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collection possibly be not so useful in the future. The latter has generally been the de facto choice and is generally a reasonable one to have made since new criteria of relevance cannot be predicted. |
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Second, different designers of the classification system have different needs, and the shifting ecology of relationships among the disciplines using the classification will necessarily be reflected in the scheme itself. As with the insurance company example above, these relationships must be resolved to make a usable form, often obscuring power relationships in the process. As Goodwin notes, ''A quite different kind of multivocality, one organized by the craft requirements of a work task rather than the genres of the literary academy, can be found in mundane, bureaucratic forms'' (1996, 66). But one must dig to find the voices. The process of filling out the forms may further obscure them. For example, the designers of the ICD recommend that its classification scheme be interpreted economically: |
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The condition to be used for single-condition morbidity analysis is the main condition treated or investigated during the relevant episode of health care. The main condition is defined as the condition, diagnosed at the end of the episode of health care, primarily responsible for the patient's need for treatment or investigation. If there is more than one such condition, the one held most responsible for the greatest use of resources should be selected. (ICD-10, 2: 96) |
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This reflects a constant condition of the use of the ICD: it has been recommended throughout its history that priority should be given to coding diseases that represent a threat to public health. This goal is clearly a good one; equally clearly it can discriminate selectively against the reporting of rare noncontagious conditions. In chapter 4 we discuss an ongoing battle between statisticians (who are not generally interested in the very rare occurrences of disease) and public health officials (who want to know about even one case of bubonic plague or Ebola!). |
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Faced with these problems, the WHO has been consistently pragmatic in its aims and clear in its explanations of the ICD. From the time of the ninth revision on, it has been recognized explicitly that "the ICD alone could not cover all the information required and that only a 'family' of disease and health related classifications would meet the different requirements in public health" (IDC-10, 2: 20). This "family" is pictured in ICD-10 as shown in figure 2.2. |
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The family itself is a diverse one: there are various standard modifications of the ICD. The most significant in the United States is the ICD-9-CM, where CM stands for "clinical modification." This |
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