Nama : Ida Bagus Budhi Astawa

NIM : 1102005177

Kasus 1

Suatu malam di sebuah Instalasi Rawat Darurat seorang dokter residen (dokter yang sedang mengikuti
program pendidikan dokter spesialis ) di Bagian Obstetri dan Ginekologi menerima kiriman pasien dari
seorang dokter spesialis Obstetri dan Ginekologi yang juga kebetulan adalah pengajar senior.

Pasien ini dikirim (dirujuk) karena hipertensi dalam kehamilan dan tertulis di surat pengantar dokter
spesialis adalah hamil dengan kemungkinan preeklamsia berat.

Saat diperiksa di tempat praktek dokter spesialis senior ditemukan hasil pemeriksaan tekanan darah
pasien tersebut 160/90 mmHg. Tekanan darah pasien ini baru pertama kali setinggi itu selama
kehamilannya. Saat ini usia kehamilannya adalah 34 minggu + 3 hari. Di tempat praktek dokter spesialis
senior tersebut pasien hanya diperiksa 5 menit karena antrean pasien sangat banyak, dan pemeriksaan
tekanan darah dilakukan oleh asisten dokter di luar ruang pemeriksaan.

Saat dokter residen memeriksa ulang tekanan darah pasien tersebut ternyata ditemukan tekanan
darahnya normal 110/70 mmHg. Pemeriksaan pada pasien dan janinnya dalam keadaan normal. Tidak
ditemukan kelainan pada hasil pemeriksaan laboratorium.

Dokter residen ini mengalami kebingungan karena menemukan fakta yang berbeda dengan apa yang
ditemukan oleh dokter spesialis senior di tempat praktek. Residen ini takut membuat kesimpulan
(diagnosis) yang berbeda dengan spesialis senior yang juga adalah gurunya. Residen ini kemudian
menyangsikan apa yang dia temukan dan memilih untuk mengikuti diagnosis yang dibuat oleh spesialis
senior.

Dia takut disalahkan jika membuat diagnosis yang berbeda.Dia takut dinilai lancang berani
menggugurkan diagnosis spesialis senior. Dan di saat laporan pagi besoknya dia takut diserang oleh
dokter spesialis tersebut dan masa depan pendidikannya akan terancam.

Akhirnya residen ini memilih “jalan aman” yaitu mengikuti diagnosis yang dibuat oleh spesialis senior. Di
catatan medis pasien akhirnya ditulis tekanan darah 160/90 mmHg dan didiagnosis dengan
kemungkinan preeclampsia berat.

Question :

1. What the ethical issue in the case above ?

Identifikasi isu moral etik dalam kasus di atas?
Answer :
The ethical issue in this case is, wrong diagnose made by the resident doctor. It’s happened
because he was too afraid to make the correct diagnosis because the earlier diagnosis was made
by his senior doctor that also have duty as his teacher. He think that he will get trouble in his
study if he against his senior diagnostic. Second, the senior doctor didn’t care about the patient.
It reveals from the way he examine the patient, he just spend 5 minutes in examine the patient
and actually he didn’t check the patient blood pressure(the blood pressure checked by the
Nama : Ida Bagus Budhi Astawa
NIM : 1102005177

senior doctor assistant outside the examination room). It show that the senior doctor didn’t
have care or lack of care to the patient.

2. Identificate personal attribute of the resident doctor against the patient and the specialized
senior doctor !
Identifikasi personal attribute dokter residen terhadap pasien dan spesialis senior!
Personal Attribute :
Confident : He didn’t have any confident to make their own diagnose, even though his diagnose
is right or correct.
Empathetic : He actually have empathy to the patient, but because he was too afraid to his
senior diagnostic and he didn’t want against his senior doctor he abandoned his empathy and
correct diagnosis.
Humane : He care about the patient problem, but because the senior diagnostic it’s makes him
make a wrong diagnosis and it show that he lack of care to the patient and more fear to his
senior doctor.
Forthright : Actually he knew the correct diagnose or the truth, but he didn’t tell the truth to the
patient and his senior doctor. He was to afraid, if he make his own diagnose, it might make the
senior doctor angry.
Respectful : He didn’t show that he respect the patient because he didn’t tell the truth to the
patient.
Thorough : The resident doctor didn’t show any persistent because he just follow his senior
doctor diagnostic without consulting his own diagnosis to his senior doctor.
3. If you were the resident doctor what will you do?
Jika anda menjadi dokter residen di atas apa yang akan anda lakukan?
If I were the resident doctor, I will consult my own diagnose to the senior doctor and then tell
truth to the patient. I will take the risk that I would be troubled because I disagree with the
senior doctor diagnostic. If the senior doctor against me, I will tell the truth to the patient with
all the risk that would came to me.
Nama : Ida Bagus Budhi Astawa
NIM : 1102005177

Kasus 2

Seorang dokter spesialis Obstetri dan Ginekologi yang baru 6 bulan bekerja di sebuah rumah sakit
swasta menerima pasien dengan membawa surat rujukan dari bidan bertuliskan:

“Mohon dilakukan operasi seksio sesaria pada pasien ini hamil aterm dengan persalinan macet. Saya
telah konseling pasien serta keluarganya dan mereka setuju untuk dilakukan operasi. Terimakasih atas
kerjasamanya selama ini”.

Dokter spesialis ini sudah sering menerima rujukan pasien dari bidan dengan rujukan (“perintah”) dari
bidan seperti di atas.

Dokter spesialis ini melakukan pemeriksaan dan menemukan keadaan pasien dan janinnya baik dan
pembukaan (dilatasi servik) sudah lengkap dan penurunan kepala janin sudah di dasar panggul. Dokter
spesialis ini yakin pasien bisa melahirkan normal tanpa perlu dilakukan operasi sesar.

Namun dokter spesialis ini khawatir bila dia tidak mengikuti kemauan dari bidan maka dia tidak akan
dikirimi pasien oleh bidan tersebut atau bidan-bidan lainnya. Karena di rumah sakit swasta tersebut
terdapat kebijakan berupa pemberian insentif sebesar 500 ribu rupiah kepada setiap bidan yang
merujuk pasien yang kemudian pasiennya dilakukan operasi sesar.

Jika pasien ini ditolong melahirkan normal tanpa dioperasi sesar, maka bidan tersebut tidak mendapat
jasa insentif dan tentu bidan tersebut akan malu kepada pasien dan keluarga pasien.

Atas pertimbangan ini maka dokter spesialis memutuskan melakukan operasi seksio sesarea.

Question :

1. Identificate the ethical issue in the case above!

Identifikasi isu moral etik dalam kasus di atas!
The ethical issue in this case was about truth telling. The specialize doctor afraid telling the
midwife about the truth that the patient has a normal pregnancy and the condition of the baby
was in good condition. He also afraid to make their own diagnose, and choose to follow the
midwife diagnostic. It show that the doctor doesn’t have any integrity.
2. Identificate Personal attribute of the doctor against the patient and the midwife!
Identifikasi Personal attribute dokter spesialis terhadap pasien dan bidan yang merujuk
pasien!
Personal Attribute :
Confident : He didn’t have any confident to make their own diagnose, even though his diagnose
is right or correct.
Empathetic : Actually have empathy to the patient, but because he considered more about the
midwife than the patient he made a wrong diagnose and follow the midwife diagnostic. It show
he has more empathy to the midwife than to the patient.
Humane : He care about the patient problem, but because the bonus that will be earn by the
midwife if he follow the diagnose he finally make a decision to follow the midwife diagnose.
Nama : Ida Bagus Budhi Astawa
NIM : 1102005177

Forthright : Actually he knew the correct diagnose or the truth, but he didn’t tell the truth to the
patient and the midwife. He was to afraid, if he make his own diagnose, the midwife will not
earn the bonus money.
Respectful : He didn’t show that he respect the patient and the midwife because he didn’t tell
the truth to the patient and the midwife.
Thorough : The doctor didn’t show any persistent because he just follow midwife diagnostic
without consulting his own diagnosis to the midwife.
3. If you were the speciallized doctor what will you do?
Jika anda menjadi dokter spesialis di atas apa yang akan anda lakukan?
First I will tell the patient that she has a normal pregnancy and tell the diagnose of the midwife
maybe wrong sometimes, then I will tell the midwife about my diagnose and tell her that her
diagnose was wrong. I will take the risk that the midwife will not send any patient again because
a good doctor will consider the well-being of the patient first.