Ruffin M T, Cohen M
Department of Family Practice, University of Michigan Medical School, Ann Arbor.
Am Fam Physician. 1994 Sep 1;50(3):625-34.
Fatigue is a common symptom among patients of primary care physicians. For many physicians and patients, interactions related to the subject of fatigue are frustrating and unsatisfying, because of differences in expectations, a narrow focus on biomedical origins or solutions, and failure to include psychosocial issues in evaluation and management. The initial office visit should focus on the patient's history, to determine the type of fatigue and establish an effective therapeutic relationship. Few, if any, laboratory tests should be ordered. The second office visit should be used to review the information collected, add any new information from the patient's diary or reports from the patient's significant others, and perform a complete physical examination. Patients whose fatigue is diagnosed as physiologic or secondary to a medical problem should receive specific therapeutic interventions. The management of other patients requires interventions that combine biomedical and psychosocial therapies with a commitment to long-term follow-up. The key to successful management of fatigue is an effective therapeutic relationship with the patient.
疲劳是基层医疗医生的患者中常见的症状。对于许多医生和患者来说，与疲劳主题相关的互动令人沮丧且不尽人意，原因在于期望存在差异、对生物医学起源或解决方案的关注狭隘，以及在评估和管理中未能纳入心理社会问题。初次门诊应聚焦于患者的病史，以确定疲劳的类型并建立有效的治疗关系。应尽量少开实验室检查单（若要开的话）。第二次门诊应用于回顾收集到的信息，补充患者日记中的任何新信息或患者重要他人提供的报告，并进行全面的体格检查。疲劳被诊断为生理性或继发于医疗问题的患者应接受特定的治疗干预。其他患者的管理需要将生物医学和心理社会疗法相结合，并承诺进行长期随访的干预措施。成功管理疲劳的关键是与患者建立有效的治疗关系。
