Self-Improvement Episodes

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 episode felt like a deep exhale. Margaret runs solo today, as she sat down with Dr. Hillary McBride—psychologist, author, and researcher—to talk about embodiment, trauma, and the radical act of tuning back into ourselves. We talked about what it means to feel your feelings in your body, why disconnection often begins as protection, and how pleasure, presence, and play can be part of the healing process. It’s about more than coping. It’s about coming home. This one surprised me, and stayed with me. I think it might do the same for you.

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.

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.

Season 1: complete! In this wrap-up episode, Margaret and I reflect on what it’s been like building this show from scratch—while also being full-time psychiatry residents. We talk about favorite episodes, unexpected challenges, what we’re still figuring out, and what’s ahead for Season 2. We also answer listener questions about training, creativity, psychedelics, and the eternal search for balance when your brain wants art and your calendar says “clinic.” There’s some honesty, some gratitude, and a whole lot of behind-the-scenes chaos.

In Part 2 of our conversation with Dr. Nikki Haddad, we went from couples therapy theory to Simpsons cosplay, and yes—it was as chaotic and illuminating as it sounds. Margaret and I roleplay Homer and Marge in a fictional session while Nikki breaks down what’s actually happening between us (emotionally, not just cartoonishly). Along the way, we talk about heteronormativity, escapism, parenting exhaustion, and the red flags that get mistaken for romance. It’s part improv, part therapy, part meltdown. But somehow, it makes sense.

In this episode, we sat down with Dr. Nikki Haddad —Margaret's residency best friend, couples and sex therapist, and one of the most thoughtful psychiatrists I know—to break down what makes romantic relationships so damn hard. We get into myths we’ve carried (and tried to shake), how sexual issues are rarely just about sex, and why our training in medicine doesn’t prepare us to talk about any of this. Nikki then walks us through the five developmental stages of a relationship and this is only Part 1. Be sure to stay tuned next week for Part 2 of the conversation!

In the last episode, Preston demonstrated to Margaret how to properly conduct a mindfulness meditation session. Due to popular demand, the sage spiritual guide is back.

In Episode 16, Preston and Margaret dive into the chaos of overnight residency, the reality of sleep deprivation, and how mindfulness can backfire when your brain just won’t sit still. From ruined meditations to hot girl walks through hospital hallways, they unpack what real-world coping actually looks like—before, during, and after the hardest moments.

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.

In Episode 14, Preston and Margaret dive into social anxiety disorder and the loneliness epidemic. From embarrassing childhood memories to awkward club encounters, they explore how social anxiety shows up in everyday life and how it differs from normal nerves. They also discuss the surgeon general’s definition of loneliness, the role of social media in increasing perceived judgment, and the neuroscience behind facial recognition, fear responses, and serotonin's impact on the amygdala.

In this episode Margaret takes the lead as she welcomes art therapist, psychotherapist, and author Amelia Knott to discuss the ethics of being online, parasocial relationships, and the impact of social media on mental health. We explore the blurred lines between personal and professional identities in digital spaces, the therapeutic power of art, and how social media fosters both connection and disconnection.

In this episode Preston and Margaret explore the endocannabinoid system, cannabis, and its impact on mental health. They break down the science behind CB1 and CB2 receptors, explain why marijuana affects people so differently, and discuss the complex relationship between THC, CBD, and dopamine. Along the way, they tackle myths about cannabis use, addiction, and medical marijuana, shedding light on what we actually know—and what remains a mystery due to historical barriers to research.

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 take a deep dive into the complex relationship between exercise, nutrition and mental health. They discuss the science behind how movement impacts the brain, debunk common myths about fitness, and explore the psychological barriers that prevent people from incorporating exercise into their lives.

In this episode Preston and Margaret embrace the season with a deep dive into Seasonal Affective Disorder (SAD). From the science behind melatonin and serotonin to the cultural and emotional frameworks that shape how we experience winter, this episode covers the biopsychosocial dynamics of seasonal depression. Along the way, they share personal anecdotes, including the surprising benefits of light therapy and reframing winter as an opportunity for growth.

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...