None of the villains self-identify as such.
There is a fundamental injustice at the heart of healthcare regulation. Like all injustices, it stems from a mismatch between rights and responsibilities. Those who hold power often lack the responsibility (accountability) to use it wisely, while those who bear the responsibility for outcomes frequently lack the power to influence them meaningfully. In times gone by they referred to the ‘whipping boy’.
This asymmetry can distort everything.
Is it acceptable to justify poor outcomes on the basis of following process and procedure? Conversely, is it ever justifiable to breach established processes in pursuit of a good outcome? These aren’t abstract philosophical questions—they’re daily realities for clinicians working under regulatory scrutiny.
And then there’s the deeper layer: ethics and morality. The doctor–patient relationship has, for centuries, been considered sacred. It is rooted in mutual trust, shared decision-making, and an intimacy that’s unique in professional life. When outcomes are poor, it is the clinician—and in ultimate instance, the patient—who must bear that responsibility.
But when regulators inject themselves into this space, the balance is disrupted. They shape decision-making but rarely share responsibility for the consequences. In theory, they exist to protect the public. In practice, they impose external distant supervision over an intimate process, altering behaviour and management while bearing no accountability for outcomes.
This causes harm.
And while we may not be able to fix it entirely, we must at least acknowledge it.
Rarely do we speak openly in the profession about the negative impact of regulatory involvement on clinical outcomes—nor about the quiet fear and intimidation many clinicians feel when faced with opaque, punitive systems that are more focused on compliance than care. More focused on process than outcomes.
We intuitively understand this phenomenon – it is not foreign to us. A priest in a parish can offer profound and compassionate care. But add layers of bureaucracy, gold-trimmed authority, and detached governance—and the religious institution becomes cold, internally focused, dis-interested in outcomes, even complicit in suffering. This is an apt metaphor for modern healthcare regulators.
No where do regulators take responsibility for the explosion in chronic degenerative disease affecting adults. Let alone Children.
Yes, their leaders espouse and self-identify with diversity and inclusion – no one debates this. But they wield the coercive power of the state – Weber’s ‘monopoly on violence’.
A world where those who make and enforce the rules, are responsible for the outcomes. How much is a one way ticket?
