We all tend to have our own ideas of what makes Silent Hunter III 'realistic', all falling short of actually building a time machine and going back to join the Kriegsmarine in 1938.
For some of us, that includes making mods for the community (shout out to you guys for your time and effort, especially the boys over at GWX and NYGM

)
For me, a 'hardcore' captain by the results of the quiz nearly everyone has taken, that includes cranking up the realism, leaving nothing but the map contacts (c'mon, the captain would get constant updates anyway), external and ships cameras on (for the eye candy), using the crew transfer feature provided in SH3 Commander as well as the sabotage/malfunction possibility, and putting in numerous mods along with GWX such as the no uniforms, lifeboat&debris, Q-ships, and more (Also, isn't there one where you have to keep an eye on food/water supply as well?)
So, that said, what do you chaps do for realism?