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How to Be Patient

Human Content

You may have noticed a new trend lately. Everyone is loud and proud about their mental health struggles (and thank goodness)! For practitioners, this movement is as exciting as it is frustrating. As each mental health taboo falls by the wayside as it enters the cultural zeitgeist, a new aspect of our specialty thus emerges. One we just don’t have enough hours in the day to keep track of, let alone engage with. From better understanding our patients’ (and our own) relationships with their conditions in a changing world, it’s more important than ever that we learn: HOW TO BE PATIENT!

Each week, join Dr. Preston Roche (Psychiatry Resident & Digital Influencer) and Dr. Margaret Duncan (Psychiatrist & Content Creator) on their quest to better understand the patients we dedicate our lives to and the evolving paths they’re bound to travel beyond the clinic. By engaging with stories and perspectives that challenge our shared understanding of a condition, we hope you’ll similarly gain new perspectives as we look at our patients, and their mental health struggles, with further nuance and empathy. (And with Dr. & Lady Glaucomflecken producing, we've been mandated to include plenty of weird medical jokes too).

Speaking of which, a key part of this is hearing YOUR stories! What’s changed your understanding of patient care? Do you have an experience that shines new light on something we’ve discussed on-air? Get in touch at: howtobepatientpod.com

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33 episodes
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English

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Monday · 48 min
Optogenetics with Dr. Singh Alvarado
In today’s episode Margaret and I are joined by Dr. Singh Alvarado a PhD neuroscientist to talk about the mysteries and beautiful applications of optogenetics. We discuss how the science came to be, why it won the nobel prize and what weird sci-fi level things it could be used for in the future. Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
October 26 · 16 min
Thinking about Thinking (brief episode with Preston)
In this solo episode with Preston we (me) discuss the neuroscience concept of metacognition and how it may apply to some of our conceptualization of current psych illnesses, along with some loose ruminating of course. For a more comprehensive and scientific review, look here! https://www.nature.com/articles/s41583-026-01081-x Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
October 19 · 49 min
Excerpts from the American Journal of Insanity (July 1851)
In today's episode we take a look back towards the history of psychiatry and read from the publication “The American Journal of Insanity.” This is the journal that predates the American Journal of Psychiatry (the name was changed in 1921). While some of the terms are outdated, the treatment principles and pathology remain eerily similar. It really shows us how far we’ve come and how little has changed in the last 150 years. Listen along to the articles and let us know what you think! Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
October 12 · 39 min
Child Psychiatry Training Explained
In this episode, Margaret and Preston talk about Margaret’s experience halfway into child and adolescent psychiatry fellowship. Margaret discusses the general requirements or parts in child training, discerning child training indications versus other training paths, and how her child training impacts her care for adult psychiatry patients. Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
October 5 · 47 min
How does image guided TMS stack up against the current method?
In this episode we're doing another journal club, this time reviewing the first randomized clinical trial comparing image-guided TMS to the traditional method using scalp targeting for depression. We walk through how TMS works, why targeting matters, what the study found at one month, and where the limitations are before this becomes standard of care. Find the paper here: https://pubmed.ncbi.nlm.nih.gov/42340706/ Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
September 28 · 59 min
The Theory of the Crunch: Holding Difficult Dynamics in Therapy
In today’s episode, Preston and Margaret discuss the psychotherapy paper The Theory of the Crunch, by Paul Libby, a psychoanalyst. In this episode and in the paper, the idea of creating a containing environment, repetition compulsion, and ways of navigating difficult interpersonal dynamics are discussed. In this episode, a more expansive, compassionate frame will be introduced both for the therapist and patient to understand how to make it through confusing and sometimes painful clinical work. Paper: The Theory of the Crunch by Paul Libby Russel: https://www.proquest.com/openview/c5d466aa2f6d7bcd126f98b6591861f7/1?pq-origsite=gscholar&cbl=32944 Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
September 21 · 58 min
Psychiatric Effects of GLP-1s (What We Know So Far)
In this episode, Margaret and I take on the en vogue topic of GLP-1s. They have been utilized for T2DM for several years and just recently took center stage in the zeitgeist for weight loss (medically indicated or otherwise). Today, we will break down possible risks to mental health in patients using these medications and, on the flipside, potential areas where we could possibly use GLP-1s primarily to treat mental illness. Paper used: Sa B, Maristany A, Subramaniam A, et al. Psychiatric effects of GLP-1 receptor agonists: A systematic review of emerging evidence. Diabetes Obes Metab. 2026;28(1):50-59. doi:10.1111/dom.70198 Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
September 14 · 58 min
Nuances in Prescribing Antidepressants
In this episode, Margaret and Preston present how two psychiatrists think about prescribing medications for depression. Using different common clinical scenarios, they discuss standard clinical guidelines, navigating weight gain and loss with SSRIs, augmentation of SSRI’s, and sexual side effects. See notes below for recommendations in the episode. VA/DoD MDD treatment guidelines, 2022 https://www.healthquality.va.gov/guidelines/MH/mdd/ American College of Physicians Depression https://www.acpjournals.org/doi/10.7326/M22-2056 Weight Change and Antidepressants https://pubmed.ncbi.nlm.nih.gov/33022115/ Pregnancy/Perinatal/Breastfeeding https://womensmentalhealth.org/specialty-clinics/psychiatric-disorders-during-pregnancy/ Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
September 7 · 1 hr 6 min
Psychiatric Roots in Greek Mythology
The Greeks described two kinds of madness, and both are fun to talk about on our pod. Inspired by the recent hullabaloo around The Odyssey, we are going to be breaking down the DSM-V diagnoses we see in the series and run through the historical roots and the stories of what we see today in mental health. Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
August 31 · 54 min
Climate Change Impacts on Mental Health with Child Psychiatrist & Pediatrician Elizabeth Pinsky, MD
In today’s episode, Margaret and Preston are joined by pediatrician and child psychiatrist Elizabeth Pinsky, MD. Dr. Pinsky works as a pediatric consult-liaison psychiatrist at Massachusetts General Hospital and her clinical interests lie at the intersection of child mental and physical health, including childhood trauma associated with medical care, fostering resilience in medically ill children, and climate change. In this episode, we discuss the current understanding of climate change on mental health and wellbeing for all, why “climate anxiety” locates the problem in the wrong place, and how healthcare workers can help in collective action to improve the climate’s health to improve all our health. Noted articles: Thermoregulation in Schizophrenia as a sign article: Redundant clothing: A readily observable marker for schizophrenia in the psychiatric emergency room population. ⁠⁠https://www.sciencedirect.com/science/article/abs/pii/000579169390007J⁠⁠ Climate communicator recommended: ⁠⁠https://www.katharinehayhoe.com/⁠⁠ Resources Referenced: ⁠⁠https://www.climatepsychology.us/⁠⁠ ⁠⁠https://www.climatepsychiatry.org/⁠⁠ Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
August 24 · 1 hr 9 min
Lessons from Improv Comedy
Laugh all you want (please laugh it’s supposed to be funny), Preston has been doing improv from the last year and he has some thoughts. Not just “yes ands” about how it makes him a better doctor, and he is dragging Margaret into the mix starting off with some improv style warm ups and ending with a philosophical commentary about the stage we all perform on. I don’t know why I am talking about Preston like I am not the one writing this. Hi it’s me, Preston. Enjoy the episode! Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
August 17 · 55 min
Kung Fu Panda & Residency: Growth Mindset
Margaret is back and today our episode pulls themes from Carol Dweck’s work and book Growth Mindset, as well as a favorite sophisticated film: Kung Fu Panda. In this episode, Margaret and Preston discuss a frame to make sense of the obstacles we meet as we change levels of training, weather you’re starting med school, doing a post doc, or changing jobs. We walk through phases of growing, including failing, flailing, and flourishing, and give examples along the way from our growth-minded Panda friend. Check out some info on Dr. Dweck’s work: https://ctl.stanford.edu/students/growth-mindset Check out a paper as well from a few years ago on limitations/evolving learning on growth mindset as a frame (we love nuance here): Yeager DS, Dweck CS. What can be learned from growth mindset controversies? Am Psychol. 2020 Dec;75(9):1269-1284. doi: 10.1037/amp0000794. PMID: 33382294; PMCID: PMC8299535. Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
August 10 · 1 hr 34 min
THROWBACK: Alcohol: Examining Alcohol culture, history, and use disorder (Season 1 Episode 15)
In Episode 15, Preston and Margaret open a bottle—of questions, stories, and science—about alcohol use disorder. What do we get wrong about “moderate” drinking? Why is detox more dangerous than most people realize? And how does alcohol quietly reshape identity, relationships, and the brain itself? With their signature blend of honesty and humor, they explore the unexpected ways drinking shows up in medicine, the myths that keep us stuck, and the messy, meaningful path to redefining recovery. Takeaways: What if “just a drink” isn’t so simple? Preston and Margaret explore how subtle patterns can blur the line between social drinking and something more. Could quitting be more dangerous than drinking? There’s a reason detox needs to be taken seriously—and it’s not what you think. What does alcohol really do to your brain? Let’s just say it’s a little more complicated than relaxation and red wine. Why don’t we talk about medication for alcohol use disorder? The answers are as cultural as they are clinical. Is recovery a destination—or something else entirely? Margaret and Preston unpack a version of success that doesn’t always fit the script. Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
August 3 · 52 min
Sex Differences in Aging Cognition with Dr. Sullivan
In today’s episode we bring on Dr. Campbell Sullivan, PsyD to discuss the interesting field of neuropsychology, a complicated niche that focuses on eliciting deficits in cognition across patters of disease. We discuss the triumphs of her field as they collaborate with both psychiatry and neurology and then get into the places she sees room for improvement, particularly in how we assess and treat cognition in the aging female brain. Join Patreon Here: https://www.patreon.com/c/howtobepatientpod -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
July 27 · 1 hr 16 min
THROWBACK: The Lithium Episode (Season 2 Episode 14)
In this preston-led episode, we take a deep dive into the history of lithium and its use in psychiatry. But because Preston is very literal, we are starting at the very beginning, inside of stars where lithium was formed at the beginning of the universe. Then we will follow this wonderful atom through history and past its FDA approval in 1970 to where we are today. Takeaways: Lithium was once sold in Seven Up as a mood-lifting ingredient—but the consequences were messy. A forgotten Australian psychiatrist helped launch lithium into psychiatry with groundbreaking trials. Despite its toxicity risks, lithium remains the gold standard for reducing relapse and suicidality. U.S. psychiatrists resisted lithium for decades—even as Europe embraced it. Preston and Margaret debate lithium’s place today: miracle stabilizer or underused relic? Citations: ⁠https://www.sciencedirect.com/science/article/abs/pii/0025556484901160⁠ Shorter E. The history of lithium therapy. Bipolar Disord. 2009 Jun;11 Suppl 2(Suppl 2):4-9. doi: 10.1111/j.1399-5618.2009.00706.x. PMID: 19538681; PMCID: PMC3712976.⁠https://pmc.ncbi.nlm.nih.gov/articles/PMC3712976/⁠ Fowler, Gene. Crazy Water: The Story of Mineral Wells and Other Texas Health Resorts. No. 10. TCU Press, 1991. -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
July 20 · 36 min
Missed Diagnoses in History Part II: Joan of Arc and King George the III
In this episode of historical psychiatric diagnoses we continue the “arc” (get it) with the story of a young girl with vivid hallucinations who galvanized the French army and a wise king who lost his sanity late in life. The interesting thing about these cases, however, is that they may have more underlying medical issues and in fact, the psychospiritual and somatic issues of the past are just as intertwined as they are today. Even to the point where we have to correct ourselves and realize that we may have been calling these incorrectly for a while. Join Patreon Here: https://www.patreon.com/c/howtobepatientpod -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
July 13 · 1 hr 24 min
THROWBACK: Heart of Psychiatry (Season 2 Episode 1)
We're pulling a throwback from season two for this one, and it's the episode I will go to the mat for as one of the most clinically useful hours of psychiatry content we've ever put out. Margaret literally calculates QTc off this episode every time she's on call and her CL attending called her out for it the other day, like, "Look at her recalculating." So when she said we should bring this one back, I didn't argue. If you're a resident, an attending who consults psych in the hospital, or a patient or family member trying to understand what it means to live after a cardiac event, start here. Join Patreon Here: https://www.patreon.com/c/howtobepatientpod -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
July 6 · 23 min
ADHD may be more of a reward problem than an attention problem
Today we'll talk through this one study from 2010 out of the Oxford Department of Experimental Psychology, "Task-related default mode network modulation and inhibitory control in ADHD: effects of motivation and methylphenidate", that I want to walk you through, because the way it reframed ADHD for me as a resident is one of the more useful brain-flips I've had this year. References: Liddle, E.B., Hollis, C., Batty, M.J., Groom, M.J., Totman, J.J., Liotti, M., Scerif, G. and Liddle, P.F. (2011), Task-related default mode network modulation and inhibitory control in ADHD: effects of motivation and methylphenidate. Journal of Child Psychology and Psychiatry, 52: 761-771. https://doi.org/10.1111/j.1469-7610.2010.02333.x https://acamh.onlinelibrary.wiley.com/share/GTA8CCG95X9ZJTK7H6XA?target=10.1111/j.1469-7610.2010.02333.x Join Patreon Here: https://www.patreon.com/c/howtobepatientpod -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
June 29 · 1 hr 36 min
THROWBACK: Motivational Interviewing (Season 1 Episode 8)
We're going back to one of our oldies but besties. This is our motivational interviewing episode from season one, which Margaret and I both agree is probably the best episode we made that whole first run. And it holds up, maybe even better now that we're further along in training and have actually used a lot of these tools in real clinical work. If you're a trainee, an educator, or just someone who's ever tried to gently move a person you love toward a change they keep half-saying they want, start here. Join Patreon Here: https://www.patreon.com/c/howtobepatientpod -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices
June 22 · 46 min
Missed Diagnoses in History: Story Time: Charles VI and Mary Todd Lincoln
I figured we'd do something I've been wanting to do for a while: story time. Specifically, the kind where I take some of history's most famous figures, walk you through what actually happened to them, and then put on my psychiatry resident hat and try to figure out what we'd actually diagnose them with today. We will be analyzing King of France, Charles VI and Mary Todd Lincoln. Get ready to hear me yap about psychiatric history! Join Patreon Here: https://www.patreon.com/c/howtobepatientpod -- Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

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