BagaimanaPenerapan

EtikolegalPelayananKlinik
Prijo Sidipratomo
Jakarta9Maret 2013SeminarAsklin
GedungPusatNiagaLantai6,JakartaInternational
g g ,
Expo(JIEX)Kemayoran,JakartaPusat
 SISTEM PELAYANAN
SISTEMPELAYANAN

SISTEMBERJENJANG/RUJUKAN
PASIENTIDAKBISALANGSUNGKEDOKTERSPESIALIS/RS
/
KECUALIEMERGENSI
GATEKEEPER:DOKTERLAYANANPRIMER
TENAGAKESEHATANLAIN,MENYATUDENGANDOKTER
DASARHUKUMPERMENKESNOMER1TAHUN2012
 KRITERIA DOKTER DIKLINIK
KRITERIADOKTER DI KLINIK

1. MEMENUHIPERSYARATANPENDIDIKAN
BERKELANJUTANYANGDITETAPKANOLEHPBIDI
(P2KB SEBESAR 200 250
(P2KBSEBESAR200 250SKP/5TH)
SKP/5TH)
2. MEMATUHIKODEETIKKEDOKTERAN
3. MEMBUATREKAMMEDISDGNBAIK,INFORMED
CONSENT
4. MELAKSANAKANKEWAJIBANDOKTER
5 MEMPUNYAISTR
5. MEMPUNYAI STR
DASARHUKUM:
UUPRAKTEKKEDOKTERANPASAL28,49,51,54,71,
 NORMA HUKUM
NORMAHUKUM
Normahukumpadaumumnyadikenaldalam3
p y
jenis,yaitunormahukumadministratif,norma
p p
hukumpidanadannormahukumperdata.
Normahukumadministratifseringkali
dikaitkan juga dengan norma disiplin
dikaitkanjugadengannormadisiplin,
meskipunsebenarnyaterdapatperbedaan
diantara keduanya Norma hukum
diantarakeduanya.Normahukum
administratifjugaterdapatdidalamberbagai
peraturan
Agus Purwadianto 2010
 ASPEK
ASPEK
HUKUM
HAK DAN
KEWAJIBAN
DOKTER
HAK DAN
KEWAJIBAN
PASIEN
 HUBUNGAN HUKUM DOKTERPASIEN
HUBUNGANHUKUMDOKTER PASIEN

IUSDELICTU :AKIBATPERATURAN
PERUNDANGUNDANGAN
MIS:RAHASIAKEDOKTERAN

IUSCONTRACTU :AKIBATADANYA
HUBUNGAN KONTRAKTUAL
HUBUNGANKONTRAKTUAL
MIS:UPAYASESUAISTANDARTERTINGGI

Agus Purwadianto 2009

 HAKPASIEN
DeclarationofLisbon(1991):TheRightsof
the patient
thepatient
UUNo23tahun1992tentangKesehatan:
pasal 53 : hak pasien
pasal53:hakpasien
UUNo.29tahun2004tentangPraktik
Kedokteran Pasal 52 dan 53
Kedokteran,Pasal52dan53.
SEDitjenYanmedDepkesRINo
YM 02 04 3 5 2504 : Pedoman Hak dan
YM.02.04.3.5.2504:PedomanHakdan
kewajibanpasien,dokterdanRS
DeklarasiMuktamarIDI:Hakdan
Deklarasi Muktamar IDI : Hak dan
kewajibanpasiendandokter
Agus Purwadianto 2009
 NORMA ETIK
NORMAETIK
Normaetikpadadasarnyamengaturtentang
p y g g
bagaimanaseharusnyaprofesionalkedokteran
berpikirdalammembuatsuatukeputusanklinik
p p
yangetis(ethicaldecisionmaking)
bagaimanaseharusnyabertindakdan
berperilakuselamaiabekerjadidalam
keprofesiankedokteran(professionalethical
conduct).
d )

Agus Purwadianto 2010

 Medical Ethics
Most physicians are governed by their
own internal
i t l code
d off ethics.
thi
The commitment to help and serve
others
h has
h traditionally
d ll taken
k
precedence over economic interests.
Medicines code of ethics is considered to
be far more stringent than the law.
Professional organizations have more
formalized codes to ensure that their
members behave ethically.
 CODEOFMEDICALETHICS

1. Q
Qualifiedinmodernsystemofmedicineonly.
y y
2. Updateknowledgeandskills,CME
3. Maintainmedicalrecords,medicalcertificate
register
4. Displaydetails
5. Observanceofsanitarylawsandregulations
 DUTIESOFAPHYSICIAN
*TOTHEIRPATIENTS

In
Incaseofemergencytreatorrefertoappropriate
case of emergency treat or refer to appropriate
physician
Informationrevealedinconfidencetobekeptsecret
p
Neverexaggerateorminimizethegravityofa
situation
 DUTIESOFAPHYSICIAN
*INCONSULTATION

Consultationonlywhenjustifiable,interestofpatient
Consultation only when justifiable, interest of patient
Laboratoryteststobecarriedoutjudiciously
Punctuality
Nevercriticizereferringphysician
Communicate opinion in writing to referring
Communicateopinioninwritingtoreferring
physician
 DUTIESOFAPHYSICIAN
*TOTHEPUBLICANDTOPARAMEDICALPROFESSION
Enlighten
Enlightenpublicregardingquarantineregulations
public regarding quarantine regulations
andmeasuresforpreventionofepidemic
Notifyconcernedauthoritiesinaccordancewith
y
laws,regulationandrules
g p p
Recognizeandpromotepracticeofdifferent
paramedicalservices
 RESPONSIBILITIESTOEACHOTHER

Render
Renderservicetofellowphysiciansandtheir
service to fellow physicians and their
immediatefamilydependents
Nophysicianorconsultantshallcriticizereferring
p y g
physician
p p y
Considerationforreputationofabsentphysician,
whiletreatingpatient
 UNETHICALACTS&MISCONDUCTS
Advertisement
Alcoholism
Abortion
Humanrightsviolation
False certification
Falsecertification
Breachofconfidence
Not taking appropriate consent of patient
Nottakingappropriateconsentofpatient
Violationofguidelineswhileconductingresearch
Foundabsentfrompositionatplaceofwork
Lets also remember
Letsalsoremember

Medicine is about : Can we?

Ethics is about: Should we?
 Expectations
Patientexpectsfromdoctor.... Whyapatientgoestodoctor..
Acure
Medication Theyfeelillphysically
Tobelistenedto
They feel ill mentally
Theyfeelillmentally
Sympathy
Advice heunderstands Theyarelonely
Theanswer Theywanttimeoffwork
A i k t
Asicknote Needadvise
Whattheywant(agenda) Dontknowwhototurnto
Comfort
Marital/familyproblems
A chat
Achat
Noharm Legalreasons
Professionalism&Respect
To be told what to do
Tobetoldwhattodo
Tofeelbetter
Thetruth
 Expectations
Doctor expects from patient
Doctorexpectsfrompatient...
Trust
Compliance to treatment
Compliancetotreatment
Agreement
The truth
Thetruth
Respect
Theywanttogetbetter
Tobelistenedto
ToobeytheRules!
 If Expectations are not met...
IfExpectationsarenotmet...
Patient may
Patientmay... Doctor may
Doctormay...
Nottakemedication Becomeannoyed
Notfollowadvice Become stressed
Become stressed
Chooseanotherdoctor Notbethorough
Losetrust
Dreadseeingpatientagain
Complain
Notcomeback Refusetoseepatientagain
Comeback Referpttoanotherdoctor
Becomemoreill/die (
(Balintcallsthisthe
Nottelldoctorwhytheycame collusionofanonymity)
Become Distressed/Sad/Angry
BecomeDistressed/Sad/Angry Notlisten
Not listen
 Doctor-patient
Doctor patient relationship in the past

Paternalism
Because physicians in the past are people who
have higher social status
doctor is seen as a sacred occupation which
saves peoples
l lives
li
The advices given by doctors are seen as
paramount mandate
 Doctor-patient
Doctor patient relationship at present

Consumerism and mutuality

Patients nowadays have higher education and
better economic status
The concept of patients autonomy
The ability to question doctors
 Doctor patient contact time
Doctorpatientcontacttime
LikeandZyzanski
y studieddeterminantsofpatient
p
satisfactioninauniversitybasedfamilypractice
inCleveland.
Theyfoundthatpatientswhostatedtheywished
They found that patients who stated they wished
theyhadspentmoretimewiththephysician
werelesssatisfied
Morrelletal.7 andRidsdale etal.8 bothfounda
greaterlikelihoodofpatientsfeelingtheyhad
inadequate time with their physician in visits
inadequatetimewiththeirphysicianinvisits
scheduledtolast5minutescomparedwithvisits
scheduledtolast10and15minutes,respectively
JGenInternMed.1999January;14(S1):S34S40.
 RiskofMalpracticeClaims

Aphysician'sriskofmalpracticeclaimsis
p ys c a s s o a p act ce c a s s
associatedwithvisitlength
p y p y
Levinsonetal.studied59primarycarephysicians
inOregonandColorado
Primarycarephysiciansfromthenoclaims
grouphadlongerroutinevisitsthanclaims
primarycarephysicians(18.3vs 15.0minutes).
Onethirdofpatientsofphysicianswithahigh
O thi d f ti t f h i i ith hi h
rateofmalpracticeclaimsfeltthattheyhadspent
less than 10 minutes with
lessthan10minuteswith
JGenInternMed.1999January;14(S1):S34S40.
 OPTIMAL VISIT LENGTH
OPTIMALVISITLENGTH
Visitlengthvariesgreatlybetweencountries
g g y
InGreatBritain,averagevisitlengthsforgeneral
practitionersarebetween5and8minutes
IntheUnitedStatesandSweden,theyare10to20
minutesormore
Inaddition,physicianswithlongervisitsmademore
In addition physicians with longer visits made more
statementsabouthealtheducationandprevention
InanotherBritishstudy,Wilsonetal.foundthat
y
physicianswhoincreasedtheiraveragevisitlength
from7.1to8.2minutesincreasedtheirratesof
hypertension screening and health education activities
hypertensionscreeningandhealtheducationactivities
JGenInternMed.1999January;14(S1):S34S40.
 PELANGGARAN ETIK
PELANGGARANETIK
1.. PELANGGARANETIKMURNI
GG U
MENARIKIMBALANJASATIDAKWAJAR
MENGAMBILALIHPASIENTANPA PERSETUJUAN
SEJAWAT
MEMUJIDIRISENDIRI
PELAYANANDISKRIMINATIF
PELAYANAN DISKRIMINATIF
KOLUSIDENGANPERUSAHAANFARMASI
TIDAKMENGIKUTIPENDIDIKAN
BERKESINAMBUNGAN
MENGABAIKANKESEHATANSENDIRI

ERYATIDARWIN
2. PELANGGARANETIKOLEGAL
PELAYANANKEDOKTERANDIBAWAHSTANDAR
MENERBITKANKETERANGANPALSU
MELAKUKANTINDAKANMEDIKYANGBERTENTANGAN
MELAKUKAN TINDAKAN MEDIK YANG BERTENTANGAN
DENGANHUKUM
MELAKUKANTINDAKANMEDIKTANPAINDIKASI
PELECEHANSEKSUAL
MEMBOCORKANRAHASIAPASIEN

ERYATIDARWIN
 SANGSIPELANGGARANETIKKEDOKTERAN

PELANGGARANETIKDISELESAIKANOLEHMAJELIS
KEHORMATANDISIPLINKEDOKTERANINDONESIA(MKEK),
YANGDIBENTUKOLEHIDI
PENYELESAIANPELANGGARANETIKKEDOKTERANTIDAK
PENYELESAIAN PELANGGARAN ETIK KEDOKTERAN TIDAK
SELALUDISERTAIBUKTIFISIK
SANGSITERHADAPPELANGGARANETIKBERUPA
TUNTUNAN

ERYATIDARWIN
TERIMAKASIH