This study found substantial disagreement among physicians about the appropriateness of indications for performing certain procedures assigned to actual cases. This rate of disagreement for actual cases was at least as large as the disagreement about the complete lists of theoretical indications. Disagreement was minimal regarding coronary angiography use; however, there was considerable disagreement regarding the appropriate use of endoscopy and carotid endarterectomy.

This disagreement among physicians demonstrates that the decision-making process is somewhat subjective and therefore open to the influence of physician bias about patients based on their race, class, and gender. Obviously the development of standardized protocols that will be adopted by physicians requires research to lessen the uncertainty about the efficacy of these and other commonly used procedures.