Manzoni G C, Torelli P
Headache Centre, Department of Neuroscience, University of Parma, Via Gramsci 14, I-43100 Parma, Italy.
Neurol Sci. 2007 May;28 Suppl 2:S130-3. doi: 10.1007/s10072-007-0765-5.
Recent epidemiological investigations have demonstrated that migraine, and more generally primary headaches, are underdiagnosed and poorly treated. To tackle and resolve this problem, in addition to identifying efficient screening means and reliable disability measurement tools, it is crucial to improve communication between physicians and patients. In particular, physicians should be willing and have time to establish a relationship of active and mutual cooperation with their patients and should do so through a number of inescapable steps: listening to patients, understanding their needs, identifying with their condition, giving them explanations and information, reassuring their concerns, advising them on what should be done, making sure that they have correctly understood what they have been told, finding out whether they want to be involved in decision-making and choosing a treatment. Patients must be in a position to freely express their opinions, with no hurry and without fear. Indeed, the time spent with patients, as Graham pointed out as early as 40 years ago, is the most important ingredient of migraine therapy. Proper measures should be taken to overcome the two major obstacles that stand in the way of a good patient-physician relationship: a physician's lack of adequate skills and the organisational absurdities of the health system.
最近的流行病学调查表明，偏头痛，更普遍地说原发性头痛，存在诊断不足和治疗不力的情况。为了解决这个问题，除了确定有效的筛查手段和可靠的残疾测量工具外，改善医生与患者之间的沟通至关重要。特别是，医生应该愿意并有时间与患者建立积极合作的关系，并且应该通过一些必不可少的步骤来做到这一点：倾听患者的意见，了解他们的需求，认同他们的病情，给他们解释和信息，消除他们的担忧，就应该做什么给他们建议，确保他们正确理解所告知的内容，了解他们是否想参与决策并选择治疗方法。患者必须能够自由地表达自己的意见，不着急且不害怕。事实上，正如格雷厄姆早在40年前所指出的，与患者相处的时间是偏头痛治疗中最重要的因素。应该采取适当措施克服阻碍良好医患关系的两个主要障碍：医生缺乏足够的技能以及卫生系统的组织不合理之处。
