The Bolam Test Explained: An Accessible Guide on How the Courts Decide Whether Medical Treatment Was Negligent
In medical negligence claims, one of the most important legal questions is whether a healthcare professional acted in accordance with an acceptable standard of care. This is something our experienced medical negligence team here at Step Legal must consider with each and every claim we take on. Fortunately, English law has developed a number of legal tests to answer this question, the most well-known of which is the Bolam test.
For decades, the Bolam principle has formed the foundation of how courts assess clinical decision-making. However, it has also evolved significantly through later case law. In this article, our Medical Negligence team provides a detailed but accessible overview of the Bolam test, how it is applied in practice, and how subsequent cases have refined its scope.
What Is the Bolam Test?
The Bolam test originates from the landmark case of:
Bolam v Friern Hospital Management Committee [1957]
In this case, Mr Bolam underwent electroconvulsive therapy (ECT) for depression and suffered serious injuries after being restrained but not given muscle relaxants. He alleged that the doctor was negligent for failing to provide those relaxants or warn him of the risks.
The court rejected his claim and established the following principle:
A doctor is not negligent if they act in accordance with a practice accepted as proper by a responsible body of medical professionals skilled in that particular art.
In simple terms, a healthcare professional will not be found negligent merely because another doctor would have acted differently. If a responsible body of medical opinion supports the approach taken, the standard of care is likely to be met.
Why the Bolam Test Matters in Medical Negligence Claims
The Bolam test recognises that medicine is not an exact science and that reasonable practitioners may legitimately disagree on diagnosis or treatment. It protects clinicians from being judged with hindsight and allows for professional discretion.
In practical terms, this means that:
- The court does not decide what it would have done
- The court relies heavily on independent medical expert evidence
- A claimant must show that no responsible body of clinicians would have acted in the same way
As a result, Bolam places a high evidential burden on claimants and makes expert evidence central to almost every medical negligence case.
Early Criticism of the Bolam Approach
Although Bolam remains influential, it has been criticised for giving excessive deference to the medical profession. Critics argued that if any group of doctors could justify a practice, patients would struggle to challenge substandard care.
This concern led to important refinements in later case law, most notably in Bolitho.
Bolitho v City and Hackney Health Authority [1997]
The House of Lords revisited the Bolam principle in Bolitho, a case involving the death of a young child from respiratory failure. The defendant argued that their actions were supported by a responsible body of medical opinion.
The court accepted that medical opinion is central but clarified an important limitation:
The professional opinion relied upon must be capable of withstanding logical analysis.
This means that the court is not required to accept expert evidence uncritically. Judges may reject medical opinions if they are internally inconsistent, unreasonable, or fail to properly consider risks and benefits.
Bolitho refined Bolam, making clear that:
- Expert opinion must be reasonable and logical
- The court retains an oversight role
- Professional support alone is not always sufficient
This marked a shift towards greater judicial scrutiny of medical evidence.
How Bolam and Bolitho Work Together Today
In modern medical negligence claims, Bolam and Bolitho operate together. The court will ask:
- Is there a responsible body of medical opinion supporting the defendant’s actions?
- If so, is that opinion reasonable and capable of withstanding logical analysis?
If the answer to both questions is yes, the claim is unlikely to succeed on breach of duty.
This combined approach balances respect for medical expertise with the need to protect patients from indefensible practices.
The Limits of Bolam: Montgomery v Lanarkshire Health Board [2015]
One of the most significant developments in medical negligence law came with:
Montgomery v Lanarkshire Health Board [2015]
This case concerned a failure to warn a patient of the risks associated with vaginal delivery. The Supreme Court held that Bolam does not apply to consent and risk disclosure.
Instead, the court established a patient-focused test, requiring doctors to disclose:
- Material risks of treatment
- Reasonable alternative options
A risk is considered material if a reasonable person in the patient’s position would likely attach significance to it.
As a result:
- Bolam still applies to diagnosis and treatment decisions
- It does not govern the duty to inform patients of risks
This represents a clear shift away from medical paternalism towards patient autonomy.
Practical Impact on Medical Negligence Claims
Understanding the Bolam test is essential for anyone considering a medical negligence claim. Its application affects:
- Whether a claim is legally viable
- The type and quality of expert evidence required
- The prospects of early settlement or litigation
Claims often fail not because harm did not occur, but because the defendant can demonstrate that their actions were supported by a responsible and logical body of medical opinion.
This is why early specialist legal advice is critical. Identifying appropriate experts and analysing whether their opinions withstand Bolitho scrutiny is a complex and technical process.
How Our Medical Negligence Team Applies the Bolam Test
Our specialist Medical Negligence solicitors, Dominic Jones, Amy Holt and Jennifer O’Brien, have extensive experience in analysing breach of duty under the Bolam and Bolitho principles. We work closely with leading independent medical experts to assess whether the care provided was defensible or fell below acceptable standards.
Where expert evidence does not stand up to logical analysis, we will robustly challenge it and pursue claims on behalf of patients who have suffered avoidable harm.
Summary
The Bolam test remains a cornerstone of medical negligence law, but it is no longer the unchallenged shield it once was. Through cases such as Bolitho and Montgomery, the courts have refined the balance between professional judgment and patient protection.
For patients and families, understanding how these principles operate can be the key to understanding whether negligent medical treatment can be legally challenged.
If you believe that substandard medical care has caused harm, seeking advice from experienced medical negligence solicitors is the first step towards clarity and accountability.
Contact us on 01270254064 or email us via enquiries@steplegal.co.uk to start your journey in securing justice and accountability today.
