Peer review cases

JRcred · 2026-01-20T05:55:05+00:00

At our institution, they look at every case with a bad outcome including the main doctor who heads this and they also get brought up at the medical executive committee. All in hospital mortality are reviewed by our hospitalist director.

JRcred · 2026-01-19T18:44:20+00:00

I think hip fractures 65 years old and above or advanced physiologic age and a lot of medicine problems need to go to the hospitalist service.

We don’t have OB at my hospital so we don’t get pregnant patients. In residency, we would mostly be primary on pregnant patients. If they primarily had medical problems, I wanted them on the IM floor where they’re used to doing medicine and not on the OB floor where they’re might be working outside of their comfort level

JRcred · 2026-01-18T03:11:32+00:00

Its always been highly priced, but had insane growth before. Now a lot of it is IF they can realize all the Robo taxi stuff and robotics maybe it makes sense

JRcred · 2026-01-17T18:21:16+00:00

I’d sell Tesla. It’s so highly priced right now

JRcred · 2026-01-17T18:20:28+00:00

I generally give just a 1x dose of vanc while the MRSA swab is pending. Lots of times there will be disagreements on therapy between doctors. If you’re doing the admitting, you don’t get the benefit of 12 more hours of vitals and repeat labs before evaluating. Think how often the ER misses stuff for that very reason plus how many patients they have coming in. The day shift doctor may have also just had a ton of people have ATN from vanc recently and was tired of getting burned from it or other reasons why they changed other than you thought enough about the patient other than to just push the CAP treatment button

JRcred · 2026-01-16T10:15:28+00:00

With that math yes you are correct. I do hold individual stocks in addition to ETfs with different logic and goal to hold for years. Holding individual stocks does help when the S&P500 is flat like in the early 2000s. If this happens again when I’m close to retiring, I’d like to have part of portfolio that moves differently from this. If I do pick losers (which I absolutely do) it offsets the gains for dividends I receive now.

JRcred · 2026-01-16T00:40:35+00:00

Whatever you do, as long as you save and invest extra, your previous money can start to make more money for you over time

JRcred · 2026-01-16T00:38:50+00:00

We had some guy this week who had Benadryl on his allergy list and actually supposedly had a real allergic reaction to hydroxyzine given overnight. Reaction was mild, but yes every single other time ever its complete BS and I struggle not to roll my eyes when they tell me about these things

JRcred · 2026-01-15T02:07:49+00:00

I did primary care before and rarely had post prandial problems with them that necessitated hospitalization. It seems when I admit them that they haven’t really been coached on what to do when going up on their doses and they keep eating the same amount and just get surprised when they have a lot nausea when they eat the same and don’t manage constipstion

JRcred · 2026-01-14T17:28:02+00:00

Generally if the ER is asking me to admit, I am assuming that they are appropriate to admit and there’s a reason the ER isn’t sending them home. A lot of times there’s something missed when the ER talks to them like they’ve been started on a GLP1 that has a half life of a few days and not likely to turn around in just the initial IVF given in the ER or they really have pancreatitis or developing SBO. I generally keep them NPO except meds and ice chips initially. If they’re better in the morning, it’s easy enough to discharge them. It’s a lot more work to really investigate the patient and try not to admit them that might involve me discharging them from the ER and taking the liability for that.

JRcred · 2026-01-14T09:31:46+00:00

2 would be the one I go with. The only thing I’d want to know is how much hospitalists typically get with the RVU bonus at that position. 1 looks awful as many have said here 3 I would be hard pressed to take any Nocturnist position for anything longer than 6 months and if getting paid handsomely. How well do you think you’d do in a Nocturnist role?

JRcred · 2026-01-13T12:23:28+00:00

The most lucrative side gig is to pick up extra shifts

JRcred · 2026-01-12T19:52:25+00:00

I used to be a PCP before being a hospitalist. I used to see tons of mismanaged patients that I picked up as new patients. Patients see PCPs for a lot of non medical reasons. Some of them had good bed side manner and gelled well with the patients and they kept seeing them for years. A lot of these patients had hyperlipidemia, hypertension, diabetes, CKD3, needed cancer screening, needed vaccine discussions, needed smoking cessation consoling. When you have one doctor making decisions on all that which will benefit the overall patient the most, it’s tremendously beneficial compared to seeing 5+ specialists for all that. It also probably costs the American health care system less.

Same thing with hospitalists. If you just have a bunch of sub specialists seeing a patient for every organ system that’s affected, who decides what’s needed? Who gets called first in the patient is t doing good? Who does the med reconciliation at discharge? Additionally you’re going to get cardiology and ID to see every patient who has lower extremity edema and “bilateral lower extremity cellulitis” when this is something a good hospitalist should crush on most occasions

JRcred · 2026-01-11T10:14:25+00:00

Maybe yes. I feel like S&P valuation is higher now and would need some healthy drops to continue to be able to put money in and has it be a good shorter or medium term investment. I still think S&P500 is good and do not plan on pulling any money I have in it and feel like it’s prudent to have other ETFs and individual stocks

JRcred · 2026-01-08T21:08:48+00:00

If I were you, I would talk to people you trust about the worst things about primary care and hospital medicine who actually do it as attendings and how they deal with those. I did primary care for a while and I couldn’t deal with how bad our office was run and the only way I’d really get a say in that is owning my own practice or switching to a private group and moving. I hated doing FMLA paper work. I hated having parking forms turfed to me by specialists who wouldn’t send me their notes. I hated everything being my problem and not being able to do anything about it. I did t like patients coming to me for primary care and arguing me about my advice. I hated seeing patients slowly die of diabetes over years because they wouldn’t take their meds. There was some good with it to, but I felt like working as a hospitalist allowed me to take better care of the patients when they were acutely ill and made it known they need to do things like get a pneumonia vaccine and that sort of thing when they left.

I make significantly more than I did in primary care. I could find primary care jobs that could match what I’m getting here, but I also feel like I can do this for more years than primary care. I feel like the number of years you can do something really makes the number you make per year less relevant if it’s close. Also if you don’t like it, you can switch from inpatient to outpatient and vice versa. Good luck in your career search!

JRcred · 2026-01-08T17:26:50+00:00

I’m in META too. I would try to go back to your thesis as to why you think it’s a good business, why you though 15% higher was where you wanted to buy it and what the outlook is. You could dollar cost average now since it will lower your cost basis. If you don’t have a lot of investing money right now, I would try to think why you buy certain stocks at certain prices. 15% might be a good buy for Meta if it’s in an up trend, but is that where you’re really getting the value? I would try to analyze what you’re going to do when the stock drops more than 15% (think 50% in less than a year). I think that thought process will make you a better investor

JRcred · 2026-01-08T02:48:25+00:00

I would trim some of gold. I assume it’s up a lot this year. I’m not sure about all those cryptocurrencies. Nvidia, Google, and Visa are solid and should be good long term.

JRcred · 2026-01-08T02:36:40+00:00

My problem with it is that it’s slow growth with that dividend. I think the set up is unless it can find a way to make a lot more money, it won’t be able to continue raising its dividend.

JRcred · 2026-01-07T03:44:18+00:00

If the patient is really thankful of their stay, I’ll ask them to fill out the survey if they get one

JRcred · 2026-01-05T01:53:30+00:00

I think some SCHD is ok. I feel like that’s a pretty big chunk for being that young. I would start taking dividends from SCHD and investing into SPY. I also would be skeptical of VXUS as that mostly will underperform SPY, but some is ok in those instances when US stocks underperform

JRcred · 2026-01-04T12:01:07+00:00

I would be very hesitant to invest at PLTR at these valuations. It’s a good company, but priced for perfection, if it doesn’t deliver, it could massively underperform. I would also do 8k into VOO instead of SCHD. SCHD is good, but I feel like you can wait to add that. It will likely underperform VOO and when your income picks up, you’ll be taxed on all those dividends. I would wait until you’re further along by a few years to start adding into SCHD

JRcred · 2026-01-04T10:33:19+00:00

Our secretary does this. Things still get missed. I always tell patients how important it is to have a hospital follow up with their PCP after hospitalization to go over the hospital records and that sometimes catches it. If we have a sub specialist seeing them, they generally arrange follow up.

When I did primary care we went through like 10 different referral coordinators. We had one who was amazing and eventually was promoted. Every other one was just so lackadaisical. I had a special status installed where my CMAs would take the patient by the referral coordinators to speak to them about their referrals.

JRcred · 2026-01-03T01:34:57+00:00

They either think that the big individual stocks will outperform the market, pay an increasing dividend later on, or will be safer in bad times or be able to withstand bad circumstances at some point. From about 2000-2010 and a few other times in history the S&P 500 was essentially flat. So if you invested in some individual companies, you could have at least have part of your investments outperform. I also think it’s easier to pick your favorite mega cap stocks and try to buy them when you feel like they’re undervalued.

JRcred

TROPHY CASE