PROFESIONALISME KEDOKTERANPENCEGAHAN DAN PEMBELAAN TUNTUTAN HUKUMDALAM KONTEKS UU PRAKTIK KEDOKTERANRadita Nur Anggraeni GintingT. Ibnu AlferralyDivisi Bioetika dan Humaniora

KETIDAKPUASAN PASIEN DAN MALPRAKTIK

ALASAN MENINGKATNYA KETIDAKPUASAN PASIENMENINGKATNYA PENDIDIKAN DAN KESADARAN ATAS HAK : ASERTIFMENINGKATNYA PENGHARAPAN ATAS HASIL TINDAKAN MEDISKOMERSIALISASI & DEPROFESIONALISASI UPAYA LAYANAN KEDOKTERANPENINGKATAN BIAYA LAYANAN : INTOLERANSI THD KETIDAKSEMPURNAANPROMOSI AHLI HUKUM & UUPKTAN S Y, 1997

Hillary 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.

Communication 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 Errors

KESALAHANdilihat dari sisi hukumSENGAJA / DOLUS:DENGAN NIAT / TUJUANDENGAN KEPASTIAN AKAN TERJADIDENGAN KEMUNGKINAN AKAN TERJADIKELALAIAN / CULPA:LATA: Gross NegligenceLEVIS: kecil

MALPRAKTEKINTENTIONAL (secara sadar)PROFESSIONAL MISCONDUCTSNEGLIGENCEMALFEASANCE, MISFEASANCE, NONFEASANCELACK OF SKILLDI BAWAH STANDAR KOMPETENSIDI LUAR KOMPETENSI

PROFESIONALISME SEBAGAI SARANA PENCEGAHAN MALPRAKTIK

PROFESIA 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.

AKUNTABILITAS 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 berintegritas

ProfessionalismProfessionalism 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

Elements 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

Elements 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"

PROFESSIONALISMTrue 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, 1997

Paul 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)

PROFESSIONALISMCOMPETENCEKNOWLEDGE AND SKILLSPHYSICAL AND MENTAL FITNESS

CONDUCT / ATTITUDEEMPATHYDUTY OF CARECOLLEGIAL RESPONSIBILITY

Threat 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.

ANCAMAN 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 lengkap

ANCAMAN 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 pasienAtau bila kedokteran melindungi anggotanya yg tidak kompeten dan tidak etis atas nama kolegialitas

Charter 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/136/3/243

Professional ResponsibilitiesCommitment to professional competenceCommitment to honestly with patientCommitment to patient confidentialityCommitment to maintaining appropriate relations with patientsCommitment to improving quality of care

Professional 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.org

Mampukah Profesionalisme mencegah malpraktik?

Professionalism

PERLUNYA PRAKTIK KEDOKTERAN DIATURETIKA PERILAKUDISIPLIN PROFESIHUKUM PUBLIK

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-histerektomi

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. APA KATA UNDANG2

ITULAH YG DISEBUT BOTTOM LINE ETHICSBELUM CUKUP UNTUK SEORANG PROFESIONAL, HARUS DITAMBAH DENGAN KEPEDULIAN KEPADA PASIEN DAN PROFESI DOKTER JANGAN MELAKUKAN:KESALAHANKELALAIANTAK SESUAI STANDAR PROFESITAK SESUAI S.O.P.MINIMAL DOKTER HARUS SEPERTI APA?

HAK DOKTERPERLINDUNGAN HUKUM SEPANJANG SESUAI STANDAR PROFESI & S.O.PMELAKSANAKAN SESUAI S.P & S.O.PMEMPEROLEH INFO YG JUJUR & LENGKAP DARI PASIEN/KELUARGAMENERIMA IMBALAN JASA

KEWAJIBAN DOKTERBERI YANMED SESUAI S.P. & SOP, SERTA KEBUTUHAN MEDIS PASIENMERUJUK BILA TAK MAMPUMERAHASIAKANPERTOLONGAN DARURAT, KECUALI BILA YAKIN ADA ORANG LAIN YG BERTUGAS DAN MAMPUMENAMBAH IPTEKDOK

HAK PASIENMEMPEROLEH PENJELASANMEMINTA PENDAPAT KEDUAMENDAPAT PELAYANAN SESUAI KEBUTUHAN MEDISMENOLAK TINDAKAN MEDISMENDAPATKAN ISI REKAM MEDIS

KEWAJIBAN PASIENBERI INFO YG LENGKAP DAN JUJURMEMATUHI NASIHAT DAN PETUNJUKMEMATUHI KETENTUAN SARKESMEMBERI IMBALAN JASA

REFORMASI PERILAKU ?KODE ETIK PROFESIPEDOMAN DISIPLIN (Perkonsil)PEDOMAN PRAKTIK YG BAIK (KKI)CHARTER ON MEDICAL PROFESSIONALISM (USA & UE)GOOD MEDICAL PRACTICE (Inggris)HUKUM ADMINISTRATIFHUKUM PIDANA

REFORMASI SISTEM ?SISTEM PENDIDIKAN KEDOKTERANSISTEM PENDIDIKAN SPESIALISASISISTEM PELAYANAN KEDOKTERAN DAN SISTEM PEMBIAYAANNYASISTEM PERIJINAN DAN PENGAWASAN SARYANKESSISTEM & BUDAYA SAFETYSISTEM PELAPORAN KASUS DAN ANALISISSISTEM PENGADUAN / KELUHAN MASYARAKAT

KESIMPULANPraktik yang baik adalah praktik yang sesuai dengan peraturan perundang-undangan:Kompeten dan berwenangSikap profesional: Sesuai etika dan standarPatuh pada disiplin profesiKepatuhan kepada Profesionalisme akan mencegah malpraktik