Dear Dr. Hemant,
There are two concepts that relate to your question - defects and defectives. A product or service can have several defects, but when we are looking at defectives either the entire product or service is defective or it is not. Not all defects get translated into defectives. From a human point of view, the following can be considered defects a) breathing too fast or too slow, heart rate too fast or too slow, c) having a temperature, d) Low hemoglobin count etc. Not all of these defects get translated into defectives. A defective could be a dead person! The definition of a defective may change from person to person. Not all of the defects become defectives. While some defects if present could directly translate into being defective.
Defectives are something that is important to the customer, while defects are something that the doctor monitors and wants to control so that if all the defects are driven down to zero, the number of defectives will also go down.
In Six Sigma, we usually work with defects rather than defectives. So, when people talk about 4 / million, what they are referring to is if there were a million opportunities for making defects, how many were actually made.
As an illustration, if we have a doctor who sees 10000 patients in a year and in each patient there are 1000 possibilities for defects. Based on medication, the doctor may be able to control/minimize/eliminate some defects while others are still there. If there are 40 defects at the end of the year, then the overall defects per million opportunities are:
DPMO = 40*1000000/(10000*1000) = 4 (4/million)
Note that this may not be the same as what the customer would experience as they usually worry about defectives rather than defects.