Season 3 Wrapped: Time To Reflect and Look Forward

Margaret: [00:00:00] Okay. My next question for us is, who was your least favorite guest? I'm just kidding. 

Preston: Be Arm 

Margaret: Me

Preston: How to be patient. 

Margaret: Welcome back to How To Be Patient, and this is our season three wrap up episode. Preston finale. How do you feel? 

Preston: It's a 

wrap 

Margaret: finale. 

Preston: Yeah. 

Margaret: How do you feel having done three seasons of our podcast? 

Preston: I mean, I feel like my lunch, which was a cold chicken wrap from Chick-fil-A, because I'm all wrapped up and excited.

Venito mode. 

Margaret: We have made 60, I think this is the 63rd episode, and we started talking about this podcast. You started thinking about this podcast with Will of. Dr. Welcome Fleck and Fame around two years ago now, and we [00:01:00] started talking about it in June, 2024. Is that right? No. 

Preston: Yeah. I think we were dreaming of this around fall of 2024.

We started recording Winter 2025, released our first episode. 

Margaret: Didn't we start recording August? 

Preston: Oh, I guess we started recording late 2020 because we, that delay four and then released, 

Margaret: well, we, no, it was June when you had like asked me and then we like had the meeting with, human content in like August and then started recording and then started releasing January, 2025.

Right? Yeah. 

Preston: Yeah. I guess you did that whole fall, so it was followed my PGY two. Yeah. 

Margaret: Wow. 

Preston: It's been quite a journey. 60 

Margaret: episodes. I know you're gonna be a fourth year. You have your fellowship like confirmed. You started this at the end of first year. I 

Preston: mm-hmm. 

Margaret: Will be mid fellowship, right? Soon.

And we're 

Preston: three season, 10. Yeah. You'll be, like a month out when this comes out. 

Margaret: Oh, that's true. 

Preston: From the halfway [00:02:00] point. 

Margaret: That's true. So today's episode, is like our other wrapped episodes. Did you ever watch the show Unwrapped on Food Network? 

Preston: I have not, 

Margaret: I feel, but imagine this 

Preston: sounds good.

Margaret: It was. It was one of my favorite shows. it's like how it's made, but for like different common foods. Anyway, today's episode we're gonna talk about our kind of reflections on this season, what we learned, what we felt like you guys liked or didn't like, and then kind of hopes and logistics for season four.

Preston, do you have any objections to this? 

Preston: No, but I, may have some. It depends on where we want to take season four. So, so right now I'm in full support. 

Margaret: Amazing. Okay. Well, one of our first points maybe to talk about is what we, like, what episode we liked the best making. I think we often, we can also say like, what one we liked the [00:03:00] outcome, but I feel like sometimes the process behind the scenes for both of us of actually like learning about planning or like outreaching to people for episodes.

Is its own process that people don't see. And so my first question for us is, what episode did you like making the most this season? 

Preston: Well, I, think that a lot of the season has been teaching me how to podcast. Well, I think before I even started a pod, I thought, oh, you just yap and have fun and be cool and be relaxed.

And that's a big part of it. But you also have to. Structure the conversation of an episode to flow in a certain narrative. And I think the hard thing about looking at topics that you find interesting and then connecting them to a podcast episode is figuring out where you can excavate the story and what level of detail you want to enter.

So I, I think that's a skill I'm proud of, which is learning how to take like a paper or something in [00:04:00] the news and turn it into an episode. I guess my favorite one in that regard is the coffee, tea, and dementia episode. I had a lot of fun with that one. I enjoyed reading the paper at the beginning, but then I could think about how I can block this into a good conversation where hopefully people have fun listening along and then also get something out of it.

And 

Margaret: yeah, 

Preston: and it like, it carries, you know, you kind of stand on its own. It's a fun conversation about a piece of literature. Yeah, so I'd say that was probably the best behind the scenes one for me. I haven't been looking as hard about the post credit situation on too many of these, 

Margaret: on too many, but you're like, once they're out there, they're out there.

Preston: yeah, you just stress yourself out about like seeing all the responses, like feedback is good to look at, but I think the best way to make this sustainable is just to make an episode and then get ready for the next one. 

Margaret: No, I agree. I agree. I think, you know this, you're gonna be able to predict this, but I.

Felt very [00:05:00] proud of, the Ai your brain on Chachi Bt, your Brain on AI episode where we had the MIT researcher and lead author of that paper actually come on and talk about it. we've talked about this on the podcast, and Preston and I talk about this. One of my long standing hopes of money for this podcast is that it also becomes something where we can have primary researchers on, and not just people who are in the like.

Public sphere 'cause they have a book coming out or because they're like someone who has some like controversial stance, but the actual people who have dedicated like decades of their life to the work that is being either quoted correctly or misquoted. And so the other part of it was just like cold emailing and actually getting a response back was really fun for me.

Preston: Yeah. I remember how excited you were when you found that lead. 

Margaret: I, 

Preston: yo we got this big, we got a big hitter [00:06:00] coming straight to the thunderdome. 

Margaret: I was like, we got a big fish. They're coming to the small pond. like time interviewed them, but we got a, yeah, so I think, it's such a relevant topic.

It's an episode that like did well. but I think it just combines so many things that. Our elements I like that we're trying to do with the podcast and your episode as like a journal club ish, one on the coffee, tea, and dementia. I also really liked because I thought it also, the way you planned it, not only was helpful in unpacking the paper, but also showing the thought process of like what a journal club is like from the inside.

because not everyone has access to actually being in, like, especially in like hyper specialized, we're gonna debate. As psychiatrists or we're gonna like look really closely at this of how to apply it or how to think about it or where to go next. And I just think that process part of it is also like a really important way of understanding how we [00:07:00] understand data and evidence and apply it.

Preston: And even just putting stuff into layman's terms, I think has so much value. Mm-hmm. we've been having like a lot of research symposium days and research clubs at UT recently. So, so it's, there's a lot of abstracts floating around, I guess I would say. and there's so much fuzzy, inaccessible language out there when, like, the core question and, the coffee, tea, dementia paper actually was very straightforward, but sometimes it's really hard to distill like, what are we actually talking about here?

So it's really helpful to have people like discuss it on the pod and say like, yeah, actually all they're looking at is, does drinking coffee increase your risk for dementia or not? 

Margaret: Right. 

Preston: Like we, we don't need to make it any more complicated than that. And there's a lot of papers where it's, you need almost like a foot in the door in the specialty to be able to say the punchline.

Margaret: Yeah. Because I think that's the problem. And I don't think that this is like, it's not like MDs are always great about this online either [00:08:00] where it, at any level of education, unless you are like a PhD in the actual field and you're publishing, so you actually are very aware. Of like the places in the field where questions are versus answered things, it can be very easy to step out of your lane inappropriately and be like, we have this paper, and so I'm a doctor.

Here's three ways I tell my patients to apply it. And sometimes those are right and sometimes they're dead wrong. And it's actually almost worse than someone who's not leading in with I'm a doctor and 

Preston: yeah, I'm, a psychiatrist and these are my top three skincare tips. Get ready to dive in with me.

Margaret: Start washing your face if you're depressed. Get your true depression treated. 

Preston: Yeah. It's like we know that dirty faces are associated with depression, so I think your dirty face is causing your depression. 

Margaret: We're, I mean, 

Preston: new La Roche passe antidepressant line coming out soon, 

Margaret: antidepressant. I mean, there are those people who have [00:09:00] done the studies on Botox for depression and then are like, I'm a psychiatrist.

It does Botox or depression, and I will say the people who are actually doing the research and think this might be legitimate, I have respect for the people doing the research. What I don't have respect for necessarily is not me causing public beef. Like I don't have respect for people who are like beef alone.

We actually should have that for season four. The theme for season four is just. Causing problems and causing fights. And 

Preston: it's like, it's a cow mooing, that's the beef alarm. 

Margaret: Oh, I love it.

But like, I don't know, it's easy to take something and then like be like, here's my specialized program based on the research, or here's my, like Botox. I have this one study that hasn't been validated, whatever. And now I just run a Botox clinic as a psychiatrist, like, 

Preston: and I tell everyone, science 

Margaret: says, I'm 

Preston: right.

Margaret: Researchers say which researchers like.[00:10:00] 

but yes. Okay. So those are our ones. So. Okay. A theme also though from that might be continuing to think about these aspects of journal clubbing, going to the mm-hmm. Going to the journal club to club. Yeah. Yeah, exactly. in season four. And also I think part of the things we've talked about before, we haven't really done this as much, is like.

Having like shorter snippets where it's like, if we're talking about a broader topic and we figuring out a way to have someone on for like 10 minutes or 15 minutes of an episode to talk briefly about a paper or something that, like, not every episode has to be the entire thing on it. And kind of thinking about ways to put episodes together differently.

That could be interesting. 

Preston: Yeah. Like we could even do, like, some people can't, don't have the time to go on a podcast for an hour and a half, but they may have time for a 10 minute phone call. Yeah, so we call them record the call, and then we [00:11:00] bring them in and kind of react to the conversation and talk about it from there.

I think that could be a great, like paradigm. 

Margaret: Yeah. Like you're talking to Delilah on the air. Who do I have with me tonight? So, so in Seattle, 

Preston: Delilah, is that who you're referring to? 

Margaret: I think so, yeah. 

Preston: Yeah. My mom, she would always play like light rock hits and Delilah would come on the air. Remember what I was.

In the summer of, early two thousands. 

Margaret: Okay. My next question for us is, who was your least favorite guest? No, I'm just kidding. 

Preston: Be Arm 

Margaret: Me. Be Arm. no. Any feedback that we got from listeners or from like, the metrics on different episodes that you found surprising this season? Like either that did well or that seemed to resonate or ones were.

Especially ones we led that seem to be like less of interest to people. I 

Preston: think [00:12:00] I, I am more surprised by how interested people are in things that I would expect to be benign or innocuous. Like, we'll write up, we'll do a whole episode and then the like, top comment will be, I wanna learn more about Preston's plants.

And I'm like, right, maybe I should talk more about my plants. Like, like I, I. I think I always just, I underestimate how interested people are in our lives, so that, I think that tickles me, that like, it feels like y'all not only care about what we're talking about, but you care about us. and that's just, I don't know.

It's powerful to me. So, so I just, for all the listeners who, have been here from day one or day 62, or I guess now day 63, just thanks for being here and, caring because it's, I think that's really what keeps us doing this. Otherwise, I would just be talking to my cat in an office with an unplugged microphone, which is therapeutic.

Like, don't get me wrong, there's value to voicing things season preview into the [00:13:00] ether. But, it's nice when the ether speaks back, you know?

Margaret: I think I remember us talking about this now, almost two years ago, and you thinking about the podcast before, I was like, gonna be a part of it. Talking about like, well, what, can I bring to it? Like, how do I make it like you asking like, what is the kind of feeling that you wanted to make it then?

And I remember saying to you, and I can't remember, I feel like it, you liked what I said, but it also vaguely pissed you off. I was like, well, like people already have up to date. So like we, it doesn't need to be like a, psychiatry topic review and not personality at all. Like people like you, like people aren't following you because.

They're like, this is where I can find 20 facts in a row about depression. They're following you. 'cause they like the stories and the personality and the way that you say it. and so I think that like those comments that are kind of about these other little parts [00:14:00] are a reflection of that, of like, there's a relational way of knowing, even through a podcast, even in a parasocial way that makes the whole thing more interesting because it's like, I know it through the eyes of Preston or Dr.

Roche. I wanna know more about this person who are the, is the eyes that I'm seeing through an I thou situation? 

Preston: An i an eye for an eye. 

Margaret: An eye for an eye. Makes the whole world a podcast now. 

Preston: so yeah, if you're listening, you're in a pair of social relationship with us, but hopefully it's like kind of a platonic, chill, parasocial relationship where I'll just kind of hang out chit chat, you know?

Margaret: The ones that I was surprised at, people's not surprised at, I guess, but like you were the one driving the existential like four part thing. But I think, I didn't expect, I thought people would like it, but I didn't expect them to like it as much as they did. Like I feel like people were actually very into [00:15:00] those episodes and were like 

Preston: common theme 

Margaret: presses, 

Preston: ideas 

Margaret: what 

Preston: the Margaret saying.

I knew people would like it, but. They liked it more than I thought they would. That 

Margaret: is not true. I support you. A you led podcast two years ago. I was like, yeah, you should do this. This is great. So miss me with that bullshit. but I didn't, I dunno, I didn't expect people who are like listening and are like healthcare workers.

I don't know. Like it feels similar to how they responded to the psychodynamic episode. That's like, I want to know more about this. Mm-hmm. And I guess I just think like, maybe in my mind, I think of our listeners as like we are healthcare workers who. I wanna have a laugh and wanna be funny, and wanna understand better how to make this all work.

But like, I don't know, kind of like how you used to talk about like psychodynamic thinking. It's like, okay, we're kind of straying away into a big world of like what ifs and abstractions and does it actually matter? 

Preston: Yeah. I, and like I remember, everyone really loved your ACT [00:16:00] episode that you led, and I think.

Most people in the general, even like mental health space, are familiar with CBT and supportive psychotherapy and kind of like general coping skills. Even act is kind of off the beaten path a little bit and everyone kind of loves that. Like it's, we're not reviewing the front page, like basic stuff and a little like niche deep dive is, I think it's what, makes you wanna learn a little bit more?

At least you're like, hopefully being led by something that's like mildly entertaining along the way. So I think that's, the thing, like psychodynamic existential, like they're just far enough off the beaten path that you probably wouldn't explore it yourself, but you'd go with someone else. You'd go with a tour guide, you know?

Margaret: Yeah, no, I like that. was there anything doing the existential series that you feel like before you did it versus after has impacted you and like kind of. Committing to it in a way for like four episodes and then staying with the material in a different way. [00:17:00] 

Preston: It was, so from my perspective, this was kind of like a book club for me.

Uhhuh, it felt like a class. You know when you have reading for a class that's due existential psychotherapy is like an eight or 900 page book, and like each section is like 300 pages. I'm like, okay, I have two weeks on top of work to read, like. 50 pages and then try to summarize this into like an hour and a half podcast where we can like talk about the main points.

So I was like, every morning I was listening to it on audiobook, like during my runs or driving to work. And then I would like come and like actually read the book when I got home. So I think like it was just 

Margaret: how, are the image of you like making your coffee and then it's like existential psychotherapy is playing in the background is like.

Extremely like romantic in the classical term. Romantic. Like, it's like I'm listening to my existentialism as I make my espresso. 

Preston: [00:18:00] Okay, let me, 

Margaret: and I like the vibe's 

Preston: Good. lemme grab the book right now. And I just want Yeah, do it. I'm gonna open up a random page and I want you to pretend that I'm the audio book and you're making coffee listening to this.

Margaret: Okay. I'm ready for it. 

Preston: Actually. Margaret, pick a, oh, sorry. It's not 700 pages. It's big. So it feels like it's more, it's only five, 

Margaret: like it's. 12,000 pages long and the fun 

Preston: insights, every six, every time I tell the story, we add like couple hundred pages. Yeah. 

Margaret: Page 323, 3, 

Preston: 2, 3. Let's see. Let's see what we got.

Okay, imagine morning coffee. Open notes to three. Opening up to this 

Margaret: sing. 

Preston: For example, opening skid affect. Stifled patient had for many years, decided not to make any effort to change. Change for reasons not germane to this discussion was a terrifying prospect for him. And consequently, he refused to commit himself to therapy and carved out a muted isolated life for himself.

Viewed objectively his choice, lay between pervasive, [00:19:00] intra and interpersonal isolation, and a more spontaneous and expressive, affective life. To continue in the decision not to change the patient distorted the options available to him and devalued the unchosen alternative and overvalued the chosen one.

He viewed affect suppression as dignity or decorum and spontaneity as animalistic loss of control where he would run the risk of being overcome by rage and tears. And I'm like, do I want elder flower syrup or vanilla syrup? probably both. And then the next, line is like, all humans will inevitably die, and it's hard to confront this fact.

And then I'm like, okay, Matt, you off to work.

Margaret: I feel like last year I like listened to Nancy McWilliams psychoanalytic diagnosis and treatment. And it was similarly where I'd be like walking like along the Charles and it'd be like, what does a true schizo [00:20:00] attachment mean according to the object relations theorist? And it was just like your brain, just like eventually is like.

It's not there anymore. 

Preston: Sometimes it feels like, like a cheese grater on your frontal lobe, you know, and it's just, gray matter zest coming outta your ears. You're like, what? Wow. I'm not sure if I'm getting smarter or getting dumber, but change is happening. 

Margaret: It's the brain version of a, workout.

You're like, I have done the correct amount of damage so that when this heals up again. It's gonna be lit. 

Preston: Brain hypertrophy stronger than what I'm doing right now. that's actually why I take creatine. It's so, my brain recovers harder than it did before. 

Margaret: That was my favorite Patreon one. The one where you were making coffee.

I was making my like shitty creatine. 

Preston: Yeah. That was so funny. we get like five minutes into the Patreon and I'm like, do you have my coffee routine? And Margaret's [00:21:00] just like, do I just keep watching you or. And I was like, oh yeah, I was 

Margaret: silent. You were 

Preston: told like, 

you can make something do if you want.

Margaret: No, no you did not. We have Jason played the recording here. He said, yeah, you just watch and you listen. I can't believe I'm, having to just sit here and watch.

And then I got up and then I said, I also have something too.

Go crazy. Fruit punch flavored creatine. Mm-hmm. Almost definitely made for high school boys, but I enjoy the fruit punch flavoring as well. 

Preston: Yeah. so what I, and I don't know, what was your feedback that you found interesting or, reactions that you saw that were strange or unexpected? 

Margaret: loved the Spotify comments section, continuing to grow.

Love that. in terms of strange.[00:22:00] 

I think I'm just like, I can't predict ever like what people, what will get more reactions or like making a pod. I think we've talked about this before, but like, making a podcast is so weird. 'cause like there are like some comments on like the YouTube and Spotify and we'll get dms and other stuff like, so there's like scatterings of reactions, but for the most part, and like, this is how I listen to podcasts too.

It's not like a TikTok where like people comment and you're like very aware of how they feel about it all the time. Like most people I think do listen to podcasts and then they go about their day. Mm-hmm. And it's interesting, it continues to be interesting how it comes back to us. And like sometimes it's direct with like the comment section, right?

But other times it's like I'm rounding in the hospital and I see someone and they're like, oh, I saw. A clip of, you know, the episode you did with Mark Mullen on TikTok, like, and I listened to the episode, I liked that you guys talked about whatever this, and so very much like [00:23:00] right now filming, you know, at our separate apartments, homes, whatever, weeks before we release an episode, it just feels like throwing something out into the world and being like, okay, go have fun out there.

I, I, we don't really know what's happening with it or how it's getting to people and then it coming back in unpredictable ways is just kind of like fun and interesting and feel, I guess it's not serendipitous, but it's interesting to feel it come back to you. 

Preston: Yeah. It's like throwing a paper airplane or a boomerang.

Mm-hmm. But I've never been good at predicting the path of a boomerang. 

Margaret: Yeah. 

Preston: You know? 

Margaret: Do you need to. That's kind of the joy of it is like that. It's like, 

Preston: yeah, 

Margaret: I don't know where this is go live. Like we're making something and sending it out into the world and then like, I don't know where it goes and lives and who hears it and what it make.

Either pisses someone off or makes them think and likes it, like whatever, and then comes back to us because someone else told them. Another person listened to it 

Preston: pisses someone off. [00:24:00] Beef alarm. 

Margaret: Beef alarm.

But like. As a creative person, which we both are. I don't know. It's like a really gratifying experience to be like, you made something and it landed somewhere like some other human took something from it. 

Preston: Yeah. it's cool to, to know that your ideas landed in someone between someone else's ears and they Yeah.

Enough to tell you. So thanks. Thanks for liking it and then telling us. We appreciate 

Margaret: it. It piss pisses you off. Love to start a beef. Someone start a beef with us. Well, yeah. Actually, I'm willing to say it at this point in the, in making this, we challenge any other psychiatry or psychotherapy, podcaster listening here to start a pretend beef with us.

Don't lie about anything, but I want you to make something so ridiculous that it almost feels like [00:25:00] it could be real. 

Preston: Yeah. And then join our step challenge and try to beat mags. 

Margaret: How many steps is she at this 

Preston: point? We are, really struggling out here. She's at 621,000 steps. 

Margaret: And how many days? We week, days, weeks.

Preston: And we have six days 

Margaret: left. Like a month, right? 

Preston: Yeah, it's in like 25 days. She did that. 

Margaret: Well, she will be doing, she's going to be our, the host of this podcast. She has won the podcast from us 

Preston: season four. Yeah. Actually it's like, racing for pink slips and mags just kind of cooked us. So yeah, you're gonna beef with us.

You got. You gotta step it out. That's all I was gonna say. 

Margaret: We are gonna take a quick break and we'll be right back.

The only person who is more stressed out by our medical training than us is our moms, because they hear every single bad test, every question mark around admissions and every bad night call and this mother's day, I wanna celebrate my mom by giving [00:26:00] her an anxiety relieving comforting gift like she gives me.

This time it's gonna be from Cozy Earth. 

Preston: Sometimes we wanna say more than thank you and this time a great bathrobe and slippers is gonna be our way of saying thank you for putting up with us all this time. 

Margaret: One of the great things about Cozy Earth is that everything that they make has a 10 year warranty or 100 night sleep trial.

So. Just like your mom was there through all 100 nights a night shift that you went through. So will your cozy Earth, rove and slippers? 

Preston: Yeah, and you can get those nights back unlike the night shift. So let this Mother's Day be a reminder that she deserves care too. Discover a cozy earth and how it turns routines into moments of softness and ease.

Head to cozy earth.com and use R Code Patient for an exclusive 20% off. And if you see a post-purchase survey, make sure you let them know that we sent you 

Margaret: because home starts with mom.

We talked about this season, so now we take a step into the future and [00:27:00] we talk about next season, Preston, the 

Preston: future. 

Margaret: Do you have any hopes or thoughts or inclinations for season four? 

Preston: Or dreams? 

Margaret: Or Dreams? Yeah. Fan chasms. 

Preston: I was gonna say dream analysis. Be a fun topic 

Margaret: that actually to 

Preston: go over. Yeah, we were talking about that in.

Supervision the other day. You have to examine the unconscious and the conscious like resistance in the patient. And the best way to examine unconscious resistance is dreams. 

Margaret: Should we read on Dreams by Freud? Next? 

Preston: That will be fun. Next, Susan? Yeah. And then how 

Margaret: long's 

Preston: We'll do our own dream journals, and that will be the icebreaker for those episodes is talking about a weird dream we've had.

Margaret: Do you ha dream a lot? 

Preston: Yeah. Recently I've been having pretty vivid dreams. 

Margaret: I feel like I don't dream very much, like I'm just gone for those eight hours, but which we can analyze in season four. 

Preston: [00:28:00] Yeah. Not dreaming. That's, worth its own, that's worth its own interpretation. so this Margaret, as she enters the more busy throes of fellowship, she's gonna be taking a brief break during season four.

So this will be kind of. New territory for me. So I'll be kind of flying solo for some of the episodes. And I think I might try to do one completely by myself. I usually like to have people to bounce off of, but that would be a fun growing opportunity for Preston. So I think I'll be looking forward to that.

And then I'm just kind of thrown around, like my own ad-lib ideas. You, try stuff. Sometimes it works, sometimes it doesn't. But you threw the boomerang. 

Margaret: Exactly. I came back to you. Yes. As Preston said. I'm not abandoning, I'm not leaving you guys, but I am in a very, busy period right now in terms of call and fellowship and we've been doing this like we said for two years, and so I'm [00:29:00] taking a little break just to focus on feeling like better about my like patient load and panel load and trying to get things kind of settled and fellowship and feel a little bit less overwhelmed day to day.

I think we've talked about burnout. Nauseam and probably our listeners can tell over if you like, listen back to the episodes during our check-ins that I have been a little bit more stressed this year. And so taking a little step back from the podcast just to kind of hopefully resettle and feel a little bit better and, more skillful at balancing some of my clinical work before coming back for season four.

Preston: Yeah. And it's, the only way that. Content creation or podcasts are sustainable, is if you're enjoying it while you're doing it. And if you're so like, worn down and burning the candle at both ends, then you're just, you know, there's, somebody who said about making bad art, but maybe very bad art.

When you're tired and [00:30:00] worn down, it's like maybe step back a little bit, you know? Yeah. Recuperate. let's get back to bad art. 

Margaret: Yeah. I think it's also like. Like, I do think the podcast is a creative process and, it's also work. And so I feel like the first, I don't know, I just, I think the burnout and like the level of stress of trying to figure out how to do an entirely different type of psychiatry, which is just like a very different pattern of emotional containment for very.

Different set of also social circumstances compared to when I was treating adults and when I was in fourth year, which was super do duper chill the first season, the first like two seasons. I think having capacity again and hopefully like this break will let me get into a better pattern of like not of actually like resting and not feeling like I'm bringing the candle at both ends.

That then that creative part comes [00:31:00] back for me. 

Preston: Mm-hmm. And like, who knows, maybe in a year and a half when Preston's in Fellowship and Margaret's an attending, that's 

Margaret: crazy. 

Preston: I'll be on a break. Like, who knows. So yeah, the, seasons of change, they're gonna happen regardless and, we're just kind of entering a new one.

Margaret: Yeah. topics I'm thinking about though, for season four, I think I would like to do a little bit more of. Psychoanalytic or psychodynamic, like we were talking about people, like, like those episodes. And so that and act, I have lots of things we could talk about with them. but I think if people want more depth on our understanding of those things, like I think there are creative ways to figure out and like people always love the role plays.

so figuring out ways to show different therapy concepts I think would be fun. 

Preston: I think it could be really, so like a lot of [00:32:00] those like kind of famous, almost founding father esque therapists, like Young and Rogers and Freud, they have tons of cases that they've written up. So I think it could be fun to like, like let's say I bring a case of like from one of Carl Young's old notes, and I just essentially introduced the case to you, like I'm presenting it to you.

Then you can like psychoanalyze the patient, give your interpretation of it, and then I can give mine and then we can see what young said about the patient. Like, I think that could be pretty interesting because then it's like we're now taking these kind of floating concepts. We've touched on a lot of different therapy modalities, but then getting to anchor them and like actual patient scenarios that.

They're not like really HIPAA anymore because they're like 80 years old. They're already 

Margaret: out there. Yeah. 

Preston: Then they've been out there. Yeah. It's public domain, so I think that could be fun to imply different [00:33:00] interpretations onto to like real genuine stories. I think I also wanna do more journal clubs.

I, I think it's helpful to, to keep people in touch with what's happening in the world. I was talking to one of my friends who she just recently graduated psychiatry residency and she said, yeah, like I enjoyed listening to the pod. A lot of it felt kind of like en entry level at first, but she was like, I really like the coffee tea dcha one because like I wasn't familiar with that.

Yeah. So there they're like, even for like the more expert listeners, you know, us going through the ABCs may be helpful for people just, you know, armchair level interested in mental health, but newspapers are coming out all the time and you can't read everything. 

Margaret: I also, the other thing I think that we should, I would like to do more is like.

Still with some depth, but like more nuanced cases around prescribing for different like clinical presentations. So like someone who talking about like complex PTSD and prescribing for someone has, who is like that comorbid with [00:34:00] OCD or like someone who you're like really not sure if there's like a bipolar diathesis for and they also have a DHD.

How do you think about prescribing stimulants for someone who may be at risk for mania, but the actual risk hasn't been like clearly seen as mania. I feel like talking about clinical cases and like those both, like what are the basics of prescribing or what is the current like evidence-based clinical guidelines and then saying like, here are three cases that are like kind of notoriously difficult ones in this subset of population.

I think giving more pharmacologic actual like guidance is something I'd like us to incorporate more. 'cause I think we've not done very many, honestly, like clinical guidance on prescribing. episodes. 

Preston: Yeah, I think I get nervous about those just because this is not medical advice. And so sometimes 

Margaret: like, yeah, but I mean, I'm thinking about like psychiatry 

Preston: psychotherapy, and there's a Yeah, I know what you're saying.

Like there's a line between, like here are actually good [00:35:00] actual like, steps to take in this, scenario. versus if you have x do Y 

Margaret: Yeah. Like, I think similarly with like the therapy vignettes, right? Like we give like a kind of gestalt of a. Situation that happens not infrequently. And then we respond to it and are like, here are ways you can think about navigating it.

And I think with medication especially 'cause like a, some, a lot of our listeners might be like therapists or social workers or primary care who are like not prescribing all the time. And so understanding a little bit more on like, why did this person do this for this OCD case that failed three trials of high dose antidepressants or something like that.

Preston: Yeah. Like. You guys, the inside baseball and how a psychiatrist might think, you know you want, if you wanna know why they prescribe something, you gotta be the psychiatrist. You gotta think like 

Margaret: them. You gotta put on, 

Preston: you gotta 

Margaret: prescribe 

Preston: like them. 

Margaret: You gotta drink. You gotta get your cigar and get a couch and think, 

Preston: and a goatee.[00:36:00] 

Margaret: Season cheese option. Have you ever had a goatee? 

Preston: No. I think you'd cancel the pod if I got a goatee. 

Margaret: If you had a goatee. No, I think we would. I think I would. I don't think so. I think I would be like so impressed by your commitment to the bit that I would be like in awe. 

Preston: Yeah, it would certainly garner attention.

People were annoyed. I shaved the mustache. I, it'll come back eventually guys. 

Margaret: The people are annoyed. 

Preston: This is my, canvas. 

Margaret: Like you have to accept me mustache. You have to accept me at my goatee for me. Mm-hmm. To, for you to get me, deserve me at my mustache. 

Preston: Exactly. Guys. It's a two-way street. 

Margaret: Yeah.

I mean, do you have any other thoughts about next season? This season? The process of making a podcast? 

Preston: I want to get on the couch. I'm at my desk. And I need to rearrange my apartment a little bit so I can record on the couch. It's my big goal. 

Margaret: It has been a good [00:37:00] switch for me. Like, it's just like I'm a person.

I'm sitting on my couch. It has helped my burnout. 

Preston: Yeah. I think pods are meant to, be done on a couch, and I think I do. 

Margaret: You should get a full on one. 

Preston: Yeah. Yeah. I was actually thinking about moving a couch into this office, but I think, well, I'll just move my camera equipment to my living room and yeah.

When I move to the east coast at the end of, residency, then maybe making my own like mini studio in my apartment, like if I get a two bedroom using the extra one for that. I think that'd be fun because 

Margaret: Cool. 

Preston: Then hopefully you'll be close enough that we could do the occasional in-person episode.

Margaret: Yeah. And be like, hello, it's a filming day. We're in studio coming to you live taking calls. 

Preston: Yeah, like if there's anything I, remember learning from the, your brain on AI episode was when we were talking about the different levels of interconnected, like activity you get from [00:38:00] layers of human interaction.

So there's like a certain amount of mirror neuron response when you're just talking on the phone and then that increases a little bit in the video. but that doesn't even compare to like a true organic in-person interaction. And it's like, darn, we're, doing the best we can with the technology we have, but you know, it could be even partier, P-O-D-D-I hear as in more, more Podcasted podcast.

Yeah, 

Margaret: no, I feel like I also like see podcasts now. I'm like, oh, it is nice that they're in the same place. Like that. Is it like It definitely makes the dynamic flowier, although I think we do a good, I think we do a decent job. From many miles away. 

Preston: Yeah, I, agree. I also think we do a decent job, but we can still be jelly of people I get to do in person.

Margaret: Yeah, I know, I don't know. I feel like, so I, something I have enjoyed was like the exist I feel like going, you walking us through it. I feel like I learned or sharpened [00:39:00] some of my like existential thinking and like was also reminded of. Reading like Man's Search for Meaning and stuff, which I hadn't read in a decade, like since like the end of college.

And so it was nice also just to like have that sharpened by you going through it and like, I don't know, getting specific with some of the themes and how to approach it. And then I was cool that was interspersed with DVT. So I don't know. I'm also looking forward to what I might learn from you, learn from our audience.

sometimes the comments like that Marsha Hand is alive and well. Once again, my bad. 

Preston: see if there was ever a beef to be started, you know, that, that's, I do not perfect. Do 

Margaret: not beef with Marshall. Like, Marsha, I feel she can fight and I would not win. I, apologize. but like someone commented like that book, like Childism and I have been reading it and it was something I'd not ever heard of and it's great.

Wow. And I'm like, thank you listeners. 

Preston: Thank you. Random Spotify comment. [00:40:00] You've, saved my life. 

Margaret: You've saved me. Yeah. Well, those are all my questions for the wrap up. Anything else you are thinking about Preston or wanna share with our listeners before we give them a little bit of a break? there's always our other old episodes to go listen to.

Mm-hmm. 

Preston: But 

Margaret: yeah. 

Preston: So now other, do you, being here, we're gonna, season four just for our longevity and consistency. Like instead of giving you guys a complete break we'll. Doing reruns of some of our old episodes. but we'll do like a commentary about them. We obviously, we have a bank of like 60 episodes now, and if you join a little later, there's kind of some bangers early on, when we were still a little bit more niche that I think it's worth revisiting and talking about again.

So watch out for those. Watch out for the press and solo episode and whatever. Half baked or full baked ideas, full baked that we bring outta the oven. 

Margaret: I'm excited for it. People have been asking for you to bring the pan [00:41:00] puppet back. I'm really, I'm excited to see what your creativity will do. Like Totally.

Just like unleashed. You laugh. I'm serious. I think it'll be fun to see. Yeah. 

Preston: Leash is coming off the puppet 

Margaret: leash. Fedora is on the leash. 

Preston: Mm-hmm. 

Margaret: Harmonica tuned. This, 

Preston: I took the safeties off on the harmonica. It's fired up. 

Margaret: Only loaded. 

Preston: Yeah. there's some other stuff we'll, share later. We have some cool pressing related contents coming down the pipeline, but we won't share it on the episode today.

That was a really annoying teaser. Like, if you're ever in a conversation, someone's like, oh, we'll talk about it later. Whatever. Don't worry about it. It's actually nothing to worry about. It's just we got some cool stuff coming, that we'll talk about later. So how's the show? We always want to hear what you think.

If you do have something to say, it on Spotify, because that's our favorite thing. You If it's 

Margaret: bullying us. 

Preston: Yeah, no [00:42:00] hatred. If it's, just pure, unadulterated vitriol. Spotify. 

Margaret: Spotify, 

Preston: it's a compliment. Spotify, 

Margaret: YouTube. 

Preston: If, you just want us to, know about a book Spotify. That's 

Margaret: Spotify. True.

Preston: It's, on, we like the Spotify comments. I don't know. I don't know what to tell you. 

Margaret: I just, it feels like when you would, I think I've said this before on podcast, when you would like. Have a, like, we can't talk here. Meet me in this Google document that we'll talk back on my, we can't talk here. Meet me in the Spotify comment section.

Preston: Not here. 

Margaret: We'll find you later in the Spotify comments, episode 42 

Preston: if you want to. Have more from my me at its prerow on YouTube and TikTok. Margaret's at batter every day on Instagram, TikTok and Substack. Thanks again for listening. We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are me, Preston, Roche, Margaret Duncan, will Flannery and Kristin Fla.[00:43:00] 

Aron Korney, Rob Goldman and Shanti Brook. Our editor and engineer is Jason Portizo. Our music is Bio Benzs 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 Do Be patient@human-content.com with any questions or concerns.

How to be patient is a human content production,

how to be patient.

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 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, probably exist for real, [00:44:00] but in the meantime, I'm just gonna pet lilac and then.

I'm gonna go dance in the background.