WRNMMC, Bethesda, Md.   –   If there is a common thread that runs through the physicians who practice in the Adolescent and Young Adult (AYA) Medicine Clinic at Walter Reed, it’s a love and passion for the care of youth.

The AYA Medicine Clinic at Walter Reed provides both primary care and subspecialty care services to patients ages 12 to 25.

“We have three fellowship-trained adolescent medicine physicians in our clinic who specialize specifically in the care of adolescent and young adult patients and their unique needs,” said Army Col. (Dr.) Joseph May, chief of the Department of Pediatrics, also called The Children’s Center, at Walter Reed. He added the clinic staff cares for beneficiaries of the Military Health System to meet their physical, mental and emotional needs.

Army Maj. (Dr.) Saira Ahmed, Army Lt. Col. (Dr.) Shaprina Williams and Dr. Harshita Saxena are the trio of physicians who lead the charge in providing care to the patients in the AYA clinic.

“I was at Walter Reed for three years for residency, then came back [here in October 2022] after three years in San Antonio for my fellowship,” said Ahmed, service chief for the AYA clinic.

A Florida native, Ahmed has been a pediatrician for seven years and an AYA physician specifically for four years. Her background is diverse, she explained. She earned her undergraduate degree in biomedical engineering from the Georgia Institute of Technology in 2009. She then earned a master’s degree in human genetics from Tulane University in 2010 before completing medical school at Drexel University College of Medicine in 2016. She did her residency at Walter Reed from 2016 to 2019 and her fellowship at Brooke Army Medical Center in San Antonio from 2019 to 2022.

“I knew from a very young age that I wanted to be a physician,” Ahmed shared. “In college, I majored in biomedical engineering, but chose the pre-med route because I wanted to work directly with people and patients,” she added.

“In between college and medical school, I served for two years as a high school mathematics teach in a low-income, underserved neighborhood in Bridgeport, Connecticut as part of Teach For America (TFA),” Ahmed said. “It was through this experience working with high schoolers that I realized that I specifically wanted to become a pediatrician. I later learned more about the field of adolescent medicine as a pediatrics resident here at Walter Reed, and it was through my time working in the AYA clinic here that I am now the service chief.”

Ahmed said her time as a high school teacher prepared her to work with adolescent and young adult patients, explaining that it gave her a better understanding of the social determinants of health that may impact an adolescent or young adult patient’s performance in school and their overall health. “I realized during my time in TFA that ensuring that students stay healthy and safe in terms of nutrition, chronic and preventable illnesses and diseases, and mental and sexual health is crucial to their overall wellbeing and success,” she shared.

Patient-centered care

Ahmed added that each of the physicians in the AYA clinic act as patient-centered medical home (PCMH) providers with their own empanelment of patients who they see for primary care needs, including yearly checkups, sports physicals, acute sick visits and more.

“We also receive consults from throughout the National Capital Region to help patients not empaneled to us with adolescent and young adult specific needs in our subspecialty service,” Ahmed shared.

“The most common referrals we get for subspecialty care are for contraception, eating disorders and mental health medication management,” Ahmed continued. “For our subspecialty services, providers across the NCR can send patients to us for consultation for pre-exposure prophylaxis, STI diagnosis and treatment, concussion diagnosis and management, reproductive health including contraception and menstrual disorders, and depression, anxiety and adjustment disorder diagnoses and medication management.”

She added patients can also be referred to the clinic for ADHD diagnosis and management, transgender and gender diverse care, substance abuse, acne management, eating disorder diagnosis and medication management.

“I love seeing adolescent and young adult patients make progress towards a goal they have made or make a good decision based on the counseling we have provided them,” Ahmed shared. She added these goals may include practicing safe sex, making healthy food choices, making sure they take their meds as prescribed, avoiding tobacco products and more.

“In adolescent medicine, we have to toe a fine line of not acting too authoritarian as if we are their parents, but also not act like we are their friends,” Ahmed explained. “I try to relate to my patients as much as possible and show them they are not alone. We see a wide variety of patients from 12 to 25 who are all at different maturity levels and different comfort levels with transitioning to adult care, so we have to meet each patient where they are at to ensure we deliver the best care possible.”

Empathy, patience, kindness

“Effective adolescent and young adult docs are empathetic, attentive listeners, open minded, and know how to negotiate,” Ahmed continued. “Our patients come from all different backgrounds in terms of race, ethnicity, gender identity, cultural background and socioeconomic status, so we as AYA docs need to always be aware of how a patient’s lived experiences can affect their health outcomes in adolescence and young adult.”

Williams, who also hails from Florida, agrees. “I enjoy working in partnership with our patients and their parents to help them transition from childhood to adulthood. “I find it rewarding to be able to assist them with navigating the physical and emotional changes to come with puberty. I am also a voice and advocate for them regarding helping them gain their independence over time, providing family and parental support, and helping them learn about their medical care and how to navigate the medical care system. It is rewarding when we see a young, confused adolescent blossom into an intelligent and independent adult.”

The assistant chief of pediatrics for Army, AYA medicine staff provider and pediatrics PCMH champion, Williams, like Ahmed, has a diverse background. She earned her bachelor’s degree in biology with minors in chemistry and Spanish from Eckerd College in Florida. She also became a certified teacher in secondary education before attending the University of Miami School of Medicine from 2002 to 2006.

“I completed a transitional year internship in 2007 at Walter Reed, my pediatrics residency in 2010, and the AYA medicine fellowship in 2018,” Williams shared.

It was also her “love in working with children” that motivated her to become a pediatrician and pursue AYA medicine.

“I was a high school teacher in a dropout prevention program prior to becoming a doctor,” Williams explained. “I enjoyed working with at risk youth and having the ability and influence in order to guide their developing and inquiring minds onto a path of success despite their past challenges.”

“I see patient care as a partnership between the provider and the patient,” Williams added. “The outcome for both parties is to maintain the patient’s health, or help the patient reach a place of maximum health, which is different for each patient depending on the clinical condition.”
She agrees that “patience, kindness, relatability, empathy, compassion, awareness of the difficulties that may arise both physically and mentally as one transitions from childhood to adulthood,” are qualities shared among the most effective AYA physicians.

An Inherited Love for Pediatrics

Saxon’s love for medicine and pediatrics are inherited.

“I’m in the unique position of being second generation adolescent and young adult medicine physician. When my mom immigrated from India, she was already a practicing pediatrician having completed her medical training at Maulana Azad Medical College and her residency training at All India Institute of Medical Sciences in New Delhi. She had to repeat residency when she came to the United States, and became fascinated by neonatology and child psychiatry, but ultimately, she did her fellowship in adolescent and young adult medicine at Children’s National Medical Center, graduating in the early 1980s. She inspired me to become a physician and her stories of amazing teens overcoming great difficulties in their lives were fascinating.”

‘I love this patient population’

Born Los Angeles, but raised in Maryland, Saxena, the graduate medical education (GME) coordinator for AYA medicine, completed her pediatrics residency at Long Island Jewish Medical Center in the then Schneider’s Children Hospital in 2005, and following in her mother’s footsteps, her AYA fellowship at Children’s National Medical Center in 2009.

“I went to the University of Maryland College Park for undergraduate, completing a double degree in English Language and Literature and neurobiology and physiology. I did my medical training at Howard University School of Medicine,” Saxena said. She’s worked at Walter Reed since 2012.

“I primarily see patients in clinic for routine and subspecialty care and provide GME support for our trainees,” Saxena continued. She added “the list is too long” regarding what she finds most rewarding about being an AYA physician.

“I love this patient population. I love connecting with teens and young adults and their families, and hopefully, making a difference in their lives. People generally learn their habits in their formative years, and through consistent and confidential care of our adolescents, we have the ability to impact their health for life.”

Care with an Open Mind, Heart

“I approach my patients with an open mind and heart. I strive to be a good listener and I am constantly working to better myself. I hope to be compassionate and caring in my approach so that my patients and their families will feel comfortable opening up to me,” Saxena added.

“Conversations sometimes have to be confidential, and it can be a challenge when parents want to be included in situations in which a growing teen or young adult would rather practice their independence and not involve their parents. Finding that balance to respect our autonomous young adult patients while also understanding that parents sometimes want to still be included can be challenging at times. Having open and honest dialogues with families ahead of visits to manage expectations can help us navigate this hurdle,” Saxena said.

Saxena summed up the sentiments of all of the AYA physicians at Walter Reed, concluding, “I just love what I do.”