Download PLENARY 1.2 PROFESIONALISME DALAM PRAKTIK

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