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

Takeaways:

The Endocannabinoid System is Vast and Mysterious: CB1 and CB2 receptors exist throughout the body, influencing pain, pleasure, nausea, and more—but the full scope of their role remains unclear.

Marijuana’s Effects Depend on the User: Some people experience relaxation and appetite stimulation, while others develop anxiety, paranoia, or even worsening nausea with chronic use.

The THC-to-CBD Ratio Matters: Over time, cannabis strains have been bred to increase THC potency, which may contribute to heightened psychiatric risks, including psychosis.

Cannabis Can Have Severe Side Effects: Long-term use can lead to cannabinoid hyperemesis syndrome (CHS)—a condition causing severe nausea and vomiting—and may increase the risk of cannabis-induced psychosis in predisposed individuals.

Medical Cannabis Outpaced the Research: While cannabis is now widely used for medical purposes, much of its effectiveness is anecdotal, and research on its long-term mental health impacts is still catching up.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

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

Takeaways:

Motivational Interviewing Bridges Ambivalence: MI helps people resolve mixed feelings about change by guiding them to articulate their own reasons for making a shift.

Change Talk Sparks Action: Encouraging patients to express their desire, ability, reasons, and need for change strengthens their motivation to take action.

Reflections Deepen Understanding: Simple and complex reflections help mirror a patient’s thoughts and feelings, making them feel heard while subtly guiding them toward insight.

Pacing Matters: Being too directive can lead to resistance, while being too passive may feel ineffective—MI teaches a balanced approach that fosters real conversations.

Practice Makes Progress: MI is a learnable skill that improves with intentional practice, making difficult conversations about change smoother and more effective over time.

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Want more Dr. David Roberts:

https://providers.uthscsa.edu/providers/david-l-roberts-1255650917/

Want more Aron Korney:

Human Values Podcast: https://podcasts.apple.com/us/podcast/human-values/id1622760459

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

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

Takeaways:

Pain Is Not Just Physical: Chronic pain isn’t just about physical damage—it involves neurological, psychological, and emotional factors that make treatment complex.

Back Surgery Isn’t Always the Answer: Failed back surgery syndrome is common, often because patients receive the wrong procedure or aren’t properly prepared for surgery.

Empathy Improves Patient Outcomes: Research shows that patients who feel heard and understood by their doctors have better surgical and pain management outcomes.

Social Media Shapes Medical Conversations: Platforms like TikTok have transformed how patients and doctors discuss pain, sometimes for better—but also with risks of misinformation.

Medical Training Can Be Dehumanizing: The culture of surgery often discourages emotional connection, but rediscovering empathy is key to being a great physician.

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Want more Dr. Betsy Grunch:

TikTok: https://www.tiktok.com/@ladyspinedoc?_t=8rhZfY7LgLe&_r=1

Twitter: http://www.twitter.com/ladyspinedoc

Instagram: http://www.instagram.com/ladyspinedoc

Facebook: https://www.facebook.com/ladyspinedoc

YouTube: https://youtube.com/@ladyspinedoc

LinkedIn: https://www.linkedin.com/in/drgrunch

Amazon: https://www.amazon.com/shop/ladyspinedoc

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

Citations:

Chapters 1.16 and 27.15. Sadock, Benjamin J, et al. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. 11th ed. Philadelphia, Wolters Kluwer, 2025.

Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018 Nov;27(11):2791-2803. doi: 10.1007/s00586-018-5673-2. Epub 2018 Jul 3. PMID: 29971708.

Stanford Center for Chronic Pain and American Chronic Pain Association Guide.

https://www.acpanow.com/acpa-stanford-guide.html#/

George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021 Nov;51(11):CPG1-CPG60. doi: 10.2519/jospt.2021.0304. PMID: 34719942; PMCID: PMC10508241.

https://pubmed.ncbi.nlm.nih.gov/30265840/

https://www.ncbi.nlm.nih.gov/books/NBK219252/#:~:text=Pain%20is%20a%20subjective%20experience,relieving%20or%20terminating%20the%20experience.

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

Takeaways:

Exercise Impacts Mental Health Bi-Directionally: Movement not only improves mental health, but mental health conditions can also act as barriers to engaging in exercise.

Fitness Advice Often Lacks Specificity: Many healthcare providers acknowledge the benefits of exercise but rarely provide concrete strategies to help patients incorporate it into their lives.

Movement Should Be Enjoyable: Finding a form of exercise that brings joy—whether it's dancing, hiking, or lifting—makes it easier to sustain and integrate into daily life.

Setting Small, Achievable Goals is Key: Utilizing SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound) can help create consistency without overwhelming pressure.

Exercise Isn't Just About Weight: Shifting the focus from aesthetics to function, strength, and mental well-being can create a healthier and more sustainable relationship with movement.

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Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

Learn more about your ad choices. Visit megaphone.fm/adchoices

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

Takeaways:

ADHD Has Deep Historical Roots: The first observations of ADHD-like symptoms date back to the 1930s, when stimulants were found to improve focus in children originally treated for other conditions.

Diagnosis Isn’t Always Simple: ADHD symptoms can overlap with anxiety, depression, and other conditions, making proper evaluation and history-taking crucial for an accurate diagnosis.

Social Media: Help or Hinderance? While platforms like TikTok can offer community and validation, they can also contribute to misinformation and oversimplified self-diagnoses.

Early Treatment Matters: Research shows that children who receive appropriate ADHD treatment, including medication, often have better long-term outcomes and lower rates of substance use.

ADHD Is More Than Inattention: The condition impacts executive functioning, emotional regulation, and impulse control, which can affect relationships, careers, and daily life beyond just focusing.

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Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

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

Takeaways:

Rapport Is More Than Liking: Building rapport isn’t just about being liked; it’s about creating trust, safety, and understanding between clinician and patient.

Authenticity Matters: Patients respond to doctors who show up as their authentic selves. Balancing professionalism with humanity is key to trust-building.

Rapport Shapes Outcomes: Research shows that strong patient-clinician relationships lead to better health outcomes, regardless of the treatment modality used.

Tailor Your Approach: Building rapport requires adapting to each patient’s unique personality and background. What works for one patient may not work for another.

Empathy Is a Skill: Empathy takes practice, energy, and intentionality. It's not about agreeing with patients, but about understanding them deeply.

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Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

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

Takeaways:

Light is Power: Exposure to light regulates circadian rhythms and can significantly impact mood. Tools like light therapy boxes are clinically proven to combat seasonal depression.

Medication Matters: SSRIs, bupropion, and melatonin agonists like agomelatine are effective treatments for SAD, with some meds even preventing symptoms when started early.

Embrace Behavioral Activation: Joining activities like winter sports or social groups can create accountability and help maintain mental health during darker months.

Reframe the Season: Viewing winter as a time for creativity, community, or solitude can transform it into a meaningful and enriching period.

Self-Compassion is Key: Feeling tired or less motivated during winter is normal. Practicing self-compassion and acknowledging seasonal changes can reduce guilt and promote well-being.

—

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

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

Takeaways:

Attachment is Dynamic: Attachment theory isn’t a fixed diagnosis—it’s a lens to understand how people relate to others and themselves.

Repair Builds Resilience: Healthy relationships are not conflict-free but can recover from disagreements and grow stronger.

Pop Psych Oversimplifies: Modern discussions about attachment styles often miss the nuance and flexibility inherent in these frameworks.

Therapy is Practice: Therapy can rewire attachment patterns by creating safe spaces for emotional repair and connection.

Humor as a Shield: Humor can be a tool for connection but also a way to avoid vulnerability—knowing the difference matters.

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Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

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Produced by Dr Glaucomflecken & Human Content

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

Takeaways:

Empathy is a Skill: You don’t have to be born with it—learning how to connect with patients can happen over time and with practice.

Authenticity Matters: Medicine isn’t about pretending to be perfect; it’s about finding a way to unify your personal identity with your professional role.

Vulnerability is Strength: Struggles, failures, and even embarrassing moments can be powerful tools for connecting with others.

Creativity Fuels Resilience: Exploring hobbies and personal interests, like Margaret’s Bad Art Every Day project, can help you stay grounded during stressful times.

Reflection Unlocks Growth: To truly understand and support patients, start by looking inward and understanding your own emotions and biases

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Watch on YouTube: @itspresro

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Produced by Dr Glaucomflecken & Human Content

Get in Touch: howtobepatientpod.com

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It’s finally time to address our professional relationships with mental health treatment in a clear, calm, and professional manner. 

It’s time that practitioners start to better understand ourselves, our patients, and our parallel journeys to address mental health struggles in this highly unpredictable cultural climate. 

It’s time a podcast trailer presented a plan to constructively explore professional development for psychiatric professionals. Perhaps, in the form of a polished audio trailer!

We sure think so. Unfortunately, you’ll have to look elsewhere.

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Get in Touch: howtobepatientpod.com

Produced by: Human Content

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