Divisi Bhmp – Meu Fk Usu 2016

Divisi BHMP – MEU FK USU

2016

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Meningkatnya pendidikan dan kesadaran atas hak : asertif

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Meningkatnya pengharapan atas hasil tindakan medis

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Komersialisasi & deprofesionalisasi upaya layanan kedokteran

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Peningkatan biaya layanan : intoleransi thd ketidaksempurnaan

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Promosi ahli hukum & uupk TAN S Y, 1997

Hillary Rodham Clinton and Barack Obama : Making Patient Safety the Centerpiece of 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.

Most Common Root Causes of Medical Errors

Communication problems 1. Inadequate information flow 2. Human problems 3. Patient-related issues 4. Organizational transfer of knowledge 5. Staffing patterns/work flow 6. Technical failures 7. Inadequate policies and procedures (AHRQ Publication No. 04-RG005, December 2003. )

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SENGAJA / DOLUS: ◦ Dengan niat / tujuan ◦ Dengan kepastian akan terjadi ◦ Dengan kemungkinan akan terjadi

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KELALAIAN / CULPA: ◦ LATA ◦ LEVIS

: Gross Negligence : kecil

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“INTENTIONAL” (secara sadar) ◦ PROFESSIONAL MISCONDUCTS

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NEGLIGENCE

◦ MALFEASANCE, MISFEASANCE, NONFEASANCE

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LACK OF SKILL ◦ DI BAWAH STANDAR KOMPETENSI ◦ DI LUAR KOMPETENSI

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PELANGGARAN DISIPLIN PROFESI

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PIDANA UMUM:

◦ Pelanggaran standar secara sengaja (Deliberate Violation) ◦ PELANGGARAN PERILAKU PROFESI ◦ ◦ ◦ ◦ ◦ ◦ ◦

Pembohongan (fraud / misrepresentasi) Keterangan palsu Penahanan pasien Buka rahasia kedokteran tanpa hak Aborsi ilegal Euthanasia Penyerangan seksual

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KOMPETENSI KURANG ATAU DI LUAR KOMPETENSI / KEWENANGAN

◦ Sering menjadi penyebab error atau kelalaian ◦ Sering dikaitkan dengan kompetensi institusi ◦ Kadang dapat dibenarkan pada situasi-kondisi lokal tertentu (locality rule, limited resources)

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Tuntutan dapat berupa kelalaian

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Jenis tuntutan yg tersering

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Bukan kesengajaan

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Tidak melakukan yg seharusnya dilakukan, melakukan yg seharusnya tidak dilakukan oleh orang2 yg sekualifikasi pada situasi dan kondisi yg identik

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A 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 selfregulation. On that view, ethics is an important descriptor for a profession, but ethics is not its essential and indispensable defining feature.

 Kontrak antarabetween kelompok profesi dengan The contract professions and

masyarakat umum. simple. society is relatively  Profesi diberi monopoli dalam menggunakan The professions are granted a monopoly keahliannya dalam pelayanan kpd masyarakat, over the use of a body of knowledge, as dengan menimbang otonominya, prestige dan well as considerable imbalan finansialnya autonomy, prestige, and financial rewards — on the  Dan sebaliknya profesi harus menjamin understanding that memberikan they will guarantee kompetensi mereka, layanan yang competence, provideyang altruistic service, altruistik, berperilaku bermoral dan and berintegritas conduct their affairs with morality and integrity

•Cruess SR et al: MJA 2002 177 (4): 208-211

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Professionalism 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

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Altruism is the essence of professionalism. The best interest of the patients, not selfinterest, 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…

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Duty 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…"

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True professionalism means the pursuit of excellence, not just competence Professionalism is predominantly an attitude, not a set of competencies A real professional is a technician who cares Professional is not a label you give yourself. It’s a description you hope others will apply to you

Maister DH: True Professionalism, The Free Press, 1997

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Cognitive knowledge, the scientific knowledge and technical dexterity 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)

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COMPETENCE ◦ KNOWLEDGE AND SKILLS ◦ PHYSICAL AND MENTAL FITNESS

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CONDUCT / ATTITUDE ◦ EMPATHY ◦ DUTY OF CARE ◦ COLLEGIAL RESPONSIBILITY

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At 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.

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Sistem Pendidikan Kedokteran yg mahal Sistem Pembiayaan yg fee for service Sistem Pelayanan Kedokteran yg for profit: komoditi ekonomi Sistem liberalisasi pengadaan obat/alkes Masyarakat yang semakin materialistik Peraturan yang tidak lengkap

 public perception that medicine to  Ketidakpercayaan masyarakat terjadifailed apabila

self-

regulate in a waybahwa that can guarantee masyarakat menilai profesi kedokteran competence, that it putyang its own interest gagal melakukanand swa-regulasi menjamin above thatdan of patients andkepentingannya the public kompetensi, meletakkan di  medicine has protected atas kepentingan pasien incompetent or unethical colleagues in the name of collegiality  Atau bila kedokteran melindungi anggotanya yg tidak kompeten dan tidak etis atas nama kolegialitas

•Cruess SR et al: MJA 2002 177 (4): 208-211

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Meetings among the European Federation of Internal Medicine, the American College of Physicians–American Society of Internal Medicine (ACP–ASIM), 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

Fundamental Principles:   

Principle of primacy of patient welfare Principle of patient autonomy Principle of social justice

Annals of Internal Medicine, Vol 136 Issue 3, 5 Feb 2002 http://www.annals.org/cgi/content/full/136/3/243

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Commitment to professional competence

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Commitment to honestly with patient

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Commitment to patient confidentiality

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Commitment to maintaining appropriate relations with patients

Commitment to improving quality of care

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Commitment to improving access to care Commitment to a just distribution of finite resources Commitment to scientific knowledge Commitment to maintaining trust by managing conflict of interest Commitment to professional responsibilities

Please visit : www.professionalism.org

Altruism Respect for others

Accountability

Honor and Integrity

Excellence Duty

ETIKA PERILAKU DISIPLIN PROFESI HUKUM PUBLIK

Eh disini tertulis bahwa kejadian kesalahan medis di rumah sakit ini sangat tinggi

Oh, pantesan, katanya gue dihisterektomi

Paul Barach, MD, MPH, Univ of Miami Medical School

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Pasal 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”.

DOKTER JANGAN MELAKUKAN:  KESALAHAN  KELALAIAN  TAK SESUAI STANDAR PROFESI  TAK SESUAI S.O.P.

ITULAH YG DISEBUT “BOTTOM LINE ETHICS” BELUM CUKUP UNTUK SEORANG PROFESIONAL, HARUS DITAMBAH DENGAN “KEPEDULIAN KEPADA PASIEN DAN PROFESI”

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Praktik yang baik adalah praktik yang sesuai dengan peraturan perundang-undangan: ◦ ◦ ◦ ◦

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Kompeten dan berwenang Sikap profesional: Sesuai etika dan standar Patuh pada disiplin profesi

Kepatuhan kepada Profesionalisme akan mencegah malpraktik