尿路症状患者の診断における病歴と診察の有用性

DIAGNOSTIC USEFULLNESS OF HISTORY-TAKING AND PHYSICAL EXAMINATION IN PATIENTS WITH UROLOGICAL SYMPTOMS

　病歴と診察所見がどの程度診断に役立っているのかを，総合外来を受診した尿路症状を有する患者111名を対象に検討した．診察医が病歴聴取後，診察後の各時点で調査票に仮説病名と主観確率を記入し，最終診断と比較したところ，最終診断と第一位の仮説病名が一致した患者の割合は病歴聴取後50.4％，診察後52.3％で，特に病歴の有用性が高かった．前立腺肥大症については他の腎尿路系疾患に比べて診察の有用性が著しく高かった．症状のうち，女性患者で「頻尿および残尿」と「排尿痛」が「膀胱炎」の診断に，男性患者で「頻尿および残尿」と「排尿困難」が「前立腺肥大症」の診断に有用であった．

In order to evaluate the relative importance of history-taking and physical examination in diagnostic process, we studied 111 patients with urinary symptoms seen at our general medicine clinic. Examining physicians recorded their hypotheses (tentative diagnosis) with subjective probabilities assigned to them after taking history, and after performing the physical examination. These hypotheses were compared with the final diagnosis established about 6 months later.