The Highway Cop Phenomenon: Dangerous

 A concerning dynamic in contemporary healthcare regulation is what I call the highway cop phenomenon. It arises from the intersection of two forces, and its impact on the professions profoundly deleterious.

Over-Regulation
In the pursuit of safety, many regulatory frameworks have expanded to cover every conceivable element of risk. While well-intentioned, this results in an intricate web of rules that often proves impossible to navigate without encountering areas of uncertainty. In practice, professionals are left operating within grey zones where absolute compliance is neither feasible nor clear, and certainly not beneficial to patients.

Arbitrary Enforcement
Compounding this challenge are the discretionary powers of the regulator. Rather than applying standards consistently and transparently, regulators at times determine selectively which rules to enforce, and against whom. When action is taken, however, it carries the full force of the law. This selective enforcement creates a climate of unpredictability and unease, with professionals exposed to significant consequences for actions that may be tolerated in others.

The Resulting Injustice
Practitioners are forced into the grey and persecuted at will. This mirrors the analogy of a highway officer who stops one driver for a minor infraction while allowing others to pass unchallenged – ostensibly due to non-risk related characteristics of the driver in question - race. In healthcare, the implications are equally serious. Such practices erode confidence in the regulatory system, inhibit innovation, and foster mistrust between practitioners, regulators, and the public.

A Call for Proportion and Consistency
What is missing is proportionality and consistency. There are core responsibilities in any area of life – in medicine that is acting in the patients’ best interests to the best of one’s ability. Consent and privacy equally essential. Completing an item number exactly is important, but it is not a core responsibility, and being courteous to drug reps is also important, but perhaps a little less so. Concentric circles of responsibility.

For regulation to fulfil its intended purpose—safeguarding patients while supporting professional integrity—it must strike an appropriate balance. Rules must be proportionate to risk, and their enforcement must be applied consistently, without prejudice or arbitrariness. Anything less undermines not only the profession but the trust on which the healthcare system depends.