Prinsip Profesionalisme

Praktek Kedokteran
dalam Perspektif Kode
Etik Kedokteran Indonesia
Prijo Sidipratomo
Ketua MKEK IDI Pusat
DISAMPAIKAN DALAM PIT VI PDUI
17 APRIL 2015
The Ritz Carlton Hotel, Pacific Place, SCBD

PENDAHULUAN
Di USA saat ini.
Todays culture of medicine is
hostile to altruism, compassion,
integrity, fidelity, and selfeffacement
Coulehan
Academic Medicine, Vol. 80, No. 10 / October 2005

Failure to affirm the primacy of the

patients welfare will result in a loss
of the public trust and medicines
slide from a revered profession to
an occupation populated with
technical experts
Hafferty
http://cmsne.org/Documents

 Physician practice recast as a profit

center rather than a group of
healers
Substitution of a calculation of cost
benefit for the ethical relations of
care and trust
Erosion of patients TRUST!
www.urmc.rochester.edu/smd/alumni/

World Health Organization ranking of health

systems in 2000

Bloomberg finds "the

U.S. spends the most
on health care on a
relative cost basis
with the worst
outcome

http://en.wikipedia.org/wiki/World_
Health_Organization_ranking_of_he
alth_systems_in_2000

 Today at the dawn of a new

century, genuine medical
professionalism is in peril
Trade or profession?
Market economy a primary
diminishing factor
www.urmc.rochester.edu/smd/alumni/

DIMANA INDONESIA ?

DI USA ANGGARAN KESEHATAN TERTINGGI DI

DUNIA
MENGHASILKAN RANGKING CAPAIAN KESEHATAN
DI URUTAN KE 37 DUNIA.
KEMUNGKINAN MEDICAL PROFESSIONALISM
MENYUMBANG PERAN.
SEMOGA PARA PENGAMBIL KEBIJAKAN DI
INDONESIA TIDAK SALAH
MENGAMBIL BENCHMARK MEDICAL

DEFINISI PROFESIONALISME DALAM

KEDOKTERAN
A commitment to compassion or clemency in the relief of
suffering (Scribonius, 47 A.D.)
Those attitudes and behaviors that serve to maintain patient
interest above physician interest.(American Board of Internal
Medicine, 1991)
Medical professionalism comprises a set of values,
behaviors and relationships that underpin the trust the public
has in doctors (Royal College of Physicians, London 2005)
Medical Professionalism is demonstration of selfawareness and knowledge of limits, high standards of ethical
and moral behavior, reliability and responsibility, respect for
patient dignity, and autonomy (Collins J. J Am Col Radiol,
2006)

PROFESSIONALISM
The conduct, aims, or qualities that characterize
or mark a profession or a professional person
Professionalism: It's NOT the job you do, it's
HOW you do the job. Anonymous
Believing passionately in what you do, Never
compromising your standards and values,
Caring about your patients, your people and
your own career. David Maister
Professionalism is knowing how to do it, when
to do it, and doing it. Frank Tyger
http://cmsne.org/Documents

THE PROFESSIONAL
Patients first
Service/public leadership
Nonjudgmental care
Collaboration
Lifelong learning

THE NON-PROFESSIONAL
Dishonest
Greedy
Impaired
Abuses power

Lacks
interpersonal
skills
Conflict of
interest
Self-serving

THE APPRENTICESHIP OF
PROFESSIONALISM

Acquisition of a knowledge base

Acquisition of skills
Acquisition of an understanding of
ethical standards, social roles and
responsibilities

Professionalism
Professionalism is the basis of
medicines contract with society
Professionalism demands placing the
interests of patients above those of
the physician
Professionalism demands setting and
maintaining standards of
competence and integrity

All definitions of Professionalism

include 3 elements
a physician has mastered a body ofknowledge
and skills, and this knowledge and training is to
be used in the service of others,
the expectation that physicians will uphold the
highest standards of ethical and professional
behaviour in all their actions and activities,
the practice of medicine involves a compact of
trust between patient and doctor a social
(moral) contract termed a fiduciary relationship.
This contract with society allows us to regulate
ourselves, both personally and professionally
http://www.med.uottawa.ca/students/md/professionalism/eng/about.html

The Core Values of

Professionalism

Honesty and Integrity

Altruism
Respect
Responsibility and Accountability
Compassion and Empathy
Dedication and Selfimprovement

http://www.med.uottawa.ca/students/md/professionalism/eng/about.h

TEN PROFESSIONAL
RESPONSIBILITIES

Commitment to

Professional competence
Honesty with patients
Patient confidentiality
Maintaining appropriate relations with patients
Improving quality of care
A just distribution of finite resources
Scientific knowledge
Maintaining trust by managing conflicts of interest
Professional responsibilities
Improving access to care

http://cmsne.org/Documents

ETIK ADALAH LANDASAN DARI PROFESIONALISME KEDOKTERAN

Altruism

Humanism

Excellence

Accountability

Professionalis
m

Ethical and Legal

Understanding
Communication Skills
Clinical Competence (Knowledge of
Medicine)
Arnold
Stern,
Arnold
and and
Stern,
20062006

Fundamental Principles
Primacy of patient welfare
Altruism contributes to the trust that is
central to the physician patient
relationship.
Market forces societal pressures and
administrative exigencies must NOT
compromise this principle

healthcare-professionals.sw.org/resources/.../medicalprofessionalism.ppt

Primacy of Patient Welfare

Primacy of patient welfare means:
Patient-centered, providing patients
the most appropriate high qualified
care that patient needs most.

Fundamental Principles
Principle of patient autonomy
Physicians must have respect for patient
autonomy.
Physicians must be honest with their
patients and empower them to make
informed decisions about their
treatment

healthcare-professionals.sw.org/resources/.../medicalprofessionalism.ppt

Fundamental Principles
Principle of social justice
The medical profession must promote
justice in the health care system,
including fair distribution of health care
resources.
Physicians should work actively to
eliminate discrimination in health care.

healthcare-professionals.sw.org/resources/.../medicalprofessionalism.pp

Professional Responsibilities
Commitment to professional
competence
Physicians must be committed to life
long learning and be responsible for
maintaining the medical knowledge and
clinical and team skills necessary for the
provision of quality care.
The medical profession must strive to
see that all of its members are
competent

Professional Responsibilities
Commitment to honesty with patients
Physicians must ensure that patients are completely and
honestly informed before the patient has consented to
treatment and after treatment has occurred.
Physicians should also acknowledge that in health care,
medical errors that injure patients do sometimes occur.
Whenever patients are injured as a consequence of
medical care, patients should be informed promptly
because failure to do so seriously compromises patient
and societal trust.
Reporting and analyzing medical mistakes provide the
basis for appropriate prevention and improvement
strategies.

Professional Responsibilities
Commitment to patient
confidentiality
Earning trust and confidence of patients
requires that appropriate confidentiality
safeguard be applied to disclosure of
patient information.
Commitment to patient confidentiality
must occasionally yield to overriding
considerations in the public interest

healthcare-professionals.sw.org/resources/.../medicalprofessionalism

Professional Responsibilities
Commitment to maintaining
appropriate relations with patients
Given the inherent vulnerability and
dependency of patients, physicians
should never exploit patients for any
sexual advantage, personal financial
gain, or other private purpose.

Professional Responsibilities
Commitment to improving quality of care

Physicians must be dedicated to continuous

improvement in the quality of health care.
Physicians must maintain clinical competence and
also work collaboratively with other professionals to
reduce medical error, increase patient safety,
minimize overuse of health care resources, and
optimize the outcomes of care.
Physicians must actively participate in the
development of better measures of quality of care
and the application of quality measures to assess
performance of all individuals, institutions, and
systems responsible for health care delivery.

Professional Responsibilities
Commitment to improving access to
care
Medical professionalism demands that
the objective of all health care systems
be the availability of a uniform and
adequate standard of care.
Physicians must strive to reduce barriers
to equitable health care.
Physicians must promote public health
and preventive medicine

Professional Responsibilities
Commitment to a just distribution of finite
resources
While meeting the needs of individual patients,
physicians are required to provide health care that
is based on the wise and cost effective
management of limited clinical resources.
The physicians professional responsibility for
appropriate allocation of resources requires
scrupulous avoidance of superfluous tests and
procedures.

Professional Responsibilities
Commitment to scientific knowledge
Much of medicines contract with society
is based on the integrity and appropriate
use of scientific knowledge and
technology.
Physicians have a duty to uphold
scientific standards, to promote
research, and to create new knowledge
and ensure its appropriate use

Professional Responsibilities
Commitment to maintaining trust by
managing conflicts of interest
Physicians have an obligation to
recognize, disclose to the general public
and deal with conflicts of interest that
arise in the course of their professional
duties and activities.

Professional Responsibilities
Commitment to professional responsibilities
Physicians are expected to work collaboratively to
maximize patient care, be respectful of one another
and participate in the processes of self regulation,
including remediation and discipline of members
who have failed to meet professional standards.
Physicians should define and organize the
educational and standard setting process and
engage in internal assessment and accept external
scrutiny of all aspects of their professional
performance

hcare-professionals.sw.org/resources/.../medicalprofessionalism.ppt

ADAKAH DALAM PASAL

KODEKI ?

baru
lama

Pasal 2 : Standar Pelayanan

Kedokteran Yang Baik
Seorang dokter wajib selalu
melakukan pengambilan keputusan
profesional secara independen, dan
mempertahankan perilaku
profesional dalam ukuran yang
tertinggi.

Pasal 8 : Profesionalisme
Seorang dokter wajib, dalam setiap
praktik medisnya, memberikan
pelayanan secara berkompeten
dengan kebebasan teknis dan moral
sepenuhnya, disertai rasa kasih
sayang (compassion) dan
penghormatan atas martabat
manusia.

Pasal 10 : Penghormatan hak-hak

pasien dan sejawat..
Seorang dokter wajib senantiasa
menghormati hak-hak- pasien, teman
sejawatnya, dan tenaga kesehatan
lainnya, serta wajib menjaga
kepercayaan pasien.

Pasal 12 : Pelayanan Kesehatan

Holistik.
Dalam melakukan pekerjaannya
seorang dokter wajib memperhatikan
keseluruhan aspek pelayanan
kesehatan (promotif, preventif,
kuratif, rehabilitatif, dan paliatif),
baik fisik maupun psikososialkultural pasiennya, serta berusaha
menjadi pendidik dan pengabdi sejati
masyarakat.

Pasal 14 : Konsul dan

Rujukan
Seorang dokter wajib bersikap tulus ikhlas
dan mempergunakan seluruh keilmuan
dan ketrampilannya untuk kepentingan
pasien, yang ketika ia tidak mampu
melakukan suatu pemeriksaan/pengobatan
atau demi kepentingan terbaik pasien,
atas persetujuan pasien/keluarganya, ia
wajib berkonsultasi/merujuk pasien kepada
dokter lain yang mempunyai keahlian
untuk itu

Pasal 16 : Rahasia Jabatan

Setiap dokter wajib merahasiakan
segala sesuatu yang diketahuinya
tentang seorang pasien, bahkan juga
setelah pasien itu meninggal dunia.

Pasal 21: Perkembangan Ilmu dan

teknologi kedokteran.
Setiap dokter wajib senantiasa
mengikuti perkembangan ilmu
pengetahuan dan teknologi
kedokteran/kesehatan.

RANGKUMAN
STANDAR DARI PROFESIONALISME
DALAM KEDOKTERAN TELAH
TERTULIS DI DALAM KODE ETIK
KEDOKTERAN INDONESIA.
ETIKA KEDOKTERAN MENJADI DASAR
DALAM PROFESIONALISME
KEDOKTERAN

TERIMAKASIH