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This study examined the effect of conservative and surgical treatment success/failure on attributions by surgeons for low back surgical outcomes. It also examined empathy as a moderator of these attributions. Forty surgeons attributed surgical outcome in a hypothetical patient to physical and psychological factors. Results indicated that surgeons were less likely to attribute the cause of surgical failure to physical factors when the patient had already failed conservative treatment for low back pain. Surgeons also were more likely to attribute failed surgery, relative to successful surgery, to patient psychological factors. An interaction effect indicated that the latter difference was significant only when the patient had previously succeeded at conservative treatment. Empathy moderated this effect: empathic surgeons were less likely to see the failed surgery patient as psychologically culpable. This self-serving attributional style, as moderated by empathy, is discussed regarding its potential impact on patient care and physician judgment processes.