KOMITE MEDIK DALAM REALITA PRIJO SIDIPRATOMO KETUA MKEK IDI 2015-2018 DISAMPAIKAN DALAM SOSIALISASI PENEGAKAN DISIPLIN KKI 2016 HOTEL SANTIKA BEKASI 23 MEI 2016
Tugas Komite Medik Meningkatkan profesionalisme staf medis yang bekerja di RS dengan cara: a. melakukan kredensial bagi seluruh staf medis yang akan melakukan pelayanan medis di RS; b. memelihara mutu profesi staf medis; dan c. menjaga disiplin, etika, dan perilaku profesi staf medis.
Kewenangan Komite Medik Memberikan rekomendasi : 1. rincian kewenangan klinis (delineation ofclinical privilege); 2. surat penugasan klinis (clinical appointment); 3. penolakan kewenangan klinis (clinical privilege) 4. perubahan/modifikasi rincian kewenangan klinis (delineation of clinical privilege); 5. tindak lanjut audit medis 6. pendidikan kedokteran berkelanjutan 7. pendampingan (proctoring) 8. pemberian tindakan disiplin
Panitia Adhoc Pasal 14 • Dalam melaksanakan tugas dan fungsinya komite medik dapat dibantu oleh panitia adhoc. • Panitia adhoc sebagaimana dimaksud pada ayat (1) ditetapkan oleh kepala/direktur RS berdasarkan usulan ketua komite medik. • Panitia adhoc sebagaimana dimaksud pada ayat (1) berasal dari staf medis yg tergolong sbg mitra bestari. • Staf medis yg tergolong sebagai mitra bestari sebagaimana dimaksud pada ayat (3) dapat berasal dari RS lain, perhimpunan dokter spesialis/dokter gigi spesialis, kolegium dokter/dokter gigi, kolegium dokter spesialis/dokter gigi spesialis, dan/atau institusi pendidikan kedokteran/kedokteran gigi.
REALITAS DI LAPANGAN
CONTOH KASUS
HASIL WHITE PAPER KKI
Case 1
Post coiling 2 hours
Post coiling 24 hours
Case 2
• DSA thrombolytic with r-TPA result : – RICA: Total occlusion of Right M1 using rTPA 30 mg – Post thrombolysis: Failed recanalization – LICA: Normal
THE QUESTION ? • • • •
IS IT COMPLICATION ? IS IT LACK OF COMPETENCY ? IS IT UN ETHICAL ? IS IT POTENTIAL FOR MALPRACTICE CASE ?
“Today’s culture of medicine is hostile to altruism, compassion, integrity, fidelity, and selfeffacement”
Coulehan Academic Medicine, Vol. 80, No. 10 / October 2005
“Failure to affirm the primacy of the patients’ welfare will result in a loss of the public trust and medicine’s slide from a revered profession to an occupation populated with technical experts” Hafferty http://cmsne.org/Documents
MEDICAL ETHICS • "Medical ethics is a discipline/methodology for considering the implications of medical technology/treatment and what ought to be." • The principles of proper professional conduct concerning the rights and duties of the physician himself, his patients and his fellow practitioners, as well as his actions in the care of patients and in relations with their families.
Medical Sciences Library, UWI
Ethics are … • • • •
Moral Principles What is good and bad What is right and wrong Based on value system
www.pdn.ac.lk
Historically • Medical ethics may be traced to guidelines on the duty of physicians such as the Hippocratic oath • A physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. • These are not laws, but standards of conduct which define the essentials of honorable behavior for the physician www.pdn.ac.lk
Four basic Principles of Medical Ethics
BENEFICENCE • Physicians have a primary obligation to use the best available diagnostic and therapeutic interventions to promote the well-being of their patients by preventing or curing diseases, relieving suffering and improving their health-status • Altruism contributes to the trust that is central to the physician-patient relationship European Society of Radiology Code of Ethics As of March, 2013
Non-maleficence • While maximizing the patient’s well-being, physicians should minimize the medical interventions’ burdens and risks for the patient • They should render service with full respect for human dignity and the best interest of the patient European Society of Radiology Code of Ethics As of March, 2013
autonomy • They should completely and honestly inform their patients ,safeguard confidentiality within the boundaries of law and empower patients to make informed decisions about diagnostic and therapeutic interventions • Patients’ decisions about their care must be paramount, as long as those decisions are in line with ethical practice and do not lead to demands for inappropriate care • Any diagnostic or therapeutic intervention requires the patient’s informed consent European Society of Radiology Code of Ethics As of March, 2013
social justice • The medical profession should promote justice in the health care system including the fair distribution and cost-effective use of limited health care resources • Physicians should work actively to eliminate discrimination in health care, whether based on age, gender, sexual orientation, race, religion, socioeconomic status or any other social category European Society of Radiology Code of Ethics As of March, 2013
THE POTENTIAL RISK IN INTERVENTIONAL NEURORADIOLOGY
RELATED TO
• • • • •
CONTRAST MEDIA X RAY DEVICES THE STANDARD EQUIPMENT SKILL OF THE OPERATOR
Kompetensi (contoh) • Kompetensi medis untuk dokter spesialis di Amerika Serikat diatur oleh ACGME (Accreditation Council for Graduate Medical Education) • Contoh : Pada kompetensi untuk melakukan prosedur endovascular neuroradiology, seseorang harus menyelesaikan program fellowship yang terakreditasi ACGME – minimal 1 tahun untuk spesialis radiologi – tambahan 1 tahun pelatihan diagnostic imaging untuk spesialis non-radiologi www. acgme. org
CONTOH MELEWATI BATAS KOMPETENSI
BAGAI FENOMENA GUNUNG ES • SANGAT MUNGKIN KETIDAK PATUHAN PADA ATURAN SANGAT BESAR • HARUS ADA UPAYA YANG TERUS MENERUS DAN MENGUTAMAKAN KEPENTINGAN PASIEN BERDASARKAN EVIDENCE DAN ETIKA
