What is epicrisis?

What Does epicrisis Mean

The Greek word epíkrisis , which can be translated as “determination” or “judgment” , arrived in Spanish as epicrisis . This concept, according to the dictionary of the Royal Spanish Academy ( RAE ), is used in the field of medicine to refer to the opinion made by a professional about the disease suffered by a person.

In general, the notion is linked to the assessment made by the doctor of the entire disease process that a patient had to go through. In this way, the summary that the specialist develops when the individual is discharged is called epicrisis , and all these data are added to their medical history.

The epicrisis, in short, is a document that the doctor prepares at the time of discharge , where it summarizes the most relevant aspects of the disease that the patient had. Many times this information is used to close an admission or hospitalization, although it also serves to initiate the follow-up stage.
Among the data that the epicrisis should contain are the main diagnosis, the patient's history, the procedures carried out by the doctors and, if any, the complications that were recorded.
Epicrisis also usually mentions the steps to follow, such as the date of the next check-ups, the medications to be taken, the diet that must be respected and the warning signs that the patient must be attentive to.
Therefore, the typical data from the medical history should be the basis of the epicrisis, and this should be clearly noted when comparing the two sources. It is an objective assessment , so that it is not possible to make modifications or changes once it has been put on paper. It is also important to note that it must be carried out by the doctor who has treated the patient directly.
Among the general data that must be included in the document are firstly those of the health institution where the treatment has taken place and then the patient's personal information, such as their full name, age, sex, number of identity and private address. Finally, the doctor must indicate the discharge date.
With regard to the data that make up the clinical history , three well-defined questions are of particular interest in the epicrisis document: the summary of the disorder, which includes the reason that prompted the patient to come to the consultation ; the provisional diagnosis that the doctor made at the time of admission to the health center; the length of time the patient has been hospitalized, with the dates of admission and discharge.

In the section on the evolution of the patient , the epicrisis should summarize the course of the disease throughout the hospitalization period. This should include the clinical status, the results of complementary examinations, changes in diagnosis, complications and the discovery of new diseases.
It is also mandatory to detail the treatment that the patient has received, taking into account the drugs that have been administered and the medical care that they have provided. The interventions minor surgical and cures should also be included in this section.
At the end of the epicrisis, the doctor must express his conclusions regarding the patient's health, as well as a series of pharmacological recommendations , regarding his diet, future medical consultations or appropriate therapies, among many other possibilities.
Another way of understanding what an epicrisis is refers to a second crisis that occurs after the onset or manifestation of a disease. It is, in this case, an important phenomenon that follows the initial crisis, leading in some cases to the elaboration of another clinical judgment about the disorder.

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