A physician or surgeon who undertakes to render professional services must meet these requirements: (1) He must possess the degree of professional learning, skill and ability which others similarly situated ordinarily possess; (2) he must exercise reasonable care and diligence in the application of his knowledge and skill to the patient’s case; and (3) he must use his best judgment in the treatment and care of his patient. Long v. Austin, 153 N.C. 508, 69 S.E. 500; Nash *522 v. Royster, 189 N.C. 408, 127 S.E. 356; Smith v. McClung, 201 N.C. 648, 161 S.E. 91; Wilson v. Hospital, 232 N.C. 362, 61 S.E. 2d 102; Jackson v. Sanitarium, 234 N.C. 222, 67 S.E. 2d 57. If the physician or surgeon lives up to the foregoing requirements he is not civilly liable for the consequences. If he fails in anj^ one particular, and such failure is the proximate cause of injury and damage, he is liable.
The plaintiff does not contend Dr. Bradshaw was deficient, either in learning or skill, or ability as a surgeon. He does contend, however, the defendant was not reasonably careful and diligent in making use of his knowledge, skill and ability, in advising the operation, and in performing it. In particular the plaintiff contends:
1. He was free from pain, fever or other symptoms and that an operation was not necessary.
2. The operation was undertaken without adequate X-ray pictures to enable the defendant to locate with sufficient certainty the piece of steel so that it could be directly approached and removed without extensive exploratory operation and search.
3. The defendant advised the plaintiff the operation was simple, whereas it was serious and involved undisclosed risks.
In determining whether the operation should have been undertaken, resort must be had to the evidence of experts. Expert opinion must be founded upon expert knowledge. The plaintiff offered the evidence of two specialists. Dr. Marr testified: “My field is X-ray examinations. I do not specialize in or practice surgery to any major extent . . . trying to remove this missile calls for very expert ability in the field of surgery.” Dr. Marr expressed no opinion as to the advisability of the operation.
Dr. Jeffreys testified: “I think it is the usual practice to remove objects that lie in this region and have given evidence that they have penetrated tissues of vital function; and I would consider it within the realm of good surgical practice in this territory, or any other territory.” The witness did state, in response to a hypothetical question that in the absence of symptoms he would be inclined not to operate. The plaintiff, therefore, is without expert testimony to support his contention the operation should not have been undertaken. The plaintiff’s witness said the operation is in accord with good surgical practice.
The plaintiff insists the operation was undertaken without adequate X-ray photographs. He testified Dr. Bradshaw had available for use in the operation the five X-rays introduced in evidence and that at least one other was made during the course of the operation, the latter not in evidence. Dr. Jeffreys was asked a hypothetical question as to whether X-rays in addition to the five introduced in evidence would be in accordance with good surgical practice. Witness, after pointing out *523the fact he did not have the photograph taken during the operation, said: “And these X-rays show the piece of metal in the base of the neck, that it is present; there is left, perhaps, the other view, which was not present in exhibits, that is mentioned in the question . . . which gives you another dimensional view . . . But that might have been desirable, but I can’t say that it was necessary, ... I would say that more X-ray views, giving all planes, as to location, its anteroposterior location . . . would aid in giving a more . . . concise view; but it still might not locate it exactly.” When analyzed, nothing in this statement is to the effect that good surgical practice required additional X-rays.
The plaintiff’s evidence is sufficient to support a finding the operation was of a very serious nature. Dr. Bradshaw, after examination, advised the plaintiff the missile might move and get to the heart, and recommended the operation. That a sharp-edged piece of steel does migrate is borne out by plaintiff’s expert evidence, especially by Dr. Jeffreys. Upon Dr. Bradshaw’s advice the operation was decided upon. It is understandable the surgeon wanted to reassure the patient so that he would not go to the operating room unduly apprehensive. Failure to explain the risks involved, therefore, may be considered a mistake on the part of the surgeon, but under the facts cannot be deemed such want of ordinary care as to import liability.
Proof of what is in accord with approved surgical procedure and what constitutes the standard of care required of the surgeon in performing an operation, like the advisability of the operation itself, are matters not within the knowledge of lay witnesses but must be established by the testimony of qualified experts. When the standards have been thus established, lay testimony may be sufficient to enable the jury to determine whether these standards were followed with ordinary care and •diligence. Smith v. Wharton, 199 N.C. 246, 154 S.E. 12.
Plaintiff’s expert testimony is sufficient to justify the finding the injury and damage to plaintiff’s hand and arm resulted from the operation. But, as in cases of ordinary negligence, the fact that injury results is not proof the act which caused it was a negligent act. The doctrine res ipsa loquitur does not apply in cases of this character. McLeod v. Hicks, 203 N.C. 130, 164 S.E. 617. In the case of Smith v. McClung, supra, Justice Brogden, quoting from Ewing v. Goode, 78 Fed. 442, said: “A physician is not a warrantor of cures. If the maxim ‘res ipsa loquitur’ were applicable to a case like this, and a failure to cure were held to be evidence, however slight, of negligence on the part of the physician or surgeon causing the bad result, few would be courageous ■enough to practice the healing art, for they would have to assume finan•cial liability for nearly all the ‘ills that flesh is heir to.’ ”
*524Of course, it seems hard to the patient in apparent good health that he should be advised to undergo an operation, and upon regaining consciousness finds that he has lost the use of an arm for the remainder of his life. Infallibility in human beings is not attainable. The law recognizes, and we think properly so, that the surgeon’s hand, with its skill and training, is, after all, a human hand, guided by a human brain in a procedure in which the margin between safety and danger sometimes measures little more than the thickness of a sheet of paper.
The plaintiff’s case fails because of lack of expert testimony that the defendant failed, either to exercise due care in the operation, or to use his best judgment in advising it. As was said in Smith v. Wharton, supra, “There can be no other guide. And where want of skill and attention is not thus shown by expert evidence applied to the facts, there is no evidence of it proper to be submitted to the jury.”
The judgment of nonsuit entered in the Superior Court is