ANAMNESIS (Greek anamnesis — reminiscence) — set of information about the patient and the development of a disease received at poll of the most sick and aware his faces and used for establishment of the diagnosis and the forecast of a disease, and also the choice of optimum methods of its treatment and prevention. In some cases during the collecting And. documentation is used.
And. — important part of complex inspections of the patient (see). Coryphaeuses of domestic medicine (M. Ya. Mudrov, S. P. Botkin, G. A. Zakharyin, A. A. Ostroumov) gave And. great value. According to Hegglin (R. Hegglin), in an office of the doctor the diagnosis is established by data And. approximately in 50% of cases, on the basis of an objective research — in 30% and on datas of laboratory — in 20% of cases. On materials to the Liar (And. Bruschke), with the help And. the correct diagnosis of stenocardia can be established in 71% of cases that exceeds informational content of an ECG.
Collecting And. it is carried out by inquiry of the patient, and in certain cases — his family and surrounding persons, especially at a research of the small children, the patients who are in extremely heavy or unconsciousness, mentally sick, deaf-and-dumb. Skillfully collected And. helps to treat correctly data of an objective research and to make idea of localization and the nature of pathological process. During the collecting And. it is necessary to be guided by the humane principles of the Soviet medicine and to consider the determination of health formulated by WHO: «Health is a condition of full physical, mental and social wellbeing, and not just absence of a disease and physical defects». And. is under construction according to a certain plan. At first bring together A.bolezni (anamnesis morbi), then And. lives (anamnesis vitae) taking into account possible influence of heredity, social and family conditions, profvrednost.
By drawing up the anamnesis of a disease specify complaints of the patient, analyze the sequence of emergence and interrelation of separate symptoms of a disease and dynamics of a disease in general. Reveal the causal and promoting development of a disease factors. Consult about earlier established diagnosis and the applied treatment, its efficiency and portability of drugs (pharmacological And.).
Studying of dynamics of a disease includes data on the state of health and working ability of the patient to a disease, about duration of a disease and features of an initial stage, about the sequence of development of various displays of a disease. Learn whether there were periods of improvement and an aggravation of symptoms, than they spoke to what medical institution of the patient addressed as his working capacity changed. The doctor shall be interested not only the facts from life and symptoms of a disease, but also the relation of the patient to these facts, features of the identity of the patient. This suffering can be an aggravation chronic or an effect (complication) of another, sometimes long ago, even in the early childhood of the postponed disease (see. Case history ).
The anamnesis of life
the Anamnesis of life gives fuller and general concept about features of an organism that is very important at individualization of treatment, and also for prevention of aggravations. And. lives can be collected according to the following scheme: 1) the postponed diseases, injuries, operations; 2) general biographic data on the periods of life; 3) heredity; 4) family life; 5) working condition and life; 6) addictions. Each doctor can use the scheme of collecting, most suitable for his work, And., which features depend on profession of the doctor and the contingent of patients. Has value and the nature of the suspected disease, weight of a condition of the patient, feature of his personality. The general requirements to And. lives shall be completeness, systemacity and individualization. In a hospital such inquiry is made very in detail, and in policlinic — only on the highlights necessary for the diagnosis and treatment. In most cases it is admissible since patients, as a rule, consult with more difficult diagnosis specialists and go to a hospital. But also in the conditions of a hospital the volume and depth And. depend on features of a disease.
The postponed diseases are listed in a chronological order, and the doctor shall not be limited to clarification only of the fact of a disease, and specify also features of a current, existence of complications and an essence of treatment when it to some extent could affect features of the real disease. It is important to know whether the TB patient, a hypertension was ill, whether the malignant tumor was suspected at it, whether he was treated by glucocorticoids, antibiotics or other drugs and as he transferred them. The patient can sometimes deny the postponed diseases (e.g., tuberculosis, syphilis, etc.). It can happen if names of a disease are unclear or unknown to the patient or he consciously hides it. Therefore the doctor shall treat critically statements on these questions. It is necessary to alter sometimes the formulation of a question, avoiding at the same time suggestion.
Concerning a profession and possible influence a dignity. - a gigabyte. working conditions on working capacity and health of investigated, find out from what age of the patient began to work in what professions and what is the time was engaged what length of service and qualification by this profession and whether there were breaks, whether performs additional work, in addition to the main, whether the occupational disease was established at it earlier and whether there were production injuries. Here the scheme of poll can be such: 1) labor process and mode of work; 2) physical, chemical and bacteriological professional harm; 3) dignity. a condition of rooms and organization of events on fight against occupational diseases on site works; 4) opinion of the patient on communication between this or that harmful moment and its disease and working capacity. Part A., concerning a profession, helps to reveal a number of the essential circumstances necessary for understanding of a basic disease. Therefore it shall be surely brought in each case history. If there are bases to connect the real disease with harmful professional factors (beam energy, noise, vibration, industrial dust, etc.), then further it is desirable to receive from the corresponding specialists confirmation on existence at the enterprise of the specified sick adverse effects. Unsatisfactory living conditions, even taking place in the past, especially in the childhood, can be reflected a pas health of the person. Find out marital status, a dignity. - a gigabyte. the characteristic of the apartment and food, distance from the place of work to housing, are learned whether the patient conducts public work as has a rest what his hobbies, habits whether there is a conflict situation of the house or at work.
Finding out features of family life of the patient, inquire after about health of the wife (husband) and children. It is necessary to know also about the state of health of parents of the patient and the immediate family, meaning hereditary predisposition of a family to these or those diseases, especially at suspicion of a malignant tumor, coronary heart disease and a brain, a hypertension, rheumatism, diseases of blood, a thyrotoxicosis, inborn defect of body, stones of kidneys or a liver, mental diseases.
It must be kept in mind that sometimes the patient for various reasons underestimates the sufferings (see. Dissimulation ) or, on the contrary, exaggerates (see. Aggravation ), or even invents them (see. Simulation ). Ability to critically estimate data depends on experience of the doctor And.
The mutual understanding and trust between the doctor and the patient protected by a medical secret (see. Deontology medical ), is centuries-old tradition. These relations shall be created in the course of collecting And. Collecting And. is a scientific method, as well as other methods of a research of the patient, and demands from the doctor of many knowledge, both special, and psychological, and also the known skill. Ability of the doctor to come into contact with the patient, to create a situation for friendly chat, is correct to ask questions in many respects defines quantity and quality of the obtained information. Analysis of data And. it has to be carried out taking into account features of the identity of the patient, and their reliability is estimated by comparison with physical, tool, datas of laboratory and with medical documentation (see. Diagnosis , diagnosis). The formulation of the developed clinical diagnosis of the patient becomes possible only as a result of use of all data obtained by means of many methods of a research and analyzed on the basis of laws of formal logic and categories of dialectics.
Creation of the effective system of poll of the patient based on use of computer facilities can promote improvement of the solution of medical and diagnostic tasks though many clinical physicians consider that And. diseases is improper area for automation. The system of questionnaires which are filled personally with the patient is an initial point of researches on improvement of collecting and record of clinical information directly from the patient. These systems are to some extent limited to introduction to the computer of data by means of punched cards (see. Diagnosis machine ). Cars which give the chance to enter answers of patients by means of the keyboard directly into the control unit are more perfect. Received And. remains written down on a magnetic tape and it can be quickly printed. According to Slak (V. Slack) and sotr., the machine program adapted for the questionnaire on an allergy for the flexibility and completeness was not inferior to medical collecting And., but surpassed it in logicality, clearness and profitability. However «machine» And. deprives of the attending physician of that direct impression, a cut it develops at a sincere conversation with the patient and it is irreplaceable for definition of individual approach and treatment.
The anamnesis at children
the Anamnesis at children has the features. The children's doctor usually should ask not the child, and most often mother, the father or other persons, the people around which are servicing and bringing up it. Correctly collected And. matters not only for a successful research and treatment, but also for the organization of the mode of life, food and education of the healthy child — highlights of prevention of any diseases at children. Some questions should be asked in the absence of the child or in a form, unclear for it. It is not necessary to refuse additional questions and to the child — the school student and even the preschool child; such quite serious conversation with the child allows to come into necessary contact with it. The answers received from the child shall be used with care since children are easily inspired and differentiate the subjective feelings insufficiently. At poll of the adult and child it is necessary to be tactful and sensitive, there should not be also a template. The most valuable data are usually reported by mother of the child.
Having found out a surname, a name, a middle name, age of the child and the reason of the address to the doctor, everything that she considers necessary is the best of all to ask mother to tell. Without tearing off the story of mother, it should give skillful questions the desirable direction. Upon termination of the story of mother it is necessary to ask in addition her on the last disease of the child, specifying complaints of the child, time of a disease, feature of its beginning and a further current, character of temperature, other displays of a disease, already carried out treatment and its results.
Having found out And. this disease, specify And. lives of the child, a condition in which its pre-natal development, earlier postponed diseases proceeded. It is better to collect these data in a chronological order. Specify the moments of the period of pre-natal development: from what pregnancy and from what childbirth the child as pregnancy proceeded; if mother was ill, then what as well as in what durations of gestation; what performed work, for what is the time before childbirth went on leave what mode of life and food was; whether pregnancy ended in time, ahead of schedule or dragged on a little; alleged cause of premature births.
The special attention is deserved by the period of a neonatality and the first year of life of the child. It is important to specify features of a childbed (bystry, long childbirth) whether the obstetric grant and what was applied (a vacuum extractor, nippers); whether the child right after the birth or after the carried-out measures of revival cried; a condition of the child at the birth — the weight, length of a body; for what day brought the child of mother for feeding as it took a breast for the first time and as fed him in a maternity home in the next days; whether it had a jaundice and what; when the rest of an umbilical cord and as the wound healed disappeared; whether the child in a maternity home was ill and if was ill then than and as he was treated; for what day of life it was written out from a maternity home if with a delay, then why (a disease of mother or child); weight at an extract. It is reasonable to specify these data according to documents from a maternity home.
The great influence renders feeding, the mode of life and education on development and incidence of the child; it is necessary to specify how the child — on hours or randomly was raised, with a night break or without it when and what were entered dokorm and a feeding up when the child is weaned; since what time and how many received the products containing vitamins (juice, fruit, berries, pharmaceutical drugs); what food was after a year and later, to the last disease and during a disease.
Along with questions of food of the child it is necessary to ask in detail as the child physically and mentally what conditions of physical training were, since first months of life developed during all the life whether there was a medical control. Whether the child visited child care facility, what opinion of tutors and teachers on behavior and school progress; the relation with companions on collective. Relationship in a family; attitude towards the child, mode of life, walks, dream etc.
It is necessary to find out what diseases and when earlier the child as they proceeded transferred, it was treated in hospital or at home, consisted or consists under dispensary observation of the rheumatologist, phthisiatrician, endocrinologist or other specialists whether happened in sanatoria where and when; whether preventive vaccination is done; whether there was positive a tuberkulinovy test (the Tuberculine test, to Mant) when; whether alien serums were entered whether received transfusions of blood etc.
Data on a family are of great importance. It is necessary to find out age of parents, their professions, a working condition and life, material security when and what acute diseases had. Special attention should be paid on detection of hereditary and family diseases, to learn whether parents in relationship consist, whether are available hron. infections and intoxications not only at parents, but also at the immediate family (tuberculosis, syphilis, disorder of exchange, allergic, endocrine, nervous, mental, alcoholism, drug addiction and other diseases). It is important to specify activity hron. infections the contact of the inspected child with these patients was also how close: number of the pregnancy and childbirth preceding at mother, number of abortions and artificial abortions and the reason of premature abortion; how many and what age there are still children in a family as they develop, than were ill whether they have displays of these or those hereditary and family diseases, how many from them full-term and premature; if there were dead, to find out the reasons of their death.
Additional data of anamnestic character can be received by the doctor in the course of inspection and treatment of the patient. Questions A. are various depending on age of the child, the nature of his disease and some other moments. It is necessary to estimate attentively And. lives and And. families and during the overseeing by healthy children.
Anamnesis mentally sick
Studying And. mentally sick plays a special role for establishment of the diagnosis and differs in a number of specific features. Distinguish subjective and objective And.
Data subjective And. receive at inquiry of the patient. However and this, at first sight rather idle time, reception is in most cases connected with considerable difficulties. Collecting And., the psychiatrist at the same time shall estimate the nature of the observed mental changes as reliability of the obtained data depends on them. Regarding cases it is impossible to obtain such data because of disturbance of consciousness, rough changes of memory, weak-mindedness or speech frustration. In other cases in connection with existence of negativism, unavailability, nonsense, hallucinations (the prohibiting voices) or tendencies to dissimulation patients refuse to report anamnestic data or distort them in the light of the painful experiences.
Collecting of objective anamnestic data — very important and responsible stage of creation of the diagnosis of a mental disease. Unlike other industries of medicine, has value not only a condition of physical health of the patient in the past, and equally and all parties of his behavior, the general and vocational education got by it, a way of life, attachments and interests, habits, professional activity, family life and the attitude towards people around, participation in public life, character of occupations in a leisure-time.
Collecting such volume of data can be a task, labor-consuming for the doctor, which implementation will require not only inquiries of family members, but also other persons, e.g. fellow workers, heads. During the carrying out such comprehensive and purposeful inspection the doctor is helped by special sisters-obsledovatelnitsy. Objects objective And. there can be letters of the patient, his note, diaries, and sometimes and the scientific works or works of art created by the patient.
Full, suitable for enough valid diagnostic conclusions And. a mental disease shall, except everything specified, to contain: genetic and constitutional data, i.e. data on hereditary burdeness of the patient with mental diseases or various personal anomalies; data on features of development of the patient in the early childhood, in particular about the nature of so-called age crises; the characteristic of the premorbidal identity of the patient, a warehouse of its character and data on possible dynamics of personal features of the patient during life; data on mental capacities of the patient, on his progress in study and work in dynamics; data on relationship with the environment, contacts, reactions to influence of various somatogenic and psychogenic factors; data on the postponed somatopathies, infections and intoxications, and also on weight and the nature of the postponed mental injuries; data on generative functions, on childbirth, climacteric, etc.
All data received by collecting subjective and objective And., are stated in the history of a disease separately and in a chronological order that provides their adequate use.
Obtaining such full anamnestic data about mentally sick is obligatory premises for dynamic studying of mental diseases.
Only data mental And., the lighting both biological, and social aspects of a disease and the identity of the patient, help to establish the exact clinical diagnosis and, in particular, allow to judge a role and character of a constitutional and genetic background, on Krom the mental disease, and features of the premorbidal identity of the patient, about true starting date of a disease, about a form of its current and degree of its progrediyentnost, about existence and the nature of the mental disorders and personal shifts preceding this disease state and also about changes of a social behavior and working capacity and opportunities of compensation of the defects of mentality caused by development of disease process develops. Opening history of development of a mental disease, And. mentally sick is the major link in knowledge of its nature and of definition of ways and methods of social and labor rehabilitation of patients.
The anamnesis in medicolegal practice
the Anamnesis in medicolegal practice is characterized by a number of features. Treat them: broad understanding And. as source of various preliminary orienting data; use And. at all types of the expertizes which are carried out at investigation of crimes against the personality; collecting And. without leading questions; the critical relation to And. in the light of the objective data obtained in the course of examination.
For obtaining anamnestic data experts use: 1) medical documents (it is reasonable in originals) — case histories, out-patient cards, results of laboratory analyses, the conclusions of consultants; 2) materials of preliminary and judicial examination (protocols of interrogations, surveys, confrontations, etc.); 3) personal explanations of the victims, suspects, defendants, defendants, and also witnesses; 4) the data reported by the persons which are subject to survey (complaint).
Content and volume And. depend on object, the purpose and conditions of conducting examination (survey in out-patient clinic or in a hospital, primary or repeated research of a corpse, different types of laboratory researches of material evidences), and also on character and set of the materials collected at different stages of preliminary and judicial examination. In the documents made at court. - medical examinations, data And. are designated as «preliminary data» or «facts of the case» (see. Documentation medical ). At registration in court. - medical documents data And. shall be registered precisely, literally or tekstualno for ensuring objectivity by drawing up the conclusions. At survey of juvenile children, especially in connection with sexual crimes, it is reasonable to collect And. at the persons accompanying the victim.
In diagnostic conclusions of the expert data are of particular importance And., if definition of mental or physical condition of the witness or victim in cases when there is a doubt in their ability correctly to perceive the circumstances important for business and to give about them the correct evidences (Art. 79 of the Code of Criminal Procedure of RSFSR and the relevant articles Codes of Criminal Procedure of federal republics) is made whether it the issue of an artificial origin of a disease, its simulation or aggravation is resolved if the corpse of the person, the dead suddenly is investigated and also if there is a need of assessment of correctness of rendering medical aid.
At a research of material evidences in court. - medical laboratories in quality And. data from the evidence and previous court are used. - medical examinations.
In conditions court. - medical practicians it must be kept in mind that collected by the expert A. can be incomplete, inexact and even intentionally distorted. All this obliges to establishment of objective data, confirmatory or in different degree denying data And.
The epidemiological anamnesis
the Epidemiological anamnesis is collected for the purpose of identification of a source of an infection, possible ways of its transfer and development anti-epidemic actions (see). The Kliniko-epidemiologichesky orientation defines specific feature epidemiological And. — one of initial links of uniform anti-epidemic and preventive activity of infectious service.
Epidemiological And. first of all gives the answer to a question of the place, circumstances and conditions under which there could be infection, and also about possible ways and ways of transfer of a contagium to other persons.
Collecting data is made purposefully, actively, almost always urgently and demands from the doctor of high vocational training and logical thinking.
Collect data on a profession of the patient, his occupations, the nature of activity, working conditions and life, living conditions, character of food, respect for personal hygiene.
Data on the immune status of the patient are important for what they consider earlier postponed infectious diseases, their prescription, effects. Receive data on the carried-out preventive inoculations, their frequency rates, terms of their effective action, postvaccinal complications, a way of introduction of a vaccine. Consider preventive use of serumal drugs, immunoglobulins, nonspecific stimulators of the protective forces of an organism able to influence not only clinic of a disease, but also duration of an incubation interval.
Corticosteroids, a phage and antibacterial agents can have significant effect on the course of infectious process. It is important to establish a dose, a regularity and duration of treatment, deadlines for administration of drugs, their portability. It must be kept in mind possible variability of microorganisms under the influence of these means. In this regard bacteriological crops on usual mediums of the materials taken from the patient can yield negative takes while actually it continues to remain a source of an infection for people around.
Especially difficult and important part A. clarification of contacts of the diseased with patients with the erased, recurrent or chronic form of an infectious disease, and also with the convalescents who are in a fever patients whose diagnosis of a disease is not established with the bacillicarriers and persons contacting to sick infectious diseases is. Also communication with animals — possible carriers of the infectious agent, stay in the epizootic center or the area with a natural ochagovost of an infectious disease during the period corresponding to limits of duration of an incubation interval of an estimated disease becomes clear; terms, season, weather conditions are specified.
In epidemiological And. finds reflection and influence of other environmental factors which in the presence of the corresponding conditions can play a role in spread of the suspected infectious disease: foodstuff, ware, drinking water or the hygienic purposes, household items, clothes, transport, to-rymi the patient used; stings of insects — carriers of contagiums or intermediate owners of infectious diseases; wounds, injuries and other disturbances of integuments, their location, roughing-out; the operations performed hemotransfusions for the last year as the possible reason of some infectious diseases (e.g., serumal hepatitis).
It is necessary to consider also a possibility of emergence, especially in border areas of the USSR, in ports. - the stations, the airports, little-known, rare infectious diseases against which the population of this area has no immunity. See also Epidemiological inspection .
Botkin S. P. Kurs of clinic of internal diseases and clinical lectures, t. 1 — 2, M., 1950; Gilyarevsky S.A. and Tarasov of K. E. Subjektivnoye and objective in diagnosis, in book: Methodological problems of diagnosis, under the editorship of A. I. Strukov, page 21, M., 1965; Glyazer G. About thinking in medicine, the lane with it., page 166, M., 1969; Lasted L. Introduction to a problem of decision-making in medicine, the lane with English, page 110, M., 1971; Hegglin R. Differential diagnosis of internal diseases, the lane with it., page 47, M., 1965; Grund G. and. Siems H. Die Anamnese, Lpz., 1957.
And. at children
Dombrovskaya Yu. F., Lebedev D. D. and Molchanov V. I. Propaedeutics of children's diseases, page 64, M., 1970; Round A. T. Anamnesis, Mnogotomn. the management on pediat., under the editorship of Yu. F. Dombrovskaya, t. 1, page 528, M., 1960; it, Propaedeutics of children's diseases, page 231, L., 1971.
Z. I. Yanushkevichus; I. V. Rubtsov (epid.), V. M. Smolyaninov (court.), A. F. Tour (ped.), E. Ya. Shternberg (psikhiat.).