ETIKA KEDOKTERAN DALAM PRAKTEK SEHARI HARI

Harun Rasyid Lubis Departemen Ilmu Penyakit Dalam Fakultas Kedokteran - USU Medan

Medical Students CME, CPD

Medical Research

Political Upheaval, War Natural Disasters

Medical Insurance Doctors Employer Doctors Employee Other Doctors

Managed Care International Community Hospital

Paramedics Health Promotion Clinic Management Disease Diagnosis Laboratories National Community

DOCTOR
Disease Prevention

PATIENT
Therapy Pharmaceutical Industry

Doctors Family

Press, Media

Public Health Practice Management MDO Medical Council

The LAW

Patients Family, Culture, Religion

Patients Work, Employer

Alternative Medicine Patient Organisation

Government Bodies

Medical Charities

THE MEDICAL ECOSYSTEM - Enlarging Circle of Influence

SYSTEMS GOVERNING HUMAN SOCIAL BEHAVIOUR

CUSTOM Mores ETIQUETTE Professional Etiquette Courtesy ETHICS Professional Values Competence Integrity Fairness Goodwill Truth LAW State, Statutes Legislature Enforcement Compulsion Judiciary Punishment Justice MORALITY Spirituality

Tradition

Religious Good vs Evil Right vs Wrong

PROFESSI, PROFESSIONAL, PROFESSIONALISM.

Professi:

Professional
Professionalism

UNSUR PROFESSIONALISME:
Knowledge (Ilmu) Skill (Ketrampilan) Attitude (sikap)

ATTITUDE
What is a good doctor? What is a bad doctor? How do doctors behave accordingly? How do doctors act professionally? How do people judge a doctor as professional?

(The CONCISE OXFORD DICTIONARY): ATTITUDE : SETTLED BEHAVIOUR, as indicating opinion

--- of mind: SETTLED MODE OF THINKING

The Oxford Advanced Learners Dictionary: ATTITUDE: WAY OF THINKING OR BEHAVING

SMCS PHYSICIANS PLEDGE

I solemnly pledge to: dedicate my life to the service of humanity; give due respect and gratitude to my teachers; practise my profession with conscience and dignity; make the health of my patient my first consideration; respect the secrets which are confided in me; uphold the honour and noble traditions of the medical profession; respect my colleagues as my professional brothers and sisters; not allow the considerations of race, religion, nationality or social standing to intervene between my duty and my patient; maintain due respect for human life; use my medical knowledge in accordance with the laws of humanity; comply with the provisions of the Ethical Code; and constantly strive to add to my knowledge and skill; I make these promises solemnly, freely and upon my honour.

PROFESSIONAL COMPETENCE. ALTRUISM ACCOUNTABILITY DIGNITY SERVICE HONOR INTEGRITY RESPECT TO OTHERS EXCELLENCE
ABIM (American Board of Internal Medicine):

Altruism:
doctors should put patients interest above self interest

Accountability:
doctors only do scientifically based actions

Dignity:
Doctors must have a firm believe that - being a doctor means to help people - and it is his/her choice to be one

Service:
doctors are to serve people .. not to be served

Honor:
medicine is a highly respectable profession world wide doctors enjoy this respect from the community from the very beginning it is up to the doctors to maintain this respect or to damage it.

Integrity:
a doctor should treat all individuals equally, disregarding gender, race, skin color, religion etc.

Respect to others:
doctors have to show/pay respect to everybody especially their patients and those related to them (relatives, families etc). Only those who manage to pay respect gain respect

Excellence:
doctors should dedicate themselves to high standards in the fast-moving world, the tremendously big leaps in medicine, meaning one should continuously improve oneself professionally (knowledge, skill and attitude).

In the context of globalization, this means competition

IF I HAD EIGHT HOURS TO CHOP DOWN A TREE, ID SPEND SIX SHARPENING MY AXE.

7 UNPROFESSIONAL ATTITUDE ISSUES : 1. ABUSE OF POWER 2. ARROGANCE 3. GREED 4. MISREPRESENTATION 5. IMPAIRMENT 6. LACK OF CONSCIENTIOUSNESS 7. CONFLICT OF INTEREST.

ABUSE OF POWER:

INTERACTIONS WITH PATIENTS AND COLLEAGUES . a. not allowing patients to voice their wishes or contribute to decision making allowing financial and academic competitiveness to affect honest evaluation of ones peer and trainees using junior colleague to enhance ones own bibliography and advance ones own academic career actions that deliberately retard the academic development of junior colleague gratuitous denigration of junior colleagues

b. Bias and sexual harassment. . All should enjoy respect for their contribution and advance to their full potential irrespective of disability, ethnicity, gender, race or religion c. Breach of confidentiality must maintain the confidences of the patient and make disclosure only in the patients interest or when disclosure in a legal requirement.

2. ARROGANCE.
offensive display of superiority and self importance. It destroys professionalism by 3 ways: reduces the ability to think of himself or herself makes empathy for the patient difficult removes the beneficial role of self-doubt.

3. GREED.
..inappropriate aspiration of fame, power or money. ..no room for understanding, compassion and other qualities necessary for the healing profession altruism, caring, generosity and integrity are compromised significantly. The treatment of GREED requires recognition.

4. MISREPRESENTATION. Lying and Fraud.

lying: failing to tell the truth. Not simply relating to untruth ( otherwise any erroneous statement is lying). Lying requires a conscious effort. can be borderline, in the best interest of patients or not. (white lies). Fraud. Service performed in order to obtain payments (insurance etc) misrepresentation of laboratory data lying about experiments.

5. IMPAIRMENT
DRUG ADDICTED ALCOHOL-DEPENDENT MENTALLY IMPAIRED
PHYSICIANS,

protected or unnoticed by colleagues and allowed to care for unsuspecting patients.

6. LACK OF CONSCIENTIOUSNESS

7. Conflict of interest