A medical malpractice claim is a derivative of a traditional negligence claim and therefore, a plaintiff must prove the traditional elements of negligence: (1) defendant had a duty to plaintiff; (2) defendant breached that duty; (3) defendant’s breach was the proximate cause of plaintiff’s injuries; and (4) plaintiff sustained damages.  Typically, the standard of care is whether defendant’s actions are reasonable as measured against a similar person, in similar circumstances.  However, a doctor owes a special or heightened duty of care to a patient and in medical negligence cases, expert testimony is required to inform the jury as to what a reasonably competent doctor would do in similar circumstances.  In Armacost v. Davis, a medical malpractice case, the trial court instructed the jury on the general principles of negligence in addition to the more stringent standard of care applicable to the doctor.  The doctor appealed claiming that the trial court abused its discretion in giving the general instructions and argued that giving both instructions confused the jury as to how to measure his conduct.  The highest court in Maryland opined that it was not incorrect as a matter of law to instruct the jury as the trial court did, but rather analyzed the instructions given to determine whether there was confusion or prejudice to the doctor.  The Court of Appeals found neither and affirmed the decision of the trial court.  The Court cautioned, however, that a trial court should make it clear to a jury, perhaps through transitional sentences or phrases, that the generalized instructions as to the standard of care are meant to merely preface the more customized instruction for the higher standard of care applicable to a health care professional.