Empirical and philosophical analysis of physicians' judgments of medical indications.

Background: The aim of this study was to investigate whether physicians who felt strongly for or against a treatment, in this case a moderately life prolonging non-curative cancer treatment, differed in their estimation of medical indication for this treatment as compared to physicians who had no such sentiment. A further aim was to investigate how the notion of medical indication was conceptualised.
Methods: A random sample of GPs, oncologists and pulmonologists (n = 646) comprised the study group. Respondents were randomised to receive either version of a case presentation; in one version, the patient had smoked and in the other version she had never smoked. The physicians were labelled value-neutral (65%) and value-influenced (35%) on the basis of their attitude towards the treatment.
Results: In the 'value-influenced' group, there was a significant difference in the estimation of medical indication for treatment depending upon whether the patient had smoked (50% (95% CI: 41-59) or never smoked (67% (95% CI: 58-76) (Chi-2 = 5.8, df = 1; p  = 0.016)). There was no such difference in the 'value-neutral' group.
Conclusion: This study shows that compared to value-neutral physicians, value-influenced physicians are more likely to base decisions of medical indication on medically irrelevant factors (in this case: the patient's smoking status). Moreover, medical indication is used in an ambiguous manner. Hence, we recommend that the usage of 'medical indication' be disciplined.