• (a) The Bolam test.
  • The Bolam test
  • Two such methods are the Bolam and Bolitho tests

What constitutes knowledge and the development of the Bolam principle Send to Email address * Open Help options for Email Address.

Is the Bolam test still a significant part of medical negligence

NICE Evidence Search | what is the bolam test

The 'Bolam test' is the legal test for negligence that comes from the case of the same name ..
Photo provided by Flickr
The Bolam principle considered until now to be a good screening modality for standard care. Practice in surgery has not reached the stage of scientific reliability where answer can be given. With Bolam, a test can be validated when two or more genuine and respected reviews are held, as the standard of care is a matter of medical judgment. However academics believe that it seems to overprotect surgeons and also allows them to set their own standards.

the status and scope of the Bolam principle - Mega Essays

The Bolam principle considered until now to be a good screening modality for standard care
Photo provided by Flickr
As far as the law of negligence is concerned the medical profession is in a privileged position because it is recognised that medical opinion may differ. Accordingly it is sufficient if a doctor, surgeon, midwife or nurse follows a practice adopted by a recognised body of medical opinion. If there is such a body of medical opinion and it is followed then the medical practitioner will not be liable for any adverse outcome despite the existence of another medical practice that would have adopted a different course which could or would have produced a better outcome. That is the Bolam test.

 

to the jury in the case of Bolam v.

the so-called Bolam principle, derived from the direction given by McNair J
Photo provided by Flickr
When there are two or more conflicting surgical opinions with regard to diagnosing or treating a patient, the Bolam principle is applied. The technical issues involved with the Bolam principle makes it difficult for the courts when dealing with negligence compared to non-medical cases or cases that does not involve healthcare professionals. Although a duty of care can be easily established but setting the standard of care is very difficult. It is not difficult to find two surgeons disagree on the optimal treatment offered to a single patient. Also, patients arrive to hospital complaining of symptoms; if developed complications post surgery, it would be difficult to establish if it is due to substandard care or just a sequel of their pre-existing symptoms and hence establish the connection between breach of care and harm caused by that breach (i.e. a patient suffering from sensory and/or motor weakness as a result of a fracture; when the fracture is fixed and the symptoms persist, no one can tell if the symptoms are the result from the fracture injury or a post surgical complication). Also, when an intervention or non-intervention is applied and it was found not to improve the prognosis, would the surgeon be hold liable if offered no care? (i.e. a surgeon not performing a laparotomy on a complicated patient suffering from perforation).

Law & ethics: The healthcare professional and the Bolam test
Photo provided by Flickr
The most essential component in negligence is to prove that the surgeon failed under the circumstances to provide an acceptable standard care to his/her patient. The circumstances vary in every single case and it is almost impossible to compare two cases; also every surgeon would react differently to the circumstances depending on the level of experience, knowledge, training and school of thought. The Bolam principle is one way to show that the care provided was standard or substandard. The Bolam principle has been perceived as being reliant on the testimony of the professionals supporting the defendant. The Bolitho case by implication imposes that the standard proclaimed must be justified on a logical basis taking into consideration the risks and benefits. The shift from the Bolam to the Bolitho approach allowed the court to reach its own conclusions based on logic rather than knowledge after taking more enquiring stance to test the medical evidence offered by both parties in litigation.


My interpretation is that Bolam test can still be valid in ..

In Penney v East Kent Health Authority, three women developed cervical cancer after a negative screening test. Despite that the claimants' slides showed abnormal cells, they were labeled as normal. The health authority defence was that these findings (abnormal cells) are differently interpreted and this should be decided according to the Bolam test. The trial judge and the Court of Appeal agreed that the "logical" act by a reasonable person is to label these slides as borderline so Bolitho was preferred over Bolam [].

Electroconvulsive therapy: old and new | ECT statistics

The main criticism to the Bolam principle as a descriptive test of what is actually done, while negligence cases usually on what should be done. The definition of a competent body of opinion is imprecise and can legitimize marginal practices. Solicitors often find it to be inconsistent with negligence principles generally.

Tort of negligence in English legal system - Law Teacher

In summary, healthcare at best is empirically imprecise and Bolam provides an ideal compromise to allow for this uncertainty. Unfortunately attempts to regulate surgical practice by 'outside agencies' using an idealistic paradigm has led to the 'Bolitho view' and further judgments which although more legally simplistic to apply is based on constructs of logic and the vagaries of the vox populare that may not withstand the test to time. Unfortunately, until the occasion of the reasonable and unbiased expert witness, many arguments which suggest logic can be critically but subtly flawed, however to rely upon this "expert" evidence may be fallacious and for a court to decide upon two contrary logical arguments may deviate even further from the truth and eventually justice.