How It Started, How It’s Going: Season 1 Wrap-Up

Preston: [00:00:00] Welcome to the final episode of the How to Be Patient Season One podcast. Margaret, 

Margaret: the finale. Happy to 

Preston: have you here. I feel, I feel like you've been here from the beginning. Is, is that right? 

Margaret: Me? 

Preston: Yeah. 

Margaret: Emotionally or. 

Preston: It's like just yesterday or last week, we were doing this together. Just last week, the week before that 

Margaret: we were talking about pelvic floors and mindfulness and social anxiety.

Preston: So as we kind of like reflect on this season, um, I wanna guide us through like our, our journey and, and look back from the start. So the icebreaker question for today is. What were some of your expectations about starting a podcast and then what did the reality look like when you actually had to sit down and talk into a microphone in front of a a camera and know that people were gonna hear it and give you feedback on that?

Margaret: Yeah, I mean, we like, I guess we've talked a little bit about this in bits and pieces, but. Of like how this started and how you were reached out to by like the Glock [00:01:00] PLNs and human content and then had decided to like, bring me on with you. So Preston and, I don't know, didn't know each other in real life, um, before the podcast, and I feel like it was kind of like a, a leap of faith for both of us to be like.

Okay, we're gonna do this project, like we're gonna sit down for 20 hours and talk. Uh, and like we'll see how it goes. So I feel like coming in, I had said to you many times over the year and at the beginning that it was like good exposure therapy for me. Um, I think, I think that has been true. Um, I. It's both been more difficult and less difficult than I thought it would be, which is a cop out answer, which I'm sure we'll get into more in this episode.

But what about you? 

Preston: Um, I, so I remember when we were first floating the idea. I, I was like looking at different friends or other people that I, I had, I knew really well and I was like, oh, it could be fun to do a podcast with [00:02:00] them. And then I thought, like, who, who do I have like, productive conversations with?

And it would be like a great foil for me because I don't want someone to just amplify all of my thoughts on a podcast. I mean, I would like it, don't get me wrong, but I'm not sure if it would like create good content. I always want to be like a purveyor of, of balanced information. I was like, this a white man with 

Margaret: a podcast, Mike.

Preston: Exactly. I was like, I need to counterweight. I need something for this DEI ceiling. I'm just, I'm just kidding. Legally, that was a joke, but. From our brief interactions, I thought, like, how cool of an idea could that be for us to engage on this? We both have understandings of psychiatry, growing understandings and content creation backgrounds, and we could use the pod as a way to, to get to know each other, and then that kind of creates like a, an interesting dynamic or a narrative.

I thought I, I think we've done a lot more of the getting to know each other off screen, but unfolded in real time as well. Yeah. [00:03:00] I was surprised at how hard it was for me to talk on the pod because I've been yapping at my phone for about two years now, and then sitting down in front of a camera, I was like, this is way different.

Like I'm used to seeing my reflection when I'm talking or being like, oh, I didn't like that. Let me try again. Take number 16 of, of saying this one sentence. 'cause I was hyper analyzing how my intonations came out and now it's just like, we just gotta do it live and take it all in. So that was really challenging for me.

Margaret: That's interesting. I don't, I don't even think I knew. I, I think the first couple episodes when we tried to and failed and then tried again later to do like the trailer, like we, you had kind of mentioned that, but I don't think I realized that it felt so different in versus what you do with TikTok. Like I think I kind of just assumed that it was like, oh, this is easy for him.

He talks to the camera. Anyway. 

Preston: Yeah, it is different. I think it's different. I think I feel more vulnerable out here. In TikTok, I can, I can keep everything closed in my little box and I decide what I wanna release out to the world. But [00:04:00] yeah, I mean, the same's true here. I can be like, Rob, cut that out. Edit all of this.

Cut out where you said 

Margaret: bleep bleep. You said these bleeping bleep bleep. 

Preston: Yeah. But when there's a guest, when there's a guest on and you're trying to formulate a thought, you can't be like, okay. Everyone on the set. I need you guys. Gimme like five or six tries to articulate this train of consciousness and then we'll start from the top.

So that, that was a great challenge. I think the, the part that was easier than I thought was actually. Floating conversations back and forth with you. I thought, I thought it was gonna be really tough to kind of have this back and forth and develop banter and I think we've done a good job of that. It's, it's come naturally, so 

Margaret: Awesome.

I feel like it's not hard to like fill an hour. I feel like if you're a therapist and you're watching this or you have conversations with people as part of your job for long stretches of time. Like the hardest therapy cases are the ones where it's like, we don't have enough to say in an hour and we're just looking at the clock together.

So that would've 

Preston: mm-hmm. 

Margaret: Certainly been a boring thing to listen to, probably for people anyway, but also [00:05:00] painful to make. 

Preston: We, we just sit there in silence and then I pet my cat. I'm like, oh, so what'd you do this weekend? Speaking of things that we in now, I give you a, to openly reflect. What'd you think of it?

Such a broad question. I know. And, and, and dear listeners, I want you guys to take a moment to reflect on it too. This isn't my, we're not doing mindfulness, just 

don't worry. Learned my lesson.

Margaret: Um, I mean, I think one of the things that at least I didn't expect, and that's coming up the most, reflecting on this, is like. When we started like putting this together and like working on it together last June, July, the world was kind of a different place and there's, that's always probably true year over year, but more and more the like question of [00:06:00] where do people get health information and, and how do we increase access to accurate information is more and more, I think important.

Um. I definitely see this podcast now as part of my, like, vocation in terms of like being a psychiatrist, but also like how do we, while we have this podcast, like how do we use it as a vehicle for good information, both for learners and for people who are just curious about their mental health in a time when things are really confusing.

Preston: So, Margaret, the, the question was, how did you feel about the podcast? 

Margaret: That that is a, that is an answer. 

Preston: I, I'm just playing. But, um, I think what I was getting at is, uh, did you like it, did you not like it? It's a, it's a part of our vocation. Uh, I think from the start. I 

Margaret: mean, I think that, that, like, I guess you asked me how do I feel about the podcast?

And it could, like what have you been reflecting on with it? And that's what I've been reflecting on 

Preston: it. The implied [00:07:00] question underneath that. 

Margaret: Yeah. Under the broad expanse of Did you like it? That's, 

Preston: that's the question you meant. I'm, I like, yeah. I liked, I was surprised, like listening back, I was expecting to, to cringe and to kinda like be annoyed with myself.

And then I found myself, I, I was like, oh, this is cool. Uh, one thing I remember was we would. I would get an answer to a question and be like, oh, I don't know how I would answer that. I regretfully forgot this question. Yeah. And I was like, good answer, Preston. I like that. I remember you having a couple moments with that too.

Margaret: Yes. Yeah, we had talked about that, like some of the episodes we'd filmed so long ago by the time they were released in January that were like, I, like, I remember I was like walking to work one day and I was listening to one of our like early in the season episodes and I was like, like, did I know the answer to you?

Asked me a question in an episode and I was like. Do I know the answer to that right now it's like I did not know it anymore. But back then we knew and it was, I also definitely forgot all the jokes we'd made along the way. And so [00:08:00] listening back I was like, nice. That was, that was funny. 

Preston: What would you say your favorite episode was?

Margaret: I tend to like guest episodes just 'cause I get to a lot of, like some of the guests that we had on, that I had invited on. I just think they're very, very smart. Experts in their field. And so picking their brain and hearing things explained to me, it was kind of like getting one-on-one very fabulous, like tutoring in some way.

So I think, um, Amelia, art Therapy in real life, uh, the way she thinks about things has written about them and the topics we covered are very near and dear to my approach to psychiatry. So I think that one was one of my favorites and she was just fun to talk to with us. 

Preston: What about you? Yeah. Oh, I would say either sex therapy or motivational interviewing.

Margaret: Yeah. 

Preston: Yeah. I, yeah, there's something about just having a really good guest that I think has carved out the best episodes for me, and, and we developed the storyline of those [00:09:00] episodes where we kind of introduced the guest, what they're an expert on. We, we get to learn, which is, I mean, awesome for our own sake.

And then we kind of have rolled it into this, um, interactive sequence towards the end where we get to, to apply what we learned and get a little bit of the hands-on experience. I think those episodes take on their own narrative and they're the best ones. 

Margaret: Yeah, I think definitely. I know we're not on the season, we're not in part two of this yet, but the, for that is one of my favorite things.

And we've talked about this, like where we got a little bit more creative with how to like. Give people some good information for like the first half or something of the episode, but then the second half, or in the case of the couples in sex therapy episode, like part two, we got to be creative and kind of play with the material to apply it, which I think is great for learning.

And also I was fun for us, for us. Mm-hmm. For me, at the very least, um, that was one of my favorite things to see us doing. During felt like in filming this is like, [00:10:00] oh, this is something cool that we can maybe, I don't know if cool's the right word, but this is something that we can do that I think is unique.

Preston: Yeah, I mean it is cool 'cause we're cool people doing cool things. So I, I guess the other thing that stood out to me is like, as our podcast started to get its own voice and character, I really liked how we. Maybe not siloed, but started to kind of show preference for different things. So on our, our individual pods, I would start to cover more of like the basic science 

mm-hmm.

And, um, neuroanatomy aspects of things. And you'd cover the more like psychotherapeutic aspects. Mm-hmm. I, I kind of see it as a balance. And I know we're worried about siloing ourselves a little bit there, but I, I feel kind of comfortable with this balance, so I, that.

Margaret: Ultimately, and I, in my mind, an ideal psychiatrist is able to go between these different lenses as we've used that metaphor, I think before, um, of being able to, [00:11:00] is like I have to weigh in, of being able to use these different ways of thinking and switch between them. So yes, both you and I have like our categories that we kind of maybe gravitate towards naturally, but it's also good to like learn.

Preston: Now the hard question. What did you not like? 

Margaret: Least favorite episode in this? Kidding, this episodes? No. Um, what did you least like? Can you go first on this one? I'm not sure. Oh, sure. 

Preston: Uh, so I, I, I'll just guess for you, we, the, the feedback I think was what you were most worried about and criticism from people.

And at the very beginning, with the first week or so. There was a lot of comments that would be like Margaret interrupts Preston too much. 

Mm-hmm. There was comment Margaret too much. 

Yeah. I mean, but those comments stick out to you. Yes. Yeah. I, I think any kind of like negative comment, it's just like the character or this, the nature of the beast that you're.

Focus more on it. Honestly, behind the scenes stuff was the hardest for me. Like scheduling. 

Yeah. 

Trying to, thing that annoyed me the most was like trying to find like time to get off [00:12:00] work to do this. Mm-hmm. Like I was really, I was excited to like be a part of a podcast, but then like I think about halfway into the season I was reminded that I'm still in residency.

Margaret: Yeah. 

Preston: Like, and you're in like a hard 

Margaret: year re you're in a heavy year presidency. Yeah. I'm 

Preston: like, I'm like trading late stays and moving around, call shifts to try to like find time to do this. And it's exciting to have like, man, 

Margaret: yeah. 

Preston: It sucks sometimes. 

Margaret: Yeah. And to add it on what you're already doing, which can be exhausting.

Mm-hmm. 

Preston: But it's nice because then you, you sit down in front of the mic and, and I feel like when I'm actually delivering the, has never really felt like work. 

Margaret: Mm-hmm. 

Preston: I've, I've been tired, but still excited. 

Margaret: Yeah. Yeah. A question comes up. In anyone who's like, I wanna, I'm in healthcare, I'm in a helping profession and whatever.

And then I also want to do advocacy or like creative expression of it as well as what my job is. I think if you're in training or when you're not in training, like how do, when your job, your full-time job is a very [00:13:00] full-time, like emotionally and literally time-wise job. How do you have the time to. Have a creative endeavor or have a different kind of thing that isn't when you're already kind of spread so thin in residency.

Preston: So I think that's it for negative stuff for me. Did you have anything else that you'd wanna see differently or that we, we got feedback on? 

Margaret: Yeah, I mean, I think for me, 

one of the things is that like we're aiming at like an ideal and we're trainees, and we're trainees in an uncertain field, that there's not like clear cut answers.

And so I think for me, trying to still like the uncomfortable thing of being like how do we explain these topics in an hour that is sort of accurate and that we've read enough for, and that like we're using our audience or our guests time well and like honoring this, the complexity and nuance of the [00:14:00] subject while also making it legible enough for people to like.

Be a 1 0 1 learner on the topic. I think that striking that balance is very hard for me, and it get, gives me a lot of anxiety around not doing a topic justice. And that continues to be hard for me, honestly. Mm-hmm. 

Preston: And I think we, we've cut ourselves some grace by acknowledging that we are trainees, we are getting stuff wrong.

It's another like, reminder to the audience that we're all learning together, like, and we're gonna, we've gotten stuff wrong, we're gonna get more things incorrect. But we have an honest effort to find accurate information and discuss it in a good faith way. Yeah, and I think that's really the process of the podcast.

Margaret: Yeah. No, I think it 

1. I think it is. I think, um, I mean, I feel this way with like work too, like being a psychiatrist. Like I, I do hold the job in such 

an idealized way I think.[00:15:00] 

It is difficult to give myself a 

break sometimes and be like, okay, you've learned enough. Like you don't, you don't need to train endlessly, you don't need to do a million fellowships. Like mm-hmm. This is definitely something that is not just for me in the podcast. 

Preston: Absolutely. It's, it's a treadmill. It's an Asim tote.

It's all about what we're reaching for.

Are some questions that people have put in and about our thoughts about the end of the season. And then we're gonna talk about directions for season two.

And we're back. 

Margaret: Do, 

Preston: do, 

Margaret: do 

Preston: Bubu. 

Margaret: This is something I forgot to mention I like, which is the question submissions people do on Instagram, which we're gonna do now. 

Preston: Yeah. Oh, great segue, Margaret. Thank you. So speaking of, did you have any questions that you wanted to start with? 

Margaret: Someone did ask me what is it about, [00:16:00] which I loved, it's about psychiatry and mental health, uh, to the person that asked that.

But what isn't it about? Really easy. Next 

Preston: question. Next question. Well slam dunk. 

Margaret: What about you, Preston? 

Preston: Um, so looking here, a lot of people are asking about like, logistics of psychiatry. Mm. So I, I wanted to give a quick overview of what our hours look like, what call looks like, and. Kinda the whole gauntlet.

So I know a lot of our, our trainees are directly in psychiatry, but there's a ton of people that are just mental health adjacent and are just kind of curious about this stuff. So psychiatry residency is different than psychology training. So all psychiatrists go to medical school. And then a residency program is four years long.

So our intern year. We do about six months of off service rotations. It's about like half a pre year, do neurology, internal medicine, emergency medicine, things like that. Then some inpatient psychiatry. Then the remaining three years you do inpatient psychiatry. So things in like inpatient [00:17:00] psychiatric wards, rehabs, um, consult liaison, so hospital consult services, and then you do outpatient.

And then there's like a mix of different electives that you can do for the final year. Some people think that psychiatry could be three years. Um, it used to be the American Board of Psychiatry and Neurology. Mm-hmm. So it was always four years because we split off from neurology a while ago. Maybe we'll rejoin someday or maybe we'll find something to do with that fourth year.

I don't know. For a lot of people that go into child, they just kind replace their fourth year with that training anyways. So, 

Margaret: but you could be like me and decide you wanna be in training forever. 

Preston: Yeah. Yeah. Margaret, you did four, four years and then you went into child. So yeah, that's six total. Nice. 

Margaret: But that does mean come July, even though I will be a fellow, I can say that I, well, not July, September, I wanna take boards.

I can be like, I am a fully certified adult psychiatrist at that point, so. 

Preston: Mm-hmm. 

Margaret: That's totally worth it. 

Preston: Yeah. That is cool. So someone [00:18:00] else asked as far as like typical hours go, so my intern year, it was usually the 60 hour weeks. Um, most of the time I was working one day on the weekends and then on off service rotations, like medicine, it's like 6:00 AM to 6:00 PM six days a week is usually what I'd expect.

And 

I dunno, it sucks. I dunno else to put that. My, this year it's been pretty nice. I have like one to two twenty four hour call shifts a month maybe. And then I get most of my weekends after that. Most of my days start on 8:00 PM and I finish around three. Um, this week I'm having, it's probably one of my worst weeks of the year, and it's seven days in a row with two call shifts, but it's just how they landed.

And outside of that, like, call gets easier as you go up, you know, it turns into like maybe one call shift a month, and then golden weekends become the norm. You just get to go into attending life where I think the average psychiatry attend works about 35 hours. So hopefully it kind of gives you [00:19:00] guys an idea of what the logistics of psychiatry looks like, at least from training to practice.

Anything you wanna add to that? 

Margaret: No, I think my experience was pretty similar. Um, I mean, part of the reason I did a fourth year before child was to have just like a. Sort of chill year, where our fourth year is pretty much like choose your own adventure, like all elective stuff. So I did like three months at an eating disorder residential, like I'm the outpatient chief and like teach a therapy elective.

And then I also just like have a very chill life outside of it to the extent that the podcast doesn't. It doesn't make me go into the 60 or 70 hours work week, uh mm-hmm. In combination with residency, which has been nice in terms of getting this like started for me. Um, but yeah, there are some programs I.

I feel like the thing they don't tell you in psych, like residency interviews is that different call, like how much, how many people you're expected to see on like emergency psych can [00:20:00] vary pretty broadly or like how many inpatient psychiatry patients you're responsible for is like often I think the thing that differentiates like workhorse psychiatry programs versus like non, in terms of how dependent they are on like resident labor.

Preston: Um, but. Yeah. Um, so next question I'm seeing is I'm curious to know your opinions towards psychedelics as a possible therapeutic tool pass.

Margaret: I don't feel qualified to speak on that. I, I have specific feelings about it. I think it depends, which is an unsatisfying answer. This needs like a whole episode, which I think we're gonna do in season two. 

Preston: Mm-hmm. Yeah, I, I think I'm, I'm a member of the wait and see tribe on that one too. Yeah. So we've seen, I think the most I've seen recently is psilocybin has some preliminary studies that are promising, and that's been in direct comparison to Lexapro.

Mm-hmm. Last I saw people would take [00:21:00] two rounds of psilocybin compared to like daily Lexapro over the course of two months that had similar efficacy on their depressive symptoms. 

Margaret: Mm-hmm. 

Preston: As far as like the nuances of if like, um, I don't remember. 

Margaret: Yeah. Because I know that's one of the things with like, ketamine is like great impacts during, but often after you stop, it stops.

I mean, which is true for antidepressants too, but it's one thing with taking a pill, another thing to like need, like going to a location to get it. 

Preston: Exactly. And so as far as like therapeutic trip sitting or whatever, um, which is kinda what I think this question is getting at. I, yeah, I couldn't, I wouldn't know more than a, a gas station clerk about that.

Yeah, no. Maybe a little bit more. But 

Margaret: we are going to have one of my co-residents on during the second season who is, who's research is in this, um, and is around like how much does the context setting or therapy assisted by psychedelics help versus like placebo. 

So stay tuned for season two. 

Preston: Okay. [00:22:00] Does simplifying info for the pod clash with clinical reality?

Margaret: Uh, yes. 

Preston: Next question. Next question. Easy. That was so easy. I think I would say it doesn't, I dunno if clash is the right word. Mm-hmm. 

Yeah. 

But it's, we purposely add a bunch of asterisk to this. Because we're giving you like pixels of a giant screen. And so, so you can be like, look, this might be true in this one special scenario, but you need the clinical experience to zoom out and see how it fits into the bigger picture.

And so I, I think what we're most afraid of is giving people one piece of true information that when blown up or applied to other scenarios, may dangerous.

Clashed or conflicted with clinical reality. It's just, it's just so hard to capture context. I would say. 

Margaret: I feel like this is like the hard thing with [00:23:00] teaching or honestly like as a learner with learning, is like you have to start with the like oversimplified sort of rule or context and like learn that well before you can start to sort of break the rules or talk about the exceptions.

I think sometimes. Sometimes in medical training, there would be lectures that were by people who were really specialized, like research scientists at my medical school. And their lectures would often be really hard to follow because it'd be like the I funny channel. And that's the entire thing. And it's like you're a second year and it's just like, what is a heart attack actually like in med school?

And then we would have an hour on that. So it's, it's difficult. I agree with you that it's like maybe clash isn't the right thing as much as. Kind of feel like you're gi I'm giving like the Doodle Bob version of the, uh, actual concept. Did you watch SpongeBob growing up? How we not covered this? Mm-hmm. On the podcast?

Yeah. Do you remember the Doodle Bob episode? Neil? [00:24:00] Yeah. But it's like, have to do 2D before you can do 3D. 

Preston: Exactly. And, and, and I think the intent of this is to spark interest for people to do their own exploration. Like we're we're best. If you really want to continue to be like a master of this or, or learn more about it, it has to be like self-directing.

You have to go find the context yourself. 

Margaret: Do your research as they say online. 

Preston: Yeah, your results may vary. Okay. Um, Margaret, did you have another question? Yes. Plug in. 

Margaret: There is a question that we can either include as I ask it or not, which is, is your program supportive? 

Preston: Yeah, I, I saw that one. I thought about it.

Um. My program supports me in every way possible, and I am so, I'm so very thankful for them in all they do. 

Margaret: I, I mean, my PD is coming on the show, so yes, [00:25:00] she's a CL psychiatrist in cardiology, so yeah, she does. Mm-hmm. I mean, I will say like my intern year I came to my program was like. Hey, I don't wanna do research.

I wanna do, like, I don't wanna do bench research, I wanna do like narrative medicine and like humanities and medicine stuff. So I feel I've been pretty straightforward and they were like, yeah, we like med ed, we like these, the humanities approach. So we'll help you start that group. So this kind of felt like a natural sequitur when I was, when I asked if it was okay.

Obviously not in a way that's like, here's my program in hospital and they stand by this because that's not what this podcast is. Mm-hmm. And they're not affiliated affiliated in any way. Mm-hmm. But my, I feel like I've been lucky that my program director really values like medical education and thinking about how we do advocacy and get information to both learners and patients.

Preston: Yeah. Um. Anything I said in Jes earlier, like my program as far as the podcast goes has been very supportive. I've had like faculty on here, um, people that [00:26:00] kind of seek out, seek me out to like introduce me as like, oh, Preston, one of our residents, um, does a lot of like social media things. And so in general they've been supportive of that.

I think I've had a, a speckled pass with it in medical school. 

Mm-hmm. 

Um, just because, and, and I was a bit more of a loose cannon then at the time too. I think my, it's a wild 

Margaret: stallion. 

Preston: Yeah. My social media presence and my podcast presence are, are a little bit independent of each other, I think. I think we acknowledge that this is a more professional space and, um, we purposely have like, I think more contained conversations here.

Um, but like, I'm going, I'm going with you to speak at a PA next month. Yeah. This, 

Margaret: when this comes out, we'll have done that, which is exciting. So exciting. 

Preston: And I think when people around you see that like the work you're doing is getting recognized in a positive way, they, I think they go from seeing you as a liability to something that actually like elevates Yeah.

The education around them. Because I think when I first started out, any social media things, [00:27:00] it was more so like as long as you don't draw any attention to the hospital, as long as you don't get the program in trouble, I don't care what you do. Which at the time was like, wow, how supportive, you know? Yeah.

Um, but I, I think the narrative shifts a little bit to like, oh, this is something that's like actively positive and that we can get behind. 

Margaret: Yeah. I think it's often what I have found. I had more of the experience in med school when I, I wasn't, I remember distinctly being interviewed for med school and having an interviewer ask me, like read my personal statement was like, this is great.

Like, you're a great writer. Why are you going to medical school? And I was like. Like I felt my, like two parts of myself like shatter apart. It's like what? Um, and I feel like a lot of people in, in healthcare and in medical training in particular, just because of how stressful the actual training is, the time commitments often have to split that part of themselves off.

And then there's all of this kind of fear [00:28:00] and. Leadership or people who, that you ask like permission from that, like don't really know. They're not necessarily in on TikTok. They don't know where people are getting information in the same way, like a Gen Z person, whatever. Like knows. And so you come up to them with your idea.

That is, makes a lot of sense and can be a great idea and maybe there's anxiety or fear around it 'cause it's so different than the model of medicine and communication that they were raised on. Even if. In theory support it. I think it's hard to like support something that you don't really know what it is.

Preston: I think a lot of times be because they're so uncomfortable with it, they see it as something that's like, the potential upside is like negligible. Yeah. And the potential downside is very tangible to them. So like why, why would to support this thing? That in my perspective, has no pros and all cons. 

Margaret: Yeah. I, I remember talking in therapy during med school and being like.

Wasn't doing, TikTok wasn't doing, was just trying to make it through med school. Right. And like surgery rotations. [00:29:00] Uh, and I remember saying to my therapist at the time, like, I just feel like this part gets in the way, like this creative part. Gets in the way of being able to focus more and it's just a distraction.

And it's very interesting to be moving towards graduation from your humanity is a 

Preston: burden 

Margaret: residency and be like, oh, I'm going to the ap. Like we're where we were asked to like be at this conference for the reason that it was something I thought couldn't belong in medicine. 

Preston: Mm-hmm. 

Um, I really, with what you said.

You're such a good writer. Why are you going to medical school? When, when I was a, either a junior or senior in college, I turned in like my final essay for, uh, an English class. My professor asked me what I was like, what I wanted to do with my life. I told her I wanted to go to med school, and she, she like sighed back in her chair.

She said, what a waste of your humanity. I was like, 

oh man.

A.

Margaret: [00:30:00] Uh, it's like 

Preston: I still think about that sometimes. 

Margaret: Yeah. No, I think there's lots of those messages. I think there's lots of those messages. I think something that's interesting for me in this year in like the chief role and then when I was running that narrative medicine group, even before, like I. Doing this podcast or like having TikTok be, not like just a couple thousand swifties who are following me.

Mm-hmm. My, my crew, my tribe. Your 

Preston: army. Your boiler Army. 

Margaret: My army. Um, but I, like, I, at this point now with the podcast and being a like chief in my residency, I feel like there'll be questions every once in a while to me when I'm talking to someone like, how do you maintain this? Creative part of yourself in training, and I wonder what you would say to that.

Preston, this is my question submitted to you. 

Preston: Thank you. I, I would say you have to nurture it like an oil lamp and the, the flames, the flames gonna get smaller. It's gonna dim, but you can't let it extinguish [00:31:00] and you can find time to nurse it again and it'll come back. So, I don't know. It's, it's like a little life inside you.

Mm-hmm. 

And 

so, so do what you can. To preserve the, the flame through times when you don't have a lot of fuel for it, and then let it burn when you're feeling good. That's what I would say 

Margaret: I No, I totally agree with that. I also think it's surprising, like, again, like, I don't know, it's surprising. I certainly didn't start posting 

about like Taylor Swift stuff and think.

And this is my 10 step career, to have a podcast to speak about psychiatry. Like that was, there was no plan. There was actively not a plan, and it was just for fun. So I, I think it's surprising how much five to 10 minutes of doing something creative, just kind of for the hell of it, can turn into, you don't know where it's gonna take you, even if it just mm-hmm.

Takes you to being more in touch with that part of yourself. 

Preston: Yeah. I don't, I don't like to give credit to the, to the source of this [00:32:00] piece of wisdom, but I saw on an Instagram reel, this, this guy saying it was with motivational music over the background, but he said, everything you want in life is on the other side of consistency.

Margaret: Dun dun, dun dun. You know, 

Preston: and it's like a David monologue and a bunch of other kind of like platitudes. But that part stuck with me. Yeah. And, and, and, and the consistency can just be five to 10 minutes. It's all you need. 

Margaret: Mm-hmm. Mm-hmm. And 

Preston: that, that's enough to keep the flame alive. 

Margaret: I think we have one more question.

Preston: Any straggler, 

Margaret: what's been the most rewarding part about starting this pod? I know you said your favorite part, but I think rewarding is a slightly different word. 

Preston: I think for me it was, it's actually reconnecting with people that I lost touch within high school and college even. There were a lot of people that were just kind of acquaintances.

Mm-hmm. 

And then they all went into medicine separately, whether they're social workers or PAs or even doctors. And then we've reconnected through the podcast because they've been like, I was just looking for mental health podcasts or content [00:33:00] and I found you. I'm a social worker now. I work at a VA somewhere, or I'm doing my social work residency here, or I'm doing, I'm in PA school.

This is so cool. And I. Like re rekindling those kind of friendships and being like, wow, look at, look at us. Like returning full circle. Mm-hmm. And we both like found our path separately and now here we are has been rewarding. And I think the other part that's been very validating is my friendship. Yeah.

My friendship friend. 

Margaret: It's 

Preston: the real podcast is the friends that make along the way in. Right. It's seeing that like this neutral observer likes what you do because as Hank Green says, your haters are gonna hate everything you do. And your friends are gonna love everything you do. So the real way to know if you're making something good is if someone who has nothing to gain or lose by communicating with you wants to reach out.

Mm, 

Margaret: yeah. That's so true. That's so true. 

Preston: So when, whenever I get one of those, I'm like, damn, nice. 

Margaret: Yeah, 

Preston: I did something cool. What about you? What's the most rewarding part been for you? 

Margaret: I think I haven't [00:34:00] known how to kind of explicitly combine. Creativity or kind of like liking what I write about on TikTok or think about for that, like that creative part with psychiatry and until doing this podcast where it feels like, okay, we can come up with like ideas.

I can, you know, ping you four times and be like, I just made the schedule for the next four episodes and a lot of emails, um. But com I think combining, I mean, I had said earlier that felt like the two parts of me had to be fractured to like make it in medicine. And I think that this podcast has been like a really great way of feeling those, like connected and intertwined in a, in a way that's been, I.

Preston: Reunification. 

Margaret: Yeah. Integration. That's always the goal of therapy integration and more fully alive synthesis synergy. So I think for me it's that seeing how those two parts can actually fit together and [00:35:00] having you force me to get over my, uh, anxiety and imposter syndrome and be on camera. 

Preston: Yeah. Here we are.

Margaret: This is all just business podcast is just in my exposure therapy assignment by Preston's. 

Preston: It's been like unbelievable. I think if we look back at the first episode to now how our comfort has changed on camera and how well we can toss the ball back and forth, so to speak. 

Margaret: Yeah, yeah. 

Preston: Well, looking forward now, what do you think will be, um, heralded in season two?

Margaret: I think it's really fun to bring, at least for me, it's fun to bring in these like. Creative, almost sketches or character play of different concepts that we're thinking about. And I, if I'm very honest, like I would've liked to hear that when I was trying to conceptually understand what it would sound like if A DBT therapist was responding to.

You know, Homer Simpson or something, something like that. Um, so [00:36:00] I, I hope in season two that we bring more in these like, creative ways of playing with the material to make it more fun for people to listen to. Mm-hmm. And also give kind of different edges or memoral kind of like weird portrayals of it that'll help like, stick out in their mind to make the memory of this information a little bit better.

Preston: So, more role playing, more experts. More impressions. 

Margaret: More impression, more. More access from more therapy 

Preston: modalities. 

Margaret: Yeah. 

Preston: What about you? One thing I think that we're gonna try next season that I'm excited for is we're, is we're gonna try to bring on a patient. 

Mm-hmm. 

And we're not talking to them like as clinicians interviewing them, but really just fellow humans that are like sharing their, 

Margaret: yeah.

Preston: Have patients or people with illnesses primarily talking. And then there's podcasts where there's just a bunch of practitioners or experts chatting, and I've seen very few where there's a combination of both. So I think as we try to discuss these [00:37:00] pathologies, having someone who's personally experienced it could add a really fun new perspective.

I think it's been a challenge for us to find people and kind of, there's a little bit more screening that has to be done. 

Margaret: Yeah. 

Preston: So it'd be a new logistical challenge, but I think we could have some really good episodes with that. 

Margaret: Yeah, I mean, I think there are core, one of the things I guess behind the scenes that we can tell listeners is like, one of the parts that makes it hard is just thinking about the power imbalances, uh, that exist in a clinical kind of setting, but also with coming on this kind of platform.

And you guys have heard all my anxieties about coming on, which maybe not everyone would have. Um, but wanting to make sure that we're. If someone is sharing that vulnerability that we're trying to do so in an ethical, autonomous way that also protects 'em and doesn't, you know, expose someone to like negative experiences from sharing their story to a, a broader, unpredictable, like [00:38:00] public listening ear, although a very kind public listening ear, but a public nonetheless.

Preston: Yeah, absolutely. The goal here is to build context and to add perspective. And we run the risk of worsening stigma or traumatizing people and, and that that's the tight rope we walk on. So high risk, high reward is what we're looking at. 

Margaret: I think one other thing that we're thinking about for season two is Preston and I can really talk for a long time, um, and.

One of the things we're thinking about is having kind of extras or other parts, or like we always get way more questions than we can answer in a single episode of starting a Patreon. Mm-hmm 

Preston: And so I actually, I have a Patreon that I use for Prerow and so we're thinking about like kind of back adapting that and using it for the podcast.

The other thing we can do with the Patreon is we can have little live sessions where. We go through and filter out your [00:39:00] questions and ask them, answer them. You can just kind of have a back and forth. Mm-hmm. I've done a couple with Dr. Glock Flecking and they've gone pretty well. Even if they're really intimate, it's like 30 people or something.

Mm-hmm. It's just a good chance for us to have like, pretty genuine interactions with y'all. And then if you have input or things that you wanna shape the podcast, um, around, like that's, that's your chance and. We really like to see what you guys are appreciating and it's one thing to see it in writing, it's another thing to, to get to talk with y'all.

So I think that could be rewarding. 

Margaret: I think one other part of why we're thinking about the Patreon is just being thoughtful around like Preston, like you're saying. It can take a lot of time to do this well, and we want our information to be kind of unbiased and. 

Preston: Yeah. So, and, and I'll say that a little bit more explicitly, not, not to give you the whole Alex Jones pitch of I'm, I'm pulling out my own money to keep the lights from turning off here.

But [00:40:00] the truth is make, making a podcast isn't free. We have a group of producers and we have equipment we have to buy. We have, um, publishing. We have our own advertisements that we have to run, and all this stuff costs money. There's people behind the scenes editing that have salaries and things that they need to do to support themselves.

So one way we can fund ourselves is with advertisements. And I think Margaret and I have like really combed through and been like, okay, I don't care if L'Oreal advertises on this or Crayola. Like that's awesome. We don't have Crayola as a sponsor, but 

hey, I like Crayola. 

Yeah, that's what I'm saying. But the thing is, what we don't want to be advertising is like your next new supplement brand that's gonna like, you know, take away your depression because like there's a couple more B vitamins in it.

And I think one we had a bit of a back and forth about was, um. Something like selling insurance policies and I, I think when we want to have these like bigger conversations down the line where we on like policy or economics. [00:41:00] A hard mark to work around to be like, oh, by the way, we're sponsored by, let's talk about the opioid epidemic.

You know what I mean? So the other reason why we're this episode 

Margaret: is done brought to you. 

Preston: Yeah, yeah. Anyways, so let's talk about all the reasons why opioids are actually good. 

Margaret: Anyway, it was, they're bad. They said it. We to redact that name out, Purdue, allegedly,

according to.

Preston: So on this episode we'll be talking about the ethics of, uh, warfare. Um, here's how to be patient, sponsored by Boeing Northrop Gruman. So all that's to say our biggest concern is staying honest and true to y'all as the audience, and a way that you can help us in achieving that goal is to support us on Patreon.

'cause then we don't have to kind of make these tough decisions. Like, do I accept this ad that I feel icky about? But then This's gonna be at the, at the cost of sometimes our own money [00:42:00] going to the pod. Mm-hmm. Well, it is our own money going to the Yeah. Podcast, but expenses that will be hard to sustain on resident salaries and things like that.

So this, these are the trade offs we make. And, um, that's essentially our pitch for if you wanna support us, that's, that's what it's gonna in the podcast. 

Margaret: This is a behind the scenes, the ethics of a podcast. Yeah. 

Preston: It's just, I dunno, I, I feel like I'm selling myself kind of, kind of hard. 

Margaret: I think we're just being honest about how it works.

And I actually, like, one of the things that Preston and I have talked about dear listener is like the, something that can be very difficult in listening to like health and wellness podcasts or like lectures is. When there's like, you're listening to it and you're like, this is great. I'm gonna follow this.

And then like an ad in the middle randomly comes up for like a mattress or something and it's like, okay, better help. I don't, I don't know what this is anymore. Um, and I, I mean, I'll say there are a couple podcasts I follow that. I have their like [00:43:00] subscription that is like an extra episode or extra bonus parts that I'm like happily pay.

Not really. 'cause I'm that ethical and I'm like, they deserve to be paid work. Although they do, but because I'm like, I really just want this extra episode. So what we're hoping to do at the Patreon is like, it's not just a donation, it's us giving you more of what you want and more specifically, more access, more time.

Um 

mm-hmm. 

We'll make something good to sell to you and then we'll have our own supplement line. 

Preston: We're yes, 

Margaret: our own ECT issues. That's what it's all about.

Preston: Thank you again to all the listeners that do leave kind feedback and other feedback and, and reviews. Ask these questions. Yeah. It's all becoming a part of the person. I like the pod. Mm-hmm. So thank you for being one of our facets. If you wanna watch full episodes, um, and video, it's gonna be on my YouTube channel at its pre.

You can always find in video and audio on Spotify and anywhere else that you get your podcasts, at least the [00:44:00] audio version. I haven't really checked Apple Podcasts or this other places. Thanks again for listening. We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are Meme Preston, Roche, Margaret Duncan, will Flannery, Kristen Flannery, Aaron Corny, Rob Goldman and Shanti Brook.

Our editor and engineer is Jason Zo. Our music is Bio Mayor Ben V. To learn more about our program, disclaimer and ethics policy submission verification, licensing terms, and our HIPAA release terms, go to how to be patient. pod.com or reach out to us at how to be patient@humancontent.com with any questions or concerns.

How to be patient is a human content production.

Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating [00:45:00] boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, they probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the background.