26. Always rule out the real possibility that symptoms are caused by medications, alcohol, street drugs, or medical illness.
27. Don't be a careless “pill-pusher,” but do understand the great value of medications used wisely for proper indications.
28. Know the risks, not just the benefits, of medications
29. Educate your patients on adverse effects, complications, and withdrawal symptoms.
30. Be alert to, and try to avoid, drug-drug interactions and include in your consideration all the many non-psychiatric medications the patient is likely to be taking.
31. Start low and go slow especially with young and old patients.
32. De-prescribing requires much more skill than prescribing—learn it well and apply it often to reduce the harms caused by over-medication.
33. Avoid the current tendency toward irrational poly-polypharmacy
34. Learn and use three treatments that are very effective, but relatively harder to use and thus very underutilized: lithium, clozapine, and ECT.
35. Never meet with drug sales people; ignore all drug company marketing; do not believe any study that was funded by a drug company; and educate patients to be skeptical of direct-to-consumer drug ads that misleadingly promote disease mongering.
36. Read the scientific literature with great skepticism and awareness that most studies do not replicate, positive results are always exaggerated, and negative results are usually buried. Do not be wowed by genetic findings—so far, they have flopped in finding causes and have no place in planning treatments.
37. Uncertainty sure beats false certainty. Accept its inevitability;’ dont jump to conclusions; and help your patients deal with the anxiety it provokes.
38. Learn statistics, especially as it applies to medical decision making, and think probabalistically, not in rigid yes/no categories.
39. Have a rich, varied, and satisfying personal life.
40. Embark on a personal psychotherapy to help understand yourself better, solve any problems you may have, correct biases based on your personality and experiences, and discover what it is like to be a patient.
41. Learn from your supervisors, but don't follow them slavishly.
42. Read widely, especially the great classic novels, and see psychologically astute movies and plays.
43. Read history and try to deduce its recurring patterns.
44. Travel the world to understand the wide diversity of human experience.
45. Do not impose your cultural biases, your religious beliefs (or non-beliefs., or your personal values on your patients).
46. For every complex question, there is a simple, reductionistic answer—and it's wrong. Don't expect or believe simple answers to complex questions, such as “What causes mental illness and how best to treat it?”
47. Instead, do have a well-rounded, four-dimensional bio/psycho/social/spiritual approach to understanding mental disorders and selecting treatments for them.
48. Be a vocal advocate for our patients. We must do all in our power to reverse the shameless neglect of the severely ill that has relegated 600,000 of them to jail or homelessness.
49. Be yourself—and grow into an even better version of yourself as you enjoy the special privilege of helping others also better themselves.
50. FIRST, DO NO HARM!