Patterns of primary care that create dependency.

Significant moral tension exists between attempts to address the medical problems of children in the public primary care clinic and the impact of these efforts on the self-reliance of children and families in providing for their own health care needs. We describe and demonstrate dependency-inducing practices. We discuss the moral reasons why such practices should be strictly limited, as well as the exceptional circumstances in which they are appropriate. These moral concerns suggest changes in how we provide clinic services, which we demonstrate by reference to common practices, such as providing free services, following up on missed appointments, and making arrangements for families with outside agencies. We argue that the mistakes of colonialism may be repeated unless enhancing the self-reliance of families becomes a major goal in the clinic setting.