Next year marks my 30th year in my profession. It’s been quite a journey, contributed by the fact my specialty (psychiatry) is ever-changing and evolving. When I look back to 1992 at myself coming out of residency, I cringe a little. From this present viewpoint of experience, my younger self was zealous, but not quite wise. If I could go back and talk to myself, I would give the following advice.

You will do a lot more good than you realize. I can’t tell you how many times you will hear from a patients ‘you do me a lot of good” and your emotional reaction will be to wonder what on earth do they mean, for in your eyes they are no better really than when you first met them. They will explain you hung in with them through it all. Being with someone on their difficult Journey does a lot of good; don’t dismiss this as trivial or not important.

Listen. This is the number one tool you will be using to get things right. It’s so easy to jump in with ‘what to do’ too quickly. “He listened to me” will be your number one asset – not what you do or accomplish.

Explain everything. Remember that intern from Minnesota you had while as a medical student at Detroit Receiving Hospital? She wasn’t the ‘best’ but you and others liked her as she talked out loud her thinking process and she explained all her actions and decisions. Go thou and do likewise.

Admit you don’t know. You were consciously/unconsciously trained to look good and have no deficits. Get rid of that rubbish. Patients will be relieved to hear you say you don’t have an answer. Follow up though with what you are going to do to get one.

You can’t help everyone. It will OK to say to someone ‘I’m sorry. I don’t believe I can help you.’ This saves time and cuts off false hope. Hanging in there trying to help isn’t often helpful.

Not everyone wants to improve. Even though folks will be coming to you this doesn’t necessarily mean they want to get better. You will want to help people and you thank everyone wants to grow and improve themselves. Some folks – more than you realize – really don’t want to improve and many more do but are not willing or lack courage to do the work to make it happen. Recognize this and don’t drag folks down the Journey path you think they need. Remember ‘The Prime Directive” from Star Trek.

The ‘wait and watch approach’ isn’t a cop out, it is good Medicine. Many problems will resolve some how some way on their own; the brain has means of sorting things out on its own. When in doubt, wait to see what happens. This pays off a lot.

Suicide happens; be prepared for it. Being a psychiatrist without a case of suicide is like being a cardiologist and hoping you can prevent all heart attacks. I have news for you: you will be working with some very sick and problematic people some of them will kill themselves. You will do your best to prevent such, and you will feel so bad when they happen. Prepare yourself now for the sadness that comes from being ultimately unable to stop someone determined to do themselves in.

Limits and structure. You will encounter lots of folks feeling out of control and at a subjectively ’10-plus’ level of symptoms, which feels like an emergency to them. This often leads to poor decisions and boundaries. Setting limits superficially feels paternal and they will not like this, but many will tell you in the long run that is what they needed and were glad you didn’t succumb to their boundary-pushing emotions.