Information for Clinicians

“So, Doc, do I need to take this medication?”

“Do you think I should go ahead with the procedure?”

What clinician hasn’t fielded questions like this? Clinicians can be uncomfortable answering, especially when the answer is not a simple “yes” or “no.” But while a treatment choice may be ambiguous, the communication about it should be clear.

It’s not always realistic for a doctor or other clinician to explain the pros and cons of a particular treatment and then expect the patient to make an informed decision. Few patients have the science background to judge the merits of a treatment’s effectiveness and possible side effects. Besides, available evidence may not apply well to an individual’s particular circumstances. Patients need their doctor’s professional guidance, and doctors need an efficient means of quantifying how strongly they favor or oppose a particular treatment. That’s why the NTS‑R was created.

At times, even five levels are inadequate to accurately express the strength of a recommendation. In these cases, clinicians may still use the NTS‑R but explain (while gesturing between two numbers on the printed scale) why their recommendation falls at an intermediate point between two levels. Documentation can be similarly qualified, e.g., “rec 3-4,” “rec 3+,” or “rec 3.5.”

The NTS‑R can also convey how a physician’s level of recommendation has changed over time, or how it might change in the future based on patients’ progress. For instance, a doctor might tell a patient that knee replacement surgery, which was a “Level 3” recommendation three months ago, is now at “Level 4” because the patient’s symptoms have worsened.

Clinicians can quickly document their use of the scales in the patient’s medical record. If the selected number for the NTS‑R is X, and the NTS‑A is Y, then the clinician can write (RX, AY) immediately following documentation of the treatment option. For example:

“PLAN:

1. Increase fluoxetine to 40mg daily (R4, A4).
2. Add zolpidem 5-10mg at bedtime as needed for insomnia, max of 1 week (R2, A5).”

Overall, the NTS‑R and NTS‑A reduce clinicians’ workload while enhancing quality of care. While not needed in every treatment discussion, clinicians are sure to find that judicious use of the scales will improve and simplify their patient communication and documentation.