Whether a doctor’s conduct is reasonable or negligent is tested by comparing it with what would be expected of a reasonable doctor in the circumstances. The test does not expect the doctor to have the highest level of skill and expertise but rather the general level of skill and diligence possessed and exercised at the time by members of the branch of the profession to which the practitioner belongs (Van Wyk v Lewis).
Whilst predominantly objective, the test does take into account the subjective attributes of the doctor in question, in particular their own level of skill and expertise.
In Louw v Patel, the general practitioner concerned had to weigh the urgency of attending to a patient requiring an appendectomy or another requiring transfer to a higher level of care for a vascular injury caused by a gunshot wound to the leg. The evidence of an expert witness appointed by the doctor was that general practitioners do not undergo triage training. The implication of this evidence was that the reasonableness of the doctor’s conduct in weighing the urgency of the two patients’ cases as a general practitioner should be tested accordingly.
However, the court decisively had regard to the particular level of skill and expertise of the individual doctor, who was a highly experienced general practitioner, frequently performing general surgery and holding numerous degrees, including a Master’s degree. Further, he conducted continuing medical education courses for other medical practitioners and had worked in a hospital trauma unit for a decade.
The doctor was accordingly found to have been negligent in failing to prioritise the urgent transfer of the patient with the vascular injury and instead proceeding with the other patient’s appendectomy. The court determined that this negligence on the part of the doctor, together with his failure to ensure that the patient with the vascular injury was transferred to a hospital with the appropriate level of care, caused the compromise of the patient’s leg and an amputation below the knee.