PRAKTIK KEDOKTERAN

PROFESIONALISME KEDOKTERANT. Ibnu Alferraly, dr. SpPA - Aliandri, dr. SpTHT

Divisi Bioetika-Humaniora-Medikolegal-ProfesionalismeMEU FKUSU20121SISTEMATIKAMeninjau kembali malpraktik dan ketidakpuasan pasien

Pemahaman profesionalisme sebagai sarana pencegahan malpraktik

UU praktik kedokteran menunjang profesionalisme

2KETIDAKPUASAN PASIEN DAN MALPRAKTIK3ALASAN MENINGKATNYA KETIDAKPUASAN PASIENMeningkatnya pendidikan dan kesadaran atas hak : asertif

Meningkatnya pengharapan atas hasil tindakan medis

Komersialisasi & deprofesionalisasi upaya layanan kedokteran

Peningkatan biaya layanan : intoleransi thd ketidaksempurnaan

Promosi ahli hukum & uupkTAN S Y, 19974Hillary Rodham Clinton and Barack Obama :Making Patient Safety the Centerpieceof Medical Liability Reform(New Engl J Med 354;21 www.nejm.org May 25, 2006)

Malpractice suits often result when an unexpected adverse outcome is met with a lack of empathy from physicians and a withholding of essential information.5KETIDAKPUASANKelalaianTidak EtisMahalFasilitasSistemInformasiKompetensiKTDPerhatianViolationOrganisasiHuman Factors6Multi-Causal Theory Swiss Cheese diagram (Reason, 1991)

7Communication problems Inadequate information flow Human problems Patient-related issues Organizational transfer of knowledge Staffing patterns/work flow Technical failures Inadequate policies and procedures

(AHRQ Publication No. 04-RG005, December 2003. )

Most Common Root Causes of Medical Errors8KESALAHANdilihat dari sisi hukumSENGAJA / DOLUS:Dengan niat / tujuanDengan kepastian akan terjadiDengan kemungkinan akan terjadi

KELALAIAN / CULPA:LATA : Gross NegligenceLEVIS : kecil9MALPRAKTEKINTENTIONAL (secara sadar)PROFESSIONAL MISCONDUCTSNEGLIGENCEMALFEASANCE, MISFEASANCE, NONFEASANCELACK OF SKILLDI BAWAH STANDAR KOMPETENSIDI LUAR KOMPETENSI10PROFESSIONAL MISCONDUCTPELANGGARAN DISIPLIN PROFESIPelanggaran standar secara sengaja (Deliberate Violation)PELANGGARAN PERILAKU PROFESI

PIDANA UMUM:Pembohongan (fraud / misrepresentasi)Keterangan palsuPenahanan pasienBuka rahasia kedokteran tanpa hakAborsi ilegal EuthanasiaPenyerangan seksual11LACK OF SKILLKOMPETENSI KURANG ATAU DI LUAR KOMPETENSI / KEWENANGANSering menjadi penyebab error atau kelalaianSering dikaitkan dengan kompetensi institusi Kadang dapat dibenarkan pada situasi-kondisi lokal tertentu (locality rule, limited resources)

Tuntutan dapat berupa kelalaian12KELALAIAN MEDIKJenis tuntutan yg tersering

Bukan kesengajaan

Tidak melakukan yg seharusnya dilakukan, melakukan yg seharusnya tidak dilakukan oleh orang2 yg sekualifikasi pada situasi dan kondisi yg identik13PROFESIONALISME SEBAGAI SARANA PENCEGAHAN MALPRAKTIK14PROFESIA profession is any group sharing a special body of knowledge, standards of education and practice, professional associations, and an ethical framework based in a social contract that permits a high degree of self-regulation.

On that view, ethics is an important descriptor for a profession, but ethics is not its essential and indispensable defining feature. 15AKUNTABILITAS PROFESI DIDASARKAN PADA KONTRAK SOSIALThe contract between professions and society is relatively simple. The professions are granted a monopoly over the use of a body of knowledge, as well as considerable autonomy, prestige, and financial rewards on the understanding that they will guarantee competence, provide altruistic service, and conduct their affairs with morality and integrityCruess SR et al: MJA 2002 177 (4): 208-211 Kontrak antara kelompok profesi dengan masyarakat umum. Profesi diberi monopoli dalam menggunakan keahliannya dalam pelayanan kpd masyarakat, dengan menimbang otonominya, prestige dan imbalan finansialnyaDan sebaliknya profesi harus menjamin kompetensi mereka, memberikan layanan yang altruistik, berperilaku yang bermoral dan berintegritas16ProfessionalismProfessionalism is the basis of medicine's contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession 17Elements of ProfessionalismAltruism is the essence of professionalism. The best interest of the patients, not self-interest, is the rule. Accountability is required at many levels - to individual patients, society and the profession Excellence entails a conscientious effort to exceed normal expectations and make a commitment to life-long learning 18Elements of ProfessionalismDuty is the free acceptance of a commitment to service. Honour and integrity are the consistent regard for the highest standards of behaviour and refusal to violate ones personal and professional codes. Respect for others (patients and their families, other physicians and professional colleagues such as nurses, medical students, residents, subspecialty fellows, and self) is the essence of humanism" 19PROFESSIONALISMTrue professionalism means the pursuit of excellence, not just competenceProfessionalism is predominantly an attitude, not a set of competenciesA real professional is a technician who caresProfessional is not a label you give yourself. Its a description you hope others will apply to youMaister DH: True Professionalism, The Free Press, 199720Paul Starr: ProfessionalismCognitive knowledge, the scientific knowledge and technicaldexterity doctors possess that enables them to diagnose and treat patients.

Moral component of professionalism, which requires that the needs of patients come before the needs of the doctor.

Collegial responsibility for doctors to monitor one another and to ensure competence in the profession (peer-review) 21PROFESSIONALISMCOMPETENCEKNOWLEDGE AND SKILLSPHYSICAL AND MENTAL FITNESS

CONDUCT / ATTITUDEEMPATHYDUTY OF CARECOLLEGIAL RESPONSIBILITY

Ethics - IntegrityEducation & Training22Threat of ProfessionalismAt present, the medical profession is confronted by an explosion of technology, changing market forces, problems in health care, delivery, bioterrorism, and globalization. Physicians are experiencing frustration as changes in the health care delivery systems in virtually all industrialized countries threaten the very nature and values of medical professionalism. 23ANCAMAN PROFESIONALISME DI INDONESIASistem Pendidikan Kedokteran yg mahalSistem Pembiayaan yg fee for serviceSistem Pelayanan Kedokteran yg for profit: komoditi ekonomiSistem liberalisasi pengadaan obat/alkesMasyarakat yang semakin materialistikPeraturan yang tidak lengkap24ANCAMAN PROFESI KEDOKTERAN = PUBLIC MISTRUSTpublic perception that medicine failed to self-regulate in a way that can guarantee competence, and that it put its own interest above that of patients and the public medicine has protected incompetent or unethical colleagues in the name of collegiality Cruess SR et al: MJA 2002 177 (4): 208-211 Ketidakpercayaan masyarakat terjadi apabila masyarakat menilai bahwa profesi kedokteran gagal melakukan swa-regulasi yang menjamin kompetensi, dan meletakkan kepentingannya di atas kepentingan pasien

Atau bila kedokteran melindungi anggotanya yg tidak kompeten dan tidak etis atas nama kolegialitas25Re-visitingMeetings among the European Federation of Internal Medicine, the American College of PhysiciansAmerican Society of Internal Medicine (ACPASIM), and the American Board of Internal Medicine (ABIM) have confirmed that physician views on professionalism are similar in quite diverse systems of health care delivery 26Charter on Medical ProfessionalismFundamental Principles:Principle of primacy of patient welfarePrinciple of patient autonomyPrinciple of social justiceAnnals of Internal Medicine, Vol 136 Issue 3, 5 Feb 2002http://www.annals.org/cgi/content/full/136/3/24327Professional ResponsibilitiesCommitment to professional competenceCommitment to honestly with patientCommitment to patient confidentialityCommitment to maintaining appropriate relations with patientsCommitment to improving quality of care28Professional ResponsibilitiesCommitment to improving access to careCommitment to a just distribution of finite resourcesCommitment to scientific knowledgeCommitment to maintaining trust by managing conflict of interestCommitment to professional responsibilitiesPlease visit : www.professionalism.org29Mampukah Profesionalisme mencegah malpraktik?30ProfessionalismCompetenceEthics31PERLUNYA PRAKTIK KEDOKTERAN DIATURETIKA PERILAKUDISIPLIN PROFESIHUKUM PUBLIK32

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Paul Barach, MD, MPH, Univ of Miami Medical SchoolEh disini tertulis bahwa kejadian kesalahan medis di rumah sakit ini sangat tinggiOh, pantesan, katanya gue di-histerektomi35APA KATA UNDANG2Pasal 55 ayat (1) UU No 23 tahun 1992 tentang Kesehatan : setiap orang berhak atas ganti rugi akibat kesalahan atau kelalaian yang dilakukan tenaga kesehatan.

Pasal 50 UU No 29 tahun 2004 tentang Praktik Kedokteran : dokter dan dokter gigi berhak memperoleh perlindungan hukum sepanjang melaksanakan tugas sesuai dengan standar profesi dan standar prosedur operasional. 36ITULAH YG DISEBUT BOTTOM LINE ETHICSBELUM CUKUP UNTUK SEORANG PROFESIONAL, HARUS DITAMBAH DENGAN KEPEDULIAN KEPADA PASIEN DAN PROFESI MINIMAL DOKTER HARUS SEPERTI APA?DOKTER JANGAN MELAKUKAN:KESALAHANKELALAIANTAK SESUAI STANDAR PROFESITAK SESUAI S.O.P.37KESIMPULANPraktik yang baik adalah praktik yang sesuai dengan peraturan perundang-undangan:Kompeten dan berwenangSikap profesional: Sesuai etika dan standarPatuh pada disiplin profesi

Kepatuhan kepada Profesionalisme akan mencegah malpraktik38

Selamat belajar39