Dyscopia

Dyscopia consists of the Latin root "copia" which means abundance or plenty (see cornucopia) and the Greek prefix "dys" which means "bad", "abnormal", "difficult" or "impaired".

It is a word which has assumed two meanings, both of which are essentially a pun based on the similarity of the sound of the words copy and cope with copia.

In the field of neurology, dyscopia is used to describe a type of dyspraxia related to dyslexia and dysgraphia (inability to read or write). Specifically it is taken to mean difficulty with copying. A similar word acopia is taken to mean a complete inability to copy text. Other terms for these conditions are dystranscribia and atranscribia.

The terms dyscopia and acopia have also crept into general medical parlance as a tongue-in-cheek shorthand notation for patients who, after being examined and found to have no specific medical condition, are deemed to be not coping with certain aspects of their life and presumed to be seeking treatment as a form of comfort from the medical profession. More recently, and controversially, the term has been used in this context as a diagnosis for admission to hospital.

The words have also been used in medical notes as a cryptic indication that certain members of a seriously ill patient's family are not coping with the situation and should be afforded some extra consideration to their feelings when the case is being discussed.

Dyscopia as 'dystranscribia'

In Neurology the words dyscopia and (less frequently) acopia are used to describe a condition which is common as one of the sequelae of cerebral commisurotomy, a neurosurgical procedure in which the left and right hemispheres of the brain are separated by severing the corpus callosum. This procedure has been shown to reduce the frequency and severity of seizures in extreme cases of epilepsy.

An effected individual will exhibit difficulty with copying simple line drawings. This is often accompanied to lesser or greater degree by difficulty with writing and other fine motor skills.

Dyscopia as 'not coping' in medical usage

The problem

Terms such as social admission, atypical presentation, and even the derogatory terms bed blocker or crumblie have been used in medical notes synonymously with Dyscopia/Acopia as a reason for hospital admission.

The use of the term has become sufficiently commonplace in medical notes that a recent publication of a psychiatric dictionary even cites it as an actual diagnosis.

Patients who are likely to be labelled with one of these terms are often frail and elderly or people with long-term disabilities. Their failure to cope is often a result of inadequate social support coupled with a deterioration of functional capability which is not clearly linked to an obvious or specific medical or psychiatric pathology.

These situations are often precipitated by a social problem such as:

• Inability or unwillingness of family members to care adequately for the patient; or
• Inappropriate or unsafe home environment e.g. low level vs. high level residential care

The controversy associated with using dyscopia and acopia as diagnoses is that they are considered dismissive terms which may result in genuine medical conditions being overlooked. For example:

• Increased frequency of falls;
• Decline in mobility; or
• Increasing unexplained pain.

In each of these circumstances, investigation of symptoms may well be a legitimate reason for admission. The concern is that this kind of labelling is accompanied by a lack of intention to investigate thoroughly. This may lead to treatable conditions being overlooked and, in turn, result in compromised quality of life and unnecessary suffering.

Dyscopia (and likewise acopia), in this context, is not generally used by the medical community for fear of insulting their patient and bringing their professional standing into question.

Social implications

There are concerns over the usage of these terms which go beyond political correctness and respect.

The primary concern is that a hospital bed is being occupied by an individual who is not sufficiently unwell to warrant hospitalisation. In the short term this may mean that a bed is unavailable for a patient in genuine need of hospitalisation and, in the longer term, it adds to the financial burden of the community which supports the hospital.

This, in turn raises questions about what social support is available for people who are marginalised by their frailty or disability. The consensus of opinion is that doctors feel that they cannot, in good conscience, send certain patients home because the lack of family or community support will result in their more-or-less immediate readmission.

The suggested solution is that more funds should be allocated to community support agencies such as home nursing and domestic help organisations. It is considered that this would result in better quality of life for the individuals concerned and provide a cost saving in the form of a reduced incidence of unnecessary hospitalisations.

Political implications

Unfortunately in many jurisdictions community welfare is funded separately to health care and so attempts to cut costs in one of these areas results in extra pressure on resources in the other.

Colloquial usage

The words 'Dyscopia' and 'Acopia' appear to be gaining traction in common usage as colloquialisms meaning emotional lability over trivial events or circumstances. This may well assist in demystifying the term and discouraging its usage in medical circles.

Another suggestion is a more literal interpretation of the latin: "unable to attain abundance" - a poor person; or "being unable to recognise when abundance has been attained" - a wealthy individual who still has a chronic need to accumulate.