Bolam Case Study

Broad application and usage of the Bolam Test

Despite the Bolam decision being rendered by a court of first instance it has become heavily relied upon, widely accepted and reinforced by the House of Lords as seen in the following cases: Maynard v West Midlands Regional Health Authority, Whitehouse v Jordan, Sidaway v Bethlem Royal Hospital Governors, Bolitho v City & Hackney Health Authority.

Clinical Judgment and competing opinions Maynard v West Midlands Regional Health Authority -1985

Maynard v West Midlands Regional Health Authority, involved obtaining a differential diagnosis between Tuberculosis or Hodgkin's disease and the degree of risk associated with the determining procedure. The patient underwent testing for Tuberculosis

Two distinguished consultants, a physician and a surgeon experienced in the treatment of chest diseases, formed a judgment as to what was, in their opinion, in the best interests of their patient... A case which is based on an allegation that a fully considered decision of two consultants in the field of their special skill was negligent clearly presents certain difficulties of proof. It is not enough to show that there is a body of professional opinion, equally competent, which supports the decision as reasonable in the sense that a responsible body of medical opinion would have accepted it as

These are the medical objectives. But a patient may well have in mind circumstances, objectives, and values which he may reasonably not make known to the doctor but which may lead him to a different decision from that suggested by a purely medical opinion”. The starting point, he said, (which sounds presciently modern), is the right of the patient to make her own decision about whether or not to undergo the proposed treatment. The doctor’s duty is to inform the patient of the material risks. A material risk is one that a reasonably prudent patient in the patient’s position would think significant. A risk did not have to be disclosed, however, if the doctor, on a reasonable assessment of the patient’s condition, takes the view that disclosure would be detrimental to the patient’s health. This caveat is the so-called “therapeutic exception”.

Lord Bridge, who also favoured the Bolam principle had the opinion that 'the disclosure of a particular risk was so obvious necessary to an informed choice on part of the patient that no reasonably prudent medical men would fail to make it." It is the medical practitioners duty to answer any questions posed by the patient