Maggie's Farm

Good practice is not simply correlated with type of system.
Two opposing examples.
I worked for the Indian Health Service as a GP (mostly pediatrics, but delivered babies, skin transplant, rattlesnake bites and such). I truly enjoyed the practice. I could provide the best medical care I was trained to give, I did not worry about malpractice (IHS system); the patients were deeply appreciative; I was on-call every fourth night. Near the end of my service, the Sioux invited me to their sundance ritual (I was the only physician inivited; the others spent their walk-rounds preaching religion to sick patients: not what I was trained to do.)

On the other hand, when I was head of child psychiatry and training at a children's hospital, I was doing walk rounds on the Pediatric ward each morning and evening. One of the residents who had initiated a consultation on a child. When I suggested further evaluation that evening, the resident said she had to leave at 5 p.m. (I knew as did the others that she was going to an evening job moonlighting as a child psychiatrist, which was against rules for trainees.)

I told her that if she left before finishing evaluating the child, she should n't bother coming in the next day. She finished the evaluation.

NS