Court Obstetric – Pediatric Issues: Evidence-Based Practice

The article reviews the impact (or lack of it) of Evidence-Based Practice on obstetric - pediatric jurisprudence within the remit of the Bolam test. It briefly reviews the judicial outcome of the classical 1957 Bolam v Friern Hospital Management Committee which led to the Bolam test and of the 1998 Bolitho v City & Hackney Heath Authority, leading to the Bolitho “enriching” of Bolam. Stressing that the legal standard of practice is essentially set by doctors themselves, the author raises justifiable queries, as to how the increasing importance of Evidence-Based Practice in Medicine has not induced concomitant legal modification to the Bolam test. And this, in spite of all the efforts, pushing for official guide-lines to replace Bolam. This applies, to all medical disciplines, but especially so, in the over-lapping world of two particular specialities, where obstetric action results in adverse pediatric outcome. The 2015 ruling by the UK Supreme Court of the obstetric Scottish case Nadine Montgomery Pursuer against Lanarkshire Health Board has at least and at last, provided its own challenge to at least part of the Bolam test namely that part dealing with the disclosure of important medical information to the patient. The author agrees with Badenoch, that this is highly likely to herald further challenges to the other two aspects of the Bolam test, namely 'diagnosis' and 'treatment' [1]. If and when this happens, it is more than likely that Evidence - Based Practice will come into its own rightful place in guiding future medical jurisprudence. One example of the nature of application of such jurisprudence in obstetric-pediatric issues, would be Cerebral Palsy. We speak of no small financial matters, aside from the heart-breaking nature of the human tragedy. Life care plans for severe Cerebral Palsy often exceed $20 to £30 million, and higher [2]. Keywords: OBGYN; Obstetric-pediatric litigation; Evidence-Based Practice; UK Law; Medico-legal jurisprudence; Bolam test; Bolitho test; Respectable body of professional opinion; Challenge; Vacuum; Standard of care, Defensive MedicineReview Introduction