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To maintain a good international system of medical classification, a huge amount of detailed information is needed about both the citizens of a particular state and about citizens of countries with whom they are in contact. No information is irrelevant. The state must have better information than the family itself. As noted in the case of New Zealand above, its need for information is effectively infinite. Below, for example, is a wish list from 1985 for a national medical information system in the United States: |
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The system must capture more data than just the names of lesions and diseases and the therapeutic procedures used to correct them to meet these needs. In a statistical model proposed by Kerr White, all factors affecting health are incorporated: genetic and biological; environmental, behavioral, psychological, and social conditions which precipitate health problems' complaints, symptoms, and diseases which prompt people to seek medical care; and evaluation of severity and functional capacity, including impairment and handicaps. To accomplish this, a series of interlinked classifications would be required, designed so that all of the information is stored in a common database. The entire spectrum of medical terminology would be included, from the layman's language used to describe ill health and terms used by professionals at the institutional level to molecular terms from each of the basic sciences and terms related to causes of death used at the international level. Feinstein, in a recent paper, proposed to capture even more data consisting of the observations and quantitation of such clinical phenomena as the type and severity of symptoms, the rate of progression of illness, the severity of co-morbidity, the functional capacity of the patient, the reasons for medical decision, problems in maintaining therapy, the impact of the ailment and its treatment on familial and interpersonal relationships, and other aspects of the physical activities and mental functions of daily life. (Rothwell 1985, 169170) |
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There is no foretelling what information will be relevant. This is what Lemke (1995) calls the dilemma of choosing between typological and topological. The construction of typologies or classes forecloses labeling options and presets the options about the range of possibilities. For scientific and ethical reasons, he argues for a topological approach in classifying persons, visualizing dimensions that may be added to in an expandable matrix (Lemke 1995). Those who gather information for the ICD and related systems face precisely this dilemma. Heidenstrom says, for example, ''to classify a chisel, a hand drill, and a spanner [wrench] together as 'hand tools', or the first two as 'cutting and piercing instruments' may be obscurantist, or even misleading. Whereas to one accident researcher it is significant that a chisel is edged, a drill pointed, and a spanner neither, to another it may be more important that the chisel is pushed, the spanner turned and the |
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