Creating a Tool Box Filled with Psychiatric Screeners and Rating Instruments to Improve Patient Outcomes
By: Saundra Jain, MA, PsyD, LPC
While psychiatry is not lacking in diagnostic tools, they are underutilized in the field. In a personal communication with Dr. John Rush, a lead architect on NIMH’s STAR-D study, he stated that based on his informal polling of audiences of psychiatrists, “Less than 10 percent routinely use any measure to assess outcomes and less than 5% use a structured interview of any type to assist in diagnosis.” My clinical experience supports Dr. Rush’s observation - scales and screeners are grossly underutilized. I saw a definite need to initiate a dialogue with my colleagues to encourage the use of scales and screeners in every day clinical practice.
Why? Simply put – they improve diagnostic yield, leading to better outcomes.
I quickly learned that clinically “what you see isn’t always what you get.” Data indicates that frequently there are years between symptom presentation and accurate diagnosis resulting in significant impairment. Many variables contribute to why these disorders are missed or are incorrectly diagnosed including:
- Patients may not be reliable historians
- Limited time
- Forget to ask certain questions
- We see what we know
As clinicians, we must always maintain a high index of suspicion and continue searching…never stop short! In building a diagnostic case, a clinician’s work closely resembles the work of a detective. Scales and screeners provide a great safety net in gathering important information/evidence and preventing that information/evidence from slipping through the cracks.
The need to incorporate scales and screeners into clinical practice is becoming a topic of great interest. Psychiatric Times’ online journal now has a link to a variety of scales and screeners. As Jay M Pomerantz, MD, Assistant Clinical Professor of Psychiatry, Harvard Medical School, Boston, described this web-based service he stated, “These scales have demonstrated high levels of accuracy and validity and the results can give important clues to possible mental disorders that warrant follow up.”
I find scales and screeners effective and time efficient. I consider these tools great for both rule-ins and rule-outs. The decision on how to use the screeners is up to the clinician – they can be patient scored, clinician scored, family scored, etc. Just like any journey, the first step in making the right diagnosis is important.
Most are drawn into this line of work in order to help others. Scales and screeners are useful tools in achieving that goal – they improve patient outcomes. Remember, these are tools for all specialties.