¶1dissenting.
¶2I respectfully dissent because the instruction given to the jury on the elements of negligence was not misleading. The charge correctly sets forth the requirements that a negligence plaintiff demonstrate a legal duty on the part of the defendant, the defendant’s breach of that duty, a causal connection between such breach and the resulting injury, and damage to the plaintiff. Johnson v. American Nat. Red Cross, 276 Ga. 270, 272 (1) (578 SE2d 106) (2003); Johnson v. American Nat. Red Cross, 253 Ga. App. 587, 591 (2) (569 SE2d 242) (2002). While there is no requirement or recommendation that a trial court instruct the jury to consider the elements of negligence in any particular order, there is no error, much less harmful error, in doing so in this case.
¶3The majority’s finding that the instruction is fatally misleading is based upon the faulty conclusion that the jury was precluded from giving “proper consideration to the totality of the facts and circumstances relevant to its ultimate determination.” This conclusion is premised upon the finding that there was evidence that the plaintiff experienced a “bad result.” The majority gives lip service to the important legal principle that the fact that the plaintiff suffers from certain medical conditions, namely bladder failure and “saddle numbness” fails to raise even the presumption of the defendant doctor’s lack of proper care, skill, or diligence. But in reality, it is implicit in the majority approach that the fact that a plaintiff has had a less-than-satisfactory outcome following medical treatment establishes professional negligence. Even when the evidence portrays a “bad result,” it must still be measured by the method shown by medical witnesses to be negligence. Kapsch v. Stowers, 209 Ga. App. 767, 769 (434 SE2d 539) (1993).
“Res ipsa loquitur is not applicable in medical malpractice *658cases in Georgia. Tn a medical malpractice case, “the general rule is that medical testimony must be introduced to inform the jurors what is a proper method of treating the particular case. ‘The . . . jury must have a standard measure which they are to use in measuring the acts of the doctor in determining whether he exercised a reasonable degree of care and skill.’ ” (Cits.)’ Horney v. Lawrence, 189 Ga. App. 376, 377 (2) (375 SE2d 629) (1988). Expert testimony must also set forth how or in what way the defendant deviated from the parameters of the acceptable professional conduct. Loving v. Nash, 182 Ga. App. 253 (1) (355 SE2d 448) (1987).” Austin v. Kaufman, 203 Ga. App. 704, 705 (1) (417 SE2d 660) (1992).
¶4Kapsch v. Stowers at 767 (1). Thus, it is inescapable that the jury consider the applicable standard of care and any departure of the defendant from it for such deviation is the gravamen of a cause of action for medical negligence. Were it otherwise, the jury would be authorized to return a verdict of liability based solely upon the sympathetic circumstances of medical treatment of the plaintiff by the defendant and resulting damage to the plaintiff.
¶5The majority states that its holding does not conflict with the well-settled principle that the doctrine of res ipsa loquitur is not applicable in medical malpractice cases. But of course it does. The majority casts itself in the role of the jury when it focuses on certain expert testimony that the “bad result” suffered by the plaintiff is a condition brought about by the defendant’s negligent administration of spinal injections. Even so, the majority acknowledges that the condition suffered must result from “a physician’s failure to adhere to the degree of care and skill used by the profession generally.” Thus, we are back to the gravamen of medical negligence. The jury simply must consider the critical question of whether there was any deviation from the professional standard, which was the focus of the methodical charge in this case.
¶6Perhaps what is most puzzling about the majority opinion is its inherent contradiction. Without any legal support whatsoever, the majority states, “a trial court should not instruct the jury that, in determining whether the plaintiff has met the burden of proving that the defendant’s negligence was a proximate cause of the injury, it must address the various elements in a set order.” However, the majority opinion itself effectively selects a particular element of negligence as preeminent, for the whole focus of the majority opinion is the element of proximate cause.
¶7This Court must examine the totality of the instructions to the jury in determining whether the charge in question is misleading. *659Ricketts v. State, 276 Ga. 466, 473 (6) (579 SE2d 205) (2003). Here, the jury was not precluded in any way from considering evidence, circumstantial or otherwise, of the plaintiff’s “bad result.” It was merely instructed to follow the law and measure such evidence in light of the applicable standard of care. It did so, and returned a verdict in favor of the defendant physician. There is no legal basis to reverse the Court of Appeals’s affirmance of the judgment entered on that verdict.
¶8I am authorized to state that Chief Justice Fletcher joins in this dissent.