Presentation on theme: "PRIJO SIDIPRATOMO KETUA MKEK PUSAT"— Presentation transcript:
1PRIJO SIDIPRATOMO KETUA MKEK PUSAT Peningkatan Etika dan Profesionalisme dalam menjalankan praktek kedokteran agar terhindar dari sengketa medikPRIJO SIDIPRATOMOKETUA MKEK PUSAT
2Sengketa medikSengketa 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
3Padahal 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
4Why 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 manner5. Negligent drug treatment.6. Negligent procedures.7. Failure to obtain informed consent.
5PERMASALAHAN YANG PALING BANYAK DIADUKAN DI INDONESIA KomunikasiKompetensiPenelantaranPembiayaanAli Baziad MKDKI 2014
6The four Cs of risk management Compassion.CommunicationCompetenceCharting
7Compassion 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
8Compassionate Example A person who is compassionate is ethical and genuinely concerned with the welfare of other people.
9Compassionate Example A person who is compassionate shows that he/she cares about other people.
10Effective Communication Definition:The means through which people exchange information, feelings, and ideas with each other.
11Consultation 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.
12Communication skills Some techniques Developed fluent dialogue with patientUsed silence effectively, allowing patient enough time to express thoughts or feelingsActively encouraged patient through use of supportive words or commentsDialogue with patient was enhanced by effective use of non-verbal behaviourUsed open, exploratory questions – inviting patient to become actively involvedAdjusted language as appropriate, to suit particular needs of the situation
13Helman’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?
14From 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."
16Communication and Malpractice Claims Facilitation = asking the patient for an opinion, asking the patient for understanding, paraphrasing and interpretingOrientation = instructions regarding the medical visit process and transitional statementsCommunication and Malpractice ClaimsPrimary Care Physicians (n = 59)VariableNo Claims (n = 29)Claims (n = 30)P- ValueVisit length, min18.315.0< 0.05No. of utterances per 15-min visit:ContentAsks questions- medical16.9NSGives information – medical28.526.3Process:Facilitation (Physician)19.411.9Orientation (Physician)14.511.2AffectLaughs (Physician)4.83.4Laughs (Patients)7.87.5Source – Levinson, 1997
17CompetenceDebate 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 doingPerformance - what the person does in his or her day-to-day practiceOne needs to be competent in order to assess competence; professionals need to be assessed by professionals.
18Competence develops along a continuum is more than knowledge and skill is more than just knowing the rulesIs a habitDoes competence = excellence?
19A Simple Model of Competence Professional authenticityPerformance or hands on assessmentDoesShows howWritten, Oral orComputer based assessmentKnows howKnowsMiller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.19
20Validity Climbing the Pyramid . . . DoesPerformance assessment in vivo:Masked SPs, Video, Audits…..DoesShows howPerformance assessment in vitro:OSCE, SP-based test…..Shows howKnows how(Clinical) Context based tests:MCQ, essay type, oral…..Knows howKnowsFactual tests:MCQ, essay type, oral…..Knows20
27KEWAJIBAN UMUMPasal 2Seorang dokter wajib selalu melakukan pengambilan keputusan profesional secara independen, dan mempertahankan perilaku profesional dalam ukuran yang tertinggi.Pasal 3Dalam melakukan pekerjaan kedokterannya, seorang dokter tidak boleh dipengaruhi oleh sesuatu yang mengakibatkan hilangnya kebebasan dan kemandirian profesi.
28Pasal 8Seorang 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
29Pasal 12Dalam 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
30Pasal 14Seorang 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 ituKODEKI
31Pasal 17Setiap dokter wajib melakukan pertolongan darurat sebagai suatu wujud tugas perikemanusiaan, kecuali bila ia yakin ada orang lain bersedia dan mampu memberikannya.KODEKI
32Pasal 21Setiap dokter wajib senantiasa mengikuti perkembangan ilmu pengetahuan dan teknologi kedokteran/ kesehatan.KODEKI
33Materi Pelengkap Wajib BP2KB Dalam pelaksanaan kegiatan Ilmiah, penyelenggara wajib menyertakan 2 pokok bahasan sebanyak 1/7 waktu kegiatan.Materi menyangkut Etika kedokteranMateri tentang patient safety.
34DAMPAK INCOMPETENCE MEDICAL ERROR PATIENT SAFETY TERANCAM TUNTUTAN DARI PATIENT TERHADAP DOKTER MENINGKATPENINGKATAN BIAYA UNTUK PENANGANAN HUKUM
35Which patients are most at risk of medication error? patients on multiple medicationspatients with another condition, e.g. renal impairment, pregnancypatients who cannot communicate wellpatients who have more than one doctorpatients who do not take an active role in their own medication usechildren and babies (dose calculations required)
36In what situations are staff most likely to contribute to a medication error? inexperiencerushingdoing two things at onceinterruptionsfatigue, boredom, being on “automatic pilot” leading to failure to check and double-checklack of checking and double checking habitspoor teamwork and/or communication between colleaguesreluctance to use memory aids
37CHARTINGthe 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
38What 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
39Common Charting Issues Affecting Care Look at these records and orders in light of each other.Patient allergiesPatient’s current or home medicationsPatient’s medical historyMedication orders: amount, method, time
40Be ThoroughEvery 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.
41Timing, timing, timingBe 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
42Be ThoroughEvery 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.
43BASIC OF MEDICAL ETHIC Autonomy Beneficence Do no harm Justice PHYSICIANDo no harmJustice
44Kewajiban dokter terhadap pasien Kewajiban dokter terhadap sejawat KODEKIKewajiban umum dokterKewajiban dokter terhadap pasienKewajiban dokter terhadap sejawatKewajiban dokter terhadap diri sendiri