~ CURRICULUM ~
Aims:
Comprehend the central position of professionalism in contemporary medical practice
Apply professionalism in the context of primary health care settings
Learning outcomes:
Awareness of professional, moral, ethical and legal implications of medical practice
Comprehension of the significance of the three dimensions of professionalism underlying contemporary medical practice
Develop awareness and basic skill required to nurturing professional personal attributes: compassion, integrity, truthfulness, truth-worthiness, and lifelong commitment or habit to maintaining professional competence and standards
Develop awareness and respect to the needs of a diverse patient population in terms of gender, belief/religion, education, ethnicity, and socio-cultural background
Differentiate between professional, moral and ethical issues
Apply the principles of moral and ethical reasoning to deal with patient value issues
Capability to apply the basic principles of medical ethics in the primary care setting
Curriculum contents:
Defining professional, moral and ethical issues
The three dimensions/ components of medical professionalism
Common educational strategies to nurture the development of affective behaviors
Basic principles and strategies of cross-cultural communication
National and global legal systems governing medical practice
The principles of moral and ethical reasoning, and ways to avoid pitfalls
~ PLANNERS TEAM ~
NO NAME DEPARTMENT
1 Dr. I.B. Alit, DFM. SpF. (Head) Forensic
2 Dr. I W. Sugiritama,M.Kes (Secretary) Histology
4 Prof. dr. N.A. Bagiada, Sp. Biok. Biochemistry
5 Drs. Supriyadi, M.Si Psychology
7 Prof. Dr. dr. N. Mangku Karmaya, M.Repro Anatomy
8 Dr. Hengki, Sp.F Forensic
9 Drs. Toya Wiartha,Apt. Pharmacy
10 Dr. I Wayan Sumardika,M.Med. MEU
11 DR. Dr. Dyah Paramitha D. M.Kes Public Health
~ LECTURERS ~
NO
NAME DEPARTMENT PHONE
1 Prof. Dr. dr. N. Mangku Karmaya, M.Repro
Anatomy 0811387105
3 Drs. Supriyadi, M.Si. Psychology 08123606296
4 Dr. Hariyasa Sanjaya, SpOG Obstetry &
Gynaecology
0361-7465168
6 Dr. Ida Bagus Alit, Sp. F Forensic Medicine 081916613459
7 Dr. Dudut Rustyadi, Sp.F Forensic Medicine 0818651015
8 DR. Dr. Dyah Paramitha D. M.Kes Public Health 0818357777
9 Drs. Toya Wiartha,Apt. Pharmacy
10 Dr. Henky,Sp.F Forensic Medicine 08123988486
11 Drs. Adioka, Apt Pharmacy
12 Prof.Dr.dr.K. Suwitra,SpPD. KGH Internal Medicine 08123803996
13 Dr. Ni Luh Dharma Kerti Natih,MHSM
~ FACILITATORS ~
Regular Class (Class A)
No Name Group Department Phone Venue (3nd
floor) 1 dr. I Wyn Subawa, Sp.OT A1 Orthopaedi 081337096388 3R.3.09nd floor:
2 dr. Made Widhi Asih, Sp.Rad A2 Radiology 081916442626 3R.3.10nd floor:
3 Dr.dr. Dyah Pradnyaparamita Duarsa, M.Si A3 Public Health 081835777 3R.3.11nd floor:
4 dr. Ida Bagus Sutha, Sp.P A4 Pulmonology 081916708565/08123990362 3R.3.12nd floor:
5 dr. Ida Bagus Wirakusuma, MOH A5 Public Health 08124696647 3R.3.13nd floor:
6 dr. Kadek Agus Heryana, Sp.An A6 Anasthesi 081338568883 3R.3.14nd floor:
7 dr. Muliani , M Biomed A7 Anatomy 085103043575 3R.3.15nd floor:
8 dr. Ketut Rai Purnami, Sp.PD A8 Interna 0818350703 3R.3.16nd floor:
9 dr. Komang Andi Dwi Saputra , Sp.THT-KL A9 ENT 081338701828/081338701878 3R.3.17nd floor:
10 dr. I Gde Haryo Ganesha, S.Ked A10 DME 081805391039 3R.3.19nd floor:
English Class (Class B)
No Name Group Department Phone (3Venue nd floor)
1 dr. Kumara Tini, Sp.S B1 Neurology 081238701081 3R.3.09nd floor:
2 dr. Lisna Astuti, Sp.Rad(K) B2 Radiology 081337934497 3R.3.10nd floor:
3 dr. Ni Wayan Sucindra Dewi, S.ked B3 Pharmacology 08113935700 3R.3.11nd floor:
4 dr. I Gusti Ayu Artini , M.Sc B4 Pharmacology 08123650481 3R.3.12nd floor:
5 dr. I Dewa Ayu Inten Dwi Primayanti, M.Biomed B5 Fisiology 081337761299 3R.3.13nd floor:
6 dr. Made Ratna Saraswati, Sp.PD-KEMD-FINASIM B6 Interna 08123814688 3R.3.14nd floor:
7 dr. Made Sudarmaja, M.Kes B7 Parasitology 08123953945 3R.3.15nd floor:
8 dr. Ida Ayu Dewi Wiryanthini, M Biomed B8 Biochemistry 081239990399 3R.3.16nd floor:
9 dr. Ketut Agus Somia, Sp.PD-KPTI B9 Interna 08123989353 3R.3.17nd floor:
~ TIME TABLE ~
DAY/
DATE Regular ClassTIMEEnglish Class ACTIVITY VENUE CONVEYER
1
Monday 16-02-2015
08.00 – 08.15 08.15 – 09.15
09.15 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.15 – 09.30 09.30 – 10.30
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.30 – 11.30 15.00 – 16.00
Introduction to the Block Lecture : Biomedical Ethics Ind. Learning SGD Break Student Project Plennary Class room Class room -Disc. room -Class room Class room Alit Henky -Facilitator -Henky 2 Tuesday 17-02-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Informed consent & confidentiality
Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room Alit -Facilitator -Alit 3 Wednesday 18-02-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Professional Personal Attribute Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room Hariyasa S. -Facilitator Hariyasa S. 4 Friday 20-02-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Patient,s right & autonomy Ind. Learning SGD Break Student Project Plennary Class room -Disc. Room -Disc. room Class room Prof. Mangku -Facilitator -Prof. Mangku 5 Monday 23-02-2015
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Empathy
Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room Supriyadi -Facilitator -Supriyadi 6 Tuesday 24-02-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Awareness to diversity in medical practices Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room D. Paramitha -Facilitator -D. Paramitha 7 Wednesday 25-05-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Legal Aspect of Medical Practice Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room Dudut. -Facilitator -Dudut 8 Thursday 26-02-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
9
Friday 27-02-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Criminal Law and Medical Malpractice
Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room Dudut -Facilitator -Dudut 10 Monday 02-03-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Lecture : Legal Aspect of Medical Record, Medical Certification and Visum et Repertum Ind. Learning SGD Break Student Project Plennary Class room -Disc. room -Disc. room Class room Alit -Facilitator -Alit
BASIC CLINICAL SKILL
11
Tuesday 03-03-2015
08.00 – 09.00 10.00 – 13.00
13.00 – 15.00
09.00 – 10.00 13.00 – 16.00
10.00 – 13.00
Guest Lecture Student Project Presentation (I,II,III) Ind. Learning Class room Class room -IDI Lecturer -12 Wednesday 04-03-2015
08.00 – 09.00
10.00 – 13.00 13.00 – 15.00
09.00 – 10.00
13.00 – 16.00 10.00 – 13.00
Lecture : Medical Certification and Visum et Repertum Writing Skill Training
Ind. Learning
Class room
- Forensic Team
Forensic Team
13
Thursday 05-03-2015
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00
14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30
15.00 – 16.00
Translating the concept and principle of medical professionalism in practice Ind. Learning Role Play Break Student Project Presentation (IV) Plennary Class room -Disc. Room -Class room Class room Prof. Suwitra Facilitator Lecturer Prof. Suwitra 14 Friday 06-03-2015
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00
14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30
15.00 – 16.00
Medical Record Ind. Learning SGD Break Student Project Presentation (V) Plennary Disc. Room -Class room Class room Class room Dharmakerti Facilitator Lecturer Dharmakerti 15 Monday 09-03-2015
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 10.00 – 12.00 15.00 – 16.00
Lecture : Prescribing
Lab Work (SGD 1-5) Lab Work ( SGD 6-10) Ind. Learning
Case Study/Feed Back/ Presentation Class room Class room Class room -Class room Adioka Team Team Team Tuesday 10-03-2015
Preparation for Exam
15
Wednesday
11-03-2015 EXAMINATION Block Team
~ MEETING OF STUDENT REPRESENTATIVES AND FACILITATORS
~
Meeting of student representatives and facilitators will be held on Friday 27th February
2015. This meeting will be organized by the planners and attended by lecturers, student group representatives and all facilitators. Meeting with student representatives will take place at 12.00 until 12.45 pm and meeting with the facilitators at 12.45 until 13.30 pm.
The purpose of the meeting is to evaluate the teaching learning process of the Block. Feedbacks and suggestion are welcome for improvement of the Block educational programs.
~ STUDENT PROJECT ~
Student have to write a paper with topics that has been given by lecturer. The topic will be chosen randomly on day 1, each small group discussion should work one paper. Students make a paper as student project an will be presented in front of the class. The paper and the presentation will be evaluated by respectively facilitator and lecturer.
Format of the paper : 1. Cover :
Tittle Name
Student Registration Number
Faculty of Medicine, Udayana University 2015 2. Introduction
3. Content 4. Conclusion
5. References (minimal 3 refferences)
Note : 5-10 pages; 1,5 line spacing; Times new roman 12
~ ASSESSMENT METHOD ~
Cognitive assessment will be carried out on Wednesday 11th March 2015. The test will be consist of 100 questions with 100 minutes provide for working. The assessment will be held at the same time for both Regular Class and English Class. SGD’s and student project’s mark will be include in the final score as describe below. The overall passing score requirement is ≥70. More detailed information or any changes that may be needed will be acknowledged at least two days before the assessment.
Skill assessment will be carried out at the end of the semester using Objective Structured Clinical examination (OSCE).
Biomedical Ethics
~ LEARNING PROGRAMS ~
Abstracts of Lectures
The principles of biomedical ethics were first introduced in late 1977 by Beauchamp and Childress, the well-known bioethicists from The Kennedy Institute of Bioethics located at Georgetown University. It was a moral framework consisted of four basic principles: respect for autonomy, non-maleficence, beneficence, and justice. There were also several derivative substantive rules, such as veracity, fidelity, privacy, and confidentiality. Admittedly, this approach has become one of the most famous works in medical field. The principle has been used as groundwork for educating many medical students as well as for training countless health care professionals all over the world because of its vast coverage of various concepts and topics in biomedical ethics. Moreover, it can be universally applied to explain and justify substantive moral issue in numerous ethical quandaries arising from medical context.
In 1990, the term ‘Principlism’ and ‘Georgetown Mantra’ were first coined by Clouser and Gert, who criticized the four principles approach. According to them, principlism refers to the practice of replacing moral theories and rules with four principles while dealing with ethical issues in medical practice. They claim that these principles have misled medical practitioners to believe that they have systematically applied the well-established principles. In fact, they have haphazardly applied numerous unrelated moral considerations in each principle without any capacity to guide their action since the principles are derived from various types of conventional moral philosophies, which are not systematically related to each other. In other words, principlism has problems with the absence of direct normative guidance and the lack of deep moral substance.
However, the main concept of principlism does not simply depend on the prima facie four principles frameworks, but strongly embedded in the concept of common morality which is defined as: “the set of universal norms shared by all persons committed to morality”. The four principles are merely a part of thin universal moral norms which should be differentiated with particular moral norms that is the specific morality found in various cultural and religious traditions in concrete communities. When applied in factual cases, hence, it is important to note these diversities by specifying the moral norms in relation to the four principles. As a consequence, usually, there are conflicts within and between principles which should be balanced with additional methods. Ultimately, the final coherent judgment should be grounded on the balancing of a “considered opinion” that is one prima facie duty is weightier than another in specific circumstances.
References:
1. Beauchamp TL, Childress JF. The Principles of Biomedical Ethics 7th ed. New York: Oxford University Press; 2013.
2. Kerridge IH, Lowe M, Stewart CL. Ethics and Law for the Health Professions. 4th edition ed. Sydney: The Federation Press; 2013.
3. Pellegrino ED. Toward a Virtue-Based Normative Ethics for the Health Professions. Kennedy Institute of Ethics Journal. 1995;5(3):253-77.
Informed Consent
Patients are entitled to make decisions about their medical care and to be given relevant information on which to base such decisions. The physician's obligation to obtain the patient's consent to treatment is grounded in the bioethical principles of patient autonomy and respect for persons and is affirmed by Indonesian law and professional policy. A large body of research supports the view that the process of obtaining consent can improve patient satisfaction and compliance and, ultimately, health outcomes.
Physician must disclose relevant and detail information, so the patient can understand it clearly. Both elements are necessary for valid consent. Physician should inform the patient adequately about the treatment and its expected effects, relevant alternative options and their benefits and risks, and the consequences of declining or delaying treatment. The physician’s goal is to disclose information that a reasonable person in the patient's position would need in order to make an informed decision. Therefore, physician may need to consider how the proposed treatment (and other options) might affect the patient's employment, finances, family life and other personal concerns. Physician may also need to be sensitive to cultural and religious beliefs that can affect disclosure.
The situation in which an adult lacks the capacity, for whatever reason, to make an informed decision is somewhat confused. Where a patient is suffering from a mental condition, he may be given treatment for his mental condition without consent. In emergency, such as an accident where the victim is unconscious or shocked, no permission is necessary and doctors must do as they think best for the patient in those urgent circumstance. Exceptions to the principle of informed consent also occur with regard to persons with impaired, such as children who are usually represented by a third party, such as parents or other close relatives, vis-à-vis the physician. Substitute decision-making poses two main questions: Who should make the decision for the incapable person, and, how should the decision be made? To answer these questions, physician should become familiar with the legal requirements.
Refferences :
Confidentiality
Professional Personal Attribute
Physicians are obliged to keep information about their patients secret. The understanding that the physician will not disclose private information about the patient provides a foundation for trust in the therapeutic relationship. Respect for confidentiality is firmly established in codes of ethics and in law. It is sometimes necessary, however, for physicians to breach confidentiality. Physicians should familiarize themselves with legislation governing the disclosure of certain kinds of information without the patient’s authorization. Even when no specific legislation applies, the duty to warn sometimes overrides the duty to respect confidentiality. The physician should disclose only that information necessary to prevent harm, and should reveal this information only to those who need to know it in order to avert harm. Whenever possible any breach of confidentiality should be discussed with the patient beforehand.
Refference :
Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone. Edinburgh. 2003 page 81-96
Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford University Press, 2008.
Kode Etik Kedokteran Indonesia (KODEKI).
Undang-Undang Republik Indonesia Nomor 29 Tahun 2004 Tentang Praktik Kedokteran
Peraturan Menteri Kesehatan Republik Indonesia Nomor 290/MENKES/PER/III/2008 tentang Persetujuan Tindakan Kedokteran
People come to physician for help with their most pressing needs-relief from pain and suffering and restoration of health and well being. They allow physicians to see, touch and manipulate every part of their bodies, even the most intimate. They do this because they trust their physicians to act in their best interests.
What constitutes a good doctor? Is technical proficiency sufficient to be a good doctor? Clearly, a physician cannot lack necessary technical knowledge and skills and still be a good doctor. Less clear is whether a technically proficient physician can lack interpersonal skills necessary to relate well to patients and still be a good doctor. The physician’s interpersonal skills are critical to establishing strong, trust-based physician-patient relationships that offer multiple benefits. Most physician-patients want a strong relationship with a primary care physician.
The quality of a patient’s relationship with a physician can affect not only a patient’s emotional responses but also behavioral and medical outcomes such as compliance and recovery. Consequently, physicians have been urged to improve their communication and patient education techniques, develop their empathetic abilities, encourage participative decision making, and convey respect and dignity.
establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity.
Refferences :
1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone. Edinburgh. 2003 page : 51-57
2. CMA. Professionalism in Medicine.2001
3. Bendapudi,N.M. et al. Patient’s Perspectives on Ideal Phsician Behaviours. Mayo Clin Proc.2006.81(3):338-344
Patient rights have recently become the centre of national attention in the practice of medicine. Patient rights encompass legal and ethical issues in the provider-patient relationship, including a person's right to privacy, the right to quality medical care without prejudice, the right to make informed decisions about care and treatment options, and the right to refuse treatment.
The purpose of delineating patient rights is to ensure the ethical treatment of persons receiving medical or other professional health care services. Without any exception, all persons in all settings are entitled to receive ethical treatment.
A patient's rights occur at many different levels, and in all specialties. The American Medical Association (AMA) outlines fundamental elements of the doctor-patient relationship in their Code of Medical Ethics. These rights include the following:
o The right to receive information from physicians and to discuss the benefits, risks,
and costs of appropriate treatment alternatives
o The right to make decisions regarding the health care that is recommended by the
physician
o The right to courtesy, respect, dignity, responsiveness, and timely attention to health
needs
o The right to confidentiality
o The right to continuity of health care
o The basic right to have adequate health care
Refferences :
Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine. Twelfth Edition.2003. page 8-14
Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone. Edinburgh. 2003 page : 3-38
Patient’s Autonomy
Empathy
Medical care in the United States has rapidly moved away from a paternalistic approach to patients and toward an emphasis on patient autonomy. At one extreme end of this spectrum is the “independent choice” model of decision making, in which physicians objectively present patients with options and odds but withhold their own experience and recommendations to avoid overly influencing patients. This model confuses the concepts of independence and autonomy and assumes that the physician's exercise of power and influence inevitably diminishes the patient's ability to choose freely. It sacrifices competence for control, and it discourages active persuasion when differences of opinion exist between physician and patient. This paper proposes an “enhanced autonomy” model, which encourages patients and physicians to actively exchange ideas, explicitly negotiate differences, and share power and influence to serve the patient's best interests. Recommendations are offered that promote an intense collaboration between patient and physician so that patients can autonomously make choices that are informed by both the medical facts and the physician's experience (Quill T.E., Brody, H., 2004).
.Refferences :
1. Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine. Twelfth Edition.2003. page 8-14
2. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone. Edinburgh. 2003 page : 3-38
The origin of the word empathy dates back to the 1880s, when German psychologist Theodore Lipps coined the term "einfuhlung" (literally, "in-feeling") to describe the emotional appreciation of another's feelings. Empathy has further been described as the process of understanding a person's subjective experience by vicariously sharing that experience while maintaining an observant stance. Even more simply stated, empathy is the ability to "put oneself in another's shoes."
Effective empathetic communication enhances the therapeutic effectiveness of the doctor-patient relationship. Appropriate use of empathy as a communication tool facilitates the clinical interview, increases the efficiency of gathering information, improved health outcomes, better patient compliance, reduction in medical-legal risk, and improved satisfaction of clinicians and patients.
Empathy was known as "bedside manner," a quality considered innate and impossible to acquire. More recently, greater emphasis has been placed on empathy as a communication tool of substantial importance in the medical interview, and many experts now agree that empathy and empathetic communication are teachable, learnable skills.
Because empathy is such a powerful communication skill in medical practice, the clinicians would scramble to learn about and use it at every available opportunity.
Awareness to diversity in medical practices
1. Batmanabane, V.Empathy: A vital attribute for doctors. Indian Journal of Medical Ethics. 2008. 5(3) :128-129
2. Hardee, J.T. An Overview of Empathy. The Permanente Journal.2003.7 (4):51-54
Culture consists of pattern, explicit and implicit, of and for behavior acquired and transmitted by symbols, constituting the distinctive achievement of human groups. Culture is a human creation, which includes codes of behavior, language, ritual and system of beliefs. The essential core of culture consists of traditional ideas and especially their attached values. So culture is learned, shared, ideas about and patterns of behavior.
A society is an organized group of individuals with specific boundaries, or criteria, of membership. We will speak of both societies and cultures in term of levels of inclusiveness (about gender as the cultural construction, values, norms and belief). Factors inherent within a given culture are also likely to influence deeply the perception and definition of illness, and any consequent actions. Although this subject highlights the different influence on health and many this factors are inter-related.
Refference:
Ross J.Taylor. et al. Health and Illness in the community. Oxford University Press. 2003
According to the Assembly of Indonesian Law of Health, Law of Health includes all regulation that is directly related to maintenance/services of health care and its’ application, which includes Civil Code, Criminal Code and Law of Administration. Law of Health is divided into two, direct and indirect.
Direct Law of Health is a law regulation that is directly related to maintenance of health, such as:
Act Number. 29 Year 2004 concerns of Medical Practice
Act Number 36 Year 2009 concerns of Health
Indirect Law of Health includes all application of law regulation that is related to law specialization, such as: Civil Code, Criminal Code and Law of Administration which can be implied in maintenance/services of health care.
The purpose of Law of Health is to provide legal protection and assurance to both giving and receiving parties in health care services. Thus, Law of Health consists of:
• Medical/Dentistry Law
• Clinical Pharmacy Law
• Hospital Law
• Community Health Law
• Etc.
Medical Law is a Law of Health in a constricted meaning, which is also the core of Law of Health which regulates the medical services. The meaning of Medical Law is divided into a broad and constricted meaning.
Medical Law in the broad meaning is all the regulations in medical services, such as medical services provided by doctors, dentists, nurses, and laboratories.
Medical Law in the constricted meaning is all the regulations that only cover the doctor’s professions, such as:
• Doctor-patient relationship
• Medical Record and medical Confidentiality
• Informed Consent
• Medical malpractice
• Euthanasia
• Etc. Refferences :
1. Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine. Twelfth Edition. 2003.page 1-8
2. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone. Edinburgh. 2003 page : 39-49
3. Sanbar, S.S. et al. Legal Medicine and Health Law Education in : Legal Medicine. Sanbar, S.S. (Ed). 1998.Page 3-10
4. Piorkowski, J.D.Medical testimony and the expert witness in : Legal Medicine. Sanbar, S.S. et al (Ed.). 1998. Page 132-144
5. Wiradharma, D. Penuntun Kuliah Hukum Kedokteran. Page 25-35 6. Ohoiwutum, T. Bunga Rampai Hukum Kedokteran.page 1-13
Health is one of the elements of the common welfare should be realized in accordance with the ideals of the Indonesian nation, as defined in the preamble of the 1945 Constitution through the National sustainable development based on Pancasila and the 1945 Constitution.
In the health development efforts that focus on enhancing the health of society, then all Human Resources (HR), including the medical profession involved, bound by the Act and Regulations in force.
A doctor after establishing the diagnosis of a disease, then provide therapy, which include the use of drugs. Therefore, with regard to the use of drugs, the doctor needs to know the laws and regulations in the pharmaceutical field so that no difficulty in practice and certainly
not against the law.
Legislation in the pharmaceutical field associated with the practice physician can refer to laws that already exist, among others:
Law Decree No. 1 of 1946 on the Criminal Code (Criminal Code)
- UU RI No 1 Tahun 1946 tentang Peraturan Hukum Pidana (K.U.H.P) Law Decree No. 36 of 2009 on Health - UU RI No 36 Tahun 2009 tentang
Kesehatan
Law Decree No. 5 of 1997 on Psychotropic - UU RI No 5 Tahun 1997 tentang Psikotropika
Law Decree No. 35 of 2009 on Narcotics - UU RI No 35 Tahun 2009 tentang Narkotika
Law Decree No. 8 of 1999 on Consumer
Protection
-UU RI No 8 Tahun 1999 tentang Perlindungan Konsumen
Law Decree No. 39 of 2004 on the Practice of Medicine
- UU RI No 39 tahun 2004 tentang Praktek Kedokteran
- Regulation of the Government of the Republic of Indonesia, Ministry of Health (Permenkes), etc. related rules., Among others:
o PP Decree No. 51 of 2009 on
Pharmaceutical Works o
PP RI No 51 Tahun 2009
Tentang Pekerjaan
Kefarmasian
o Minister Regulation No. 688 / Menkes / Per / VII / 1997 on Psychotropic Substances Circulation
o Permenkes No 688 / Menkes / Per / VII / 1997 Tentang Peredaran Psikotropika
o Permenkes No. HK.02.02 / Menkes / 068 / I / 2010 Obligations Using Generic Drugs at public health facilities
o Permenkes No HK.02.02 / Menkes / 068 / I / 2010
Tentang Kewajiban
Menggunakan Obat Generik di
Fasilitas Pelayanan
Kesehatan Pemerintah
Drugs produced by the pharmaceutical industry, and then distributed to the means of distribution, namely the Large Pharmacy (PBF), retail pharmacy (pharmacy, drugstores licensed), and health-care facilities (hospitals, health centers, Polyclinics). In the distribution, drugs are classified into groups based security:
1. Group Counter marked with green dots.
2. Drug Free Group Limited (List W) marked with blue dots.
3. Hard Drugs Group (List G) is marked with a red circle with the letter "K" in it.
4. Mandatory Drug Pharmacy Group (List G1, G2, G3) are marked with a red circle with the letter "K" in it.
5. Group of Psychotropic Drugs (List G) is marked with a red circle with the letter "K" in it
References:
1. Direktorat Jenderal Pengawasan Obat dan Makanan Departemen Kesehatan Republik Indonesia, Kumpulan Peraturan Perundang-Undangan Bidang Obat, Tahun 1996
2. UU RI No 36 Tahun 2009 Tentang Kesehatan 3. UU RI No 35 Tahun 2009 Tentang Narkotika
4. UU RI No 29 Tahun 2004 Tentang Praktek Kedokteran 5. PP RI No 51 Tahun 2009 Tentang Pekerjaan Kefarmasian
In general, the understanding of criminal law is the law which legislate and control a human’s forbidden act and when this is disobeyed, the respected person will be charged according to law. A doctor is said to have done a criminal act when he/she breaks the rules stated in Indonesian Criminal Law (KUHP), and other laws, for an example, Law of Health.
A patient or his/her family’s dissatisfaction towards a medical care received from a doctor or a hospital can evoke a legal action. The legal action occurred perhaps not because of the mistake done by a doctor or the hospital, but because of the breach in medical ethics, medical disciplines, or even the criminal act and the medical malpractice itself. Occurrence of medical malpracticeis solely because of the doctor’s negligence which causes loss for the patient and his/her family. To prove a malpractice has occurred, there are two proving procedures or mechanism, the first is direct proving method using 4D criteria; Duty, Dereliction of duty, Damage and Direct causation. The second proving procedure is via indirect method using doctrine Res Ipsa Loquitor (the thing speaks for itself).
Refferences :
1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone. Edinburgh. 2003 page : 15-21
2. Flamm, M.B. Medical Malpractice and the physician defendant in : Legal Medicine Sanbar, S.S. et al. (Ed.) 1998. Page 123-129
Doctor who main profesion for health sevices also has responsibility to make medical documents in form of certificate needed by patient, third party and state in the name of law. These medical documents consist of Health Certificate, Sick Leave Certificate, Certificate of non-infected from any contagious disease and etc. There are trends of upward need to medical certificate for many different purposes according to development of medical technology and science. Nowadays, Certificate of Patternity, Certificate of Gender, Certificate of Virginity and etc are frequently needed.
Basic principal of medical certificate on medicolegal aspect mainly consist of fact and medical opinion. Facts based on medical examination meanwhile medical opinion made according to medical procedure. Therefore, medical certificates are tightly attached to medical confidentiality.
Doctor profession has many responsibilities, one of them is legal duty. This responsibility is an obligation mainly assisting law and trial process. For instance, Visum et repertum is medical certificate made for law enforcement. The division of visum et repertum depends on substance needed by the state. Generally, it is differentiated in to Psychiatric Visum et Repertum and Physical Visum et Repertum. Physical Visum et repertum can be divided in to death victim Visum et repertum and live victim Visum et repertum. Meanwhile live victim visum et repertum can be made for physical violence and toxin VeR and sexual harassment VeR.
Medical record in other hand is a note for all medical information collected from patient examination and analysis including medical procedure performed. Medical record is compulsory to all practicing doctor which has function for administration, legal, financial, research data and education. Its legal function needed as a source for medical certificate and VeR aside used as written evidence on medical dispute.
Refferences :
1. Hirsh, H.L. Medical Record in : Legal Medicine. Sanbar, S.S. et al (Ed.).1998. Page 280-296
2. Plueckhahn, V.D. and Cordner, S.M. Ethics, Legal Medicine and Forensic Pathology, Second Edition. 1991. Page 111-122
LEARNING TASKS
Vignette 1
Five terminally ill patients will undergo a surgery. One needs a heart transplant, one needs a new pancreas, one needs a liver transplant, one needs a kidney transplant, and one needs bone marrow transplantation. An 80-year-old woman comes into the hospital, who proves to be a suitable transplantation match for all of the terminally ill patients. However, she only suffers a broken hip. (Newson, 2014)
Assignments:
1. What is the ethical issue in this case?
2. Should the doctor kill the old woman and pass her organs to the others? Why? 3. Could you please explain your reasoning based on ethical theories?
Vignette 2
You are asked to prepare a case study to present to a supervisor tomorrow. You want to examine a 40-year-old woman with aplastic anemia because she is the only patient in the ward who matches with the case asked by the supervisor. When the patient was asked for permission she replied: “You can if you have to but I’d rather not, I’ve just seen four medical students and I’m tired”. (Kerridge, 2013)
Assignments:
1. What is the ethical issue in this case? 2. Will you examine the patient? Why?
3. Could you please explain your reasoning based on ethical theories?
Vignette 3
AB is a medical student. She is strongly opposed to abortion for religious reasons. One day she is asked by a supervisor to assist a termination of pregnancy. (Kerridge, 2013)
Assignments:
1. What is the ethical issue in this case?
2. If you are AB, will you assist the supervisor? Why?
3. Could you please explain your reasoning based on ethical theories?
Self Assessment
1. What is ethics?
2. List and explain the principles of biomedical ethics! 3. List and explain any ethical theories that you know!
4. Please read the KODEKI (Kode Etik Kedokteran Indonesia) and then analyze each article based on the principles of biomedical ethics!
Vignette 1
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm (a weakening in the wall of the aorta which causes it to stretch and bulge). The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is a photo model and actress; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence; the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. What is your view on the application of the principle of informed consent in this case? 4. Try to find the reason, why the doctor decides as he did?
5. If you were doctor in this case, what would you do? (Explain your arguments based on prima facie duties, the principle of informed consent, ethical theory, KODEKI, and legal aspect)
Vignette 2
Joice and Doni have been married for 12 years and have a 6-year-old son. Doni’s father and grandfather died from cancer when they were in their early forties. Because of the strong family history of cancer, Doni wanted to have a genetic test to find out his level of risk. Although no clear diagnosis was possible, tests indicated that he was at risk of hereditary non-polyposis colorectal cancer. Now, Doni is feeling tired and unwell, and has a colonoscopy. The test reveals that he has inoperable bowel cancer. Joice is concerned that their son might also be at risk of colon cancer when he is older. She asked you to do a genetic test for his son to see if he is at risk.
Assignment:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should parents be allowed to have their children tested for adult-onset genetic conditions? Why?
4. What would you do? (Explain your arguments based on prima facie duties, the principle of informed consent, ethical theory, KODEKI, and legal aspect)
5. What are the foreseeable consequences of your decision? Can you justify this decision to accommodate: the patient or the patient’s family value; to your consultant; and to your peers?
DAY 2
Vignette 3
Tony is 35 years old and is married. He has had unprotected sex with prostitutes on 2 occasions. Although he is asymptomatic, he becomes anxious about the possibility of having contracted a venereal disease and consults his physician. After conducting a thorough physical examination and providing appropriate counselling, Tony’s physician orders a number of tests. The only positive result is for the HIV blood test. The physician offers to meet with Tony and his wife to assist with the disclosure of this information, but Tony states that he does not want his wife to know about his condition.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should the doctor disclosed this information to his wife? (Explain your arguments based on prima facie duties, the principle of confidentiality, ethical theory, KODEKI, and legal aspect)
4. What are the foreseeable consequences of your decision? Can you justify this decision to accommodate: the patient or the patient’s family value; to your consultant; and to your peers?
5. Does it make any difference if the Tony’s diagnosis is not HIV? Explain!
Vignette 4
A 75-year-old woman shows signs of abuse that appears to be inflicted by her husband. As he is her primary caregiver, she feels dependent on him and pleads with you not to say anything about it.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should you report this case to the police? (Explain your arguments based on prima facie duties, the principle of confidentiality, ethical theory, KODEKI, and legal aspect)
4. What are the foreseeable consequences of your decision? Can you justify this decision to accommodate: the patient or the patient’s family value; to your consultant; and to your peers?
Vignette 1
Mr. A complained that when urinating he had pain. He went to a hospital and was managed by an urologist who said that laser treatment should be performed because it might be due to prostate. So far only USG had been performed. The doctor was threatening to such an extent that the patient sister started crying. The threat was made like this: “If a laser is not performed, you will have to read the holy verses," that is, he would die. This physician proceeded to perform intravenous pyelography. Then the patient was instructed to undergo a laser treatment that same evening by paying an advance of approximately Rp. 15.000.000,-. The patient was bewildered and contacted his brother who was engaged in the health field. He told him to delay it for one day until he would reach there. But the physician got angry and said, If this was not conducted, he would not care any more. It was not until realizing who his brother was that the physician was alerted. He asked what he should do to apologize for what he had done. Finally, the hospital director and one of his staff apologized to his brother. The patients decided to go to another private hospital where ultrasonography (USG) and other specific laboratory examinations showed that it was an inflammation.
Assignments:
1. Identify the moral-ethical issue in this case
2. Identify the professional personal attribute in this doctor-patient relationship 3. What is your view about the doctor’s attitude in this case?
4. Has the doctor tried to demonstrate his/her empathy? Explain!
Vignette 2
Dr. P. an experienced and skilled surgeon, is about to finish night duty at medium-sized community hospital. A young woman is brought to the hospital by her mother, who leaves immediately after telling the intake nurse that she has to look after her other children. The patient is bleeding vaginally and is in great deal of pain. Dr. P examines her and decides that she has had either a miscarriage or self induced abortion. He does a quick dilatation and curettage and tells the nurse to ask the patient whether she can afford to stay in the hospital until it is safe for her to be discharged. Dr. Q comes in to replace Dr. P, who goes home without having spoken to the patient.
Assignments:
1. Identify the moral-ethical issue in this case!
2. Identify the professional personal attribute in this doctor-patient relationship 3. If you were doctor P, what would you do?
4. Has the doctor tried to demonstrate his/her empathy? Explain!
Day 3
Learning Tasks
1. what is patient’s right?
2. what is the purpose of patient’s right
3. Describe the basic of patient’s right?
4. What is patient autonomy
5. Discuss about paternalism in doctor-patient relationship?
6. Discus about the balance of physician recommendation and patient autonomy
Vignette 1
The family of the patient in terminal state need your help to close the treatment.
Assignment
What is your respond in this situation?
Vignette 2
Patient with HIV AIDS has plan to get married.
Assignment
What will you do?
Vignette 3
A patient come to the hospital and admitted to an intensive care unit with a chronic, progressive illness and has a small but real chance of leaving the hospital alive if he submits to invasive treatment. The patient feels that he has suffered enough, and he requests supportive care only.
Assignment
What is your decision?
Vignette 4
A very rich patient pays you a lot of money and asks you to copy the prescription from another doctor. The drugs are very essential for his life.
Assignment
Day 4
What will you do?
Vignette 5
The 64-year-old patient suffering from diabetes mellitus, and gangrene had developed on his leg causing sepsis with high fever, indicating it was a progressive gangrene. He was a former lawyer. The doctor advised the patient and his family that he have an amputation to prevent the spreading of infection and safe patient’s life. The family agreed, but the patient did not. The family followed the doctor reasoning: “I do not want the patient to die merely because of gangrene and diabetes”. Then the doctor told the family that if the patient fell into a coma, the doctor would have the right to undertake a professional intervention to save his life without having to obtain the patient’s approval. Once the patient went into coma, the doctor asked the family to sign the informed consent for the amputation. The amputation was finally done.
Assignments:
1. Identify the ethical issues in this case!
2. What is your view on the application of the principle of patient’s autonomy in this case?
3. Is there any violation to the patient’s right in this case? Give your reason!
4. What do you think about the patient’s autonomy, if the patient comes in a state of unconsciousness?
5. What do you think about the patient’s autonomy, if the patient is a child?
6. What do you think about the patient’s autonomy, if the patient is mentally ill?
7. Has the doctor in this case applied the principle of informed consent? Explain!
8. Under What circumstance informed consent given by the family is justified ?
Vignette 6
Mrs. X is 35 and is in need of dialysis. She is refusing treatment because she is scared of the treatment which she believes is invasive. She has been counseled about the nature of the treatment-there are no alternatives that would be of practical benefit. She is competent to make treatment decisions. She understands that if she refuses dialysis she will die. She has a daughter of 15 years who lives at home. The clinicians feel very strongly that should receive dialysis but despite numerous attempts to persuade her refuses.
Assignments:
1. Identify the ethical issues in this case!
2. What is your view on the application of the principle of patient’s autonomy in this case?
Write an experience, when did you feel empathy and when you feel sympathy. Your feelings descriptions should be clear that includes: how it came, when it came, why it came, and what you're doing when it came.
Example of feeling description :
“ Waktu saya bertemu dengan pemulung tua ibu Ketut Sunie, hati saya tergetar, kok tega-teganya petugas malam itu mengusir dia dari halaman kantor. Dia berjalan sendirian, padahal dia sudah sangat tua dan renta....wah teganya. Hati saya semakin kasihan saat melihat dia menyeret kantong plastiknya dan jika kelelahan dia tidur di emperan toko dengan hanya beralaskan koran. Hati saya semakin trenyuh saat dia menceritakan pengalaman hidupnya yang penuh dengan derita, ingin rasanya saya setiap hari menyediakan makanan dan tempat beristirahat untuk dia,....E aaalah kok yha tega-teganya anggota satpam itu”
Once your feelings descriptionsis is clear, then describe whether these feelings can affect your attitude toward the events on your everyday life. Give your opinion if these feeling are useful for yourself and your profesion as a doctor and if useful how you maintain these feelings.
Write your observation report with a brief on A4 paper with a font 12, 1.5 spaces line as much as 4 pages. The report will be discussed at the Small Group Discussion, and also will be discussed at the Plenary Session.
Assigments :
1. What is the difference between empathy and sympathy and give an examples ! 2. Explain with your own word the definition of empathy!
3. Why empathy is important in medical practice
4. Is empathy can be developed or learned? If the answer is yes, how?
Task 1
Please try to interview one of your friends in SGD with the following questions: 1. What is her/his father (or family leader) name and job?
2. With whom are he/she staying at his/her house?
3. If one of the family members falls sick, who will label the illness? 4. Which health provider will he/she be taken to?
5. Who make the decicion for it (question no. 4)?
According to task above, please discuss within your SGD. 1. Why should we ask name and job of the family leader?
2. What image of the family could we get by asking name and job of the family leader? 3. What is the family type?
4. What can we imagine from the answer? 5. Why are they labeling the illness like that ? 6. What is their seeking behavior?
7. How is the decision making process in that family?
Please make a summary and we will choose a group randomly to present in front of the classroom!
Task 2
Please try to interview
an elderly person
with the following questions:1. What is his/her name (full name)?
2. Where is he/she come from?
3. What is his/her ethnicity?
4. What is his/her occupation?
5. What is his/her last education?
6. What does he/she think about geriatric?
7. Is he/she enjoy his/her life?
Observation Guide
1. Observe his/her clothing.
2. Listen and observe his/her language and body language.
3. His/her behaviour.
4. His/her personal hygiene.
5. His/her topic in their conversation.
6. His/her expression in enjoying their life.
Please make a summary and we will choose a group randomly to present in front of the classroom!
Day 6
According to task above, please discuss within your SGD
1. By knowing his/her name, could you know what is his/her ethnic,
stratification(especialy ascribe stratification)?
2. Could you know the gender difference by the name?
3. Why do we need to know about their education and occupation? Please
explain your answer.
Vignette
Paul Farmer is a physician and anthropologist who for the last two decades has split his time between Harvard and a medical clinic in rural Haiti. He has watched HIV/AIDS since its earliest days in Haiti, and his writings put the pandemic into its historical and international context.
In the early 1980s, Haiti had become the symbol of AIDS for North Americans, but this was merely the latest definition of Haiti for Americans. For 200 years Haiti had been a dark, sinister place. From the time of Columbus, the island was exploited by the Spanish and then the French. As the Indian population died off, enslaved Africans were brought in to work the plantations. Serious slave uprisings began in 1971, and by 1804 the Republic of Haiti had become only the second country to free itself from European colonial rule. But the first such country, the United States, still maintained slavery, and the example of Haiti’s violent slave revolt terrified the planters of the American South. From the mid-19th century
the United States regularly sent warships to protect American interests in Haiti, and from 1915 to 1937 the U.S. Marines occupied Haiti.
Voodoo, with its dark, ecstatic rituals, added to the sinister image of this troublesome land. In the early years of HIV/AIDS, when it was little understood, and when many poor refugees from Haiti were found to be HIV positive, it was easy for North Americans to blame Haitians for the disease.
From the Haitian standpoint, however, AIDS was just the latest indignity foisted on the country from the United States. But a more proximate reason for the illness was explained by Haitian folk beliefs in witchcraft-someone has sent misfortune to another. In his earlier work(e.g., 1992) Paul Farmer emphasized the atmosphere of accusation and counteraccusation that characterized the early days of HIV/AIDS, as well as the historical and cultural contexts from which these accusations were made. In his later work (1999) he concentrates on the effects of poverty. HIV/AIDS cannot be curred, but it can be controlled by massive and very expensive medication that is simply out of reach of most Haitian peasents :
One can be impressed by the power of modern medicine and yet dejected by our failure to deliver it equitably . . . Moving along the fault lines of society, HIV continues to entrench itself among the world’s poor and marginalized. (Farmer, 1999:264-265)
And so this medical anthropologist, after years of facing the biological, cultural, and historical aspects of HIV/AIDS, winds up with the realization that it is the inequalities built into the transnational social system that will sustain and spread HIV/AIDS among the poor. And once more we see the utility of thinking in terms of a biocultural model, for neither part can be understood alone.(Heider, 2004 in Seeing Anthropology 3rd ed. p 414-415).
Learning Task
1.What is Haitian think about HIV/AIDS? Discuss with your group! 2. What is your perception of health?
3. What do we mean by illness? What the different with disease? 4. What do we mean by seeking behavior?
5. Why culture has important role to human health and illness?
societies?
7. Discuss, how are you develop the strategies of cross-cultural perspective in the case above.
8. What are another determinant factor of the disease above that Paul Farmer thought?
Vignette 1
A mother, 68 years old, who currently staying with her married child, have been experiencing series of minor cerebral hemorrhage for the past 11 years and for the past two years she has been unable to talk and showing signs of diminishing hearing abilities. This has resulted in lack of communication between her and her family. The family later requested a doctor to do euthanasia to her.
Assignments:
1. In your opinion, what the doctor should do?
2. In your opinion, is the doctor guilty if at all he/she grants the family’s request of euthanasia towards her (mother)? Explain!
3. What is your point of view regarding the ethical aspect in euthanasia?
Vignette 1
A doctor in private practice in the peripheral area, visited by patients with the condition of "withdrawal syndrome" due to the habit of using narcotics.
Assignments:
1. What action you as a physician who practices in peripheral regions?
2. What follow-up of patients is related to the habit of using drugs?
3. Mention things that can be done by a doctor in drug delivery to the patient?
4. Narcotics which class should not be used for treatment?
Vignette 2
Day 7
Legal Aspect of Medical
Practice
Day 8
Pharmaceutical Regulations
Related to Medical
A doctor on duty in the government hospitals provide prescription drug patents in the request "medical representative" of a particular drug factory. The hospital already has a hospital formulary generic drugs and have a complete inventory and always available.
Assignments:
1. What is your opinion as a doctor?
2. For the purposes of private practice, doctors buy drugs directly into the Large Pharmacy (PBF), how in your opinion?
3. What is your opinion when the brand drug prescription from a doctor patent replaced with generic drugs and what it implies that the same dose, at the request of the patient?
Vignette 3
An individual private practice physicians in remote areas storing , dispensing , and deliver drugs directly to patients to speed up services to patients so that patients recover quickly.
Assignments:
1. How do you think as a doctor practice ?
2. If the existing Pharmacies/chemist at that area whether the actions of doctors they will be justified under the Act in force ?
3. If medicines are provided doctors is free of drugs and drug classes limited free ( Over The Counter ) , Give your opinion and explain what you think .
Vignette 1
A female, aged 14 years old, went with her mother to a hospital with possible pregnancy after forced to do an intercourse with her neighbor. The test results reveals positive pregnancy test aged 6 weeks of gestation. The girl then consulted to psychiatry department, diagnosed with mild post psychic traumatic depression. The mother then requested the medical doctor to do an abortion procedure with an excuse that her daughter not yet ready mentally and physically to conceive the pregnancy and so that she can be back to school again.
Assignments:
Day 9
1. In your opinion, what the doctor should do regarding the mothers request?
2. When the doctor agrees’s for an abortion, can the doctor be said to have done a criminal act? Explain!
Vignette 2
A young man, aged 21 years old, had a traffic accident. He is diagnosed with right epidural hematoma by a surgeon in the hospital where he receiving treatment. The surgeon suggested a trepanation procedure to be done to evacuate the bleeding occurred. In the operation room, the surgeon has done the trepanation procedure in the left lobe instead of doing in right lobe. After a while, the surgeon realized that he has mistakenly interpreted the CT scan results. The surgeon then has done the trepanation procedure in the right lobe to evacuate the bleeding. After operation done and the patient treated in the same hospital for few days, the patient discharged in improved condition.
Assignments:
1. In your opinion, does the mistake done by the surgeon considered a malpractice? How do you prove it?
2. After arriving home, the patient then realize that there has been a mistake in the operation done (trepanation) and he decided to sue the surgeon to compensate the damage done to him. In your opinion, how the surgeon should do or explain his decisions to defend himself from a possible malpractice charge?
Vignette 3
A 45-year-old man was suffering from intestinal cancer stage IV. The surgeon who handled him post medically decided the patient to be operated though the possibility of success was very little. However, it was preferable as compared with no operation. In consideration of the patient’s weak condition and the anticipated influence of anesthetic, the surgeon undertook the operation in a hurry in the hope that the patient’s condition would not become worse due to the surgery. After the operation and during treatment, the patient complained of a chronic stomachache despite long administration of analgesic. To find out the cause of pain, an X-ray of the abdomen was made and the image showed that a metal instrument was lying inside the patient’s abdomen.
Assignments :
1. Does the doctrine res ipsa loqiutur apply on the above case?
2. Explain the term and condition of res ipsa loquitur!
3. What are the conditions that can serve as a defense on the above case?
Vignette 1
A husband punched his wife till made her fell and hit a table. This violence caused by his suspicion on their 2 years old child not from their married. His wife was brought to hospital and examined by doctor A. Doctor A recorded all findings from examination and treatment
Day 10
Legal Aspect of Medical Record,
Medical Certification and Visum et
given on medical record. On examination found bruises on right forehead and open wound on left temple that required treatment.
His wife brought by police to hospital and asked for wound VeR. The victim want to have Sick Leave Certificate for getting off from duty cause she works in a private company. A few days later, her company asked for Medical Certificate needed to reimburst to health insurance company.
On the other hand, her husband insist for patternity test to their child by DNA examination to ensure the real father. Based on the test result, he want Certificate of Patternity to the corresponding child.
Assignments:
1. Medical certificate has vary form according to patient need but in general it has the same components. Discuss about this components!
2. Medical certificate required by the law must follow medicolegal procedures. Discuss about this medicolegal procedure and how it is connected with profession responsibility in law!
3. Discuss about medical confidentiality aspect on medical certificate making process! 4. If the requirement for medical certificate delayed after examination. Discuss about the
solution regarding to this certificate making process!
Vignette 2
A policewoman escorted a 20-year-old girl who was a victim of sexual harassment. A doctor at the emergency department examined her after obtaining the consent from her.
Assignment:
1. What the doctor should do to document the result of the examination?
2. The policewoman requested the doctor to make medico-legal report (visum
et repertum). Explain the role of and procedures to make visum et repertum!
BASIC CLINICAL SKILL
MEDICAL CERTIFICATION AND VISUM ET REPERTUM WRITTING SKILL
TRAINING
TRANSLATING THE CONCEPT AND PRINCIPLE OF MEDICAL
PROFESSIONALISM IN PRACTICE
MEDICAL RECORD
Date and Place :
Wednesday, 04
thMarch 2015
Class Room and Lab. Bersama
Facilitator : Forensic team
LATAR BELAKANG
Profesi dokter memiliki berbagai tanggung jawab meliputi tanggung jawab terhadap pasien, tanggung jawab moral (moral duty), tanggung jawab hukum (legal duty) dan tanggung jawab terhadap sesama dokter. Tanggung jawab moral berhubungan dengan etika kedokteran sedangkan tanggung jawab hukum merupakan tanggung jawab profesi terhadap negara. Dalam tanggung jawab hukum, profesi medis harus menerapkan (aplikasi) ilmu dan teknologi kedokteran untuk membantu proses hukum dan peradilan.
Tanggung jawab hukum bersifat obligasi (keharusan) tidak bisa ditolak oleh seorang dokter,karena akan dikenakan sanksi hukuman. Disamping itu,tanggung jawab hukum secara universal di seluruh dunia berdasarkan konsep “ balancing public interest” yang menekankan dalam memenuhi tanggung jawab hukum dapat mengabaikan tanggung jawab lainnya.
Salah satu tanggung jawab hukum bagi profesi dokter adalah pembuatan sertifikasi medis baik untuk kepentingan masyarakat maupun kepentingan hukum. Sertifikasi medis untuk masyarakat seperti penerbitan Surat Keterangan Medis dan Surat Keterangan Kematian. Sedangkan untuk kepentingan hukum, sertifikasi medis berupa Laporan Mediko-legal (medico Mediko-legal report). Laporan MedikoMediko-legal di Indonesia secara khusus diberikan nama VISUM ET REPERTUM.
Jumlah dan jenis sertifikasi medis berkembang sesuai dengan “State of the art” dari perkembangan IPTEKDOK, sehingga sekarang banyak ragam sertifikasi medis, seperti Surat keterangan keayahan, surat keterangan tidak berpenyakit menular, surat keterangan kegadisan dan lain sebagainya.
Konsep dasar sertifikasi medis adalah FAKTA dan PENDAPAT yang disampaikan secara tertulis oleh dokter tentang apa yang diperiksanya. Fakta merupakan bukti fisik dan pendapat merupakan opini berdasarkan keilmuan kedokteran.
Sehubungan dengan Visum et Repertum, penerbitannya diatur oleh hukum positif di Indonesia khususnya pasal 133 KUHAP. Sebagai Keterangan Ahli tertulis, Visum et Repertum diatur dalam pasal 179 KUHAP dan pasal 180 KUHAP.
Istilah Visum et Repertum hanya ada di Indonesia dan tidak pernah ditemukan di negara lainnya di dunia. Meskipun istilah Visum et Repertum hanya ada di Indonesia tetapi
Day 12
MEDICAL CERTIFICATION AND
VISUM ET REPERTUM WRITTING
konsepnya sama dengan konsep Laporan Mediko-legal di negara-negara lainnya. Secara internasional, hukum memerlukan dua bukti yaitu bukti fisik (physical evidence) dan bukti pendapat ( opinion evidence). Bukti fisik diperoleh dari pengamatan fisik secara implisit yang pengertiannya sama dengan “visum” sedangkan bukti opini merupakan interpretasi dari bukti fisik secara ekplisit dan pengertiannya sama dengan “repertum”.
Kompetensi dokter sangat diperlukan profesionalitasnya dalam pendekatan implisit dan eksplisit dari bukti yang tertuang dalam Visum et Repertum. Pendekatan implisit (implisit reasoning) diperlukan dalam pengumpulan bukti fisik. Bukti fisik diperoleh dari pemeriksaan dan observasi yang didasari komitmen teori, ilmu kedokteran dan tujuan medis tertentu. Bukti pendapat (opinion evidence) merupakan interpretasi terhadap fakta medis berdasarkan pemikiran kritis (critical thinking). Pemikiran kritis ini adalah unsur eksplisit dalam pembuatan visum et repertum. Pemikiran kritis profesi dokter berdasarkan dua pendekatan yaitu pendekatan medis (medical reasoning) dan pendekatan hukum (legal reasoning).
Disamping itu, kompetansi dokter diperlukan dalam memberikan bukti yang sah dan dapat diterima (admissible) di pengadilan berdasarkan relevansi, tidak tersanggahkan, otentik, reliable dan tidak diperoleh dengan jalan yang melanggar hukum.
Berdasarkan uraian diatas, maka dapat disimpulkan pentingnya kemampuan klinis pembuatan sertifikasi medis dan Visum et Repertum diberikan kepada mahasiswa kedokteran dengan alasan sebagai berikut :
1. Profesi dokter memiliki berbagai tanggung jawab, diantaranya adalah tanggung jawab hukum (legal duty). Tanggung jawab hukum bersifat obligasi dan didasari konsep “balancing public interest” yang tidak bisa ditolak dan dapat mengabaikan tanggung jawab lainnya.
2. Pembuatan sertifikasi medis, khususnya Visum et Repertum adalah salah satu tanggung jawab hukum profesi dokter
3. Profesionalisme pembuatan sertifikasi medis dan Visum et Repertum harus terus dikembangkan karena sertifikasi medis berkembang sesuai dengan state of the art (SOTA) dari perkembangan IPTEKDOK.
4. Kompetensi dokter diperlukan untuk memberikan FAKTA dan PENDAPAT medis secara tertulis baik untuk masyarakat maupun untuk hukum
5. Kompetensi dokter diperlukan dalam melakukan pendekatan secara implisit dalam mengumpulkan bukti fisik dan pendekatan eksplisit dalam memberikan opini medis
TUJUAN Tujuan Umum
Agar mahasiswa mempunyai kompetensi mengerti tentang konsep pembuatan sertifikasi medis dan Visum et Repertum serta mampu membuatnya secara mandiri untuk memenuhi kewajiban hukum profesi dokter
Tujuan Khusus
1. Mahasiswa mengerti tentang prosedur Mediko-legal penerbitan Sertifikasi medis dan Visum et Repertum
2. Mahasiswa memahami anatomi umum dari sertifikasi medis dan Visum et Repertum 3. Mahasiswa mampu mengidentifikasi bukti fakta dari sertifikasi medis dan Visum et
Repertum
4. Mahasiswa mampu menuliskan secara naratif berdasarkan interpretasi medikolegal bukti fakta dalam sertifikasi medis dan Visum et Repertum
