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What Are the 4 D’s of Medical Malpractice?

Medical malpractice is a term that encompasses the many different scenarios in which a doctor, medical professional, or healthcare worker fails to provide appropriate treatment, gives substandard treatment, or omits an appropriate action, and this leads to treatment that causes the patient to experience harm, injury, or even death.

Unfortunately, these events are not rare. Some of the most common causes of malpractice suits against physicians are:

  • Failure to diagnose in a timely manner
  • Misdiagnoses
  • Unnecessary surgery
  • Failure to order necessary tests
  • Mistakes in medications, either in dosage, contraindications, or prescriptions
  • Failure to take a proper patient history and therefore missing complications
  • Leaving surgical equipment inside the body after a procedure
  • Using improperly sanitized equipment or tools
  • Mistakes made during childbirth that could cause lack of oxygen or injury to the baby

To determine what does and does not count as medical malpractice, legal experts have developed an effective system for evaluating claims. These are called “The Four D’s of Medical Malpractice.”

When these four criteria are met, we know that a medical malpractice event has occurred and it is appropriate to pursue damages.

The 4 D’s are: Duty, Deviation, Direct Cause, and Damages. Let’s break down these four different categories in order to understand what each one means and how it relates to medical malpractice lawsuits.


Does every doctor have a duty to provide medical care to every person they meet? We can all understand why the answer is “no.” A doctor is not required to treat every person they encounter, even if the person is in need of medical treatment. For example, imagine that a person is sitting at a wedding reception and shares a recent list of medical concerns with a doctor who is seated at the same table. Is that doctor obligated by duty to provide medical care for their fellow wedding guests? Of course not.

That physician cannot be held responsible for failing to diagnose or provide treatment for the individual they’re talking with. However, what if that individual made an appointment to see their physician, shared the exact same concerns, and was greeted with indifference? What if their physician didn’t take their concerns seriously and therefore didn’t schedule the appropriate tests and screening procedures?

If that patient later discovered that they had a condition that had become worse because it hadn’t been caught in time, they may have a medical malpractice scenario on their hands.

Medical professionals have a duty to treat their own patients, with whom they have already established a patient/provider relationship. The “standard of care” is a phrase that is accompanied by years of legal interpretation, but is generally agreed upon to mean: “care and treatment with the degree of skill, care, and diligence as possessed by or expected of a reasonably competent physician under the same or similar circumstances.”


Once it has been established that the physician had a duty to provide an appropriate standard of care, the next test is to answer the question of deviation: did the provider deviate from their duty?

This can be tricky because each individual could have a different interpretation of what is a deviation from duty and what isn’t. These questions can help a patient, lawyer, or judge determine if deviation occurred:

  1. Did the doctor fail to act in a way that aligns with the best practices in their field?
  2. Would a doctor in the same field, in the same circumstances, have responded differently?
  3. Is it reasonable to believe that any reasonable doctor would not have acted the same way?

Essentially, this process is about demonstrating that medical negligence occurred because the provider failed to provide treatment that any other reasonable provider would have done in similar circumstances.

This does not mean that your doctor has to make a perfect choice, 100% of the time. It means that your doctor’s performance should be in line with the industry’s standard practices.

Direct Cause

Going through your medical records and finding mistakes or misjudgments is not the way to prove that medical malpractice has occurred. For example, imagine that a doctor forgot to put in orders for a routine test based on your age or medical history. A week later, you realize the mistake and call her office. She agrees that it was an oversight, orders the screening test, and you are able to get your bloodwork done. Good news: you are healthy, and the screening comes back clean.

Did your doctor make a mistake in forgetting to schedule the routine test? Yes, it could be argued that she did. But she did not directly cause any medical issue for you. You have not suffered injury, illness, or death because of her misstep. This would be an inappropriate reason to seek a medical malpractice suit against her.

In contrast, what if she ignored the gold standard of recommending a certain test based on your age, and the next year, after you experience symptoms of a problem, you get diagnosed with something that has gotten much worse over the last year because it was undetected? This would be a situation where the doctor’s oversight may have had a direct causal effect on your health.

Proving direct cause is about determining that the actions of the provider had a definitive impact on your health, safety, or well-being.


If a provider had a duty to treat you, but they deviated from that duty and directly caused you harm, you may have experienced damages.

Damages can be physical harm, mental harm, or both. It’s also not uncommon for financial damages to be considered; if medical malpractice led you to miss work or owe additional medical debts, those damages need to be addressed.

Damages can be proven by medical records, receipts, and prescriptions, as well as personal testimony.

What can you do if you have been affected by medical malpractice?

If you suspect that you’re the victim of medical malpractice,  we are here to help. McCoy & Sparks is a law firm dedicated to helping anyone in Central Kentucky who has suffered from an unjust injury.

When you trust us with your case, we work tirelessly to get you the result you deserve. Contact Us for a risk-free consultation or call 844-4KYWINS