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This statement revealingly indicates a recognition by the system's developers that reality is indeed more complex than their registration system can describe. All the analytic points made to date in this chapter can be read into this one statement: the ICD is a pragmatic classification ("the most effective public health objective"); and it segments the world up spatially and temporally into causal zones that underwrite preferred stories ("it is necessary to break the chain of events . . . at some point"). |
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The cause of death as given on the death certificate by the attending physician is frequently not, as Fagot-Largeault points out, the cause of death that enters into the statistical record. The classifications entered on the certificate are themselves systematically recoded so as to constrain the kinds of story that the statistics tell. |
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One informal algorithm is that precision always beats no precision. (This is an echo of John King's wonderful observation about technical arguments in the policy domain: "some numbers beat no numbers every time.") On a deeper epistemological level, the substitution of precision for validity is often a needed expedient in getting work done (Star 1989a, Kirk and Kutchins 1992). It may also become a kind of gatekeeping tool in theoretically defining a ground of knowledge. It functions as follows in the ICD: |
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Where the selected cause describes a condition in general terms and a term that provides more precise information about the site or nature of this condition is reported on the certificate, prefer the more informative term. This rule will often apply when the general term becomes an adjective, qualifying the more precise term. |
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| Example 57: | I (a) | meningitis | | (b) | tuberculosis | |
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Code to tuberculous meningitis (A17.0). The conditions are stated in the correct causal relationship. (ICD-10, 2: 48) |
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This is doubtless a very reasonable rule. It is significant, however, that it sets in train a process that begins putting in mediating layers between what the doctor says and what gets reported. |
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In general, these mediating layers refashion the story that the act of classification permits. The records clerk is given a license to change the doctor's classification in such a way that it will reflect the best current medical theories: "Rule 3. If the condition selected by the General Principle or by Rule 1 or Rule 2 is obviously a direct consequence of another reported condition, whether in Part I or Part II, select this primary condition."
17 Thus, for example: "Where the se- |
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