Here is an article from Ken Covinsky on Kevinmd.com.
I too, have found that not only are the nurses and doctors in an assisted living and skilled nursing have a lack of concise or correct information to the recent care of their patient in a hospital but also the patient’s primary care doctor (PCD) lacks the same information! Each time I have had my client come back to their respective communities, I have had to readdress the medications given them with their PCD as well.
In advocating on my client’s behalf, I request the attending physician in the skilled nursing community work with my client’s PCD. The PCD usually does not want to “interfere” with the skilled nursing doctor but, as far as I am concerned, the PCD are the ones who know my client’s medical history the best and are most likely to better understand their needs.
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