Medicine Episodes

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.

What is aphasia, really and what happens when your brain no longer cooperates with your ability to speak or understand language? In this episode, Preston and Margaret tackle the messy, frustrating, and often isolating world of language disorders, focusing on the real-life implications of aphasias. They walk through the clinical causes, what it looks like day-to-day, and how aphasia differs from other speech and cognitive issues. Along the way, they share stories of miscommunication, explore the frustrations of being misunderstood, and dig into how patients and clinicians can better work together when words are hard to find.

Is it all in your head or is pain more complex than we’ve been led to believe? In this episode, Margaret and I dig into the psychological and biological factors that shape our experience of pain, including how the brain processes physical discomfort, the emotional toll it takes, and what role medications actually play. We also share stories from our own lives and clinical work that highlight how pain shows up in complicated, often misunderstood ways. If you've ever wondered why your body hurts when your heart is breaking, or why painkillers don’t always work, this one’s for you.

Margaret and I sat down to speak on a topic we rarely hear spoken plainly: suicide, and more specifically, suicide risk assessments. We didn’t plan to tidy anything up or wrap it in easy language. Instead, we tried to sit with it—the fear, the responsibility, the human ache behind it all. We talk about how suicide shows up in our clinical work, how it’s shaped us personally, and why we both believe silence helps no one. This isn’t a “how-to” or a lecture. It’s a real conversation between two people trying to hold space for pain, and maybe offer a little hope in the process.

This is the episode I wish we never had to make—and also the one I wish I’d had from the beginning. Margaret and I talk about suicide from inside the profession: what it’s like to lose a patient, how we carry that grief (or numbness), and why the aftermath is rarely as clear-cut as people think. We talk about the fear of getting it “wrong,” the complicated relief that can come when a patient is finally at peace, and the moments when you realize you’re not the only one who saw it coming. And maybe the most important part? We talk about how hard it is to talk at all. This one’s raw. And necessary. And still full of tenderness.

It’s Part 2 of our deep dive into eating disorders—and this time, we’re going even deeper. We kick off by unpacking our mock therapy session with Dr. Helen Liljenwall, which unexpectedly hit close to home for all of us. Then we take a sharp turn into the medical realities of starvation, including refeeding syndrome, the female athlete triad, and why your heart is always in the equation (literally). But what happens when patients refuse to eat—and we have to decide whether they need a psychiatric hold? Who gets to say when a person with an eating disorder has lost capacity? And is “terminal anorexia” a compassionate truth—or a dangerous excuse? If you’ve ever wondered what it really takes to treat eating disorders, this is the episode to hear. It's raw, real, and it doesn’t flinch.

This is Part 1 of our two-part deep dive into eating disorders—and we’re starting at the beginning. Margaret and I sit down with psychiatrist and eating disorder specialist Helen Sanon, MD to walk through the basics: What are the major types of eating disorders? What do they actually look like in real life? And how do we treat something that’s rooted in both biology and culture? We cover everything med school skipped—then try to practice what we’ve learned in a fake (but emotionally real) therapy session with Dr. Helen as the patient. Spoiler: it got uncomfortable in all the right ways.

This episode hit harder than I expected. Margaret and I talk about what it feels like to care for patients who remind us a little too much of ourselves, especially when we’re also the ones filling out the paperwork for a psychiatric hold. We dig into what a 5150 (or 5585) really means, how to sit with that kind of authority, and the emotional mess of seeing a patient’s fear reflect your own. This one’s about boundaries, over-identification, supervision, and the heartbreak of sometimes needing to say, “I care about you and I can’t be your doctor anymore.”

In this episode, Margaret and I take on burnout—what it actually is, where the term came from, and how to tell when you’re not just tired, but something deeper is cracking. We dig into the history, the Maslach Inventory, moral injury, and why burnout isn’t in the DSM (yet). We also share our own unhinged burnout moments (yes, mine involves harmonica) and explore how to tell the difference between burnout, depression, and just being in the wrong place.

We opened up the inbox and wow… y’all really came through. In this first-ever Q&A episode, Margaret and I answer your questions about coping during med school, surviving feedback, dealing with emotional exhaustion in residency, and why outpatient goodbyes feel like actual breakups. I also overshare about marathon training (again), Margaret brings the wisdom and the theater metaphors, and we all learn what bald eagles actually sound like. It’s a mix of serious, strange, and unexpectedly honest—basically, peak us.

This week, I learned I have a pelvic floor. And yes, I realize I’m a doctor and should’ve known that already. Margaret and I talk with pelvic floor physical therapist and viral educator Dr. Alicia Jeffrey-Thomas, who somehow made me breathe through my butt on mic. We cover everything from incontinence and pelvic pain to TikTok fame, trauma-informed care, and the surprisingly emotional world of core stability. Alicia breaks down the science and the stigma behind one of the most misunderstood parts of the body—and I try to keep up while sitting on a pillow and trying not to Kegel too hard.

In this episode we sit down with genetic counselor Julia Castro to demystify the world of genetic testing and counseling. They explore how genetic information can help (or sometimes confuse) patients, why more testing isn't always better, and the ethical dilemmas of knowing too much about your future health.

In this episode Preston and Margaret are joined by Dr. David Roberts to explore the fascinating world of motivational interviewing (MI)—a counseling technique designed to help patients navigate ambivalence and commit to meaningful change. Dr. Roberts shares insights from his years of experience training psychiatrists and therapists, breaking down MI into practical techniques that anyone can use to foster deeper, more effective conversations. We even do a fake therapy session with our producer Aron Korney!

In this episode Preston and Margaret welcome their first guest, neurosurgeon and content creator Dr. Betsy Grunch (aka Lady Spine Doc), for a deep dive into pain — how we treat it, how we misunderstand it, and how the system often fails those who experience it.

In this episode Preston and Margaret tackle one of the most talked-about topics in mental health today—ADHD. From the historical roots of the diagnosis to the impact of modern social media trends, they explore how our understanding of ADHD has evolved over time. They discuss the challenges of diagnosing ADHD in both children and adults, the role of social media in spreading information (and misinformation), and the real-life impact of the disorder.

In this episode Preston and Margaret explore the complex concept of rapport in healthcare. They reflect on the challenges of building meaningful connections with patients and the impact these relationships have on medical outcomes. From awkward early encounters in medical school to techniques they've developed as psychiatry residents, this episode unpacks what it means to truly connect.

In this episode Preston and Margaret dive into the science and personal experiences surrounding attachment theory. They discuss its origins, its modern-day interpretations, and how it shows up in everyday relationships.

In this debut episode of How to Be Patient, psychiatry residents Preston Roche and Margaret Duncan open up about their personal journeys into medicine and the challenges they’ve faced in connecting with patients—and themselves. From navigating early patient interactions to grappling with their own vulnerabilities, they explore the balance between authenticity and professionalism. With humor, candid storytelling, and a dash of introspection, this episode sets the stage for a season of thoughtful discussions on empathy, growth, and the art of being present in healthcare. Get ready for the tale of two doctors!

It’s finally time to address our professional relationships with mental health treatment in a clear, calm, and professional manner. It’s time that practitioners start to better understand ourselves, our patients, and our parallel journeys to address mental health struggles in this highly unpredictable cultural climate. It’s time a podcast trailer presented a plan to constructively explore professional development for psychiatric professionals. Perhaps, in the form of a polished audio...