Thursday, October 09, 2008


In newFNP's clinic, we are sticklers for identifying prenatal depression.  God help you if we diagnose it, but damn it all if we don't assess for it at bloody every visit!

The manner of assessment is a form called the PHQ9.  It is a series of nine questions developed to elicit depression via a Likert Scale of 0-3.  Generally, the patients fill it out as they wait behind closed doors for their provider.  Sometimes they tally the score; other times they leave that piece to newFNP.  NewFNP is cool with it either way as it takes her a nanosecond - plus or minus - to tally the thing.

This is sort of what the PHQ9 looks like:

I feel tired.   0      1      2      3

I have less energy than usual.            0      1      2      3

My appetite has changed.                   0      1      2      3

... and then six more questions.  Zero means not at all, three means quite a bit.  

Easy peasy right!?!

At the bottom of the page, there is a space to tally up one's result.  It looks like this:

______ + ______ + ______ = ______________

Makes sense, does it not?  Add the column directly above and write it down.  Then, add the three totals.  

So today newFNP looked at the PHQ9 of a 16-year old pregnant woman with a not altogether ideal social situation and saw 6 zeroes, 2 ones and 1 two.  Not too bad!  This young woman did the tallying herself and it went a little something like this:

___6___ + ___2___ + ___1___  = ______________

Is everyone with newFNP?  Six zeroes = 6, two ones = 2 (correct) and one two = 1.  Hmmmm.  Now, newFNP understands what she was doing, but what this young lady misunderstood is that we are looking for a cumulative score rather than for the frequency with which each answer appears.  

Then, rather than adding left to right, this lady did math the old fashioned way.  On the side of the paper, she had written:


Not 6 + 2 + 1.  62 + 1.  And newFNP though that she had mathophobia!

Grand PHQ9 score: 63.  On a scale of 0-27.

In newFNP's institution of education, we spoke frequently of scaffolding our pediatric and adolescent patients who were experiencing stressful times, illnesses, etc.  NewFNP does a fair amount of scaffolding with this client - much more so than with her non-adolescent prenatals.  But she is not sure that there is enough scaffolding in the world to counteract the effects of limited IQ and a fucked up social situation coupled with the impending birth of a child.  


Anonymous said...

Dumb question of the day:
What is scaffolding and how can I do it with my patients??

Anonymous said...

dumb question of the day...why does my antibiotic make me feel so weird? They told me to finish the whole bottle and I'm trying to but it's so hart. why? (well, maybe that is because you are taking VICODIN every eight hours and never even filled the abx script!!!)

Anonymous said...

that's perhaps one of the funniest stories I have ever heard. Keep em coming!

-Katie, RN/ FNP student