Let us get some insights into Dr. Sana Khan's journey, experiences, and success with Priya Bairagi, Mansha and Anjali Singh from MedBound Times.
Sana Khan has completed her MBBS from University of Maiduguri (UNIMAID), Nigeria in 2010, MD Pharmacology from All India Institute of Medical Sciences, India in 2018. She is currently pediatric resident physician at SUNY Downstate Medical Center, New York City, United States of America.
Anjali: Dr. Anjali Singh: Hello ma'am and welcome to this DocScopy session with MedBound Times. How did you transition into pediatrics, or was it something you had always dreamed of?
Dr. Sana Khan: So, here's my story. I completed my medical school in Nigeria, where I was born and raised. Both my parents are Indians, and my father is a professor in Nigeria. After finishing medical school, I decided to return to India, but I knew how competitive it is there. I had to take the MCI exam (Medical Council of India) as a foreign graduate to obtain my license in Delhi and become eligible for any PG entrance exams.
Many people doubted my chances of success, considering I came from Nigeria and had to compete in such a challenging environment. However, I believe that determination is key, and you don't have to achieve exceptional results right away. You can improve gradually and consistently to reach your goals. I dreamt of being in AIIMS in Delhi, and I was inspired by Shah Rukh Khan's words that determined individuals can achieve their dreams.
I attempted the AIIMS PG entrance exam multiple times but was initially unsuccessful. However, I didn't lose hope. I continued working and persevering. Finally, on my third attempt, I achieved a rank within the top 500, which surprised me. Although I didn't get my preferred specialization in pediatrics, I received a good rank in pharmacology. I decided to pursue it and build a foundation through research, as my ultimate dream was to go to the US for further studies. Pediatrics remained a passion of mine, but I needed to figure out how to combine it with my aspirations.
During my three years of MD in pharmacology at AIIMS, I had a fantastic time. The research opportunities were groundbreaking and helped lay the groundwork for my USMLE journey. My aim was to go to the UK or the US, and pharmacology seemed like a suitable path for me. It covered various aspects and provided a solid research background.
After completing my MD in pharmacology, I embarked on my USMLE journey, taking the necessary steps. I realized that opportunities are abundant, and with passion and interest, one can pursue any field, even without prior experience. Although I lacked a background in pediatrics, I had an award in the subject from my medical school. In my personal statement, I highlighted my passion for pediatrics and my determination to pursue it. Additionally, writing has always been one of my passions, so I could express myself effectively.
When applying for residency programs, I focused solely on New York because my spouse resides there, even though it is a highly competitive state. I held onto my belief that persistence and continuous efforts would yield results. Unfortunately, I didn't get accepted the first time I applied. However, I didn't let it discourage me. I decided to identify my mistakes, improve myself, gain more experience, and further showcase my dedication to pediatrics during interviews. Resilience paid off, and I was selected for a pediatric residency, which was an unexpected achievement given my background in pharmacology.
I want to emphasize that one shouldn't give up just because they don't succeed at first. Throughout my journey, I encountered failures, but my persistence and consistency played crucial roles in achieving my dreams. I always tell people that you shouldn't let setbacks define you. If you keep trying and working hard, you will eventually achieve your goals. That's the belief I live by.
Anjali: My next question is, what are the unique challenges and rewards of working in pediatrics, especially in the US healthcare system?
Dr. Sana Khan: I am a trainee, but from what I've seen, the reward is always there. I feel that all over the world, when you see satisfied parents, you also feel happy. Treating adults and Treating children is unique, as when you're treating children, you're not just treating them; you are treating their whole family. The whole family becomes anxious when the child is sick, and their well-being is interconnected. That's the most rewarding part – when the child gets well, the family also feels relieved. The US healthcare system has a lot of support systems, with numerous social services available for various needs. There are free services for children or families who cannot afford certain medical expenses, which is a positive aspect here.
However, challenges exist, just like anywhere else, but I would say one significant challenge in this place is dealing with medicolegal issues. There's a high level of accountability for every action you take as a healthcare provider. You can't simply say you did something without proper documentation and evidence. Everything must be evidence-based, and you have to justify every decision you make. The legal system is always present, and parents have significant rights, which can sometimes lead to defensive medicine for doctors. Parents have the ability to involve the law and court if they feel the need. Despite this challenge, I enjoy being cautious and meticulous in my approach to patient care.
Priya: How do you ensure effective communication with young patients and their families? As children may not always be able to express themselves verbally, how do you establish a connection with them?
Dr. Sana Khan: That’s the best thing about pediatrics; you have to understand without them speaking, you have to know what they are going through. Not all of them can express that they are in pain. There are so many other ways to identify for example if a child is in pain, from observing their heart rate to various other specific features. It's not just the look on their face; even simple vital signs like heart rate can indicate if the child is in distress. Pediatrics is unique in that aspect; communication is not always verbal, and you can pick up on cues through various other means.
Another essential aspect in pediatrics is that parents are often right. Most of the time, you will find that the mother knows best and it's crucial to always listen to the parents because if a mother is telling you something, she is genuinely worried. It's essential to exercise a lot of judgment and consideration in your approach, especially because the patient cannot always communicate verbally.
Priya: Could you please share some strategies or examples of treating pediatric patients?
Dr. Sana Khan: Yeah, I mean, you see many cases in pediatric ICU and pediatric ER where patients come in very late, almost unconscious, not even aware of their surroundings. But after receiving immediate treatment, you witness remarkable recoveries. I know numerous cases like that where patients arrived with severe symptoms like coughing, noisy breathing, and inadequate oxygen intake, requiring interventions such as ventilator support. However, ultimately, the patients improved and regained their health. The best part about pediatrics is that children do not pretend. They are genuinely innocent, and if they are well, they show it. You can observe dramatic improvements, especially in younger children. There are several examples of such cases, and that's the beauty of pediatrics.
Priya: What are some of the most common pediatric conditions or illnesses you have encountered in your practice?
Dr. Sana Khan: In the US, the common pediatric conditions I have encountered are different compared to India and Nigeria. In India and Nigeria, we often see cases of dehydration and malnutrition. However, here in the US, the most common conditions I come across are skin conditions such as allergies, respiratory problems like asthma and reactive airway disease. It's interesting to note the differences in the prevalent conditions between these countries.
Priya: How do you collaborate with other healthcare professionals such as nurses and therapists to provide comprehensive care to your patients?
Dr. Sana Khan: It's a very nice system here. Usually, it's teamwork, always involving social work. Case managers handle social issues that may be present within the child's family also they manage special care facilities for long-term patients who may have disabilities, such as neurological brain conditions, for example cerebral palsy, where they cannot walk or talk, and parents may be unable to care for them at home. We have facilities where these patients can be kept and receive the necessary care, and the government funds these services. Honestly, it's a good system here, and patients are well taken care of. Another aspect of collaboration is with therapists, counselors, and psychiatrists, as teenagers often face issues like anxiety and depression. These professionals are readily available to provide the required support. It's like working as a team, and we have connections with various specialists in different hospitals. If a patient has a specific problem, we can easily refer them to specialists in fields like nephrology, gastroenterology, and other pediatric specialties. The hospitals have numerous specialists, making referrals convenient.
Priya: What role do you believe technology plays in improving paces healthcare? Are there any specific technological advancements that have supportive effects on your practice?
Dr. Sana Khan: I think there are a lot of ongoing advancements, and there are so many things happening. Even though I am still in the training stage, I have noticed numerous advancements. For example, when I was in Nigeria, it was challenging to find a vein in children for IV lines due to their tiny veins. But now, there are vein finders and ultrasound-guided techniques that make it much easier. In diabetic children, there are devices that can monitor their sugar levels continuously throughout the day, which is a great advancement. Every organ system has seen significant progress, and there are numerous examples, such as advanced devices for neurology that can detect seizures. The list goes on and on; there's a vast array of advancements in various areas of pediatric care.
Anjali : What differences do you observe in the healthcare systems of Nigeria, India, and the US?
Dr. Sana Khan: There are significant differences, I would say. In Nigeria, the healthcare system had limited diagnostic facilities compared to India, where the diagnostic infrastructure is quite impressive. In India, there are so many advancements in healthcare. The US is similar to India in many aspects, but the US has better financial support, providing many services free of cost than India. Here in the US, even the smallest healthcare issues can be addressed because of the relatively lower patient volume. In India, due to the high patient load, doctors often have to prioritize and focus on the main problem, leaving other issues to be addressed later. Nigeria, on the other hand, lacks both the patient volume and adequate facilities. Another noticeable difference is the approach to patient care. In India, reliance on patient history and physical examination is more common, while in the US, everything is well-organized, and evidence based. Prescriptions in the US are highly regulated, and healthcare providers need to justify every medication prescribed, unlike in India where you can easily buy medications over the counter. These differences have a significant impact on various aspects of healthcare.
Anjali: Speaking of the difference between the US and Indian healthcare systems, I want to ask if you have noticed any differences in the types of patients you encounter, particularly in pediatrics. In India, was there a higher concentration of patients inclined towards infectious diseases?
Dr. Sana Khan: Of course, it's very common here. In India, there were more cases of infectious diseases. You had a lot of cases of diarrhea and bacterial infections. Those were very common there. But here, it's more focused on non-infectious conditions. Most of the ER visits here are for minor issues. In India, unless the patient's condition is very severe, people are cautious and only come to the emergency department for significant problems. But here in US , even for minor issues, parents bring their children to the ER because the visits are covered by insurance, and they don't have to pay out of pocket.
Patients are different in both countries like in India, cases of malnutrition and undernutrition are more but here in the US, childhood obesity is a major problem. We see here a lot of cases related to overnutrition and have to focus on controlling that. Additionally, due to the large Jewish community here, there is a higher incidence of childhood cancers related to genetic factors. This is something you see more commonly here compared to India.
Stay tuned for the second part of this interview!