Scales are worth the time
Thank you for bringing the issue of measurement-based psychiatric practice to light (“Long overdue: Measurement-based psychiatric practice,” From the Editor, Current Psychiatry, April 2009). As nurse practitioners, we were strictly taught to elaborate on psychiatric symptoms and progress, which is why the notes are called “progress notes” and not “shorthand notes.” I use blank forms of various modified scales—such as the Hamilton Rating Scale for Depression and Positive and Negative Syndrome Scale—and I checkmark and write all 4 axis and global assessment of functioning scores. These objective findings include a short version of the mental status exam. On the top of the chart, I note subjective symptoms. I never use general syntax such as “Pt. is improving, doing well.” Also, I utilize a 0-to-10 scale for overall improvement, with 0 being the worst and 10 being no symptoms.
In my treatment plan, I state which symptoms have resolved and which have not. My psychiatrist friends object to that because it is time-consuming. The fact is it takes only approximately 5 minutes.
Board-certified psychiatric nurse practitioner