Early in my career as a psych NP, I constantly asked myself, “What medication should I be prescribing?” I was treating highly complex patients in community mental health, and I often felt like a fraud—uncertain of how to move forward with confidence.
It took time (and a lot of experience), but I finally realized something critical: the question shouldn’t be “What med?”—it should be, “What do I think is going on here?” Because in psychiatry, diagnosis comes before anything else.
When it comes to diagnosis in psychiatry, the biggest barrier to successful outcomes often isn’t the treatment—it’s the diagnostic process itself. Because without the right diagnosis, you’re a lot less likely to prescribe (or recommend) the right treatment.
Medication Doesn’t Matter Without a Correct Diagnosis
Clinical trials—the ones we rely on to guide treatment—start with one key step: an accurate diagnosis. Every data point, every measurable outcome in those studies is built on the assumption that the diagnosis is correct. If we skip or rush that part in real-life clinical settings, we risk applying treatments to the wrong problem.
That’s why diagnostic accuracy isn’t optional—it’s everything.
If we misdiagnose, we can easily spend years guiding care in the wrong direction. But when we take time to get the diagnosis right, the best next steps become clearer.
My Framework for Better Diagnostic Accuracy
Over time, I’ve developed a structured approach that helps me pause, assess, and proceed with clarity—even in complex cases:
- Start with the right question: “What’s going on here?”
- Gather data points: Use validated assessment tools and targeted clinical questions
- Narrow the possibilities: Develop a working diagnosis and clear differential diagnoses
- Then, and only then, consider treatment
Most mental health conditions have a limited number of evidence-based treatment options. The hard part isn’t choosing a medication or treatment—it’s figuring out the right diagnosis that determines which treatments apply.
Want to Strengthen Your Diagnostic Skills?
When I feel stuck or overwhelmed in treatment planning, I always return to this truth: Diagnosis is everything.
It may not give you the fastest solution, but it gives you the right one.
If you want to sharpen your clinical decision-making and feel more confident diagnosing and treating patients, check out my free Master Mental Health training.