Attributions: Uses of Social Science Knowledge in the ‘Doctoring’ of Primary Care

Abstract

As primary care medicine assumes greater stature, so increase public and academic pressures for its improvement. The same scientific rationalization of the doctor’s interventions for acute medical disease in the hospital is now expected of the doctor’s acts in medical practice. These represent new pressures because, in the past, the doctor’s job outside the hospital was regarded as mere vocational work, quite apart from, and of little concern to, the academic and scientific enterprise of the university medical school. The current modern renewal of primary care is now within the medical school. In this new setting, it is argued, the traditional clinical sciences alone cannot rationalize the doctor’s tasks of care and application of the behavioral sciences becomes necessary. Thus, both behavioral scientists and clinical teachers are trying to make “doctoring” more scientific, struggling to relate social science knowledge to the doctor’s job. By doing so, they hope to improve, as the public expects, the care of patients. Yet such knowledge and clinical work cannot be automatically linked when that social science knowledge has often been developed out of interests other than what the doctor does and when the doctor’s own reflective analyses of the processes of care have been scant indeed — hence the struggle to make useful connections. This paper is one example of such an effort, an exercise in relating social science knowledge and clinical action. It identifies the doctor’s tasks of primary care, illustrates the use of attributions in these tasks, and then reviews the literature about attributions from anthropology, medical sociology, social psychology, and clinical medicine.

“The Process is not physical, it’s mental, and if your mind says you’re weak, you’ll be tired physically. Your mind is where you control evrything. What you think is what you are.”

Alex Grammas,

Manager, Milwaukee Brewers