How to diagnose yourself. Advice from American doctors. Medical diagnosis of the patient and its types

In ancient times, when there were no methods or hardware diagnostics, doctors, in order to determine the patient’s condition, relied only on external signs of trouble. After looking carefully at the man for some time, the doctor confidently diagnosed him.

Today, a conclusion about a disease, as a rule, is made only after the patient has undergone necessary tests. But at the same time experienced doctors, just like their ancient predecessors, widely use diagnostics based on external signs. Actually, why don’t the patients themselves adopt some of the doctors’ observations? After all, this will help a person quickly navigate his condition and not rack his brains over which specialist to make an appointment with, but rather an appointment, and in the office immediately clearly identify his symptoms. This will greatly help the doctor in your treatment.

Here is a list of some signs of disease proposed by American doctors.

Legs. A lot of people have leg pain, and in old age it bothers almost everyone. After all, they carry a huge load every day. By noting where this stress is most pronounced, you can understand what changes are happening in your body.

So, if a hard callus “horseshoe” stretches along the edges of the heels, especially with cracks, this indicates possible problems with joints or the musculoskeletal system in general. For example, if the skin hardens along the outer edges of both heels, then you need to pay attention to the condition of the spine, if inside, closer to the instep of the foot, then it is worth checking the intestines. Rough skin on the inner edges thumbs leg should prompt you to visit an endocrinologist and ask him to examine your thyroid gland.

Looking at swollen calves and ankles, usually talk about excess water in the body and, accordingly, about deficiencies in the functioning of the kidneys and heart. But the reason for this may be the most banal - swelling often occurs if a person sits at a desk for a long time or, conversely, stands on his feet for many hours (like, for example, hairdressers). In such cases, it is easy to get rid of swelling, and at the same time excess static load on the musculoskeletal system, changing your body position every half hour and doing a short warm-up. It is also useful to redistribute the load on the foot: for example, walk on tiptoes, on the outer and inner edges of the foot, massage the sole. The fact is that there are dozens of biological points connected to all internal organs, kneading which will activate these organs. If your condition allows of cardio-vascular system, give your legs a feasible load: walk more, climb top floor not by elevator, but on your own.

Leather. This one large organ human body can tell a lot about him. In particular, dry and flaky skin indicates a lack of vitamins A or B, white spots on the skin may indicate a lack of a number of other vitamins, including C. They are also a sign of disease thyroid gland or developing diabetes.

It happens that “bruises” remain on the body from the slightest pressure. In this case, consultation with a specialist in blood diseases is necessary, since the appearance of hematomas is a symptom of anemia and a number of other diseases of the circulatory system.

Nose. When red streaks appear on the tip of the nose, it is usually thought that the person is addicted to alcohol. But to the same extent, this also indicates problems with the heart muscle. If the entire tip of the nose turns red, you can think about decreased stomach function and duodenum. A white tip of the nose indicates problems with blood circulation.

Nails reddish-brown color indicates kidney disease. thick neck often accompanies the appearance of goiter, a disease of the thyroid gland associated with iodine deficiency in the body.

Capable of many things tell your eyes, which is not by chance called the mirror of the soul and body. Diagnostics by the iris of the eye has long been included in the arsenal of doctors. But you may not even know about the nuances reflected through the iridology device, but judge your health status by appearance eye. If they are clean, clear, with a clear pattern of the iris, then everything is fine in the body. Redness or blurriness of the iris may indicate liver problems. But the swelling of the lower and upper eyelids may indicate both a disruption of the heart and kidneys, and problems with gynecology.

If you have bad hearing, this may indicate many problems, not counting the “ear” ones directly. Hearing loss often occurs when hypertension, osteochondrosis cervical region, kidney diseases, brain diseases and a number of other ailments.

Which is correct: diagnosis "cancer" or diagnosis: cancer?

Correctly: cancer diagnosis(no punctuation between the defined word and the application) ; Diagnosis - cancer(a dash is placed between the subject and the predicate).

Question No. 296127

Good afternoon Question about the word "nosology". Often in the educational and methodological literature on pedagogy there are phrases “children with various nosologies”, “the curriculum is compiled according to nosologies”, etc. Under nosologies in in this case this refers to hearing, speech, vision impairments, etc. Doctors say that in their professional slang the word “nosology” is used to mean “diagnosis” or “several diagnoses”. However, in dictionaries I did not find any other meaning for this word other than “The branch of medicine that studies types of diseases and their classification.” Please tell me whether it is correct to use this word in the meaning of “diagnosis/diagnosis”? Or should we use, for example, the phrase “form of the disease”? Thank you!

Russian help desk response

We believe that such use is limited to the professional sphere (does not correspond to the literary norm).

Question No. 294978

Pay attention to question No. 294554. The phrase “hydrocephalus of the brain” is not pleonasm, because there is hydrocephalus spinal cord. In this case, the definitions of “head” and “dorsal” are very important, because they are responsible for the accuracy of the diagnosis. The doctors would kill you guys.

Russian help desk response

The question was whether the combination was a pleonasm. Yes, it is a pleonasm. However, it does not follow from this that such a combination is prohibited for use by doctors (apparently, this understanding of the answer is the reason for the possible threat). Not every pleonasm is a mistake. There are pleonasms that have become established as terms. The revolutions you cited are an example of this.

Question No. 291204

If the body’s adaptive capabilities cannot be improved, patients diagnosed with a postoperative ventral hernia should be operated on only for health reasons. Is a comma necessary after the word "in the event of"?

Russian help desk response

A comma is not required.

Question No. 285045

Put the numeral in the correct case: We met in 1574 similar cases. In 478 out of 866 cases the diagnosis was confirmed. Add 11 to 284. The weight of a whale’s heart reaches 1200 kilograms. About 679 people called the editorial office.

Russian help desk response

We don't do homework. The “Writer’s Book” will help you complete the task yourself.

Question No. 283998

Good afternoon! please tell me if quotation marks are needed in this case: they have diagnosed ("children's) cerebral paralysis(") how are medical diagnoses written in writing?

Russian help desk response

The name diagnosis a is written with a lowercase letter and enclosed in quotation marks.

Question No. 282241
Diagnosed with diabetes mellitus./Diagnosed with diabetes mellitus.

Russian help desk response

Quotes are needed.

Question No. 279848
The question is this. How to place punctuation marks correctly?
1. Diagnosis: "First degree obesity."
2. The diagnosis of “first degree obesity” is not a problem.
Which option is correct 1 or 2? Thank you in advance.

Russian help desk response

Correct spelling: Diagnosis “First degree obesity” is not a problem.

Question No. 277491
Hello. It raises a question when writing a diagnosis and with capital letter and in quotation marks in a sentence like this: “The percentage of children diagnosed with autism spectrum disorder continues to rise.” Please tell me what spelling of the name of the diagnosis will be correct in this case. Thank you in advance.

Russian help desk response

There is no reason to write the diagnosis in capitals.

Question No. 274962
What punctuation marks should be used in the case of a sentence like “The patient has been diagnosed with amnesia”?
The word "Amnesia" is highlighted in quotation marks and written with capital letters or is it preceded by a dash or colon? Which is correct?

Russian help desk response

Right: A diagnosis of amnesia was made.

Question No. 272052
Hello! Please tell me whether it is necessary to enclose the name of the diagnosis in quotation marks and write it in capitals, for example, ... diagnosed with epilepsy or ... diagnosed with "Epilepsy"?

Thank you in advance.

Russian help desk response

If the name diagnosis and does not agree with the generic word, quotation marks are usually used. But there is no reason to write in capitals. Correctly: epilepsy was diagnosed.

Question No. 264804
Hello!
please tell me and, if possible, explain how to write the “name” of doctors correctly in the following sentence:
"Wide Application general x-ray examination clinicians chiropractors due to a greater extent to the need to form a nosopathological diagnosis and..."
i.e. I wonder if a dash will be placed here, by analogy with a hyphen in the single addition “doctor-generalist”?
thank you in advance. you will help a lot)

Russian help desk response

Yes, a dash is appropriate here.

Question No. 262815
Dear “Gramota”, I repeat my question. Please answer (it’s very interesting and important for work).
Why are there no quotation marks in the combinations luxury class, swing style, profession welder, but in the combinations the color “metallic”, the stamp “top secret”, the diagnosis “pneumonia”, the specialty “mathematics” there are quotation marks?
Why in the combination “director Petrov” the application is director, and in the combination “swing style” the application is swing? And in the combination “my son Borka” the application is my son or Borka? The rule is contradictory. It says: if the application is placed before the word being defined, then a comma is not placed, but if it is nevertheless placed, then the word being defined and the application are swapped - that’s all. In “my son Borka” the application is my son, and in “my son, Borka” the application is Borka. This rule explains the comma that is already there, but does not explain when to put it.
What determines the clarifying intonation (and the placement of a comma) in applications expressed by a proper name?
He looks like my son Borka.
He looks like my son, Borka. Here, according to Rosenthal, the criterion is uniqueness or plurality. What other criteria are there? The Complete Academic Handbook of Punctuation hints that in single application the comma is affected by the prevalence of the combination being defined, but there are no examples or clarifications.

Russian help desk response

Thanks for the questions!

You point to one of the most difficult and controversial places in Russian spelling. First about the quotes. The fundamental difference between combinations profession "welder" And specialty "mathematics" no, it is advisable to write such combinations uniformly. (However, there is still one difference: you can create a grammatically correct consistent combination welder profession and it is impossible to create a consistent combination major in mathematics; This is already a difficulty in the area of ​​grammar, and not in the area of ​​text design, although the latter stems from the first).

And how uniformly - let's proceed from the emerging practice of writing. If the application is a variable, inflected word, then in the case of case mismatch, quotation marks appear, which act precisely as a graphic sign of mismatch. Therefore, in practice, combinations such as specialty "mathematics", profession "welder" etc. Combinations style + luxury, retro, pop, empire, baroque and others are combinations with immutable applications; in order to further indicate this immutability, quotation marks are not needed.

These are polar cases. The examples you named are intermediate between the two poles, which is why there is a discrepancy in design in them.

Now about commas. The root of the problem is what is considered the main and what is the dependent word in a phrase, because a phrase implies subordinating connection between its parts, between the words included in it. Thus, the problem again leaves the purely punctuation framework and moves into the sphere of grammar, that is, the structure of the text, its structure, logical relationships between words. And these logical relationships are built by the author of the text, the author of the thought, the message. And therefore, the final decision - when choosing one of the possible (we emphasize: possible, i.e. logically consistent) options - lies with the author of the text.

Question No. 261014
Would the phrase “making a diagnosis” be correct? What about “making a diagnosis”?

Russian help desk response

Combination making a diagnosis wrong, establishing diagnosis - correct.

Question No. 252692
Hello!!!
How to correctly spell the diagnosis "diabetes mellitus" or the diagnosis "diabetes mellitus" or the diagnosis " Diabetes"?

Russian help desk response

Correctly: diagnosis of diabetes mellitus.

Doctors are called to help people. Unfortunately, in difficult situations they are not always able to save the patient, because the countdown is carried out in seconds, and each decision may prove fatal. Judging doctors for not being able to heal everyone is wrong because they are only human.

However, in some cases, a disastrous outcome could have been avoided if not for negligence and inattention medical personnel. This behavior in mandatory must be stopped and the culprit punished. After all !

So, what to do if the doctor decides not to correct diagnosis?

Features of the crime

Medical malpractice cases are considered among the most complex cases in legal practice. Patients are often dissatisfied with the work of doctors, but do not always decide to start proceedings, because in order to establish wrongness medical officer, we need proof.

So, it is necessary, first of all, to establish whether the diagnosis was made incorrectly due to the doctor’s fault (due to his inattention or). For this purpose, a medical examination is carried out.

Experts, using test results, recreate the situation in which the accused doctor found himself when making the diagnosis. If, based on these data, experts conclude that any doctor of appropriate qualifications could make the correct diagnosis, there are grounds for calling the negligent doctor accountable.

Thus, making an incorrect diagnosis is punishable when it was made through the fault of the doctor. This could be simple laziness, ignorance (cases of professional illiteracy are not uncommon), inattention or a biased attitude towards the patient, in a word, an irresponsible attitude towards one’s responsibilities.

To learn about why an incorrect diagnosis made by a doctor is so dangerous, watch the following video:

Algorithm of patient actions in case of a medical error

When a patient has reasons to suspect that he was diagnosed incorrectly (most often, this becomes clear from the deterioration of the person’s condition), this assumption should be confirmed or refuted.

Where to contact?

There are several authorities that you can contact if you discover an error on the part of the attending physician.

It is most logical to start with the administration of the hospital itself, since if you immediately contact higher institutions, you will still be redirected there in order to find out the circumstances on the spot.

Administration of a medical institution whose doctor made an incorrect diagnosis

The first thing you need to do is write a complaint to the head of the department where you were treated incorrectly, or directly to the head physician if the situation is complicated.

Most often, problems that arise are resolved at this stage. The doctor’s actions are reviewed by management, and if they are found to be incorrect, your claims are satisfied.

If the hospital administration does not cooperate and refuses (the response to the complaint must be in writing), you should complain further.

Ministry of Health

A territorial branch of the Ministry of Health can be found in every subject of the Russian Federation. This body always has a public reception room where complaints from the public are accepted for consideration. After all, the purpose of this organization is to control the work of medical institutions.

There are several ways to file a complaint with the Ministry of Health:

  • Personally;
  • Send the paper by mail;
  • Send a letter of complaint by e-mail;
  • Leave the text of the complaint on the official website.

As in the case of the hospital administration, they must answer you, and in the form that you indicated in the complaint. The application is given 30 days to review.

Prosecutor's office

Since the duties of the prosecutor's office include monitoring compliance current legislation citizens and organizations, filing a complaint against a doctor with this body is quite natural.

Court

To defend their rights, each person can file a claim in court. However, you should remember that your claim must be substantiated and supported by evidence in the form sick leave, outpatient card, test results, and prescriptions.

It is with the help of the court that one can achieve compensation for damage when the management of the clinic refuses to solve the problem peacefully.

Financial compensation in favor of the plaintiff will be requested from the organization where the doctor who made the incorrect diagnosis works. After which the hospital can recover these funds from the negligent employee.

The claim is filed in the usual manner. All Required documents are attached to it.

Police Department

  • In some cases, medical negligence leads to significant consequences, described as grave harm, the infliction of which by negligence is punishable under Article 118 of the Criminal Code of the Russian Federation.
  • In addition, the reason for contacting the police may be negligence (Article 293), non-compliance with accepted sanitary and epidemiological standards (Article 236) and concealment of certain circumstances that led to a deterioration in human health (Article 237).
  • Cases of intentional infliction of serious harm are extremely rare (Article 111).

The fact that you are being treated incorrectly should also be reported to the insurance service, which will provide an examination.

If the mistake was made by a doctor private clinic, all the above measures also apply. In addition, you can contact the Rospotrebnadzor office, which monitors the work of all enterprises and legal entities.

Rules for filing a complaint

A fixed sample complaint against a doctor (including a pediatrician) about misdiagnosis no, so we will name only a few recommendations for its preparation, which will allow us to succinctly and accurately present all the facts:

  • Statement header. It is written, as is customary, in the upper right corner of the sheet. This should contain the following information:
    • Names of the body to which this complaint is sent;
    • Full name and position of the person to whom the paper is addressed;
    • Personal data including full name, telephone number and address;
  • In the center of the sheet, under the header, you must indicate the name of the document: “Complaint against a doctor” or “Claim”;
  • Main part. Here you need to briefly and succinctly state the situation, if possible, refer to the law that, in your opinion, has been violated. Here you should point out the available evidence;
  • Filling out claims (taking measures in connection with negligent attitude towards the work of medical staff, calling for responsibility, punishment, compensation for damage);
  • Date and signature of the applicant;
  • List of attached documents.

You can find the rules for filing a claim in court in Article 131 of the Code of Civil Procedure of the Russian Federation. In principle, it will contain the same information. In addition, it will be necessary to indicate the fact that pre-trial measures were taken, that is, an attempt to resolve the issue with the hospital administration before filing a claim.

Read last about what a doctor faces for an incorrect diagnosis in accordance with the legislation.

Responsibility of the doctor and medical institution for incorrect diagnosis and treatment

Criminal liability for an error in assignments that led to severe consequences for the health of the patient, and doctors are rarely convicted of criminal negligence, and, as a rule, such a case receives wide resonance.

If a doctor does not make the correct diagnosis, this does not always indicate his lack of professionalism; sometimes the diagnosis depends on the patient. How can I help my doctor make a diagnosis?

A typical visit to the doctor most often looks like this: the patient describes his symptoms, gets tested and undergoes examinations, then the doctor analyzes the information and makes a diagnosis. The clinical picture is not always clear, so the diagnosis is a theory based on symptoms. There are often circumstances that make it difficult to make a correct diagnosis.

There are three types of error when making a diagnosis:

  • Incorrect diagnosis - the doctor correlated the symptoms with the wrong disease and made a mistaken diagnosis;
  • Delayed diagnosis - the diagnosis was made, but the doctor did not prescribe treatment until the symptoms became more clear;
  • Missed diagnosis - the disease fits the symptoms, but the doctor did not make a diagnosis.

Many medical errors occur due to the fault of the patient; for example, people often suppress certain facts, considering them insignificant. In order for the doctor to make the right decision, you must help him. Take this information seriously, as an incorrect diagnosis causes you to waste money and energy, and also undermines your trust in doctors.

Doctors make an incorrect diagnosis in approximately 10% of cases, and it does not matter the status of the doctor or the level of the medical institution.

High achievements in the field medical technologies play a large but not decisive role. Conclusions of the most modern tomographs and results genetic tests will be interpreted by humans, who may be mistaken. It's about about the simplest and most common diagnoses, rare diseases, on the contrary, are most often diagnosed accurately.

First of all, you need to understand that the doctor is the same person as you, he can also get tired, get distracted by serious problems at work or family, being hungry or not getting enough sleep. No one is immune from medical error, you don’t need to react to them overly emotionally, your task is to follow several rules and help the doctor make a diagnosis.

Find an experienced and caring doctor

Doctors must be meticulous with their patients and patient when gathering information. If you have a thought that your doctor is neglecting additional examinations, which means you need to find another specialist whom you trust.

Prepare for your visit

Before visiting a doctor, write down all your complaints on a piece of paper, as well as major changes in your life for Lately, these may be strong psycho-emotional shocks, travel abroad, physical exercise and other. Consider every factor that could somehow influence your condition. During your initial visit to the doctor, you need to prepare for him all the results of the latest tests and examinations, the opinions of other specialists, as well as a list of all the diseases that you have suffered from previously.

Tell us about all your symptoms

Just tell the doctor everything you feel, without missing a single symptom; perhaps a small detail will help the doctor build a logical chain. When you describe painful sensations, mention the nature of the pain when it first appeared. Speak voluminously and clearly, so that the doctor does not have to extract information from you or come up with it himself.

Ask about all the diagnostic options

Very often doctors choose the most severe symptoms and select a diagnosis for them, so don’t hesitate to ask the question, what other disease could there be with the same symptoms? A simple question will give you more information about your health and give your doctor the opportunity to look at your clinical picture on the other side.

Specify information about examinations

If the doctor has prescribed tests and examinations for you, then ask him about each of them, you need to understand why you should undergo this or that test, and at the same time, the doctor will justify the diagnosis for you.

Don't assume the absence of bad tests is good news

If all examinations and tests show normal values, then you shouldn’t be happy that you are not sick. If you continue to feel unwell, tell your doctor and pay his attention to every sign of illness.

Respect the doctor's work

You should never enter into conflict with your doctor or react too emotionally to him, as this will only prevent him from making the correct diagnosis. When visiting a doctor, be calm and reasonable, do not spread negative emotions to a specialist, they will immediately affect you.

Know your role in making a diagnosis

A correct diagnosis can only be made through joint, well-coordinated work between the doctor and the patient. If you feel like you are not getting enough attention, consider looking for another specialist.

The tradition of formulating a medical diagnosis is a legacy of the “interpretation of signs” from the time of Hippocrates and the later “epicrisis”. The legislation does not define this concept. The most widespread and widely used definition is: “ Medical diagnosis- these are the doctor’s conclusions about the state of health of the subject, about the existing disease (injury) or about the cause of death, expressed in terms provided for by the classifications and nomenclature of diseases.”

According to I.V. Davydovsky medical diagnosis has three categories:

  • Main disease
  • Complications of the underlying disease
  • Concomitant diseases

Over many decades of existence, the medical diagnosis formula has confirmed its logical and practical value.

“The attending physician establishes a diagnosis, which is based on a comprehensive examination of the patient and compiled using medical terms a medical report on the patient’s disease (condition), including the cause of the patient’s death. The diagnosis usually includes information about the underlying disease or condition, concomitant diseases or conditions, as well as complications caused by the underlying disease and concomitant disease"- noted in paragraphs 5 and 6 of Article 70 Federal Law dated November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in Russian Federation».

And part 2 of Article 14 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” determines that the powers of the federal body executive power producing public policy and regulatory legal regulation in the field of health care, including: 11) approval of the procedure for organizing a document flow system in the field of health care, unified forms medical documentation, including in electronic form. Thus, only specified body The executive branch determines in which points of the unified forms of medical documentation (outpatient card, dispensary observation card, sanatorium-resort card, certificates, extracts, etc.) and in what form the diagnosis is formulated. Order of the Ministry of Health of Russia dated December 15, 2014 No. 834n “On approval of unified forms of medical documentation used in outpatient settings and the procedure for filling them out” approved: form No. 025/u “ Medical card patient receiving medical care on an outpatient basis", form No. 043-1/u "Medical record of an orthodontic patient", form No. 030/u "Control card of dispensary observation", Form No. 070/u "Certificate for obtaining a voucher for Spa treatment", form No. 072/у " Sanatorium-resort card"; form No. 076/у “Sanatorium-resort card for children” according to; form No. 079/у " Medical certificate for a child leaving for a sanatorium health Camp"; Form No. 086/у “Medical certificate (medical professional advisory opinion).” These documents emphasize the important role of the earliest and most complete formulation of the diagnosis, which is why records of the initial examination of the doctor, examination of other specialists, the head of the department, consultation medical commission and generalization of data by the attending physician clinical examination necessarily ends with a diagnosis. On the first page of the outpatient card, diagnoses of all diseases for which the patient is being treated are indicated. dispensary observation. On the second page, all final (refined) diagnoses made for the first time or again are recorded.

In Russia International classification diseases (ICD) is considered the International Statistical Classification of Diseases and Health Problems, X revision (1995), adopted by the Forty-third World Health Assembly (Order of the Ministry of Health of the Russian Federation dated May 27, 1997 No. 170 “On the transition of health authorities and institutions of the Russian Federation to the international statistical classification diseases and health problems, X revision"). It is according to this classification that the diagnosis should be made. Do not forget that the ICD is primarily a statistical classification. More details about the classification can be found in the article “”.

Undoubtedly progressive step in 2015, the Order of the Ministry of Health of the Russian Federation dated July 7, 2015 No. 422an “On approval of quality assessment criteria” was published medical care"(hereinafter referred to as Order No. 422an). The criteria for the quality of medical care established by this order affect not only the immediate process of providing medical care, but also issues related to the formulation and registration of a diagnosis. The document separates the requirements for making and registering a diagnosis in outpatient and inpatient conditions. Thus, paragraph 3 states that a preliminary diagnosis is established by the attending physician during initial appointment patient when providing medical care on an outpatient basis, no later than 2 hours from the moment of treatment, and clinical diagnosis installed within 10 days from the date of application. The latter must be documented in the appropriate entry in the outpatient card and be based on data from the anamnesis, examination, data from laboratory, instrumental and other research methods, and the results of consultations with medical specialists. Entire volume diagnostic measures should be provided for by standards of medical care, as well as clinical guidelines (treatment protocols). If there is difficulty in making a diagnosis, a consultation of doctors is held and an appropriate entry is made in the outpatient card with the signature of the head of the outpatient department medical organization. If it is necessary to provide medical care in a hospital setting, a referral to a hospital is issued indicating the clinical diagnosis.

When providing medical care in inpatient conditions and in a day hospital, a preliminary diagnosis is established by a doctor in the admission department or a doctor in a specialized department (day hospital) or a doctor in the anesthesiology-reanimation department (center) of a medical organization no later than 2 hours from the moment the patient enters the medical organization. Establishing a clinical diagnosis must be made within 72 hours from the moment the patient is admitted to the specialized department ( day hospital) medical organization, and upon admission of the patient to emergency indications no later than 24 hours. Clinical diagnosis in an inpatient setting is based on the same criteria as in outpatient medical care. If there is difficulty, the clinical diagnosis is established by the decision of a council of doctors, drawing up a protocol and making an entry in a special section stationary card, with the signature of the attending physician and the head of the department. We remind you that these criteria are used for the purpose of examining the quality of medical care, which is currently carried out only within the framework of compulsory medical insurance. You can find out more about this in the articles: “”, “”.

From July 1, 2017, new criteria for assessing the quality of medical care, approved by Order of the Ministry of Health of Russia dated July 15, 2016 No. 520n, will come into force.(hereinafter referred to as order No. 520n).

Let us note that, in contrast to the norm contained in Order No. 422an, Order No. 520n does not contain a time limit for making a preliminary diagnosis by the attending physician during the patient’s initial appointment. Read more about this in the article “ » .

We remind you that these criteria are used for the purpose of examining the quality of medical care, which is currently carried out only within the framework of compulsory medical insurance. You can find out more about this in the articles: “”, “”.

Order of the Federal Compulsory Medical Insurance Fund dated July 21, 2015 No. 130 “On amendments to the Procedure for organizing and monitoring the volume, timing, quality and conditions of providing medical care under compulsory health insurance, approved by order of the Federal Fund for Compulsory Medical Insurance” health insurance dated December 1, 2010 No. 230” introduced the presence of a discrepancy between clinical and pathological-anatomical diagnoses of categories 2-3 into the list of grounds for refusal to pay for medical care (reduction of payment for medical care) due to defects in the provision of medical care. For the first time, the expert opinion (protocol for assessing the quality of medical care) includes diagnostic criteria: assessment of the wording, content, time of diagnosis and justification negative consequences errors in diagnosis.

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A unified classification of types of diagnoses has not yet been established. IN clinical practice The customs of business medical circulation include several definitions of diagnosis: differential diagnosis, laboratory, immunological, preliminary final. Differential diagnosis is rather part of the rationale and method of medical thinking. Data from laboratory and immunological tests, as objective signs and symptoms, may be included in the heading “underlying disease.” Preliminary diagnosis and final diagnosis can be called “preliminary clinical diagnosis” and “final clinical diagnosis”, but they should not be distinguished as types.

The most reasonable conclusion is that the type of medical diagnosis is determined by the functions it performs. The following types of diagnosis are distinguished: clinical, pathological-anatomical, forensic, sanitary-epidemiological diagnosis.

Clinical diagnosis- this is a diagnosis established for a patient in a hospital setting or long-term outpatient observation, facilitating treatment and further prevention diseases. Preliminary diagnosis(incomplete) is diagnosed during the initial examination, and on its basis an examination and treatment plan is drawn up; it can be symptomatic, syndromic, or nosological. A detailed diagnosis (full) is formulated in a certain time period on the basis of anamnesis, examination, laboratory, instrumental and other research methods, the results of consultations with medical specialists provided for by the standards of medical care, as well as clinical recommendations(treatment protocols), promotes complex treatment And secondary prevention, it can be syndromic or nosological.

Pathological and anatomical diagnosis- the final part of the autopsy report, in which the pathologist, based on the analysis of morphological data and clinical materials, formulates a synthetic conclusion about the nosological form, dynamics of the disease (or diseases) and immediate cause of death. The procedure for its registration is regulated by Order of the Ministry of Health of Russia dated June 6, 2013 No. 354n “On the procedure for conducting pathological and anatomical autopsies.”

Forensic diagnosis- this is a special conclusion about the nature of the injury (disease), the condition of the subject or the causes of death, drawn up on the basis of a forensic medical examination to resolve issues arising in forensic investigative practice, and expressed in terms accepted in forensic medicine. Order of the Ministry of Health and Social Development of the Russian Federation dated May 12, 2010 No. 346n “On approval of the Procedure for organizing and conducting forensic medical examinations in state forensic institutions of the Russian Federation” establishes the procedure for conducting examinations and making a forensic diagnosis.

Sanitary and epidemic diagnosis- this is the formula for the conclusion of an epidemiologist about the epidemic nature infectious disease, properties epidemic focus and features of the epidemic process, expressed in terms provided for by the nomenclature and classifications accepted in epidemiology. The sanitary-epidemic diagnosis does not directly concern the patient, but is aimed at identifying the characteristics of the emergence, formation and spread of the epidemic focus.

If a diagnosis is made incorrectly, both criminal and civil liability may arise.

Based on clause 9, part 5, article 19 of the Federal Law of November 21, 2011 No. 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation,” the patient has the right to compensation for harm caused to health during the provision of medical care. An incorrect diagnosis is always associated with an incorrect, incomplete, and sometimes simply harmful treatment and can lead to complications of the disease, deterioration of condition, disability and even death, which is undoubtedly harmful to health, which in judicial practice there are numerous confirmations. So in the Appeal ruling of the Moscow Regional Court dated May 18, 2015 in case No. 33-11200/2015, the role of an incorrect diagnosis was emphasized as a reason for poor quality medical care “as a result of the fact that the fracture acetabulum was not diagnosed and appropriate treatment was not carried out, and the patient was recommended to become more active, moving on crutches, the injury was aggravated due to the formation of a dislocation of the head femur, which subsequently required an additional operation aimed at eliminating the dislocation of the femoral head... In the event that a fracture of the acetabulum would have been diagnosed in D.I.H. in the Sergiev Posad hospital, the treatment, with a greater degree of probability, would have been carried out conservatively, that is, without performing an operation of osteosynthesis of fragments of the acetabulum and reduction of the dislocation of the femoral head.... due to shortcomings in the provision of medical care, he was given an incorrect diagnosis , which subsequently led to surgical interventions. On December 1, 2013, he was recognized as a disabled person of the second group.” On this issue, judicial practice is clear. Thus, in the Appeal ruling dated May 18, 2015 in case No. 33-4519, the Perm Regional Court noted that “In accordance with clause 9, part 5, article 19 of Federal Law No. 323-FZ of November 21, 2011, “On Health Protection citizens in the Russian Federation”, the patient has the right to compensation for harm caused to health during the provision of medical care. In accordance with Article 150 of the Civil Code of the Russian Federation, health is an intangible benefit. In accordance with Article 151 of the Civil Code of the Russian Federation, if a citizen is caused moral harm by actions that violate his personal non-property rights, the court may impose an obligation on the violator monetary compensation moral harm. In accordance with 1068 Civil Code of the Russian Federation, entity or a citizen compensates for harm caused by his employee in the performance of labor (official, official) duties... Late diagnosis did not contribute to the interruption pathological process and could worsen the prognosis of the disease. Judicial panel comes to the conclusion that poor quality medical services, associated due to its specificity with the need for the plaintiff to use medicines, not really aimed at treatment existing disease for a long time, lack of medical assistance in treatment<...>, the presence of physical suffering during the period of treatment due to an incorrect diagnosis undoubtedly caused moral harm to the plaintiff.”

Criminal liability may arise when:

  • official forgery - entry by an official into official documents knowingly false information, as well as introducing corrections into the specified documents that distort their actual content, if these acts were committed out of mercenary or other personal interest (in the absence of signs of a crime provided for in Part 1 of Article 292.1 of the Code) (Article 292 of the Criminal Code of the Russian Federation) ;
  • falsification of evidence civil case a person participating in the case or his representative (Article 303 of the Criminal Code of the Russian Federation).

If the diagnosis is incorrect, criminal liability may also be imposed under Art. 109; 118 of the Criminal Code of the Russian Federation and not only, depending on the consequences that occurred as a result of an incorrect diagnosis (causing serious harm to health or death to the patient).

To summarize, we can conclude that making a diagnosis (by timing, type, form, reasons) is currently regulated, and work in this direction continues. Currently, these criteria are widely used in judicial practice to assess the harm caused.