ABSTRACT
The Bolam rest of the standard of clinical care required by law appears to hinder attempts to narrow differences between customary patterns of medical practice and evidence-based praeoee. The customary care Bolam standard suffers from the possible disadvantage of lagging behind evidence-based standards, hot may carry the advantage of its safety having been tested by time and wide professional experience. Clinical guidelines designed to hasten the incorporation of evidence-based practices into routine care must be well validated in risk/benefit terms to patients, especially if the guidelines advocate treatment patterns that significantly depart from customary care. In the UK, it is unlikely that authors or sponsors of faulty guidelines will be held liable for patient injury, because the courts expect the treating clinician always to exercise appropriate discretion and judgment and not to apply advice mechanically. The legal status of recommendations contained in guidelines should be made clearer to doctors.
