The term indication (from Latin indicare "to show") or indication (also healing indication ) indicates when medical treatment is appropriate (indicated). In connection with surgical interventions , one also speaks of an operation indication .
The medical indication or indication can generally be defined as:
“[...] a professional judgment in individual cases, initiated by the (presumed) will of the patient, standardized by the ethical principles of 'use' and 'no harm' and based on comparative prognoses between the untreated course of a disease and the effectiveness of Interventions. It is a recommendation to the patient and a professional self-standardization by the doctor. "
Example: In the case of clinical picture "X", the therapy method "Y" is indicated, ie appropriate or indicated ("clinical picture" is not to be used synonymously with diagnosis , but comprises the overall condition and life situation or perspective of a patient). The term indication does not represent administrative, ideological, financial, legal or other non-medical reasons in its fundamental meaning.
The following gradation of indications has become established in clinical usage (the transitions are fluid):
- Emergency indication: life-threatening, acute clinical picture requires acutely life-saving measures (e.g. emergency operation in the case of acute life-threatening bleeding after trauma - here: death would be expected immediately without medical intervention).
- Vital indication: life-threatening clinical picture requires life-saving measures (e.g. cardiac surgery for a transposition of the large vessels - here: death would be expected without medical intervention, as the clinical picture leads to death after a few months at the latest).
- Absolute indication: a clinical picture requires appropriate therapy in order to be able to keep negative effects on the health of a patient as low as possible (e.g. crossectomy and exhairesis of the great saphenous vein with great saphenous vein insufficiency IV ° according to Hach - here : The life and the quality of life of the patient are foreseeable, among other things, by the increased occurrence of thromboembolism and the progression of the disease as a rule).
- Relative indication: a measure is advantageous for a patient with a corresponding clinical picture, but not absolutely necessary (e.g. surgical removal of a tendon sheath hygroma - here: the hygroma is annoying, can become larger and may impair the patient's quality of life).
- No indication: a measure is not indicated in the case of a corresponding clinical picture, as it does not promise any benefit for a patient (e.g. beta blockers (low dose) for urinary tract infections - here: beta blockers are not expected to improve the clinical picture).
- Contraindication or contraindication : a measure is inadmissible in the case of a corresponding clinical picture, since the disadvantages outweigh the benefits (e.g. acetylsalicylic acid mustnot be takenbecause of its anticoagulant effect if the bleeding tendency is increased ).
- Causal indication: a measure is indicated based on the cause of a clinical picture (e.g. abscess treatment for sepsis - here: the abscess is the cause of blood poisoning).
- Symptom-related indication: a measure is indicated on the basis of a symptom of a clinical picture (e.g. analgesia in the case of osteoporotic vertebral body compression fracture - here: the pain reliever has neither an influence on the underlying disease nor the process of fracture healing, but it is due to the associated patient if necessary severe disabling pain).
- Diagnosis- related indication: a measure is indicated on the basis of a single diagnosis in the context of a clinical picture (e.g. vitamin B 12 injection due to hyperchromic, macrocytic anemia in autoimmune gastritis - here: the vitamin can improve the anemia that is associated with the inflammation occurs).
There are two types of indications in psychotherapy :
- Selective indication : If psychotherapy is very standardized, it is important that only patients who are suitable for this procedure are admitted. The selection of the right procedure for the patient is called selective indication (e.g. psychoanalysis or behavior therapy, inpatient or outpatient). It is prognostically oriented.
- Adaptive indication also called process-related (L. Schmidt-Atzert, M. Amelang, 2012): Here the therapy is adapted to the patient over the course of the process. It is process and success related.
- differential indication : "If this question relates to the decision as to which therapeutic method is most suitable for a patient, it is a question of the differential indication." (Thomas Fydrich, L. Schmidt-Atzert, M. Amelang: Psychologische Diagnostik, doi: 10.1007 / 978-3-642-17001-0_10 , Heidelberg 2012)
- Urban Wiesing: Indication. Theoretical foundations and consequences for medical practice. Kohlhammer, Stuttgart 2017, ISBN 978-3-17-033010-8 , pp. 147 .
- Sabine Herpertz: Disorder-oriented psychotherapy . Elsevier, Urban & FischerVerlag, 2008, ISBN 978-3-437-23730-0 ( limited preview in the Google book search).
- Wolfgang Senf, Michael Broda: Practice of Psychotherapy: An integrative textbook . Georg Thieme Verlag, 2011, ISBN 978-3-13-158545-5 ( limited preview in the Google book search).