I had the pleasure of getting externship opportunity with the well renowned cardiologist in Houston “Dr. Muhammad Usman Khan, MD”, at HCA Houston Northwest Hospital and his clinic Epic Heart & Vascular Center. He is undeniably a great preceptor, an amazing human and a compassionate doctor. He brought the best possible version of me, made me learn things that would not be possible solely through academically. The hardwork that he put in every single day is commendable.
Under his shadow and guidance, I got a chance to get direct hands on experience with the patients at his clinic that made the rotations even more worthwhile. Dr. Khan helped me acquire both inpatient and outpatient exposure. I learnt the utilization of EMR system.
Dr. Khan provided me with the opportunity to directly communicate with the patient independently. On average I was seeing more than fifteen patients regularly at his clinic. I evaluated patient’s EMR profiles first which included their medical records, did their physical examination, took history, provided consult, making notes and came up with the diagnosis of new patients. I would then discuss their diagnosis and management options with Dr. Khan and counsel the patients and documented all of this on the EMR system. The opportunity of having to do all of this independently, greatly accelerated my learning progress & clinical skills. Working directly on EMR system has really prepared me for residency programs. It made me confident enough to tackle challenging cases that I could encounter during my residency in future and also brushed up my patient communication skills. I was able to relate my academic knowledge with clinical world and come up with most challenging diagnosis. For instance, there was a patient who had hypertension presented with bilateral breast tenderness at follow up, Dr. Khan was really impressed when I suggested that his breast tenderness is actually due to gynecomastia caused as an adverse effect of spironolactone which he was taking for his hypertension.
I also witnessed different managements of various venous pathologies which include venous procedures like Venaseal, Varithena and radiofrequency thermal ablation of varicose veins. I witnessed Repatha injection, its indications and usage. Dr. Khan also provided me the opportunity to learn with his echo technician staff who were very humble enough to teach me nuclear stress test, echocardiography, carotid doppler as well as arterial & venous duplex ultrasonography which was a worthwhile experience. I was very keen to work with the staff at his clinic, it taught me team work and help me learn standard protocols that are followed among US healthcare system.
I also actively participated in case discussion and presentations. I presented latest AHA/ACC guidelines on management of Hypertension. Dr. Khan was highly impressed and appreciated me when I presented that diet rich in potassium causes significant decrease in blood pressure. I was also given daily assignment and topics like Ogilvie syndrome, the effect of composition of Himalayan pink salt on hypertension, isolated systolic hypertension, Minoxidil effect on edema and pleural effusion, typical component of chest pain, advantages and risk of right sided versus left sided radial artery access while performing PCI and many more. We discussed new devices currently being used. I observed the indication of using MCT & how it was performed. I was thrilled to see how LINQ device is implanted subcutaneously to monitor cardiac rhythm in atrial fibrillation. Dr. Khan and I had a discussion about Watchman Implant which is implanted in left atrial appendages and is a one-time, minimally invasive procedure for people with non-valvular atrial fibrillation who need an alternative to blood thinners. Dr. Khan also discussed ECGs with me which gave me a better understanding minor details for e.g. identifying possible inferior wall infarcts by looking at Q-waves in leads II, III, AVF.
Dr. Khan provided me with a great opportunity to show my enthusiasm for research field. I presented a great article “Impact of Periprocedural Pulmonary Hypertension on Outcomes after Transcatheter Aortic Valve Replacement” in Journal Club and also discussed other articles such as “Racial and Ethnic Differences in Bystander CPR for Witnessed Cardiac Arrest”.
At the HCA Houston Northwest Hospital, I attended patient rounds with Dr. Khan, observed multiple procedures like cardiac catheterization of coronary artery disease and atherectomy of peripheral artery disease, transesophageal echocardiography (TEE), coronary angiography & percutaneous intervention (PCI), angioplasties including coronary and peripheral angiopathies. I saw many patients with valvular heart disease and learn about their management. I also witnessed Cath lab procedures involving “Shockwave” lithotripsy, one of them involved treatment of Superficial Femoral Artery. I had witnessed many patients with mild AR/MR/TR and also with pulmonary insufficiency. Cardiology consults in patients with comorbidities like stroke, diabetes and on dialysis. Dr. Khan also took me to observe procedures at Houston Methodist Hospital and Tomball Hospital.
In a Nutshell, Dr. Khan is highly generous, supportive and selfless human being who not only helped me professionally but also groomed me personally into becoming a better version of myself. He appreciated me for my hardwork, my curiosity towards patients and my quest to explore more. His positive and constructive criticism helped me flourish more. The rotations has fueled up my passion and enthusiasm to get back to USA and pursue cardiology as my career choice. He taught me gentleness, love for the job, empathy towards patients and above all punctuality. He goes beyond his professional duty to help struggling students accommodate well and get the best of learning experience which has made me confident and gave me insights of American Healthcare system. His support was priceless. During teaching he never left a stone unturned. I highly recommend anyone who is looking for USCE to rotate under his mentorship.