PROFESIONALISME

KEDOKTERAN
PENCEGAHAN DAN PEMBELAAN TUNTUTAN HUKUM
DALAM KONTEKS UU PRAKTIK KEDOKTERAN
Radita Nur Anggraeni Ginting
T. Ibnu Alferraly
Divisi Bioetika dan Humaniora
KETIDAKPUASAN
PASIEN DAN
MALPRAKTIK
ALASAN MENINGKATNYA
KETIDAKPUASAN PASIEN
MENINGKATNYA 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 & 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.
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. )


Most Common Root Causes of Medical Errors
KESALAHAN
dilihat dari sisi hukum
SENGAJA / DOLUS:
DENGAN NIAT / TUJUAN
DENGAN KEPASTIAN AKAN TERJADI
DENGAN KEMUNGKINAN AKAN
TERJADI
KELALAIAN / CULPA:
LATA: Gross Negligence
LEVIS: kecil
MALPRAKTEK
INTENTIONAL (secara sadar)
PROFESSIONAL MISCONDUCTS
NEGLIGENCE
MALFEASANCE, MISFEASANCE,
NONFEASANCE
LACK OF SKILL
DI BAWAH STANDAR KOMPETENSI
DI LUAR KOMPETENSI
PROFESIONALISME
SEBAGAI SARANA
PENCEGAHAN MALPRAKTIK
PROFESI
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 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 SOSIAL
The 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
integrity
Cruess 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
finansialnya
Dan sebaliknya profesi harus menjamin
kompetensi mereka, memberikan layanan
yang altruistik, berperilaku yang bermoral dan
berintegritas
Professionalism
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
Elements of
Professionalism
Altruism 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
Professionalism
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"
PROFESSIONALISM
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. Its a description you hope
others will apply to you
Maister DH: True Professionalism, The Free Press, 1997
Paul Starr: Professionalism
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)
PROFESSIONALISM
COMPETENCE
KNOWLEDGE AND
SKILLS
PHYSICAL AND
MENTAL FITNESS

CONDUCT /
ATTITUDE
EMPATHY
DUTY OF CARE
COLLEGIAL
RESPONSIBILITY

Threat of Professionalism
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.
ANCAMAN PROFESIONALISME
DI INDONESIA
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
ANCAMAN PROFESI KEDOKTERAN =
PUBLIC MISTRUST
public 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
kolegialitas
Charter on
Medical Professionalism
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
Professional
Responsibilities
Commitment to professional competence
Commitment to honestly with patient
Commitment to patient confidentiality
Commitment to maintaining appropriate
relations with patients
Commitment to improving quality of care
Professional
Responsibilities
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
Mampukah
Profesionalisme
mencegah malpraktik?
Altruism
Accountability
Excellence
Duty
Honor and
Integrity
Respect for
others
Professionalism
PERLUNYA PRAKTIK
KEDOKTERAN DIATUR
ETIKA PERILAKU
DISIPLIN PROFESI
HUKUM PUBLIK
Paul Barach, MD, MPH, Univ of Miami Medical School
Eh disini tertulis bahwa
kejadian kesalahan medis di
rumah sakit ini sangat tinggi
Oh, 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 ETHICS
BELUM CUKUP UNTUK SEORANG PROFESIONAL,
HARUS DITAMBAH DENGAN KEPEDULIAN
KEPADA PASIEN DAN PROFESI
DOKTER JANGAN MELAKUKAN:
KESALAHAN
KELALAIAN
TAK SESUAI STANDAR PROFESI
TAK SESUAI S.O.P.
MINIMAL DOKTER HARUS
SEPERTI APA?
HAK DOKTER
PERLINDUNGAN HUKUM SEPANJANG
SESUAI STANDAR PROFESI & S.O.P
MELAKSANAKAN SESUAI S.P & S.O.P
MEMPEROLEH INFO YG JUJUR &
LENGKAP DARI PASIEN/KELUARGA
MENERIMA IMBALAN JASA
KEWAJIBAN DOKTER
BERI YANMED SESUAI S.P. & SOP,
SERTA KEBUTUHAN MEDIS PASIEN
MERUJUK BILA TAK MAMPU
MERAHASIAKAN
PERTOLONGAN DARURAT, KECUALI
BILA YAKIN ADA ORANG LAIN YG
BERTUGAS DAN MAMPU
MENAMBAH IPTEKDOK
HAK PASIEN
MEMPEROLEH PENJELASAN
MEMINTA PENDAPAT KEDUA
MENDAPAT PELAYANAN SESUAI
KEBUTUHAN MEDIS
MENOLAK TINDAKAN MEDIS
MENDAPATKAN ISI REKAM MEDIS
KEWAJIBAN PASIEN
BERI INFO YG LENGKAP DAN JUJUR
MEMATUHI NASIHAT DAN PETUNJUK
MEMATUHI KETENTUAN SARKES
MEMBERI IMBALAN JASA
REFORMASI PERILAKU ?
KODE ETIK PROFESI
PEDOMAN DISIPLIN (Perkonsil)
PEDOMAN PRAKTIK YG BAIK (KKI)
CHARTER ON MEDICAL
PROFESSIONALISM (USA & UE)
GOOD MEDICAL PRACTICE (Inggris)
HUKUM ADMINISTRATIF
HUKUM PIDANA
REFORMASI SISTEM ?
SISTEM PENDIDIKAN KEDOKTERAN
SISTEM PENDIDIKAN SPESIALISASI
SISTEM PELAYANAN KEDOKTERAN DAN
SISTEM PEMBIAYAANNYA
SISTEM PERIJINAN DAN PENGAWASAN
SARYANKES
SISTEM & BUDAYA SAFETY
SISTEM PELAPORAN KASUS DAN ANALISIS
SISTEM PENGADUAN / KELUHAN
MASYARAKAT
KESIMPULAN
Praktik yang baik adalah praktik yang
sesuai dengan peraturan perundang-
undangan:
Kompeten dan berwenang
Sikap profesional:
Sesuai etika dan standar
Patuh pada disiplin profesi
Kepatuhan kepada Profesionalisme akan
mencegah malpraktik