This paper relates the results of three months of participant observation and interviews in a public venereal disease clinic. The research was directed toward assessment of the relationship of clinic efficiency (a smoothly operating bureaucratic clinic) and clinic effectiveness (a major reduction of illness within a community). The venereal disease clinic is described as an efficient and well planned health unit with three major objectives: a) checking the increase of V.D. through preventive medicine; b) detection and treatment of V.D. within the community; and c) provision of health services to lower S.E.S. segments of the population. Research results indicate that these (effectiveness) goals are systematically defeated through pursuit of bureaucratic (efficiency) objectives alien to the patient population, and, secondarily, through the more common problem of value conflict between staff and patients. The report concludes with evidence which indicates the extent of the damage done to effectiveness goals and suggests that effective health delivery systems may best be attained apart from present concepts and mechanisms of public health programs and philosophies.