PROFESIONALISME

KEDOKTERAN
T. Ibnu Alferraly, dr. SpPA - Aliandri, dr. SpTHT
Divisi Bioetika-Humaniora-Medikolegal-Profesionalisme
MEU FKUSU
2012

SISTEMATIKA
Meninjau

kembali malpraktik dan

ketidakpuasan pasien

Pemahaman

profesionalisme
sebagai sarana pencegahan
malpraktik

UU

praktik kedokteran
menunjang profesionalisme

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.

Human Factors
Tidak
Etis
Kompetensi
Kelalaian
Perhatian
Violation
KETIDAKPUASAN
KTD

Informasi
Organisasi

Mahal
Fasilitas
Sistem

Multi-Causal Theory Swiss Cheese

diagram (Reason, 1991)

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. )

KESALAHAN
dilihat dari sisi hukum
SENGAJA

/ DOLUS:

Dengan niat / tujuan

Dengan kepastian akan terjadi
Dengan kemungkinan akan terjadi
KELALAIAN

LATA
LEVIS

/ CULPA:

: Gross Negligence
: kecil

MALPRAKTEK
INTENTIONAL

(secara sadar)

PROFESSIONAL MISCONDUCTS
NEGLIGENCE

MALFEASANCE, MISFEASANCE,
NONFEASANCE
LACK

OF SKILL

DI BAWAH STANDAR KOMPETENSI

DI LUAR KOMPETENSI

PROFESSIONAL MISCONDUCT
PELANGGARAN

DISIPLIN PROFESI

Pelanggaran standar secara sengaja

(Deliberate Violation)
PELANGGARAN PERILAKU PROFESI

PIDANA

UMUM:

Pembohongan (fraud / misrepresentasi)

Keterangan palsu
Penahanan pasien
Buka rahasia kedokteran tanpa hak
Aborsi ilegal
Euthanasia
Penyerangan seksual

LACK OF SKILL
KOMPETENSI

KURANG ATAU DI LUAR

KOMPETENSI / KEWENANGAN
Sering menjadi penyebab error atau
kelalaian
Sering dikaitkan dengan kompetensi
institusi
Kadang dapat dibenarkan pada situasikondisi lokal tertentu (locality rule, limited
resources)

Tuntutan

dapat berupa kelalaian

KELALAIAN MEDIK
Jenis

tuntutan yg tersering

Bukan
Tidak

kesengajaan

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

PROFESIONALISME
SARANA PENCEGAHAN
MALPRAKTIK

SEBAGAI

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
Kontrak

The contract
between
professions
antara
kelompok
profesiand

dengan
umum.
society ismasyarakat
relatively simple.

diberi monopoli
dalam
Profesi
The professions
are granted
a monopoly
menggunakan
keahliannya
dalam as
over the use of a
body of knowledge,
pelayanan kpd masyarakat, dengan
well as considerable
autonomy,
prestige,
menimbang
otonominya,
prestige
dan
and financial
rewards on the
imbalan
finansialnya
understanding
that
they will
guarantee
Dan
sebaliknya
profesi
harus
menjamin
competence,mereka,
provide altruistic
service,
kompetensi
memberikan
layanan
yang
altruistik,
berperilaku
and conduct
their
affairs with
morality and
yang
bermoral dan berintegritas
integrity
Cruess SR et al: MJA 2002 177 (4): 208-211

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

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

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
apply
to you
Maister will
DH: True
Professionalism,
The Free Press, 1997

Paul Starr: Professionalism

Cognitive

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)

PROFESSIONALISM
COMPETENCE

KNOWLEDGE AND
SKILLS
PHYSICAL AND
MENTAL FITNESS

CONDUCT

ATTITUDE
EMPATHY
DUTY OF CARE
COLLEGIAL
RESPONSIBILITY

Education & Training

Ethics - Integrity

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

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

ANCAMAN PROFESI KEDOKTERAN

= PUBLIC MISTRUST
Ketidakpercayaan
public perception
masyarakat
terjadi
that medicine

apabila
menilaiinbahwa
failedmasyarakat
to self-regulate
a wayprofesi
that
kedokteran
gagal
melakukan
swa-regulasi
can guarantee competence, and that
yang menjamin kompetensi, dan
it
put
its
own
interest
above
that
of
meletakkan kepentingannya di atas
patients and
the public
kepentingan
pasien
medicine

has protected incompetent

or unethical
colleagues
in the name
Atau
bila kedokteran
melindungi
of collegiality
anggotanya
yg tidak kompeten dan tidak
etis atas nama kolegialitas
Cruess SR et al: MJA 2002 177 (4): 208-211

Re-visiting
Meetings

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

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

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?

Professionalism
Altruism
Respect for
others

Accountability

Ethics

Competence
Honor and
Integrity

Excellence
Duty

PERLUNYA PRAKTIK
KEDOKTERAN DIATUR

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

APA KATA UNDANG2

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

MINIMAL DOKTER HARUS

SEPERTI APA?
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

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

SELAMAT BELAJAR