KONSIL KEDOKTERAN INDONESIA
PROFESIONALISME DALAM PRAKTIK KEDOKTERAN: Kompetensi, Kewenangan dan Etika
Dr.dr.Sukman T Putra, SpA(K), FACC KONSIL KEDOKTERAN INDONESIA
CV Dr. Sukman T Putra • Dokter, FKUI (1977) • Spesialis Anak (FKUI,1987), Konsultan Jantung Anak (1993) • Fellow, Pediatric Cardiology, Royal Children’s Hospital< Melbourne (1990-1991) • Doktor (S3). FKUI (2013) • Dokter Puskesmas di Provinsi Riau (1978-1983) • Ketua PP Ikatan Dokter Anak Indonesia IDAI (2005 – 2008) • Secretary General ASEAN Pediatric Federation (APF) ( 2002-2007 ) • Ketua Dewan PDSm IDI ( 2003 – 2006) • Wakil Ketua Umum II PB IDI (2006-2009) • Sekretaris Jendral PP PERKANI (2004 -2007) • Wakil Ketua Perhimpunan Kardiologi Anak (PERKANI) (2007-2010) • International Fellow of American Academy of Pediatrics (AAP) 2004 • Fellow American College of Cardiology (FACC), 2003 • Council Member Asia Pacific Society of Pediatric Cardiology ( 2006-2008 ) • Teasurer ASEAN Pediatric Federation /APF (2011-2014) • Wakil Ketua MPPK IDI (2009-2012) • Wakil Ketua MPPK IDI (2012 – 2015) • Ketua Divisi Pendidikab Profesi KK( 2014-2019) • Anggota Dewan Pakar, PB IDI (2015-2018)
OUT LINE Background & Introduction Professionalism in Medicine What is a Doctor and What does a Doctor do ? What is a good Doctor ? What is Competency in Medicine ? Kompetensi Dokter di tingkat Pelayanan Primer Ethics in Professionalism The Role of Medical Association in Health Care Take Home Message Conclusion
• MEDICINE is more than the sum of our knowledge about disease.
• MEDICINE CONCERNS the experiences, feelings, and interpretations of human beings in often extraordinary moment of fears, anxiety and doubt…. Stern DT. Measuring Medical Professionalism (2006)
SOCRATES: “Tell me: is a doctor in the precise sense…a moneymaker or someone who treats the sick ? Tell me about the one who is really a doctor.” THRASYMACHUS: “He’s the one who treats the sick.” Plato, The Republic
What is a DOCTOR and What does a Doctor DO ??
What is a Doctor & What does a Doctor do ? A century ago : “ the role of doctors was clear & simple” …to acquire facility in the art of diagnosis … to grow in clinical judgment … to appreciate the relative value of symptoms and the physical signs … to give the patients and his friends the forecast or prognosis … to conduct the treatment that the patients may be restored t health Prof. William Osler (Oxford) MJA 2005;183:560-561
What is a Doctor & What does a Doctor do ?
One hundreds years on…. ...... .......... Things has changed
MJA 2005;183:560-561
What is a Doctor & What does a Doctor do ?
The medical profession is built around a networks of relationships created between the doctor and “other people” not only “sick people”
Not all who visit DOCTORS are sick or Patients DOCTORS always remain for EVERYONE The Good Doctor ( 2002 )
Doctors are often portrayed as: • • • • • • • •
Poor communicators Arrogant Defensive Too quick to use jargon Resistant to change Self-interested Operating in an exclusive Highly paid club culture Doctors in Society : Medical Professionalism in changing world Royal College of Physicians (2005))
Patients need a Good Doctors: • Care of their patients their first concern • Keep their knowledge and skills up to date • Maintain good relationships with patients & colleagues • Honest & trustworthy • Act with integrity
Physician Today are experiencing frustration as changes in the health care delivery system invirtually all industrialized countries threaten the very nature and values of medical
professionalism Medical professionalism in the New Millenium: a physician charter MJA vol 177,2002
What is a Profession ? “A profession…is an occupation that regulates itself through systematic, required training and collegial discipline; that has a base in technical, specialized knowledge; and that has a service rather than a profit orientation, enshrined in its code of ethics…” Starr
Profession is a complex concept, the definition of which has been attempted for centuries. It has been studied and defined by many from a variety of disciplines with some agreements, much conflict, and some useful additions.
The practice of medicine is NOT a Business and can never be one…… Our fellow creatures cannot be dealt with as a man deals in corn and cost, the human heart by which we live must control our professional relations.
Sir William Osler, 1903
1
A Profession is … a recognizable occupation in which practitioners have a degree of autonomy over their work, are involved in working with significant applied theory, and work within a framework of values and ethics which are broadly agreed across the 2 occupation.
SS 2011
Definition of Professionalism Professionalism is demonstrated through a foundation of clinical competence, communication skills, and ethical and legal understanding, Upon which is built the aspiration to and wise application of the principles of professionalism : excellence,
humanism, accountability and altruism
A definition of professionalism
Measuring Medical Professionalism (2006)_)
Components of professionalism Competence Ethics
Collegiality
Accountability
Altruism
Standard of professional conduct
Accountability of the physician Private Payers
Patient
Government • Proffessional competence • Legal and ethical conduct • Adequacy of access
• Proffessional competence • Financial performance • All six domains
Lawyers And Courts
• Proffessional competence • Legal and ethical conduct • Adequacy of access
Physician
• Proffessional competence • Legal and ethical conduct • Adequacy of access • Public health promotion
Professional Associations
• Proffessional competence • Legal and ethical conduct • Financial performance
Hospitals
• Proffessional competence • Financial performance
Employers
• Financial performance
• Proffessional competence • Legal and ethical conduct • Financial performance
Investors
Managed Care Plants
Modified from Emanuel, E. J. et. Al. Ann Intern Med 1996;124:229-239
Medical Professionalism ACCOUNTABILITY Procedures and processes by which one party justifies and takes responsibility for its activities
“self regulating activities for which physicians can be held accountable, and range from their professional competence and legal and ethical conduct to financial performance”
What is professional competence? The habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served.
Competence builds on a foundation of basic clinical skills, scientific knowledge, and moral development
Kompetensi Dokter di Tingkat Pelayanan Primer (Primary Care)
KONSIL KEDOKTERAN INDONESIA
STANDAR KOMPETENSI DOKTER INDONESI 2012
SISTEMATIKA SKDI 2012 Area Kompetensi
Kompetensi INTI Komponen Kompetensi
Kompetensi yang diharapkan Pada akhir pemelajaran LAMPIRAN • Daftar Pokok Bahasan • Daftar Masalah • Daftar Penyakit •Daftar Keterampilan Klinis
Komponen Area Kompetensi 1. Profesionalitas yang luhur (berke-Tuhanan YME, mermoral dan etika dan disiplin)
2. Mawas Diri dan Pengembangan Diri (mawas diri, belajar sepanjang hayat, mengembangkan pengetahuan) 3. Komunikasi Efektif (berkomunikasi dengan pasien dan keluarga, mitra dan masyarakat) 4. Pengelolaan Informasi (mendesseminasikan informasi secara efektif pada pasien dan tenaga kesehatan lainnya) 5. Landasan Ilmiah Ilmu Kedokteran (menerapkan ilmu biomedik, humaniora, kedokteran klinik dan kes.masyarakat, dan mengelola masalah kesehatan) 6. Keterampilan Klinis ( prosedur diagnostik dan tata laksana) Sesuai dengan LEVEL Kompetensi
Standards of care • • • •
Clinical guidelines Practice guidelines Protocols Standard operating procedures • Algorithms • Clinical pathways • Standing orders
Must be: # Evidence-based # Periodically revised
In Indonesia
The “same things” to be done with “different ways” (NOT STANDARDIZED) Prof Heyman, Washington University (2008)
KOMPETENSI
Pebgelolaan masalah Kesehatan
Ketrampilan Klinis
Landasan Ilmiah Ilmu Kedokteran
Pengelolaan Indformasi
KOMUNIKASI EFEKTIF MAWAS DIRI DAN PENGEMBANGAN DIRI PROFESIONALITAS YANG LUHUR Pondasi dan Pilar KOMPETENSI (SKDI 2012)
Professiionalism in Medicine
Society’s Expectations of Medicine : Services fo the Healer Assured Competence Altruistic services Morality and integrity Accountability Transparency Source of objective advice
Medicine’s Expectations of Society: Trust Autonomy Self regulation Participation in public policy Shared (patients and society) responsibility for helath Status and rewards (non-financial and financial)
DISIPLIN KEDOKTERAN (MEDICAL DISCIPLINARY) Sesuai dengan PERKONSIL No 4/2011 Tentang DISIPLIN PROFESIONAL DOKTER DAN DOKTER GIGI ( 28 pelanggaran disiplin)
DISIPLIN KEDOKTERAN (MEDICAL DISCIPLINARY) Sesuai dengan PERKONSIL No 4/2011 Tentang DISIPLIN PROFESIONAL DOKTER DAN DOKTER GIGI ( 28 pelanggaran disiplin)
Pelanggaran Disiplin Professional Dokter (28) Antara lain: Melakukan Praktik Kedokteran dengan tidak kompeten. Tidak merujuk pasien kepada Dokter lain yang memiliki kompetensi yang sesuai Mendelegasikan pekerjaan kepada tenaga kesehatan tertentu yang tidak memiliki kompetensi untuk melaksanakan pekerjaan tersebut Menjalankan Prkatik Kedokteran dalam kondisi kesehatan fisik dan mental yang tidak baik yang dapat membahayakan pasien Melakukan pemeriksaan atau pengobatan berlebihan yang tidak sesuai dengan kebutuhan pasien DLL…… (24)
ETHICS of PROFESSIONALISM ETHICS : simply refers to moral principles of standards governing conducts BIOETHICS : is essially an umbrella term for moral conduct in broad area of life, sciences and Medicine
Bioethics deals with issues related to health and health care management, animal welfare , environemental science Encompass the following subjects : Phylosophy of science, biotechnology, politics, law, medicine and theology WHO
ETHICS of PROFESSIONALISM
CLINICAL ETHICS : patient-based clinical decisionmaking A system of principles governing medical conduct with respects to patiens and family The ethics of Professionalism in Medicine :
more concerned with the characteristics and behaviours of physicians in the context of medicine as a PROFESSION Desirable behaviours: Altruism, accountability, excellence, duty, honor, integrity, respects each other
Professional authority (kewenangan profesi) The legitimation of professional authority: 1. The knowledge and comptence of the professional have been validated by a community of “peers” 2. The validated knowledge and competence rests on rational scientific grounds 3. The professional judgments and advice are oriented towards a set of substantives values such as health.
Paul Starr, 1984
Health systems
Professional Organizations
Medical schools
CPD
Professionals
Healthcare
Standard of professional conduct: Competence Accountability Altruism Collegiality Ethics
Standards of care
SS 2011
Clinical governance: Education & training Clinical effectiveness Accountability R&D Clinical audit Risk management
What is the Role of
Professional Medical Society ?
MEDICINE IS, in essence a “MORAL ENTERPRISE”
Its professional association should be built on ethical foundation. Such association should promote the interests of those they serve
This sadly, has not always the case when economic, commercial , and political agendas so often take precedence over ethical obligation JAMA 1999;282: 984-986
AT PRESENT
Medical profession confronted to: explosion of technology, changing market forces problems of health care delivery system bioterrorism globalisation Increasing difficulties of physician to meet their responsibilties to patients and society
Health System Financing Access Human resources Quality of Health Care
Revitalizing Professionalism Role of associations important to: - set and maintain standards - to expand and disseminate knowledge - to inform the public
Institutions and professional societies are necessary to support and stabilize professionalism
Doctors
Patients
Hospital Health Services Provider
Health Care System
Hospital by Laws Medical Acts Hospital staffs
Quality of Health Care
Health System Developing countries face many challenges to building robust,reliable health system: insufficient financing lack of inter-agency coordination, poorly function ing information system health worker shortages
We seek the system that gives physicians the autonomy and freedom
To make the best decision to their patients without the intrussions or interferences from outsider; a system that promotes professionalism, integrity and highest ethical and educational standards......... 21st Century Health Care Leader
Professional Medical Society Role
Education Licensing Regulation Representation WMA, 2005
Conclusion
• Professionalism in Medicine is built under the construction of excellence, humanism,accountability and altruism based on Ethical & legal standing,Communication skills, Clinical Competence • Professionalism –including professional competence- should be introduced in early years of medical training and throughout residency programs • Dalam Praktik Kedokteran : Level Kompetensi profesi kedokteran, dan kewenangan klinis terkait erat dengan Etika Klinis dan Disiplin Profesi Kedokteran
Take Home Massage • BE A Good Doctor : Professional and Accountable Patients need a
Good Doctors: • Maintain good relationships with patients & colleagues • Honest & trustworthy • Act with integrity
