P
ROFESIONALISME DALAM
P
RAKTIK
K
EDOKTERAN:
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
• 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….
SOCRATES
:
“
Tell me:
is a doctor in the precise
sense…a
money-maker
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.”
What is a DOCTOR and
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
What is a Doctor &
What does a Doctor do ?
What is a Doctor &
What does a
Doctor do
?
MJA 2005;183:560-561
One hundreds
years on….
... ...
Things has
changed
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
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
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
“
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
…”
What is a Profession ?
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
The practice of
m
edicine
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
p
rofessional
r
elations
.
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
occupation.
1
2
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
Components of professionalism
Competence
Accountability
Altruism
Collegiality
Ethics
Physician
Patient
•Proffessional competence
•Legal and ethical conduct
•Adequacy of access
Lawyers And Courts
•Proffessional competence
•Legal and ethical conduct
•Adequacy of access
Professional Associations
•Proffessional competence
•Legal and ethical conduct
•Adequacy of access
•Public health promotion
Hospitals
•Proffessional competence
•Legal and ethical conduct
•Financial performance
Managed Care Plants
•Proffessional competence
•Legal and ethical conduct
•Financial performance Investors •Financial performance Employers •Proffessional competence •Financial performance Private Payers •Proffessional competence •Financial performance Government
•All six domains
Accountability of the physician
Medical Professionalism
ACCOUNTABILITY
“self regulating activities for which physicians
can be held accountable, and range from their
professional competence and legal and ethical
conduct to financial performance”
Procedures and processes by which one party
justifies and takes responsibility for its activities
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
Kompetensi Dokter di Tingkat Pelayanan Primer
(Primary Care)
KONSIL KEDOKTERAN INDONESIA
STANDAR KOMPETENSI
DOKTER INDONESI
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
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,
KOMPETENSI Pe n g e lo la a n Indfor masi La nd asa n Ilmia h Ilmu Ke do ktera n Ke trampi la n Kli ni s Pe bg el ol aa n masa la h Ke seh ata n KOMUNIKASI EFEKTIF
MAWAS DIRI DAN PENGEMBANGAN DIRI PROFESIONALITAS YANG LUHUR
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
DISIPLIN KEDOKTERAN
(MEDICAL DISCIPLINARY)
Sesuai dengan PERKONSIL No 4/2011
Tentang
DISIPLIN PROFESIONAL DOKTER
DAN DOKTER GIGI
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
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
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.
Medical
schools
Prof
essional
Or
ganiza
tions
Professionals
Standard of
professional
conduct:
Competence
Accountability
Altruism
Collegiality
Ethics
Clinical governance:
Education & training
Clinical effectiveness
Accountability
R & D
Clinical audit
Risk management
CPD
Healthcare
Standards of care
Health systems
SS 2011What is the Role of
Professional
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
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
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
Health ServicesHospital
ProviderPatients
Health Care
System
Hospital by Laws Medical Acts Hospital staffs
