Why does my psychiatrist ask me the same twenty questions every month?
Observation Every month I answer the same set of questions for my psychiatrist. The same wording, the same order, about my own condition.
Where this ends up: medicine compares you to a population in order to diagnose, and to yourself in order to monitor, and it switches tools deliberately between the two. Almost every other field that judges people runs the first comparison forever and never switches.
Notice what the repetition is for. My answers this month mean nothing on their own. They mean something against my answers from last month, and the month before, because the only comparison that matters is me against my own record. Whether the medication is working is not a question about how I compare to other people. It is a question about how I compare to myself in June.
Medicine quietly runs on two different kinds of comparison, and it switches between them on purpose. To diagnose, it compares you to a population. Where do your numbers sit against everyone else’s. To monitor, it compares you to yourself. Same instrument, same wording, repeated, read as a line over time rather than a point on a curve. Different question, different tool, and a clinician knows which one they are holding.
Hypothesis Almost every other field that judges people runs the first comparison forever and never switches. A performance review scores you against a scale built across people. A standardised test places you in a distribution. An engagement survey benchmarks your team against a norm group. All diagnosis, no monitoring. Imagine a doctor who assessed you against the population every visit and never once compared you to your own last visit. That is most of how the working world measures people.
The design details of the monthly ritual are doing quiet work, and they are the same rules I arrived at the slow way when building self-observation sheets for myself and two friends. The wording never changes, because a rephrased question breaks the comparison with every previous answer. The person answers for themselves, rather than being rated by someone else. And it happens on a schedule, not when something feels wrong, because a record with entries only from bad weeks is a record of bad weeks.
Observation There is also something the monthly ritual cannot do, and the gap is instructive. Those twenty questions can show that something changed. They cannot show why. The score moves, and the appointment becomes a detective exercise, because nothing was tracked alongside it. Sleep, stress, season, what else was happening. An outcome line with no conditions line next to it can detect, but never explain.
Suggestion Some treatment does build the conditions line in. Structured programmes that ask for something daily, not monthly, and ask what was happening alongside how someone was doing, are tracking exactly the pairing this site keeps arguing for: outcome and condition, recorded together, on the same day, not reconstructed from memory weeks later. I am not naming a specific programme or claiming this is standard, because I have not verified how common it is or what the evidence says about whether it changes anything. It is a real design, not a hypothetical one, and it is closer to what this whole project has been trying to build than the monthly ritual is on its own.
Question So the question this leaves me with. The within-person method is not exotic. It is standard practice, printed on a form, validated enough that treatment decisions rest on it. What exactly is the argument that your work, your learning, your good and bad weeks deserve a worse measurement system than this?
Where this stops. This is an essay about the structure of measurement, drawn from being on the receiving end of it. I have deliberately not named the questionnaire, and nothing here evaluates any instrument, clinician or treatment. I am not a clinician.
What this is not. Advice. Nothing on this page suggests anyone change anything about their own care, and my monthly twenty questions are a thing I am glad of, not a complaint.