INTRODUCTION TO MEDICAL

PROFESSIONAL

Djamhoer Martaadisoebrata
Dept. Obstetrics & Gynecology
Fac of Medicine, Univ of Padjadjaran
What is PROFESSIONAL ?
A calling requiring specialized knowledge and often
long and intensive preparation including
instruction and skills and methods as well as in
the scientific, historical or scholarly principles,
underlying such skills and methods, maintaining
by force or organization or concerned opinion,
high standard of achievement and conduct, and
committing its members to continue study and
to a kind of work which has for its prime
purpose the rendering of public service.

Scientifically speaking it covers all
dimensions : COGNITIVE, PSYCHOMOTOR
and AFFECTIVE, which depict the
capacities of INTELLIGENT QUOTIENT
(IQ) and EMOTIONAL QUOTIENT (EQ)
The International Commission of
Higher Education for 21
st
Century
UNESCO 1998
Learning to know Cognitive Dimension
Rational attitude.
Learning to do Operational/Psychomotor
Dimension Practical attitude
Learning to be
Emancipation/Emotional/Affective Dimension
Ethical attitude
Learning to live together Ecological Dimension
Cooperative attitude
ARE DOCTORS PROFESSIONAL ?
INDEED WE ARE, because :
Medical curriculum is professionally
prepared.
Doctors are clinically and ethically
competent.
We have professional organization, IDI,
POGI, IKABI etc, with solid statues and
rules of association.
ATTENTION !!!!
NEW GRADUATED YOUNG DOCTORS ARE
NOT YET PROFESSIONAL, ONLY
POTENTIALLY PROFESSIONAL
Welch WH(1850-1934)
Medical education is not completed at
medical school, it is only begun.
To be professional :
They must have experience (Experience is
a good teacher).
Long life education
Periodical self assessment, particularly in
ethical conduct.
HEALTH PARADIGMS IN MEDICAL
PROFESSION
1. PROFESSIONAL CHARACTERISTICS :
SCIENTIFIC and BIOTECHNOLOGICALLY
ACCOUNTABLE
SKILLFUL
APPROPRIATE (BIO)ETHICAL CONDUCT
GOOD MANAGER

2. MORAL PHILOSOPHY of MEDICAL ETHICS
Beneficence : good deeds of doctors
Non Malficence : do not inlfict harm
Autonomy : right of patients to receive the
best information and service, involved in
clinical decision making, treated as equal.
Justice : full access to medical service, for all.
3. HEALTH SERVICE, in accordance to
definition of MEDICINE :

Medicine in the ART and SCIENCE of the
DIAGNOSIS and TREATMENT of THE
DISEASE and the MAINTANANCE of
HEALTH

SCIENCE clinical competence (expertise)
to make D/ and Th/ = CURE
ART ethical competence CARE
Proper health care = combination of CURE
and CARE, given proportionally.
BIOETHICS
MC Cullough & Laurence
Is the disciplined study of the morality of
health care, including the morality of the
physicians, patients, the institution of
health care that organize, deliver or pay of
health care, and heath care policy
Abel
Bioethics is the interdisciplinary study of
problems, caused by the development of
biology and medicine, in micro as well as
in macro scale, and its impact on the
community values systems, at present, as
well as in the future.

BIOETHICS
MEDICAL ETHICS
HOSPITAL ETHICS
ETHICS IN BIOMEDICAL RESEARCH
Medical Ethics
Regulation of behavior or conduct of
physicians to patients
REMEMBER HIPPOCRATESs OATH !!!!
HOW DO WE BEHAVE AND
CONDUCT ETHICALLY ?
Be honest, humble and full of compassion
Promise to give the best information and
care
Do not act paternalistically, but treat the
patients as equal
Acknowledge patients right for integrity,
confidentiality and decision making
CURRENT ISSUES IN MEDICAL
PROFESSION
Shift of paradigm: Paternalistic Equality
Ambivalent feeling :
1. Admiration for biomedical technology
(CURE)
2. Dissatisfaction for malpractice and
ethical misconduct (CARE)
Negative ethical issues is increasing,
quantitative, qualitative and more openly
EXTREME EXAMPLE OF NEGATIVE
ISSUES
I will sue the doctors until they have only
their underwear
There are 29 lawyers, ready to defend the
helpless patients, free of charge, from
malpractice of the doctors
I will open their eyes, to make realize, not
to act arrogantly
Are our behavior really as bad as that ?
Has our medical profession gone down as
low as that ?
FOR A CORRECT ANSWER, WE MUST
HAVE THE COURAGE TO CONTEMPLETE
HONESTLY, INDIVIDUALLY AS WELL AS
INSTITUTIONALLY
JONSEN et al : development of
Clinical Ethics to prevent Ethical
Conflict

Clinical Ethics is a practical discipline
which provide a structured approach in
decision making, by identifying, analyzing
and solving ethical issues in clinical
medicine.
FOUR TOPICS related to CLINICAL
ETHICS
Medical Indication, a capacity of a doctor
in clinical decision making, including
diagnosis and intervention, as a result of
his education, experience and professional
attitude.
Patients preference, patients behavior as
a reaction to doctors suggestion which
could be an approval or refusal.

Quality of Life (QOL). It is necessary to
predict before hand whether the QOL after
treatment will be better, stationary or
worse.
Contextual factors, external factors closely
related to treatment and care of the
patients, such as family, social,
economical, cultural and law.


ETHICAL CONFLICT WILL OCCUR IF
THERE IS A PROBLEM IN ONE OR MORE
OF THOSE TOPICS.


IF Jonsens PARADIGM, IMPLEMENTED
CONSISTENTLY = definition of MEDICINE
(CURE & CARE)

DOES THE CURRENT NEGATIVE ISSUES
IN MEDICAL PROFESSION OCCUR
BECAUSE OF INCONSISTENCY IN
IMPLEMENTING Jonsens PARADIGM ?

FACTORS CAUSING ETHICAL
CONFLICT OR MALPRACTICE
Basically, they are bad doctors
Basically, they are good doctors, due to
personal needs, environmental influence,
tight competition, unintentionally, involved
in malpractice of ethical misconduct
Provision of Code of Ethics, not sufficient


Communitys demand for health care is
increasing
Globalization, especially introduction to
high biomedical technology and human
right, without reservation
Inconsistency in implementation of
Jonsens paradigm
IT IS POSSIBLE TO NEUTRALIZE ALL THOSE
NEGATIVE ISSUES ?
I M P O S S I B L E !!!
Because the causes are multifactorial,
and will always exist
BUT AT LEAST WE COULD & SHOULD
MINIMIZE IT.
HOW SHOULD WE REACT TO THOSE
NEGATIVE ISSUES ?
WE SHOULD ADMIT THAT ARE SOME
UNDENIABLE NEGATIVE ISSUES, BUT THOSE
ARE INDIVIDUAL CASES, NOT A GENERAL
PICTURE OF MEDICAL PROFESSION
THEREFORE IT IS OUR DUTY COUNTERACT IT
BY IMPROVING OURSELVES, INDIVIDUALLY AS
WELL AS INSTITUNIONALLY
IT WILL NOT BE EASY, BUT IS CHALLENGING
CONCLUSIONS
Doctors are professionals : scientific and
biotechnologically accountable, skillful, Ethically
Acceptable, and good manager.
Current Issues in Clinical Ethics : People has
Ambivalent Feeling toward Medical Profession,
positive as well as negative.
Some of negative issues are true, hence
introspection and contemplation are imperative


PROGRAN PENDIDIKAN
DOKTER SPESIALIS
Peserta : Dokter, profesional
(postgraduate), mandiri, lebih
bertanggung jawab
Materi keilmuan : kognitif, psikomotor
dan afektif
Tujuan : Pembekalan kompetensi
klinik (IQ) dan kompetensi Etik
(EQ)
lanjutan
Sumber ilmu dan ketrampilan : dosen,
kepustakaan dan penderita.
Kegiatan : belajar dan memberikan
pelayanan.
Tanggung jawab : terhadap diri
sendiri, institusi dan penderita.
Lulusan : Dokter Spesialis (Umum),
Profesional.
REFERENCES
1. Martaadisoebrata D. Pengantar ke Dunia
Profesi Kedokteran. Edisi Pertama. Yayasan
Bina Pustaka SW, Jakarta, 2004
2. Dorlans Medical Dictionary
3. Welch WH. Quoted from A Practical Guide For
Medical Teachers. Eds. Dent JA, Harden RM.
Harcourt Publishers Limited
4. Jonsen AR, Siegler M, Winsdale WL. Clinical
Ethics, A Practical Approach to Ethical Decision
in Clinical Medicine. 5
th
ed. McGraw Hill, 2002