What advice would you give a new psychiatrist? Twitter gives a consensus

This post can also be found on Storify here, where I think it reads smoother (and the embedded tweets don’t all have my question-tweet attached above).

I find learning how to be a psychiatrist pretty hard – let alone learning how to be a good one.  I’ve been at it for over a year now and though I’m quite a bit better than I was when I started, I still regularly catch myself in situations where I have absolutely no idea how to go about making things better – sometimes I think I might  have even made things worse. So I decided to ask for some tips from people who know quite a lot more about being a good psychiatrist than I do – my Twitter followers.

I’m very grateful to them for their input – the avalanche of replies was instantaneous and full of wisdom – and I’m hoping that the select few I’ve chosen for this blog post does them justice as a whole.

I think that you’d be most likely to find this post useful if you’re quite junior, like me – but hopefully even consultants might find something that could make them think.

1. How you are with yourself

I think these tweets are about having the strength to realise that you’re at the bottom of a very large mountain that needs to be climbed, which won’t be easy, but being okay with that. There’s no need to change anything about yourself or put on an act – deliberately or otherwise – if you’re a good person. I think doctors can sometimes get into the habit of being defensive and unwilling to admit mistakes or uncertainty – probably because they are trained in an environment that values the right-wrong dichotomy – but in psychiatry, this can be counterproductive.

2. How you are with your patients

This section, for me, is about humility, patience and genuine human care. There doesn’t seem to be anything that needs to be learnt out of a book to do what these tweets suggest – just be good to people, let them speak, believe them and be honest. Treat them like human beings, like equals. I have found that over the last year, I may have improved at being able to figure out how someone is feeling, and even how to talk about it in complicated psycho-babble, but these aren’t what these tweets are about – they’re about just being there, in the moment, caring.






3. How you are with your colleagues 

A lot of new psychiatrists will come into the speciality from another medical speciality, maybe general medicine or surgery. In these specialities, the doctors are very much in charge. They ask other professionals to get involved if they need them, because that’s just how it seems to work well. This isn’t the case in psychiatry – there is no inherent place at the top of the tree for the psychiatrist. We’re just another member of the team, and it certainly took me a while to adjust to this. Hubris doesn’t help.


4. How you are with your ideology

Again, in the rest of medicine, doctors don’t really give a second thought to ideology – the problem is medical, the solution is medical, and anyone who disagrees can be swatted away like the cranks they are. Not so in psychiatry – biology forms only one strand of how we conceptualise people – and some believe, with reasonable support – that we shouldn’t be thinking in biological terms at all. Embracing this and accepting that there are lots of ways to help someone get better is the only way you’re going to succeed.


And stick to what you know…


About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

3 Responses to What advice would you give a new psychiatrist? Twitter gives a consensus

  1. sarah says:

    I’m not on twitter but wanted to comment – keep being open to underlying biological and chemical causes of mental illness symptoms. There is information on Lyme Disease & associated infections, parasites which are really common throughout the body, heavy metal toxins and mould toxins and other illness and diseases.
    I’m speaking as someone who was written off for nearly 20 years and who lost my home, relationship, physical appearance and career through mental illness only to finally find out now that there’s a strong likelihood of infection with Lyme & parasites.
    The DSM makes it really easy for psych’s to write drugs to manage symptoms and have their consciences eased, when many people can suffer from awful side-effects (obesity, diabetes, tardive dyskinesia etc) which can be devastating to them and compound their problems and shorten their lives.
    Also, it’s worth finding out about Open Dialogue in Finland.

  2. Pingback: This Week in Mentalists – Becoming Bourgeois Edition | The World of Mentalists

  3. mala says:

    Late to the party, but you may want to question patients about what styles suit them, in case they already know. For example, many people loathe CBT, for all the reasons Rogers stated. Never met anyone who disliked his method… but have met a lot of people who’ve only ever had CBT and think that is all there is — and then leave therapy because it is such a horridly impersonal and cold way of dealing with a human being.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: