In his Notebook I (page 47) Chekhov summarised the plot for "Anna on the Neck", then yet to be written: "A poor girl, gymnasium student, with five brothers, marries a rich state official who counts every single piece of bread, demands from her subserviance and gratitude, is scornful of her relatives... She endures all this, trying not to argue with him, so as not to fall back into destitude again. Then the invitation to the ball comes. Here she causes furore. An important person gets infatuated with her, makes her his lover... Now, seeing how her husband's chiefs fawn before her, at home she's full of disdain: 'Go away you fool!' " The actual story's plot is similar, except that Anna here is much older (she remembers her gymnasium years as belonging to her 'childhood past'), and has two brothers.

The story's title is a double-entendre, having to do with the Order of Saint Anna and the methods of its wear. Anna's husband Modest Alexeyich has just received the 2nd class OSA, a cross which was supposed to be worn on the neck.