Presentation on theme: "Peningkatan Etika dan Profesionalisme dalam menjalankan praktek kedokteran agar terhindar dari sengketa medik PRIJO SIDIPRATOMO KETUA MKEK PUSAT."— Presentation transcript:
Peningkatan Etika dan Profesionalisme dalam menjalankan praktek kedokteran agar terhindar dari sengketa medik PRIJO SIDIPRATOMO KETUA MKEK PUSAT
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
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
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.
PERMASALAHAN YANG PALING BANYAK DIADUKAN DI INDONESIA Komunikasi Kompetensi Penelantaran Pembiayaan Ali Baziad MKDKI 2014
The four Cs of risk management Compassion. Communication Competence Charting
Compassion the feeling of empathy for others.empathy Compassion is the emotion that we feel in response to the suffering of others that motivates a desire to helpemotion
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 t he 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
Helmans Folk Model (1981) The patients 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 ThinkingMalcolm Gladwell "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).
"Interestingly, there was no difference in the amount or quality of information they gave their patients; they didnt provide more details about medication of the patients 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 didnt."
Communication and Malpractice Claims Primary Care Physicians (n = 59) VariableNo Claims (n = 29)Claims (n = 30)P- Value Visit length, min < 0.05 No. of utterances per 15-min visit: Content Asks questions- medical NS Gives information – medical NS Process: Facilitation (Physician) < 0.05 Orientation (Physician) < 0.05 Affect Laughs (Physician)4.83.4< 0.05 Laughs (Patients)7.87.5NS Source – Levinson, 1997
17 Competence 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.
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 Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. Knows Shows how Knows how Does Professional authenticity Written, Oral or Computer based assessment Performance or hands on assessment
20 Validity Climbing the Pyramid... Knows Shows how Knows how Does Knows Factual tests: MCQ, essay type, oral….. Shows how Performance assessment in vitro: OSCE, SP-based test….. Does Performance assessment in vivo: Masked SPs, Video, Audits….. Knows how (Clinical) Context based tests: MCQ, essay type, oral…..
ETIKA MENJADI LANDASAN DARI KOMPETENSI
STANDAR KOMPETENSI DOKTER TH 2012STANDAR KOMPETENSI DOKTER TH 2012
SETELAH MENJADI DOKTER
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.
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
Pasal 12Pasal 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
Pasal 14Pasal 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
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
Pasal 21 Setiap dokter wajib senantiasa mengikuti perkembangan ilmu pengetahuan dan teknologi kedokteran/ kesehatan. KODEKI
Materi Pelengkap Wajib BP2KB Dalam pelaksanaan kegiatan Ilmiah, penyelenggara wajib menyertakan 2 pokok bahasan sebanyak 1/7 waktu kegiatan. 1.Materi menyangkut Etika kedokteran 2.Materi tentang patient safety.
DAMPAK INCOMPETENCE MEDICAL ERROR PATIENT SAFETY TERANCAM TUNTUTAN DARI PATIENT TERHADAP DOKTER MENINGKAT PENINGKATAN BIAYA UNTUK PENANGANAN HUKUM
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
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
Common Charting Issues Affecting Care Patient allergies Patients current or home medications Patients 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 doesnt know who wrote it, it may be inadmissible.
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 institutions polices and procedures. Kevin P. Riché, 2009, Protecting Yourself from Medical Malpractice Claims
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 doesnt know who wrote it, it may be inadmissible.
Justice PHYSICIAN Beneficence Do no harm Autonomy BASIC OF MEDICAL ETHIC
KODEKI Kewajiban umum dokter Kewajiban dokter terhadap pasien Kewajiban dokter terhadap sejawat Kewajiban dokter terhadap diri sendiri