1. PRIJO SIDIPRATOMO KETUA MKEK PUSAT
Peningkatan Etika dan Profesionalisme dalam menjalankan praktek kedokteran agar terhindar dari sengketa medik
PRIJO SIDIPRATOMO
KETUA MKEK PUSAT

2. Sengketa medik
Sengketa Medik adalah sengketa yang terjadi antara pasien atau keluarga pasien dengan tenaga kesehatan atau antara pasien dengan rumah sakit / fasilitas kesehatan.
Biasanya yang dipersengketakan adalah hasil atau hasil akhir pelayanan kesehatan dengan tidak memperhatikan atau mengabaikan prosesnya.
Dr.M.Nasser SpKK.D.Law, 2011

3. Padahal dalam hukum kesehatan diakui bahwa tenaga kesehatan atau pelaksana pelayanan kesehatan saat memberikan pelayanan hanya bertanggung jawab atas proses atau upaya yang dilakukan (Inspanning Verbintennis) dan tidak menjamin/ menggaransi hasil akhir (Resultalte Verbintennis).
Dr.M.Nasser SpKK.D.Law, 2011

4. Why FPs get sued 1. Failure to diagnose or a delay in diagnosis
2. Negligent maternity care practice.
3. Negligent fracture or trauma care.
4. Failure to consult in a timely manner
5. Negligent drug treatment.
6. Negligent procedures.
7. Failure to obtain informed consent.

5. PERMASALAHAN YANG PALING BANYAK DIADUKAN DI INDONESIA
Komunikasi
Kompetensi
Penelantaran
Pembiayaan
Ali Baziad MKDKI 2014

6. The four Cs of risk management
Compassion.
Communication
Competence
Charting

7. Compassion the feeling of empathy for others.
Compassion is the emotion that we feel in response to the suffering of others that motivates a desire to help

8. Compassionate Example
A person who is compassionate is ethical and genuinely concerned with the welfare of other people.

9. Compassionate Example
A person who is compassionate shows that he/she cares about other people.

10. Effective Communication
Definition:
The means through which people exchange information, feelings, and ideas with each other.

11. Consultation skills Probably the most important skill in medicine Hippocratic oath
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
All that come to my knowledge in the exercise of my profession or in the daily commerce with men, which ought I not to be spread abroad, I will keep secret and will never reveal.

12. Communication skills Some techniques
Developed fluent dialogue with patient
Used silence effectively, allowing patient enough time to express thoughts or feelings
Actively encouraged patient through use of supportive words or comments
Dialogue with patient was enhanced by effective use of non-verbal behaviour
Used open, exploratory questions – inviting patient to become actively involved
Adjusted language as appropriate, to suit particular needs of the situation

13. Helman’s “Folk Model” (1981) The patient’s perspective - what the Patient wants to know
What has happened?
Why has it happened?
Why to me?
Why now?
What would happen if nothing was done about it?
What should I do about it or whom should I consult for further help?

14. From Malcolm Gladwell's book Blink - The Power of Thinking without Thinking
"Recently the medical researcher Wendy Levinson recorded hundreds of conversations between a group of physicians and their patients. Roughly half of the doctors had never been sued. The other half had been sued at least twice, and Levinson found that just on the basis of those conversations, she could find clear differences between the two groups
"The surgeons who had never been sued spent more than three minutes longer with each patient than those who had been sued did (18.3 minutes versus 15 minutes).

15. "Interestingly, there was no difference in the amount or quality of information they gave their patients; they didn’t provide more details about medication of the patient’s condition. The difference was entirely in how they talked to their patients.
She had judges rate the slices of garble for such qualities as warmth, hostility, dominance, and anxiousness, and she found that by using only those ratings, she could predict which surgeons got sued and which ones didn’t."

16. Communication and Malpractice Claims
Facilitation = asking the patient for an opinion, asking the patient for understanding, paraphrasing and interpreting
Orientation = instructions regarding the medical visit process and transitional statements
Communication and Malpractice Claims
Primary Care Physicians (n = 59)
Variable
No Claims (n = 29)
Claims (n = 30)
P- Value
Visit length, min
18.3
15.0
< 0.05
No. of utterances per 15-min visit:
Content
Asks questions- medical
16.9 NS
Gives information – medical
28.5
26.3
Process:
Facilitation (Physician)
19.4
11.9
Orientation (Physician)
14.5
11.2
Affect
Laughs (Physician)
4.8
3.4
Laughs (Patients)
7.8
7.5
Source – Levinson, 1997

17. Competence
Debate about performance and competence:
Lay input can be helpful but non-professionals are not able judge professional behaviours. Checklists are only part of the process.
The acquisition of knowledge, skills and abilities at a level of expertise sufficient to be able to perform in an appropriate work setting (Harvey 2004)
Competence - what the person is capable of doing
Performance - what the person does in his or her day-to-day practice
One needs to be competent in order to assess competence; professionals need to be assessed by professionals.

18. Competence develops along a continuum is more than knowledge and skill
is more than just knowing the rules
Is a habit
Does competence = excellence?

19. A Simple Model of Competence
Professional authenticity
Performance or hands on assessment
Does
Shows how
Written, Oral or
Computer based assessment
Knows how
Knows
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. 19

20. Validity Climbing the Pyramid . . .
Does
Performance assessment in vivo:
Masked SPs, Video, Audits…..
Does
Shows how
Performance assessment in vitro:
OSCE, SP-based test…..
Shows how
Knows how
(Clinical) Context based tests:
MCQ, essay type, oral…..
Knows how
Knows
Factual tests:
MCQ, essay type, oral…..
Knows 20

21. ETIKA MENJADI LANDASAN DARI KOMPETENSI

22. STANDAR KOMPETENSI DOKTER TH 2012

26. SETELAH MENJADI DOKTER

27. KEWAJIBAN UMUM
Pasal 2
Seorang dokter wajib selalu melakukan pengambilan keputusan profesional secara independen, dan mempertahankan perilaku profesional dalam ukuran yang tertinggi.
Pasal 3
Dalam melakukan pekerjaan kedokterannya, seorang dokter tidak boleh dipengaruhi oleh sesuatu yang mengakibatkan hilangnya kebebasan dan kemandirian profesi.

28. Pasal 8
Seorang dokter wajib, dalam setiap praktik medisnya, memberikan pelayanan secara kompeten dengan kebebasan teknis dan moral sepenuhnya, disertai rasa kasih sayang (compassion) dan penghormatan atas martabat manusia.
KODEKI

29. Pasal 12
Dalam melakukan pekerjaannya seorang dokter wajib memperhatikan keseluruhan aspek pelayanan kesehatan (promotif, preventif, kuratif, dan rehabilitatif ), baik sik maupun psiko-sosial-kultural pasiennya serta berusaha menjadi pendidik dan pengabdi sejati masyarakat.
KODEKI

30. Pasal 14
Seorang dokter wajib bersikap tulus ikhlas dan mempergunakan seluruh keilmuan dan ketrampilannya untuk kepentingan pasien, yang ketika ia tidak mampu melakukan suatu pemeriksaan atau pengobatan, atas persetujuan pasien/ keluarganya, ia wajib merujuk pasien kepada dokter yang mempunyai keahlian untuk itu
KODEKI

31. Pasal 17
Setiap dokter wajib melakukan pertolongan darurat sebagai suatu wujud tugas perikemanusiaan, kecuali bila ia yakin ada orang lain bersedia dan mampu memberikannya.
KODEKI

32. Pasal 21
Setiap dokter wajib senantiasa mengikuti perkembangan ilmu pengetahuan dan teknologi kedokteran/ kesehatan.
KODEKI

33. Materi Pelengkap Wajib BP2KB
Dalam pelaksanaan kegiatan Ilmiah, penyelenggara wajib menyertakan 2 pokok bahasan sebanyak 1/7 waktu kegiatan.
Materi menyangkut Etika kedokteran
Materi tentang patient safety.

34. DAMPAK INCOMPETENCE MEDICAL ERROR PATIENT SAFETY TERANCAM
TUNTUTAN DARI PATIENT TERHADAP DOKTER MENINGKAT
PENINGKATAN BIAYA UNTUK PENANGANAN HUKUM

35. Which patients are most at risk of medication error?
patients on multiple medications
patients with another condition, e.g. renal impairment, pregnancy
patients who cannot communicate well
patients who have more than one doctor
patients who do not take an active role in their own medication use
children and babies (dose calculations required)

36. In what situations are staff most likely to contribute to a medication error?
inexperience
rushing
doing two things at once
interruptions
fatigue, boredom, being on “automatic pilot” leading to failure to check and double-check
lack of checking and double checking habits
poor teamwork and/or communication between colleagues
reluctance to use memory aids

37. CHARTING
the act of compiling data on clinical records or charts (computerized or paper).
The charts are updated regularly to keep physicians and other health care workers advised of changes in the patient's condition.
The data usually include fluctuations in temperature, pulse, respiration, other variable factors, and much more, including all nursing care

38. What you chart may be the first and only objective evidence of what happened.
Plaintiffs’ lawyers evaluate and plan their cases based on the strength of the medical records.
Bad charting rarely causes injuries to patients, but leads to lawsuits and can complicate otherwise defensible cases.
Kevin P. Riché, 2009, Protecting Yourself from Medical Malpractice Claims

39. Common Charting Issues Affecting Care
Look at these records and orders in light of each other.
Patient allergies
Patient’s current or home medications
Patient’s medical history
Medication orders: amount, method, time

40. Be Thorough
Every blank space is a question a plaintiffs’ lawyer will supply his own answer.
Describe what was found or reported and how. Describe what you did about it.
Use full names and titles as appropriate.
Sign it. If a court doesn’t know who wrote it, it may be inadmissible.

41. Timing, timing, timing
Be precise. Witness testimony can never recreate a sufficient timeline.
One of the most common complaints about nursing care is the time in which it took to have something done or reported.
Know your institution’s polices and procedures.
Kevin P. Riché, 2009, Protecting Yourself from Medical Malpractice Claims

42. Be Thorough
Every blank space is a question a plaintiffs’ lawyer will supply his own answer.
Describe what was found or reported and how. Describe what you did about it.
Use full names and titles as appropriate.
Sign it. If a court doesn’t know who wrote it, it may be inadmissible.

43. BASIC OF MEDICAL ETHIC Autonomy Beneficence Do no harm Justice
PHYSICIAN
Do no harm
Justice

44. Kewajiban dokter terhadap pasien Kewajiban dokter terhadap sejawat
KODEKI
Kewajiban umum dokter
Kewajiban dokter terhadap pasien
Kewajiban dokter terhadap sejawat
Kewajiban dokter terhadap diri sendiri

45. TERIMAKASIH