This article analyses tensions between the dominant management rationality and health work. By means of philosophical concepts and bibliography revision it was found that clinical and public health practices are structured as praxis, a term defined by Aristotle. It does not work automatically, depending on a human being to reflect and decide in most situations, making mediation between established knowledge and singular context. So, it is recommended the adoption of a management model that enables and favors the combination of professional autonomy and sanitary responsibility.152337-44