The ideology of the American medical profession: An attribution perspective∗

Physicians have a variety of opinions about the failures of American health care and who is responsible for those failures. (Failure is defined here as the unexpected illness or death of a patient.) Attribution theory specifies the processes involved social construction of beliefs that attribute responsibility for unexpected events to self and others, and the specification of social situations that are likely to result in different types of attributions. This paper suggests that attribution theory is a useful perspective for understanding the diversity and character of public policy statements made by medical specialists in the years since Medicare.

Using existing literature on the nature of medical practice we infer what types of medical practices are likely to increase a physician's interest in unexpected illness and death and to produce explanations of these events that attribute responsibility for them to self (the physician), to the limits of medical knowledge, to the patient's environment, to misfortune and to the patient. We show evidence that medical specialists make all these types of attributions and that the types they make are associated with the conditions of practice in their fields. We develop hypotheses relating to the nature of the decision-making process resulting in different types of attributions for future research on professional ideology, which we define here as the set of beliefs shared by members of a profession or groups thereof concerning the relative role responsibilities of the profession to its patients and to society.