"Doctor knows best."\
It is a phrase we have all heard repeatedly. For some, it has stuck. For
others, it has been challenged. But what does it really mean? And why is
it wrong?
There was a time when, legally, if a doctor did something that other
responsible doctors would have done, that was enough. That was the Bolam
test. If your clinical decision was backed by a reasonable body of
medical opinion, you were protected even if someone else might have done
it differently.
The Bolam test came from a case in 1957. Bolam v Friern Hospital
Management Committee. A patient suffered fractures during
electroconvulsive therapy. The court ruled there was no negligence
because what the doctor did aligned with accepted medical practice at
the time.
In simple terms: if your peers agreed with your action, you were good.
That was the legal standard. And to be honest, that still shows up in
court today when expert witnesses are brought in to justify your
actions. But something changed about 10 years ago, and it changed
everything.
In 2015, the case of Montgomery v Lanarkshire Health Board changed the
game and shifted power from the hands of the Doctor to the hands of the
Patient, when a diabetic woman of small stature was not informed of the
risk of shoulder dystocia during vaginal birth. The baby ended up with
serious complications.
The doctor thought telling her might lead to her asking for a C-section,
which he felt was not necessary at the time, and so he did not tell her.
Therefore, she sued. And won!
The court ruled that patients are no longer passive recipients of care.
They have a right to make informed decisions about their treatment. This
was the Montgomery Standard. And it became law.
So, What's the Real Difference?
· The Bolam Test made the doctor the centre of the decision.
· The Montgomery Standard makes the patient the centre.
Instead of asking, "What would other doctors have done?"\
The question now is, "What would a reasonable patient want to know?" or
"Was the patient informed of the risk?"
Instead of hiding behind consensus or experience, the clinician must now
explain:
- What are the risks?
- What are the alternatives?
- Why am I recommending this treatment?
- What does the patient prefer?
This is This is the essence of shared decision-making, and it is the
opposite of medical dictatorship.
Something you might be thinking if you are a physio is, "why does this
matter in everyday practice and how does this concern me"? Or You might
be thinking, "But I already do this." And the truth is, maybe you do.
But ask yourself:
- When you prescribe exercises, do you explain why you chose those
ones?
- If you opt for a corticosteroid injection instead of exercises or
imaging, do you explain the reasoning?
- Do you invite the patient into the decision, or do you expect them
to just go along with your plan?
This is not about being defensive. It is about being collaborative.
Back in university, students would argue: "Who's the most powerful
person in the hospital?"\
Some said doctors. Others said nurses.
But in reality?\
It is the patient.
Their voice matters. Their consent matters. Their understanding matters.
And every decision must go through them first. If you feel a patient
would get better with exercises but the patient has opted for surgery,
who are you to come in the way of that. You goal is to ensure that they
are aware of the risk and benefits and that they are equipped to make
the right decision.
So my dear physio in clinic.
- Listen better
- Explain clearly
- Involve patients meaningfully
- Document discussions properly
- Respect patient autonomy even when their choice differs from ours
In the end, this is what good clinical care looks like:\
Doing things with the patient, not to them.
Top of Form
Subscribe to my blog and get my regular thoughts right to your email
Submit
Bottom of Form
Explore my journey as a physiotherapist leader.
[privacy policy/cookie policy](https://adebolabadiru.co.uk/policy)
© 2025. All rights reserved.
This website uses cookies to provide necessary site functionality and to
improve your experience. By using this website, you agree to our use of
cookies.
AcceptDecline
-
-
-
-
-
-
-
How Your Smile Can Put You in Trouble in Clinic
Adebola Badiru