What is the Bolam test for breach of duty?
Doctors have a legal duty of care for the safety and well-being of their patients. The 'Bolam test' is used to establish whether a medical professional has breached their duty of care, potentially leading to a clinical negligence claim.
What is a Duty of Care?
Doctors, nurses, anaesthetists and medical professionals have a legal obligation to provide a reasonable standard of care when carrying out their duties. This obligation is known as a duty of care.
If a health care professional breaches their duty of care and a patient is injured or made ill as a result, there may be grounds for a medical negligence claim.
The primary test used to establish whether there has been a breach of professional duty is the Bolam test.
Bolam v Friern Hospital Management Committee 
The Bolam v Friern Hospital Management Committee  is a tort law case that establishes a healthcare provider's professional standard of care.
The case concerned a patient who sustained serious fractures during electro-convulsive therapy (ECT). Mr Bolam sought compensation on the basis that his doctor had been negligent because:
- The doctor did not administer muscle relaxation before the procedure
- Mr Bolam was not restrained during the procedure
- Doctors had not warned Mr Bolam about the risks involved.
Mr Bolam's claim failed. At the time, it was not the usual practice to give patients muscle relaxation. Some doctors thought that administering a muscle relaxant or restraining the patient might increase the risk of fracture. In addition, patients were not routinely warned of the relatively small risks associated with ECT, unless the patient specifically asked about the risk.
In this case, it was decided that the medical team had followed the accepted medical protocols at the time. As such, the medical team was not deemed to have been negligent in the way they carried out the ECT.
How is the Bolam test applied?
To satisfy the Bolam test, a medical professional must show that he acted in a way that a responsible body of medical professionals in the same field would regard as acceptable.
The Bolam test is essentially a peer review of a doctor's behaviour. If others would have acted in a similar way, then the doctor is unlikely to have breached his duty of care.
It does not matter that other medical professionals might have delivered a different treatment or acted differently. Given the complexities of modern medicine, it is possible, and even likely, that a dissenting doctor might have done things differently. The key point is that a group of similar professionals think that the doctor acted in an acceptable manner.
The importance of following practice guidelines
Today, bodies like the National Institute for Health and Care Excellence (NICE) publish extensive practice guidelines that give doctors (and personal injury solicitors) objective benchmarks for comparison.
A doctor who acts contrary to the recommendations laid down by NICE is likely to be found to have breached their duty of care, even if another group of doctors supports the doctor's actions or care decisions.
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