we actually managed to kill.
—— Moshe Schein
【译文】通常，我们最记得的是那些险些被我们治死的患者，但永远不要忘记那些实际上是我们设法杀死的患者。
【点评】此处“我们设法杀死的患者”往往就是乱作为之罪。
14.Doctors frequently get it wrong.One out of five patients today is in the hospital because incorrect treatment by a physician put him or her there.
—— Andrew Saul
【译文】医生们常犯错。今天，医院1/5的患者是因为医生不正确的治疗把他（她）送进医院的。(https://www.daowen.com)
15.To a patient after removing her breast (without a biopsy) for a benign lesion: "madam, I have made the most awful mistake, I've never before done such a thing in my whole life, I don't know how you can ever forgive me".
—— John Homans, 1877——1954
【译文】（没做术中活检）就切除了一个良性病变的乳房，然后对患者说：“太太，我犯了最可怕的错误，我这辈子从未做过这样的事，我不知道你怎么能原谅我。”
【点评】无语，悔之晚矣！
16.More mistakes are made from want of a proper examination than for any other reason.
—— Russell John Howard, 1875——1942
【译文】缺乏适当检查所导致的错误比其他任何原因都多。
17.A few observations and much reasoning leads to error; many observations and a little reasoning to truth.
—— Alexis Carrel, 1873——1944
【译文】观察少、推测多必定出错；多观察、少推测才能发现真相。
【点评】聪明的外科医生相信他所看到的而不是看到他所相信的。
18.In any given operation the source of error will never be determined if more than one person is involved.
【译文】任何一台手术，如果有一人以上参与其中，就永远无法确定错误的来源。
【点评】手术台上职责不清，一旦犯错则难以明确责任，主刀应负全责。
19.It is usually the second mistake in response to the first mistake that does the patient in.
—— Clifton K.Meador
【译文】置患者于死地的往往是对第一次错误的应对不当所引发的次生错误。
【点评】因此，及时正确地处理第一个错误非常重要。
20.You want a surgical team that faces each error, each mishap, straight up,names it, and takes steps to prevent its recurrence.
—— Francis D.Moore, 1913——2001
【译文】 你需要一个这样的手术团队，能直面每一个错误，每一次不幸，直接说出责任人的名字，并采取措施防止再次发生。
21.Human error complicated by organizational factors is the main cause of accidents.
—— P.O.Nystrom
【译文】组织失当导致人为错误复杂化是意外发生的主要原因。
【点评】差错的预防与控制需要有效的组织管理制度。
22.To err is human.To forgive is against departmental policy.
【译文】人非圣贤，孰能无过，但宽恕是违反部门政策的。
【点评】错误虽不可避免，但处罚不可没有。
23.I have thought it no disgrace to let the world see where I failed of success, that those that come after me may learn what to avoid; there being more instructiveness often in an unfortunate case than in a fortunate one.
—— Richard Wiseman, 1620——1676
【译文】 我一直在想，让大家知道我过去失败的原因在哪里并非什么耻辱，可避免后来者重蹈覆辙。失败案例总比成功案例能带给我们更多启示。
24.Nothing stands out so conspicuously, or remains so firmly fixed in our memory, as something in which we have blundered.
—— Marcus Tullius Cicero (106 BC——43 BC)
【译文】 没有什么比我们曾经深陷大错而更引人注目、更让我们刻骨铭心的。
25.All that is wrong cannot be righted——be sure the wrongs are rightly sighted.
—— Francis D.Moore, 1913——2001
【译文】 不是所有的错误都能得到纠正——但应确保及时认识到错误之所在。
26.It is the peculiarity of the bore that he is the last person to find himself out.
—— Oliver Wendell Holmes, 1809——1894
【译文】一个令人讨厌的魔咒是，自己总是最后一个发现自己（错误）的人。
27.A surgeon maintains a mental catalogue of the things he did wrong at various times in his career and tries never to repeat them.
—— Francis D.Moore, 1913——2001
【译文】职业生涯不同时期犯了哪些错事，外科医生应在脑子里列个清单，力戒再犯。
28.Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures.
—— Rene Leriche, 1879——1955
【译文】每个外科医生（心中）都有一个小墓地，时常去这个辛酸和遗憾之地祈祷，以帮助他寻找失败的原因。