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Treating Back Pain and Trending on Tik Tok
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. — 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. — 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. Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:34:52
Exercise, Nutrition and Mental Health
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. — Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:19:18
ADHD In the Media
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. — Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:18:45
Rapport Building
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. — Watch on YouTube: @itspresro Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc. — Produced by Dr Glaucomflecken & Human Content Get in Touch: howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:22:07
Making it Through Winter: Seasonal Affective Disorder and Winter Mental Health Tips
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. — Produced by Dr Glaucomflecken & Human Content Get in Touch: howtobepatientpod.com Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:11:28

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About How to Be Patient

You may have noticed a new trend lately. Everyone is loud and proud about their mental health struggles (and thank goodness)! For practitioners, this movement is as exciting as it is frustrating. As each mental health taboo falls by the wayside as it enters the cultural zeitgeist, a new aspect of our specialty thus emerges. One we just don’t have enough hours in the day to keep track of, let alone engage with. From better understanding our patients’ (and our own) relationships with their conditions in a changing world, it’s more important than ever that we learn: HOW TO BE PATIENT! Each week, join Dr. Preston Roche (Psychiatry Resident & Digital Influencer) and Dr. Margaret Duncan (Psychiatrist & Content Creator) on their quest to better understand the patients we dedicate our lives to and the evolving paths they’re bound to travel beyond the clinic. By engaging with stories and perspectives that challenge our shared understanding of a condition, we hope you’ll similarly gain new perspectives as we look at our patients, and their mental health struggles, with further nuance and empathy. (And with Dr. & Lady Glaucomflecken producing, we've been mandated to include plenty of weird medical jokes too). Speaking of which, a key part of this is hearing YOUR stories! What’s changed your understanding of patient care? Do you have an experience that shines new light on something we’ve discussed on-air? Get in touch at: howtobepatientpod.com

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