Sarah Chan

The Long Flight Home: Managing a Patient's Need to Return Amidst Psychosis

She does not believe she is sick.   Even with her sister supervising, Rita has stopped taking her medication.  Hours after Rita's first dose, her sister finds half-dissolved tablets in tissues hidden all around the bedroom. In the appointment Rita looks guarded and defensive.  My heart sinks.  I have

Recovery in First Episode Psychosis

There are a series of clinics across Canada and internationally whose sole purpose is to treat patients with first episode psychosis. Here in Ottawa, our first episode psychosis program, aka FEPP, is made up of a multidisciplinary team including nurses, social workers, psychiatrists, and other allied health. These clinics were

How to Think about Thinking: A Psychiatrist's approach

Psychiatry deals with the intangible parts of the brain; some might call it the mind. And how we know the mind exists, how the mind most commonly communicates to its owner is by having thoughts. In health, our thoughts serve a purpose. They help us to understand, to connect and

AI has arrived: My experience using a Medical Artificial Intelligence Scribe in Psychiatric Practice

Documentation in my job, meaning writing my clinical notes and filling out other necessary paperwork (e.g. Notes for patients' work or school, government forms etc.) takes up an additional 1-2 hours of my day. What this looks like is I typically see patients from 9-5pm leaving documentation to

Conversations in Therapy

What is a therapist but someone trying to figure out who she is in the context of you, the patient? What I love about therapy are the important questions that arise that are fundamental to all of us and our well-being. Questions about connection and being understood, questions about identity

My Grandmother's Ritual: A More Personal Essay on Aging

My life could not be more different than my grandmother's.  She was born and raised in a farming village in China and deprived of an education because she was female.  She narrowly escaped having her feet bound because she was too important to the family's livelihood,

How to Feel Better: The Basics

Patients seek out mental health services with the hopes of feeling better.  I see it as the job of the clinician to help patients understand better why they are feeling as they do; to help patients organize what must feel chaotic and distressing.  Most importantly, mental health clinicians try to

What is Time Well-Spent?

There are so many moments where I feel demoralized, exhausted and unappreciated.  So it is important that I recognize when I am feeling better about myself and the work.  It warrants some time and space also. Today I am feeling grateful and honored that I get to do what I

Advocating for a Ban on Surveillance Capitalism

Please consider joining me in writing to your member of parliament (can be found here: https://www.ourcommons.ca/members/en), regarding legislation regulating/banning surveillance capitalism. My MP is the honorable David McGuinty. Here is what I have sent to him, please feel free to use it as a

When Relationship is the job: a Sisyphean task

"Did I even stand a chance?" I think to myself.  If I were to talk to my younger self, with what I know now, would I have said anything?  Probably not.  What is there to say to a younger, less experienced, idealistic version of myself?  Perhaps I would

Medications and Therapy in First Episode Psychosis: Difficult Crossroads

I had been seeing a patient for 6 months now for psychosis but also longstanding personality problems and other difficulties. When she first came into my care, she was not sure if she wanted to be on any medications and so I decided that I would follow along for some

Dying is not Giving Up

I am seeing a woman who has a progressive terminal illness. She is 80 years old and has outlasted her prognosis by 10 years. Since I started seeing her 3 years ago, I have seen the steady decline of her physical being. In the last 6 months, the cognitive decline

A Missing Ingredient in Mental Health Recovery

I see many people through their journeys from illness to wellness. A big sign that someone is not doing well and the severity of their symptoms, is when they have taken time off work. I am often consulted when what was initially supposed to be a two-week break, has become

One Patient, Two Perspectives

It can be difficult to put into words why I have found my psychiatric training and how standard psychiatry is practiced today lacking. On one end, we have smart, compassionate, well-meaning, highly trained clinicians and on the other end, we have motivated patients wanting help. Both of whom want the

The Promises and Pitfalls of Psychedelics

There has not been a mental health subject that has gotten more attention in recent years than psychedelics. It seems like they are a cure for everyone. In the medical literature, we are seeing positive results in many patient populations, from treatment-resistant depression, to drug addiction and post traumatic stress

In Therapy: The Patient stops Flirting

What had me thinking about this patient's flirting at all was when it stopped.  It is so strange that while it was going on, I did not feel like talking about it or writing about it.  Isn't it interesting how secrecy can be part of attraction

Looking Forward. Looking Back. Where am I?

Where am I? I am coming to terms with the limitations of my training in being able to manage the mental health crises that walk through my doors every day. Where am I? I am actively seeking out different psychiatric education and mentorship that better reflect my own experiences in

It is Time We Begin to Matter

Ahmed was referred to me for a chronic deep depression. He had always lived in the shadow of his father, and this continues even after his father passed 10 years ago. His father was a very respected and revered man at the local temple. People often sought his advice and

Turns out I am an Intensive Parent. Here is My Experience So Far.

I am on vacation with my two children. They are 5 and 7 years old. As I enter into this stage of parenting what becomes more clear is that when you give your children what you did not have, they do not appreciate it like you would hope. They have

Talking To Depression: Do Not Give Up

Warning, this article mentions suicide. In real-world clinical practice, depression is the most common complaint.  Because of how it has entered into the mainstream, it is also the most non-specific complaint and has come to represent a catch-all term that can mean many things.  After a thorough assessment,  what comes

Chronicles in Therapy: Can I be Forgiven?

I had a patient, Marie, with severe physical impairment and depression, tell me the impact this has had on her relationship with her son. She admits she was absent mentally and emotionally for most of his childhood and sees his current disrespect for her as punishment for this. She has

On Call Psychiatry: A Review of Some Cases

Of note, this article does mention and discuss suicide I was on call recently over the weekend.  What this means at the hospital where I work is that I go into the psychiatric emergency unit for 830-9am to review any admissions that took place overnight.  The staff on call the

It is OK to Not Feel Good - A meditation ...of sorts

It does not mean you are broken. It does not mean you are depressed (though check with a therapist or doctor if you are concerned about this). It does not mean you need medication. It is ok to ask yourself what brings you joy. It is ok not to know.

A Patient Flirts in Therapy

When a patient starts to flirt with me, I think, "here we go." I know it is flirting when the person who is persistently depressed starts to laugh more in sessions and may slip in a dirty joke or two. I can tell the person is flirting when

Some thoughts after an Autism Conference

Thought #1) The title of the conference was "Is this Autism? Recognizing the less obvious presentations of autism". It was taking place at the Royal Ottawa Hospital, our tertiary care mental health hospital. I had registered because I thought this was going to be about diagnosing autism in