What is the Bolam test and when should it be used?

This case in particular provides us with what has become the accepted rule for assessing what the the appropriate standard of care should have been in cases of medical negligence: the Bolam test. The test basically expects that standards of care have been followed in accordance with a responsible body of opinion – i.e. the medical professional must demonstrate that they acted in a way that a responsible body of medical professionals in the same field would regard as acceptable or reasonable.

Mr Bolam was a patient at a mental health hospital managed by the Friern Hospital Management Committee and had agreed to have electro-convulsive therapy as part of his treatment. The medical professionals carrying out the therapy did not give Mr Bolam any muscle relaxant and his body was not restrained in any way. During the procedure Mr Bolam violently convulsed and flailed about violently and dangerously, injuring himself in several different places before the procedure was stopped – including a fracture in his hip. Mr Bolam subsequently made a medical negligence compensation claim against Friern Hospital Management Committee, arguing that they were negligent in their treatment of him for failing to administer muscle relaxants, not restraining him and not providing full warnings about the risks involved with electro-convulsive therapy.

Mr Bolam’s compensation claim ultimately failed because, at the time, it was not generally the accepted practice to give patients muscle relaxants and some doctors thought that providing a muscle relaxant and/or restraining the patient might actually increase the risk of injury. Also, a standard practice at the time was to not warn patients of the risks of electro-convulsive therapy unless they asked. Therefore it was found that the medical team treating Mr Bolam had acted in an acceptable manner and followed the generally accepted medical practices, and were subsequently found not be negligent in any way.