"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.

「你想看看你的肌腱嗎？」

專門處理手部和腕部的外科醫師阿西夫．伊爾亞斯準備為他的病人縫合傷口。但他先讓她有機會看她放射性疼痛的來源：看起來像淡粉色彩帶糖的一束肌腱。他用一件細長的外科手術器材把肌腱往外推，以展示新獲解放的彈性。

病人艾絲瑟．瓦伊瑙幾乎喘不過氣地說：「真不錯。」

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?!”

伊爾亞斯做的手術稱為狹窄性肌腱滑膜炎（俗稱媽媽手）緩解術，手術時病患通常會麻醉。但瓦伊瑙受到醫學好奇心驅使，加上很不喜歡麻醉，選擇保持清醒，只打了一針局部麻醉針，讓前臂失去知覺。

基於費用和醫學考量，愈來愈多手術是在病人保持清醒和注視下進行。但是在接受手術的病人選擇睜大眼睛之際，醫生與病人之間的行為準則卻沒跟上這種新做法的腳步。病人可能因為似乎予人不祥之感的沉默而緊張，或是因為所謂的辦公室幽默而覺得尷尬。醫師們也才剛剛開始明白，當病人處於警覺狀態時，可不能說「糟糕！」或「我沒預料到」，甚至「哇，我的老天啊，你在做什麼？！」

“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.

芝加哥大學的醫學倫理專家馬克．席格勒說：「我們談手術劇場已談了一千年，這幾年，病人才頭一次加入演員陣容。」他最近在「美國外科手術期刊」上發表了一篇有關清醒手術過程中醫病溝通的研究報告。

選擇看著自己的手術進行，是病人自主運動的又一表現，在這個運動中，病人反抗醫師的家長式作風，樂於更深入參與自身的治療。

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.

一些研究顯示，部分病人覺得在手術時保持清醒，反而不像被麻醉那麼讓人焦慮，儘管可能會看到駭人的景象。

瓦伊瑙不需要術前身體檢查、驗血、靜脈注射，甚至一位麻醉主治醫師。當護理師用輪床把她推出手術室時，她顯得既意外又愉快，她說：「這還沒有我接受過的一些根管治療可怕呢。」

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.

機器人與人類競逐工作機會，究竟誰是贏家？去年，兩位知名經濟學家描繪了一個人類領先的未來，但現在他們宣布了不同的贏家：機器人。

受自動化影響最大的行業是製造業。根據兩位經濟學家，麻省理工學院的達倫．艾斯摩格魯與波士頓大學的帕斯庫爾．雷斯特雷波所完成的一份新報告，每千名工人配備1個機器人，最多會使6名工人失業，薪資也會下跌0.75%。這似乎是把機器人既大又直接且負面的影響加以量化的第一份研究報告。

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.

這份報告所以顯得特別重要，主要是因為原先這兩位研究人員對科技對就業的影響始終較為樂觀，而兩人的專業表現在他們的領域深受重視。去年兩人在一份報告中說，自動化程度提高很可能會創造新的、更好的就業機會，所以就業和工資最終將恢復到先前的水平。正如同起重機取代了碼頭工人，同時也為工程師和金融家創造了相關的就業機會，他們的理論指出，新技術已為軟體開發人員和數據分析師創造新的就業機會。

不過，那份報告僅是一個概念練習。新的報告使用了現實世界的數據，並得出一個較悲觀的未來。這兩位學者表示，他們驚訝地發現其他職業的就業機會增加極少，無法抵消製造業的就業機會損失。他們表示，前述就業機會增加還是可能發生，不過，就眼前而言，失業者人數眾多，且前方沒有明確道路可行，特別是沒有大學學歷的藍領階級。

“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.”

艾斯摩格魯說：「結論是：即使整體就業情況和工資恢復，過程中仍有輸家出現，且這些群體需很長時間才能復元。」

他說：「若你在底特律工作10年，你不會有能進入醫療保健領域工作的技能。市場經濟本身不會為這些在變革中首當其衝的工人創造就業機會。」

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.

這份報告提供了科技取代人類就業機會的證據，但它與美國財政部長米努勤發表的談話大相逕庭。米努勤在美國新媒體Axios的一項活動中說，人工智慧取代人類工作，「甚至不在我們雷達螢幕上」，是「50或100年後的事」。

上述研究分析了工業機器人對美國當地勞動力市場的影響。研究結論是，1990年至2007年期間，機器人是製造業減少67萬個就業機會的元凶，這一數字還會上升，因為工業機器人的數量預計將增至四倍。

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文／王麗娟

文中指出根據研究人員的報告，對藍領階級而言，自動化（automation）是比貿易（trade）和委外生產（offshoring）更大的就業長期威脅。自動化技術取代人力，一直是就業者的一大恐懼。不過，機器最終是否能完全取代人類，迄今仍是見仁見智的議題。許多人認為，機器人（robot）因為缺乏自我意識，只能輔助（complement），無法取代（replace）人類。

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。