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The Doctor Always Know Best

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The Doctor Always Know Best

Laws are created to protect all the people in society and provide fairness in judging people’s actions. That aspect is among the most important when considering the laws that govern the activities of medical practitioners and the organizations that employ them. The healthcare industry is dogged by both positive cases of healing and negative cases where the actions of medical staff, or the lack of, lead to worse outcomes. Determining the legal liability for such cases is critical for the sake of justice for all the participants. The burden of proof for medical negligence lies with the plaintiff, and the law largely favors healthcare organizations and practitioners.

Bolam Test

The Bolam test is a standard of measure established in the case Bolam v Friern Hospital Management Committee to help check the legal liability that a medical practitioner holds towards a patient. In the case, Bolam sued the doctor for not giving more warnings about the risks involved with the treatment, failing to administer a relaxant, and offering more manual restraint before the treatment1. From this case, the jury argued that since other medical practitioners considered all the doctor’s actions to be standard, the doctor could not be held liable even if the treatment outcome was harmful.

The primary argument of the court is that to determine the liability that a medical practitioner holds towards the patient, one must consider whether the actions they did were in line with the standard practice accepted by a responsible body of medical men with knowledge on the treatment of a specific ailment. Also noteworthy was that the doctor’s liability was considered by checking if the treatment outcome would have been adversely different if the doctor had taken a different course of action. That consideration is central to most of the arguments that involve checking the liability of a doctor.

In the case of Bolitho v City and Hackney Health Authority, the Bolam test was also applied to check how liable Hackney Health Authority was towards the treatment outcome. The judge in the case argued that there was negligence in not performing her duty towards the patient, but her actions were not directly the cause of the patient’s death2. As such, it was reasonable that she got considered innocent. The case went to the court of appeal, but the judge held that the Bolam test was applicable and thus the doctor was innocent. The doctor’s wrongdoing is excused because her actions did not directly lead to the patient’s death.

Legal Causation

Bolitho v City and Hackney Health Authority illustrated that even when the defendant is found guilty of some negligence, several considerations are still made that could exclude them from any liability. The first is measuring how remote the damage caused is to the various actions. The process first checks the ability to have foreseen the damage that occurred. It also checks the ability to foresee the specific level of damage even when it was foreseen3. In both cases, if it was not possible to think that such damage would occur, the case is ruled in favor of the defendants.

The second consideration checks the intervening events that can change the chain of causation. When a breach occurs, the defendant is held liable only for the effects of that specific breach4. If another event happens after the breach and leads to a worse outcome, it is notable that the defendant is considered innocent, and thus the plaintiff has to cater for the losses. Some argue that the law is biased in the defendants’ case, and all these measures are variables in the healthcare industry. It’s easy for the defense to argue their case, especially when using other medical professionals.

Proven Negligence

In a few cases where negligence has been proven, it is reasonable to say that the evidence needed needs to be broadly open and without any doubt. Lowe v Havering Hospitals NHS Trust provides an excellent example where the plaintiff was found guilty of negligence as they failed to take action that would have prevented a worse outcome for the patient. Changing medication due to the higher blood pressure could have reduced the risk of a more severe stroke5. The case indicates that the plaintiff can only be held liable when the evidence is easily measurable, and the outcome could be predicted due to many other similar cases.

Bias In Favor Of the Defendants

In the case of Maynard v West Midlands RHA, it is evident that the law has a bias in favor of the defendants. Professionals in the field gave two opposite views, which were valid. The court chose to side with the view that would have found the plaintiff guilty of negligence as it sounded more relevant based on the facts presented. However, the court of appeal argued that the trial judge could not select which view was more relevant to the case6 , essentially arguing that the plaintiffs will always be found as not liable in the case of two opposing views. The bias allows many plaintiffs to present an opposing view of the evidence in court and get away with wrongdoing. The trial judges cannot select which professional views are correct.

Wilsher v Essex AHA is another case where the plaintiff was found to have done an action that could directly have impacted the patient’s health. The patient got oxygen injected into an umbilical vein instead of an artery. The process led to retrolental fibroplasia, which resulted in blindness. The problem was not the only cause of blindness, but the defendants could not prove that any other issue the child was facing may have caused the problem. As a result, the trial judge argues that the defendants were guilty, but it is a stand that the appeals court later overturned7. The key ruling was that the onus of proof of causation rested with the plaintiff and that the defendants could not be held guilty for not proving otherwise.

In all these cases, the most common denominator is that the plaintiff is often found not to provide enough evidence to prove that there was negligence on the part of the defendants. The bar for conviction is set too high, and there are just too many issues that could lead to the plaintiff being considered innocent. In the health care industry, it is common to find that the doctor does not always know best as they are also humans that commit mistakes during their practice. However, the bar for their convictions is set too high, and all the weight of proving the negligence is placed on the plaintiff, which makes finding doctors guilty very difficult.


In conclusion, the burden of proof for medical negligence lies with the plaintiff, and the law largely favors healthcare organizations and practitioners. The idea that the doctor always knows what is best gets indirectly enforced on the masses as the previous rulings have shown that the plaintiff bears all the weight of proving the allegations they may hold. Issues such as changing causation and the measure of remoteness make it much harder to convict doctors even when they are found guilty of negligence that may have caused harm to a patient. While it is essential to give the benefit of the doubt to doctors as they work, it makes sense also to have fair rulings that hold them accountable if they are negligent.


Bolam v Friern Hospital Management Committee

Bolitho v City and Hackney Health Authority

Giliker, Tort (7th ed. 2020) Chapter 6: 6-021 to 6-035Top of FormBottom of Form

Hughes v Lord Advocate [1963] AC 837

Lowe v Havering Hospitals NHS Trust

Maynard v West Midlands RHA

Wilsher v Essex AHA

  1. Bolam v Friern Hospital Management Committee↩︎

  2. Bolitho v City and Hackney Health Authority↩︎

  3. Hughes v Lord Advocate [1963] AC 837↩︎

  4. Giliker, Tort (7th ed. 2020) Chapter 6: 6-021 to 6-035↩︎

  5. Lowe v Havering Hospitals NHS Trust↩︎

  6. Maynard v West Midlands RHA↩︎

  7. Wilsher v Essex AHA↩︎

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