CLINICAL SKILL HANDOUT FORENSIC MEDICINE AND MEDICOLEGAL

Clinical Skill Lab Forensic Medicine-Medicolegal Medical Faculty of Hasanuddin University Makassar 2012

Forensic Medicine-Medicolegal

TABLE OF CONTENT

Cover Table of Content ............................................................................................. Preface ........................................................................................................... Medicolegal in Patient Care (theoritical background) ..................................... Learning Objective ......................................................................................... Learning Stretegies ........................................................................................ Reference ....................................................................................................... Preparation .................................................................................................... Evaluation ....................................................................................................... 1 2 3 5 6 6 7 8

Forensic Medicine-Medicolegal

PREFACE

This Clinical Skill Handout is for medical student in Forensic Medicine and Medicolegal. The major objective of this manual is that the student can master some major skills needed in patient care management that in line with Good Medical Practice,

We would like to appreciate to all contributors who have helped in compiling this Clinical Skill Manual .

Makassar, 1 October 2010 Coordinator of Clinical Skill Lab Forensic Medicine and Medicolegal

Forensic Medicine-Medicolegal

MEDICOLEGAL IN PATIENT CARE

Medical Indications are the facts, opinions, and interpretations about the patient's physical and/or psychological condition that provide a reasonable basis for diagnostic and therapeutic activities aiming to realize the overall goals of medicine: prevention, cure, and care of illness and injury.

Every discussion of an medicolegal problem in clinical medicine should begin with a statement of medical indications. Therefore, medical indications are those facts about the patient's physiological or psychological condition that indicate which forms of diagnostic, therapeutic, or educational interventions are appropriate. Medical Indications describe the day-to-day work of clinical care for patients diagnosing their condition and providing helpful treatments. The medicolegal principles that should govern these activities are the 4 moral principles of physician, that is respect patients autonomy, beneficence, non-maleficence and justice. The most ancient moral maxim of medicine, stated in the Hippocratic oath, is "I will use treatment to benefit the sick according to my ability and judgment but never with a view to injury and wrongdoing." Another Hippocratic imperative to physicians states, "be of benefit and do no harm" . Therefore, in medicolegal, beneficence primarily means do the best for the sake of patient, the duty to try to bring about those improvements in physical or psychological health that medicine can achieve. These objective effects of diagnostic and therapeutic actions as well as rehabilitation. Nonmaleficence means going about these activities in ways that prevent further injury or reduce its risk. In this skill training session, the attitude of doctor in patient management will be learnt. This will incorporate some major topics: 1. Four basic moral principle of physician 2. Taking Good Medical Record 3. Establishing a proper Informed Consent 4. Exercising respect for Patient Confidentiality

Forensic Medicine-Medicolegal

In addition, doctors are professional whose main objective is caring for patients health; there are ten professional responsibilities that should be noted: 1. Commitment to professional competence. 2. Commitment to honesty with patients, emphasizing both informed consent, and prompt reporting and analysis of medical error. 3. Commitment to patient confidentiality. 4. Commitment to maintaining appropriate relations with patients such as the avoidance of patient exploitation for sexual advantage, financial gain, or other private purpose. 5. Commitment to improving quality of care. 6. Commitment to improving access to care. 7. Commitment to just distribution of finite resources. 8. Commitment to scientific knowledge. 9. Commitment to maintain trust by managing conflicts of interest. 10. Commitment to professional responsibilities emphasizing the individual and collective obligations to participate in processes to improve patient care

Forensic Medicine-Medicolegal

LEARNING OBJECTIVE

General Objective After conducting the skill training, students are expected to be able to conduct taking proper medical record, informed consent and exercise to respect patients confidentiality. Above all, the four basic moral principle of physician should always be the basis in our patient care management. Spesific Objective After finishing the skills training in this manual, students are expected to be able to apply : 1. Four basic moral principle of physician 2. Good Medical Record 3. Proper Informed Consent 4. Patient Confidentiality

Forensic Medicine-Medicolegal

LEARNING STRATEGIES Instruments and Tools : Manual book of CSL for Medicolegal Standart measurement / Ruler Patient status, ballpoint Audio-visual / Camera Spygmomanometer Stetoscope Patient Scenario

Learning Method : 1. Observation on the play 2. Discusssion 3. Active participation (simulation) 4. Evaluation using check list

References Beauchamp TL, Childress JF. Chapter. In: Beauchamp TL, Childress JF, eds. Principles of Biomedical Ethics. 6th ed. New York, NY: Oxford University Press; 2009:140186; 197239. Brennan T, Blank L, Cohen J, et al. Medical professionalism in the new millennium: a physician charter. Ann Int Med 2002; 136:243246.

Forensic Medicine-Medicolegal

PREPARATION Prepare the room used for role play The setting used was a GP ( General Practicioner) office with three patients already seated inside the room waiting for the doctor Brief the patient about their scenario Instruct the other student to observe the play and to take note if necessary Instruction for the patient Play accordingly to the scenario provided for each patient When the doctor is conducting history taking and the scenario does not contained the solution, the patient is allowed to improvised Instruction for the doctor Play as a doctor taking the patient history as already been teached in previous major (system) Instruct the doctor to enter the room prepared and thus begin the play

Forensic Medicine-Medicolegal

Evaluation No 1 Activity Greet the patient, introduce self to the patient

Ask two of the other patient to wait outside the examination room (patient confidentiality; nonmaleficence; justice)

Take consent from the patient after informed the patient the purpose of the history taking and examination afterward (informed consent; autonomy)

Start the history taking properly (beneficence) and fill the medical record provided accordingly (medical record)

Chek the patient vital status (informed consent; autonomy; beneficence)

Made the working diagnosis based on the history taking result and vital status (beneficence; nonmaleficence) TOTAL 0 1 2 : not performed : performed but not perfect / complete : perfectly performed