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Finally, even where everyone agrees on how classifications or standards should be established, there are often practical difficulties about how to craft them. For example, a classification system with 20,000 bins on every form is practically unusable for data-entry purposes. The constraints of technological record keeping come into play at every turn. For example, the original ICD had some 200 diseases not because of the nature of the human body and its problems but because this was the maximum number that would fit the large census sheets then in use. |
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Sometimes the decision simply about how fine-grained to make the system has political consequences as well. For instance, describing and recording someone's tasks, as in the case of nursing work, may mean controlling or surveilling their work as well, and may imply an attempt to take away discretion. After all, the loosest classification of work is accorded to those with the most power and discretion who are able to set their own terms. There are financial stakes as well. In a study of a health insurance company's system of classifying for doctor and patient reimbursement, Gerson and Star (1986) found that doctors wanted the most fine-grained of category systems, so that each procedure could be reimbursed separately and thus most profitably. Data-entry personnel and hospital administrators, among others, wanted broader, simpler, and coarser-grained categories for reasons of efficiency. These conflicts were, however, invisible to the outside world, which received only the forms for reimbursement purposes and a copy of the codebook for reference. Both the content of the categories and the structure of the overall scheme are concerns for due process within organizationswhose voice will be heard and when will enough data, of the right granularity, have been collected? |
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Infrastructure and Method: Convergence |
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These ubiquitous, textured classifications and standards help frame our representation of the past and the sequencing of events in the present. They can best be understood as doing the ever local, ever partial work of making it appear that science describes nature (and nature alone) and that politics is about social power (and social power alone). Consider the case of psychoanalysts discussed at length in Young (1995), Kirk and Kutchins (1992), and Kutchins and Kirk (1997). To receive reimbursement for their procedures, psychoanalysts now need to couch them in a biomedical language (using the DSM). |
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