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data quality. John Carter, in a paper discussing "the problematic death certificate" recommended that: "The American Medical Association should be asked to restate annually its resolution of 1980 that 'the American Medical Association encourage physicians to give thoughtful attention to more accurate completion of death certificates'" (Carter 1980, 1,286). |
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In a study of death certification, Cameron and McGoogan found that: "diagnostic accuracy bore an inverse relationship to the patient's age" (1981, 273). That is, the practicing physician does not see accurate recording of the death of an old person as a high priority. This is a bureaucratic extension of Sudnow's (1967) "social death" and of Glaser and Strauss' "social value of the dying patient" (1965). |
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When it comes to use of the tables produced with the ICD as a basis, in general: "practicing specialists want more categories and urban statisticians want less" (Société des Nations, Organisation d'Hygiène, Commission d'Experts Statisticiens, CH/experts stat./143 1927, 12). Here, specialists wish to know the breakdown of each disease strain, whereas the public health urban statistician wants broader, action-oriented categories like nutritional deficiencies, environmental factors that could be changed, and so on. This has at times led to a double bind: "So-called administrative statistics have no value in the eyes of practitioners, who as a result are completely uninterested in it; whereas, unless these practitioners provide exact data, then the scientific value of administrative statistics has to be called into question" (Société des Nations, Organisation d'Hygiène, Commission d'Experts Statisticiens, CH/experts stat./143 1927, 2). The ICD does not speak to general practice. Froom ascribes the need for an international classification of health problems in primary care to the fact that attempts: "to use the . . . ICD to classify health problems encountered by general practitioners have often been unsuccessful" (From 1975, 1,257). To continue to draw the parallels with decentralized control of distributed work in firms, one hears clear echoes here of the infamous tension between R&D on the one hand and marketing on the other about the need for precision vs. speed. |
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The different groups have spoken to issues at the core of the ICD. Statisticians, for example, wanted the first ICD to have only 200 categories, since a statistical table as used in censuses could only be approximately that many lines long. For them, lists had to be stable over time and space for comparability. "This is why diseases must be classed according to their seat and not their nature or their cause. |
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