Margaret and I decided to tackle the questions that have been circling our DMs, including the controversial continuum of harm reduction, where does "good enough" care end and "enabling" begin? We also touch on the complexities of diagnosing autism across genders, the "stolen valor" of internet neuroscientists, and why I’m convinced that oppositional defiant disorder (ODD) might sometimes just be a side effect of adults who’ve forgotten how to listen.

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I’m flying solo for most of this one while Margaret is off saving dolphins (or just finishing a hospital admission ), but I’ve brought in a heavy hitter to help me tackle one of the most awkward parts of medical training: feedback. Paul Tran, the creative force behind Alimentary School, joins me to discuss why the feedback we give and receive in the clinic usually, to put it bluntly, sucks.

We dive into the "Politeness Concept," where supervisors give a quick "good job" just to save face and get out of the room, leaving learners with zero actionable data. Paul introduces the concept of "Wise Feedback", 19 words that can completely change how a student engages with their work, and we break down the "Four T’s" of delivery: Tact, Timing, Intent, and Tone. From the trauma of childhood soccer critiques about our noses to the "glass-shattering" realizations of a former competitive figure skater, this episode is about turning subjective observations into meaningful coaching.

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In this journal club episode, we break down the recent findings from a landmark (in my opinion) study on the associated risks between caffeine consumption and dementia risk. Spoiler alert! More coffee might actually be protective against dementia; however, we need to take these findings with a grain of salt (or creamer) and understand how the nuance of this information can help both our lives and our understanding of neurodegenerative diseases. 

Zhang Y, Liu Y, Li Y, et al. Coffee and Tea Intake, Dementia Risk, and Cognitive Function. JAMA. 2026;335(11):961–974. doi:10.1001/jama.2025.27259

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A topic that we were silent on during our Aphasia episode was the importance of Speech-Language Pathologists in the care of patients with Aphasia and, more broadly, throughout different types of care for patients in the hospital, in rehab, and outpatient. Today, we are joined by SLPs and co-hosts of Speech Talk Eva Johnson and Emily Brady to ask all our questions about how SLPs approach cognition, dysphasia, and values in care. Check out their podcast (which is also part of the Human Content family!) at Speech Talk! 

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Spoiler Alert! The key to not feeling isolated is to (wait for it) be around other people! Humans are naturally driven social creatures, but the ways in which we attempt to run from isolation become the problem. In this episode, we discuss how isolation is an ever-present fear, how existential isolation differs from interpersonal and intrapersonal isolation, and how meaningful, balanced relationships can form to fill the void.

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In the second part of our intro to DBT episodes, we welcome expert education and DBT clinician, Dr. Kiki Fehling. We talk about how Dr. Fehling found DBT, how her teaching made it to TikTok, and then get into cases about how to talk about DBT with patients and what an introductory session might sound like. In our Patreon section, we go further into some favorite exercises in DBT with Dr. Fehling.

Oh, Margaret also has to walk back an error she made on the previous DBT episode, and Preston gets to enjoy seeing Margaret be wrong. 

Check out the full uninterrupted episode and bonus segments every week at our Patreon, ⁠https://www.patreon.com/howtobepatientpod⁠.

Check out Dr. Fehling’s book and work at ⁠https://www.kikifehling.com/books⁠.

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In this episode, I sit down with Amine (whyamino) a med student and content creator who recently went viral for his skits about engaging with patients from different cultural backgrounds. Due to pressure and complaints of “promoting stereotypes,” the content was eventually taken down. The audience feels some ambivalence about this, and it raises questions about portrayal and stereotypes, is their portrayal uniformly bad or can demonstrating a knowledge and nuance of a subgroup through humor be a way to demonstrate cultural and, by extension, clinical competency?

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Today Margaret and I take on our own freedom in today’s episode, which is part 2 of a 4-part series on Existential Psychotherapy. The existential postulate that we are all ultimately free to make our own decisions (and therefore must live with those decisions) can be a source of distress but also a path to the pursuit of a meaningful life - it all comes down to how you go about it. And we will chat about it all, freely.

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In preparation for a more thorough DBT episode with experts in the field, Margaret leads us through a “DBT 101” covering the essentially axioms of dialectical behavioral therapy along with the pillars of mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness.

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In this episode, we explore the current political climate and the possibility of the return of institutionalized mental health care. Though this is not a political podcast (I think Preston says that 5 times) , all of medicine is political,and it’s important to discuss the overlap. 

Tune in to the Patreon section to directly support the creators and for more discussion about how institutionalization is handled in other countries!

Citations:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7607734/#:~:text=other%20OECD%20countries-,The%20mean%20length%20of%20stay%20in%20psychiatric%20care%20beds%20in,highest%20percentage%20ever%20%5B11%5D

OECD Stats

https://www.oecd.org/en/publications/a-new-benchmark-for-mental-health-systems_4ed890f6-en/full-report/component-4.html?utm_source=chatgpt.com

https://www.sciencedirect.com/science/article/abs/pii/S0168851023002300?utm_source=chatgpt.com

https://www.scribd.com/document/632946247/WikerTS-2019-Supportedaccomodationforpeoplewithschizophrenia

Ruud T, Friis S. Community-based Mental Health Services in Norway. Consort Psychiatr. 2021 Mar 20;2(1):47-54. doi: 10.17816/CP43. PMID: 38601095; PMCID: PMC11003347.

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