Modern Athena, MD

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Friends, adulthood can be tiring. This mochi cat understands and recommends you get enough rest. 💕

Chibird store | Positive pin club | Webtoon

You are not behind in life.

There’s no timetable that we all must follow.

It’s made up.

7 billion people can’t do everything in the same order.

What’s early? What’s late? Compared to who?

Don’t beat yourself up for where you are. It’s YOUR schedule and everything is right on time.

maslow’s hierarchy of needs but every level is about soup

The peacock. The music. The person leaping over a tombstone. The cemetery. It just works.

“GRAVE PEACOCKING” IM DEAD

So answer is yes we do want an Indian Cinderella next

fuck yeah I mean can you IMAGINE the dresses?! just anarkali style alone

i mean

any of these

could easily fit the profile

Fuck yeah i want an Indian Cinderella

Yes.

YES GIVE ME THAT DIVERSITY.

UNIRONICALLY GIVE ME INDIAN CINDERELLA

Um yes please?

We read Chinese Cinderella at school. I know it’s not Indian but it’s still another culture

Actually, the Cinderella story is very old and has hundreds, even thousands of variations across various cultures and time periods.

The story of Rhodopis is considered to be one of the earliest variants of Cinderella and comes from Ancient Greece. The tale of Ye Xian, aka the Chinese Cinderella, dates from around 860 AD.

There is a Japanese Cinderella story that dates from the 13th century. There’s a Vietnamese variant, an Iranian variant, and a whole bunch that pop up in One Thousand and One Nights. Like seriously, it’s all over the place. I wouldn’t be surprised if there actually was an Indian variant of Cinderella but I just haven’t heard of it.

I love how the tweet was like what you want more?? And we all went bitch yes

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Just for context for those of you not in medicine, the average time to get in with endocrinology from time referral is completed to appointment is basically 8-12 weeks or longer, unless the endocrinologist thinks you’re dying in the hospital basically. Endocrinology and rheumatology are hands down the hardest specialties to get someone into, and it turns out not feeling good and being in pain are not the triage criteria for dying. 

I had a patient fire me as their PCP today essentially because I cannot force endocrinology to see someone. They’re leaving to “find an office that can process referrals and refills more efficiently” (refills noted because I didn’t fill a script within 4.5 hours of receiving a request) and then had the audacity to ask for immediate refills and referrals right afterwards. 

Low key wish I could watch them discover that minimum it’s going to take 2 weeks to get established with a new PCP (most recent stats suggest this is more like 18 days) and then find out that endocrinology still takes 8-20 weeks to get into, all the while also having to realize that actually all PCP offices have a policy on how long it takes to respond to a refill request, and that it doesn’t actually matter how many times a medication is sent to the pharmacy if the pharmacy has the med on back order. 

smh. Like, I get that patients don’t understand how the utterly convoluted and terrible USA system works, but when I am explaining that I actually have no control over an endocrinologists schedule, asking for me to somehow put an appointment in to a clinic I don’t work at in a system I don’t work in or have access to is basically asking me to use a magic wand.  

For more perspective: in the small town I’m in its more like 3-6 months to see endocrinology. I did manage to get someone in with thyroid storm in 6 weeks which means I manage them in the meantime 👎🏼. I have another patient with multiple endocrine gland failure (thyroid, parathyroid, type 1 DM, gonads) and we did get them in to endo in about 3 months. Rheum is just as bad or worse. They’re 9-12 months out for new patients near me. So I usually do most of the rheum work up and start what meds I can but I can’t start them on fancy biologics. It sucks. Neuro is available fairly quickly but there are maybe 2 good ones near us who who’ll actually put forth an effort to search for a diagnosis on patients with weird symptoms. My patient with autoimmune encephalitis (yep, don’t see that 🦓 everyday) was told it would be 3 months before they could be seen. It took multiple calls and 80+ pages of faxed records proving the diagnosis before they’d see the patient earlier.

Also for folks to realize: most specialists haven’t reviewed your records before they see you. The doctors often have no say in when you are scheduled and don’t see the referral info in advance of the visit. Someone who may not even have clinical experience is usually in charge of scheduling you. So if you have a weird/acute/severe issue that requires quick attention, it often takes a phone call direct from your PCP to the specialist or their assistant to get you seen in a timely manner. Example: cardiology scheduled my patient’s stress test 6 weeks out because the referral was from GI (patient insisted it was reflux when I told them it was angina. GI agreed it was angina). I called and got the test moved up to 3 days out. Patient had coronary artery bypass surgery 2 days after the test. They likely didn’t have 6 weeks to wait. So if you feel like your wait is too long, you can ask your PCP to intervene, but if they tell you it still won’t happen any faster or that there are sicker patients in line ahead of you who can’t be postponed, believe them and back off.

Regarding speed of referrals and scheduling, non-med folks also need to understand that under-staffing is an issue everywhere, and it’s not necessarily one we can fix quickly. My office is down 2 people right now, which means our 3 MAs are all doing the work of 1.5 people now. We are hospital owned so we only get the staff the hospital says we can have, so we may or may not get a fill-in person some days to help. For privately owned offices, it often means big money and time to hire and train new folks. It can’t be fixed quickly. And medical staff get sick just like regular people do. If your doctor has a massive kidney stone and has to have lithotripsy, as my partner did once, then your refills might be a tad late. Give them some grace. You don’t know what’s going on behind the scenes, and I assure you that nobody is sitting around playing games and checking TikTok during work hours in a medical office. If your stuff doesn’t get done, it usually means someone else had more pressing issues than you did.

And finally, it would be great if some patients realized that in medicine, the customer is not always right and customer satisfaction is not always priority #1 (yeah yeah patient satisfaction surveys are a thing but your doctors mainly care about practicing good medicine). Put on your big kid panties and take some personal responsibility. Don’t get mad that it took 4 hours to respond to your call. You are not your doctor’s only patient. They can’t drop everything to send in your viagra because there might be someone having a heart attack in the office and that’s kind of more important to deal with. Remember that failure to plan on your part does not make for an emergency on my part. Keep track of your meds. Ask for refills at your appointment or call a few days before you run out so you have a buffer. Take your meds with you to appointments so they can be checked to avoid errors in prescribing. If you feel like you are waiting too long for an appointment, call first thing in the morning and ask to be worked in if there are cancellations. We are eager to fill empty spots. Take some initiative.

I second all of this. I have had patients yell at me about referrals and sometimes I can help, but mostly I can’t. Derm takes 3 months minimum, there is no such thing as an emergency in their book. Yesterday I got yelled at because a local chiropractor wasn’t answering the patient’s phone calls.... I never referred to that chiro, or any chiro. The patient set this up themselves. Or two days ago when someone sent a rambling message about how unhappy he was with his care through a GI doc at the competing hospital network- not because we’d referred him, but because their office wasn’t answering his repeated same-day messages fast enough.

I rant about the customer-service direction medicine is being forced in every day. I have a patient who stopped taking all their meds (not due to cost or lack of access or lack of insurance, just because they didn’t want to take them) and then, understandably, their lab work reflected this very visibly. I had to complete paperwork for them, which now reflects this lab work that they caused themselves, and for the last 3 weeks we’ve gotten angry phone calls, portal messages saying we’ve ruined their life, and a 3 hour irate sit-in staged in my waiting room demanding that I change my documentation (ie LIE) which only ended when the police were called. Someone else said I was violating my Hippocratic oath if I didn’t refill a Med they’ve been out of for several months, when they haven’t come into the office for over two years and haven’t had labs for that Med in 4y- and it’s not a life-threatening Med if they don’t get it.

Sometimes I wish more people understood more about medicine. Other days I wish we weren’t moving towards such a customer-service based society. But every day I am just exhausted by people.

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when i was in elementary school, i thought that the reason we were supposed to capitalize the first letter of people's names was as a sign of respect, so i always refused to capitalize the name of my fourth grade teacher or george bush, because i did not respect them

lower case (derogatory)

Pffft... his expressions send me

#fyi all these are on youtube#he has a channel

Yes. He's uploaded them to YouTube from TikTok for people who don't have TikTok.

Onward noble steed

Um, It Makes Total Sense We’re All Into Sea Shanties Now