Neuropsych Report Writing

[neurotic_cow]

Hello! I was reviewing some of the example report templates provided on the IOPC website and am always so fascinated by how different approaches there are to writing neuropsych reports. I was particularly curious if anyone has any thoughts about the pros/cons of including a lengthy written test results section vs. including a score appendix/data and simply providing an integrated summary of the findings, specifically within an outpatient hospital setting. I've had supervisors do both so since I'll be starting to practice independently soon, I am trying to figure out what I want to do and what makes the most sense/is best clinical practice.

P.S. I have read Jacobus Donders' book, I am just curious what people do in the real world

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[WisNeuro]

I have a written results section and a bare bones summary datasheet. I still prefer the written results section because it is also where I can detail behavioral obs on specific tests, or highlight certain key patterns. Part of where another neuropsychologist could see my thought patterns for ruling certain things in and out. Some of that gets lost with only test scores. That being said, my reports are fairly templated at this point, so I can write that results section in 10 minutes or less in most circumstances. And, I wouldn't call it lengthy, by any means. My reports are probably 5-7 pages, which includes that summary sheet.

 

[AcronymAllergy]

I have included a score table in my reports for a few years now and strongly prefer that over a narrative-style results section. None of my referral sources at my then-employer (a VA clinic) complained after I made the switch a year or two into independent practice.

My reports are still too long, as I'd ideally like to get them down to 3-4 pages, but that's a work in progress. My recommendations usually take a couple pages, so getting the rest of the report down to 2 pages may not be realistic, depending on the referral source and type of evaluation. I'm also hesitant to cut down the history portions too much because I've had multiple referring providers say they especially appreciate those sections and my summary/impressions. It's my eternal struggle.

Edit to speak to what WisNeuro mentioned above: I agree that the main advantage, IMO, with the written results section is the ability to explain behavioral observations and your potential thoughts on what the scores might mean (e.g., if you think a low score is due to X rather than Y). If I have any noteworthy observations, I'll now generally include them in my summary and/or the mental status section. This doesn't always flow as well as including them in a test results section, so it's a trade-off I've accepted.

 

[borne_before]

I know I come from the school world, but Mather and Schneider have an essentials to assessment report writing, that is 10/10. Schneider has the assessing psyche blog that is amazing. My reports about 10-15 pages. But, I use a ton of bullet points and probably too many recommendations. I spend the majority of my effort on the integrated summary section which is like never over a page.

 

[Pragma]

Results in a table with a very brief narrative summary of any underlying patterns or notable observations. Usually 4-6 pages total.

 

[PsyDr]

I ask what the referral source wants, and write for the audience. Those people are paying for your services, not other psychologists.

IMO, the current style of reports is like long division... it's great for teaching, but not for established professionals. If you go back far enough, reports were not written in the current fashion. So why are we writing this way, if referrals want it a different way?

 

[AcronymAllergy]

I ask what the referral source wants, and write for the audience. Those people are paying for your services, not other psychologists.

IMO, the current style of reports is like long division... it's great for teaching, but not for established professionals. If you go back far enough, reports were not written in the current fashion. So why are we writing this way, if referrals want it a different way?

Also a good point. You may end up with different report styles for different referral sources, much like you may have different report styles for different types of evaluations/referral questions.

 

[szymk1sm]

I'm ECNP at an AMC and have been experimenting with report writing.

Currently, I write most of my reports in this order: Summary / Impressions, Rec's for Providers, Rec's for Patient and Family (these sections in larger font - typically 11 - takes up about 3 pages)... then I do a templated HPI, Cog Concerns, ADLs, Mood, other aspects of the history, etc. in smaller font (about 9) then B. Obs (size 9) & Table (size 8; I've fashioned my table to include raw / standardized scores and it only takes up 1 page; I also highlight areas of cognitive weakness / impairment and / or elevated mood symptoms).

My reports are still long (about 8 pages total in Word), but I've been experimenting with more concise language, bullet points, bolding important info, etc. At least one referring provider seems to appreciate this style (our EMR is Epic and they can find what they need right at the top rather than having to scroll through to find dx & rec's). Not your typical format but I like it and it seems to be working.

 

[Therapist4Chnge]

I always ask the referral source. Over the years I've tweaked my reports based on this feedback. I now use a letter format to frame the case and deliverables (i.e. review documentation, interview, neuro report). I also include a summary sheet, which often saves me time later bc it cuts down on requests for the raw data. For legal cases, it's more likely they'll want the raw data, but for clinical cases, raw data rarely get requested. My reports are definitely shorter as the years go on, mostly because of feedback from providers. Clinical reports are usually 5-7 pages (assuming minimal doc review, no submitted questions). For legal cases, the reports are anywhere from 10-25+ pages.

In regard to in-patient assessment....a summary paragraph is what 98% of providers want. Bullet points for the clinical summary and recommendations are even more preferred. It definitely is important to know your audience.

 

[AcronymAllergy]

I also believe there have been surveys of neuropsychologists querying their typical report lengths by setting (or this information was subsumed in other practice-related surveys). I want to say the average was something like 5-7 pages, but I could just be making that up. The Donders book may have that information in it; I have a copy, but it's at home and I can't check it at the moment.

My own reports are typically 6-7 pages for clinical evals. Forensic are longer.

 

[smalltownpsych]

I ask what the referral source wants, and write for the audience. Those people are paying for your services, not other psychologists.

IMO, the current style of reports is like long division... it's great for teaching, but not for established professionals. If you go back far enough, reports were not written in the current fashion. So why are we writing this way, if referrals want it a different way?

Agreed with your general points, but just wanted to add that as a psychologist I have actually reviewed many more assessments than I have administered. Some was to determine appropriate placement for residential treatment and others to guide me in my own treatment planning. I have gone over psychological tests with patients or parents and it is useful to have some of the thought processes and observations that went into making the conclusions. It is amazing at how skewed the original message can get so it helps to know some of that. That being said, I don’t like having to sift through a lot of extraneous and irrelevant info that is included just because that was how someone was taught.

Also, this is one of my pet peeves, please say who said what about whom, patient report vs parent report vs examiner report vs current therapist, teacher, cop etc. makes for much different thought processes. If I see another patient has a history of aggression without any source or elaboration, I swear I might just lose it. 🤯

 

[roryportman]

Somewhat related note- is it on fellowship that we are allowed to fully develop reports in our OWN style, at least in terms of formatting? Or are we still at the whim of our supervisors? Does it depend on the site and supervisor?

I'm wondering this as I sit here on a Saturday morning, backed up on reports mainly because my current practicum site requires lengthy background in prose style that eat up most of my time (and seem least useful to providers but lmk if some think otherwise). I was previously at a site where we used bullet point for the most relevant history, and overall the report was concise and IMO very useful for referral providers (typically neurologists).

So another question- which adult NP fellowship sites utilize the bullet point format, at least for the bg history? Which sites have started to put summary/impressions at the TOP rather than the bottom of the report? I know of Henry ford and nyu who do some of these things.

Of course I'll consider many things other than report style when ranking fellowship sites, ha, but I'm curious atm.

 

[WisNeuro]

Somewhat related note- is it on fellowship that we are allowed to fully develop reports in our OWN style, at least in terms of formatting? Or are we still at the whim of our supervisors? Does it depend on the site and supervisor?

I'm wondering this as I sit here on a Saturday morning, backed up on reports mainly because my current practicum site requires lengthy background in prose style that eat up most of my time (and seem least useful to providers but lmk if some think otherwise). I was previously at a site where we used bullet point for the most relevant history, and overall the report was concise and IMO very useful for referral providers (typically neurologists).

So another question- which adult NP fellowship sites utilize the bullet point format, at least for the bg history? Which sites have started to put summary/impressions at the TOP rather than the bottom of the report? I know of Henry ford and nyu who do some of these things.

Of course I'll consider many things other than report style when ranking fellowship sites, ha, but I'm curious atm.

IME, you're still using your supervisor's style, as you are still working under their license, and it is technically their work product that is going out there. It can be a hassle with some supervisors, but as a ranking variable, I'd put it pretty far down my list.

 

[Therapist4Chnge]

You might have more flexibility, it depends on your mentor/supervisor(s).

 

[neurotic_cow]

Somewhat related note- is it on fellowship that we are allowed to fully develop reports in our OWN style, at least in terms of formatting? Or are we still at the whim of our supervisors? Does it depend on the site and supervisor?

I'm wondering this as I sit here on a Saturday morning, backed up on reports mainly because my current practicum site requires lengthy background in prose style that eat up most of my time (and seem least useful to providers but lmk if some think otherwise). I was previously at a site where we used bullet point for the most relevant history, and overall the report was concise and IMO very useful for referral providers (typically neurologists).

So another question- which adult NP fellowship sites utilize the bullet point format, at least for the bg history? Which sites have started to put summary/impressions at the TOP rather than the bottom of the report? I know of Henry ford and nyu who do some of these things.

Of course I'll consider many things other than report style when ranking fellowship sites, ha, but I'm curious atm.

In my own personal experience, I have definitely had to practice/write reports how my supervisor sees fit. There are things that I would rather do/not do but have to do what they want since it is their license. But it might depend on the program.

At the hospital system where I did my internship, we always put the impressions and recommendations as a separate note in EPIC at the top, followed by the HPI section/test results because that's what referral sources wanted. Apparently it was too much effort to scroll to the bottom of a report. I personally haven't seen anyone use a bullet list in a report yet.

 

[Therapist4Chnge]

In my own personal experience, I have definitely had to practice/write reports how my supervisor sees fit. There are things that I would rather do/not do but have to do what they want since it is their license. But it might depend on the program.

At the hospital system where I did my internship, we always put the impressions and recommendations as a separate note in EPIC at the top, followed by the HPI section/test results because that's what referral sources wanted. Apparently it was too much effort to scroll to the bottom of a report. I personally haven't seen anyone use a bullet list in a report yet.

I remember those days. Then I went to a letter w an Exec Summary, then full report. At some point I drifted away from that and now just do a letter and standard report, but def shorter than the ramblings and every last detail like grad school.

 

[PsyDr]

Agreed with your general points, but just wanted to add that as a psychologist I have actually reviewed many more assessments than I have administered. Some was to determine appropriate placement for residential treatment and others to guide me in my own treatment planning.

You'd hate my clinical reports. While I understand the idea, I have found that the more I explain, the more people argue.

When applied to patients, it's a fine line. Patients can't argue the science, so they'll argue about the history. Frankly, that is usually a waste of my time.

When that same line of reasoning is applied to professionals, I think some of that line of thinking implies the idea that it is my job to educate other professionals. It's not my job to provide executive summaries for people too lazy to do the work. I'll do the assessment, write the treatment recs, give the feedback, and that's it. I'm not going to spend a hundred hours reading about a subject, and give the reader the ability to approximate that work.

It is amazing at how skewed the original message can get so it helps to know some of that.

Report results as a projective tool. It's an interesting idea. Why do you think that is the case?

Somewhat related note- is it on fellowship that we are allowed to fully develop reports in our OWN style, at least in terms of formatting? Or are we still at the whim of our supervisors? Does it depend on the site and supervisor?

Depends. I had to use my supervisors style in fellowship, except for inpatient work. I modified my reports after I went into solo practice.

I'm wondering this as I sit here on a Saturday morning, backed up on reports mainly because my current practicum site requires lengthy background in prose style that eat up most of my time (and seem least useful to providers but lmk if some think otherwise). I was previously at a site where we used bullet point for the most relevant history, and overall the report was concise and IMO very useful for referral providers (typically neurologists).

I've had referral sources say, the utility of neuropsychologists is that we are cheap, so we can spend time getting in depth histories. Others only read a one paragraph summary. Others prefer a phone summary. No one likes a graphic summary for whatever reason. It all depends.

 

[smalltownpsych]

You'd hate my clinical reports. While I understand the idea, I have found that the more I explain, the more people argue.

When applied to patients, it's a fine line. Patients can't argue the science, so they'll argue about the history. Frankly, that is usually a waste of my time.

When that same line of reasoning is applied to professionals, I think some of that line of thinking implies the idea that it is my job to educate other professionals. It's not my job to provide executive summaries for people too lazy to do the work. I'll do the assessment, write the treatment recs, give the feedback, and that's it. I'm not going to spend a hundred hours reading about a subject, and give the reader the ability to approximate that work.


Report results as a projective tool. It's an interesting idea. Why do you think that is the case?




Depends. I had to use my supervisors style in fellowship, except for inpatient work. I modified my reports after I went into solo practice.

I've had referral sources say, the utility of neuropsychologists is that we are cheap, so we can spend time getting in depth histories. Others only read a one paragraph summary. Others prefer a phone summary. No one likes a graphic summary for whatever reason. It all depends.

I would probably like your reports as your writing on this board tends to be succinct and logical. The part I referenced of the skewed interpretation refers to experiences I have had where patients say the testing says one thing and then I look at it and see something completely different. When I’ve noticed this, it seems like the people are keying in on the most negative message out of testing. I think of one patient with a TBI who described this horrible report and she was sure that she would not be able to function. That’s not what the testing said at all. Or cases where there is a significant discrepancy in cognitive domains and they call the lowest one their IQ.

Also, a referral for placement recommendations is probably a whole different animal from most neuropsych referrals. In fact, I didn’t generally like neuropsych tests for that purpose because we typically worked with cognitively intact individuals who had emotional and Interpersonal dysfunction and most of the neuropsych tests that I reviewed didn’t address those factors. Just give me a WAIS and a detailed psychosocial history and that would tell me what I need to know to determine if they were a good fit for my program.