Intended for healthcare professionals

Observations Ethics Man

How good a doctor do you need to be?

BMJ 2012; 345 doi: (Published 21 November 2012) Cite this as: BMJ 2012;345:e7858
  1. Daniel K Sokol, barrister and honorary senior lecturer in medical ethics, Imperial College London
  1. daniel.sokol{at}

If doctors have a duty of care, they must act with adequate skill. But what does that actually mean?

In 1954 John Bolam was a psychiatric patient at the now defunct Friern Hospital, London. To treat his depression the medical team administered electroconvulsive therapy, a relatively new treatment at the time. As they did not give Bolam a relaxant drug before the treatment, nor adequately restrained him during it, he sustained fractures of the pelvis. In his directions to the jury, the judge in a trial of the medical team stated the principle now widely known as the Bolam test: “A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.”1

After retiring for 40 minutes the jury found that the medical team had not been negligent.

The Bolam test applies not only to treatment but also to diagnosis, advice, and the provision …

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