and I returned to the medical university where I studied.  我回到我曾就读的医学院。

I saw real patients and I wore the white coat for the first time in 17 years,in fact since I became a management consultant.  我穿上白大褂，见了真正的病人，这是自我17年前成为管理顾问以来的头一次。

There were two things that surprised me during the month I spent.  我在那里的一个月，有两件事情让我吃惊。

The first one was that the common theme of the discussions we had were hospital budgets and cost-cutting, 第一，医学院里常常讨论的话题是医院的预算和削减开支。

and the second thing, which really bothered me,  第二，也是真正让我忧心的

actually, was that several of the colleagues I met,  是我遇到的几位同事。

former friends from medical school,  他们是我在医学院的昔日好友，

who I knew to be some of the smartest,  他们是我所认识的最聪明，

most motivated, engaged and passionate people I'd ever met, 最有积极性的，热衷参与并富有激情的人。

many of them had turned cynical, disengaged,  但是，他们中的很多人，现在变得漠然且愤世嫉俗，

or had distanced themselves from hospital management.  或与医院管理保持距离。

So with this focus on cost-cutting,  当我们专注于削减开支的时候，

I asked myself, are we forgetting the patient?  我问我自己，我们是否忘记了病人的存在？

Many countries that you represent and where I come from struggle with the cost of healthcare. 很多国家，包括你们的，也包括我的都在为医疗保健支出而烦恼。

It's a big part of the national budgets.  这项支出占据了国家预算的很大一部分。

And many different reforms aim at holding back this growth.  而许多医疗体制改革的目标就是控制这项支出的增加。

In some countries, we have long waiting times for patients for surgery. 在一些国家，看病等待期很长,特别是需要手术的病人。

In other countries, new drugs are not being reimbursed,  还有一些国家，新药没有补助，

and therefore don't reach patients.  于是病人也不能用上新药。

In several countries, doctors and nurses are the targets, to some extent, for the governments. 在很多的国家，医生和护士在一定程度上成为政府削减开支的针对目标。

After all, the costly decisions in health care are taken by doctors and nurses. 毕竟，那些花费昂贵的医疗措施都是由医生和护士来决定的。

You choose an expensive lab test,  是这些人在选择高成本的实验，

you choose to operate on an old and frail patient.  也是这些人在选择给孱弱的老人做手术。

So, by limiting the degrees of freedom of physicians,  所以，（政府想）通过限制医生的自由，

this is a way to hold costs down.  来达到降低开支的目的。

And ultimately, some physicians will say today that they don't have the full liberty to make the choices they think are right for their patients. 最后导致的结果是医生发现他们没有充分的自由来为他们的病人选择最适合他们的治疗方案，