For medical negligence or deviation from the standard of care to be established, the patient must be able to prove the presence of the four Ds

1. Duty,
2. Dereliction,
3. Damage, and
4. Direct cause

Duty: The patient must be able to prove that there existed a patient-physician relationship and the physician owed a duty to a patient.

Dereliction: The patient must be able to prove with evidence that the physician failed to comply with the standards expected of his profession.

Damage: That the physicians breach of duty has led them to suffer injury, either physical or emotional.

Direct cause: The patient should be able prove that the physician is directly related to any injury they suffered.