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The Four Ds of Medical negligence, Explained


Medical negligence is a thankfully rare occurrence on an individual basis – but it can happen nonetheless, and in the 2018-19 financial year alone the NHS paid out over £2.4 billion in clinical negligence compensation. If you believe you have been the victim of medical negligence, you will have to be able to prove that the so-called ‘four Ds’ of medical negligence have taken place. But what are they, and what do they mean for you? Read on to find out the four pillars of a concrete medical negligence case.

Duty of Care

Duty of care refers to the professional relationship between a healthcare-giver – whether a nurse, doctor, surgeon or technician – and their patient. Duty of care is a simple designation with more complex ramifications. Essentially, a doctor who has agreed, or ‘consented’ to provide care for you must do so effectively and knowledgeably, and if your ailment is beyond their experience they must refer you to a specialist with the requisite experience. Failure to do so is one quarter of your medical negligence case – though duty can be understood differently from practitioner to practitioner; a GP’s duty of care is less significant than that of a specialist with regard to specialist illnesses.


Dereliction is the description of the errors that may have resulted from the previous failure in duty of care. Your doctor may have misdiagnosed your illness and neglected to forward you to a relevant specialist – or even missed a diagnosis entirely, despite presenting symptoms. These are derelictions of duty, as they directly result in harm to the patient. Dereliction could also describe mistakes made in surgery or midwifery, mis-prescribing drugs and treatments or even outpatient negligence. If you can prove dereliction – on which the majority of cases are based – you may well have cause to retain the services of a medical negligence solicitor.


Damages do not concern the active failures of the practitioner or service in question, but instead the losses incurred by you as a result of their alleged negligence. These damages must be quantifiable in some way; they may include any costs incurred to correct the mistake made, from private healthcare bills down to taxi fares between otherwise avoidable appointments. If you were left disabled as a result of medical negligence, the cost of supportive materials and aids, as well as public transport, would be factored in. Damages can also include any mental illnesses resulting from the negligence, which – though difficult to put a monetary value on – can be quantified carefully with evidence, testing, and documentation of the length of time you’ve taken out of work, or that you’ve taken you to recover.

Direct Cause

The final piece of the puzzle is direct cause – that is, proving that dereliction caused you to suffer the damages outlined above. If you cannot conclusively relate failures by your caregiver to the monetary, physical and mental costs given in your negligence case, you do not have a viable case to make. This may seem like a straightforward step, but common-sense correlation will not count for much in court. If your GP prescribed the wrong medicine, which resulted in a liver injury, conclusive tests would have to illustrate that the drug caused that injury – and not hereditary illness, or self-harm.