Agus Purwadianto

Ketua MKEK Pusat

Karo Hukor Depkes RI
Rp..
Rp??
BAGAIMANA IBI ?
Professionalism
Honesty
Integrity
respect for patients
commitment to patients welfare
compassionate regard for patients
dedication to maintaining competency
in knowledge and technical skills
Charter on
Medical Professionalism
Fundamental Principles:
Principle of primary of patient welfare
Principle of patient autonomy
Principle of social justice
Annals of Internal Medicine, Vol 136 Issue 3, 5 Feb 2002
http://www.annals.org/cgi/content/full/136/3/243
Professional Responsibilities
Commitment to professional competence
Commitment to honestly with patient
Commitment to patient confidentiality
Commitment to maintaining appropriate
relations with patients
Commitment to improving quality of care
Professional Responsibilities
Commitment to improving access to care
Commitment to a just distribution of finite
resources
Commitment to scientific knowledge
Commitment to maintaining trust by
managing conflict of interest
Commitment to professional responsibilities
Please visit : www.professionalism.org
Good doctors
combine
individual

clinical
expertise and best
available
external
evidence; they

are
thoughtful,
evidence based
practitioners

Good doctors
use "intangible

personal
resources" in the care of
their patients; . attaches
to vocationalism in
medicine and to the
personal

qualities
required of its practitioners,
including truthfulness

Good doctors
reflective turn of mind
open to audit
and to learning from

mistakes ....
personal qualities more
prominently than
proficiency in
knowledge and
technical skills.


NOT PATERNALISM
MUTUALLY PARTNERSHIP
NOT TRIBALISM
COLLEGIALISM
NOT SELF-SACRIFICE
SHARED RESPONSIBILITY
GOOD MEDICAL PRACTICE
Elemen esensialnya adalah :
professional competence,
hubungan baik dengan pasien
dan kolega, dan
kewajiban etika professional
JADI JANGAN : SOMBONG, RAKUS, MALAS BELAJAR, JAHAT,
MENGEKSPLOITASI PASIEN
Professional Competence
(Epstein & Hundert 2002)

The habitual & judicious use of
communication, knowledge,
technical skills, clinical
reasoning, emotions, values, and
reflection in daily practice for
the benefit of the individual and
community being served

6 Areas of competence

1. Patient care ( clinical
reasoning)
2. Medical knowledge
3. Practice-based learning &
improvement ( info managmnt)
4. Interpersonal & communication
skills
5. Professionalism
6. System-based practice ( health
economics & teamwork)

w/ PRINCIPLES BASED ETHICS (KDB)
CORE : ETHICS !!!!
Dimensions of Prof. Competence

Cognitive
Technical
Integrative
Context
Relationship
Affective/moral
Habits of Mind
VIA PRINCIPLE BASED ETHICS
VIA PRINCIPLE BASED ETHICS (KDB)
ETIKA SOSIAL (KESEJAWATAN)
ROLE MODEL, CULTURAL TRANSM
GAB KEPUT. KLINIS + ETIKOLEGAL
PROFESIONALISM-DEBATES
Cognitive of PC (1)

Core knowledge
Basic comm. Skills
Info management
Applying knowledge to real-world
situation
Using tacit knowledge & personal
experience
Abstract problem solving
Self-directed acquisition of new
knowledge

Sistim sertifikasi--yang
bertujuan untuk menjaga
dan menjamin kualitas
kompetensi seorang
dokter untuk berpraktek;
REGULATORY BODY


Sistim regulasi praktek
kedokteran yang
bertujuan untuk menjaga
kepentingan masyarakat
terhadap mutu pelayanan
kedokteran;
Sistim advokasi--yang
bertujuan untuk menjaga
kepentingan anggota
profesi kedokteran;
Dinamika Struktur Kedokteran

K
O
L
E
G
I
U
M

M
E
D
I
C
A
L


A
S
S
O
C
I
A
T
I
O
N

LISENSI
STANDAR IPTEK
= KKI
DISIPLIN = MKDKI
MKEK
FK + CME/CPD IDI
Akreditasi AIPKI/IRSPI
DEPKES
PMKS 512/07
REKOMENDASI
KOMPETENSI
UJI
KOMPETENSI
PROFESIONALISM
SISA PELANGGARAN ETIK
REGISTRASI BERDASARKAN KOMPETENSI
STR
SIP
Standar
Kompetensi
Sertifikat
Kompetensi
OP
(Kolegium )
Konsil
Kedokteran
S
E
R
T
I
F
I
K
A
S
I

Psl 29, ayat 3, point d: Syarat surat
tanda registrasi dokter
Memiliki sertifikat kompetensi
Penjelasan Pasal: Huruf d
Sertifikat kompetensi dikeluarkan oleh
kolegium yang bersangkutan.
Pasal 7, ayat 1, point 2:
Konsil Kedokteran Indonesia mempunyai
tugas mengesahkan standar pendidikan
profesi dokter-;
Pasal 8, point 3:
Konsil Kedokteran Indonesia mempunyai
wewenang mengesahkan standar
kompetensi dokter-;
Standar
Pendidikan
Pasal 26, ayat 2, point b:Standar pendidikan
profesi kedokteran- untuk pendidikan profesi
dokter spesialis- disusun oleh kolegium kedokteran.
Pasal 8, point 3:
Konsil Kedokteran Indonesia mempunyai
wewenang mengesahkan standar kompetensi
dokter-;
Dr Spesialis
Dr Umum
/PDSp
Uji kompetensi
TINDAK-TANDUK PROFESIONAL
VERSI UU PRADOK
MENGATUR PELAKSANAAN PRAKTIK :
HUBUNGAN PASIEN-DOKTER
INFORMED CONSENT
REKAM MEDIK
RAHASIA KEDOKTERAN
STANDAR: PELAYANAN, PROFESI, S.O.P.
HAK DAN KEWAJIBAN
KENDALI MUTU DAN BIAYA
PEMBINAAN, DISIPLIN, PIDANA
AKUNTABILITAS PROFESI
STANDAR PENDIDIKAN
UJIAN & STANDAR KOMPETENSI
STANDAR PERILAKU
STANDAR PELAYANAN MEDIS
STANDAR PROSEDUR OPERASIONAL
PEDOMAN PEMBINAAN & PENGAWASAN
PEDOMAN KENDALI MUTU, BIAYA, AUDIT
MEDIS
PR BAGI PDSp
Dokter bermasalah
1. Kurang pengalaman dan tekanan kerja
2. Konflik pribadi
3. Kecacatan infirmitas/inkapasitas
4. Kurang pengetahuan - inkompetensi
5. Berbuat kriminal
Continuum of Problem Doctors

problem
doctors
Litigious
Society

Defensive
Medicine
Malicious
Prosecution
Malpractice Crisis


Ethico-legal
Conflict Persistent
Continuum of Professionalism
Agus Purwadianto - 2008

Kompe-
tensi
Kewe-
nangan

Etika
Profesi
Dibawah
permukaan
Kelihatan Formal


Dirasakan Pasien
Ketrampilan
Medik &
High Learning
kekuasaan Kualitas personal bonafide
EKSTERNAL
Empati, kekitaan
Pahlawan kemanusiaan
INTERNAL : Nurani, sikap,
Kepribadian, kes. mental
Dr
Bermasalah
IDI
dr.
herbal
Perawat
herbal
ASPETRI
Regulator/Pemerintah
Ditjen Yankes

Paling dipercaya publik
KLINIK/
RUMAH
SEHAT
IDI/PDGI
IAI/OP LAINNYA

PERMENKES SAINTIFIKASI JAMU
PROFESI BERSUMPAH
OKUPASI
FASYANKES
KODE ETIK
MAJELIS ETIK
SOP PELANGGARAN
SELF-THERAPI : PARADIGMA SEHAT IN ACTION
Intensitas Kepercayaan
Penentu Penyebab Kematian
Vital dlm hub antar orang asing & amat
rentan bonafiditas > kontrak P-K
Profesi kembangkan keahlian moral = syarat
konsisten & eksplisit bonafiditas via
otokritik tujuan, nilai, sumpah & kode etik =
catatan publik & sejarah praktek
Kepercayaan = harapan via keyakinan kuat
yg jadi tumbuh kuat
hirarki kepercayaan awal kecil, lama
membesar.

Accountability
Discipline
Ethico-legal System
Agus Purwadianto, 2005
Patients Safety
Law as
social engineering

Liability
Value of
Health

Patient/Client
Family

Health Personnel
Health Facilities
Health system
Medical Goals
Responsibility
Ethics
Professional
Dignity
PROFESSIONALISM
SOCIAL CONTRACT
PUBLIC TRUST
BEST INTEREST,
PREFERENCES,
MEDICAL INDICATION
CONTEXTUALITY
BALLANCING
CONFLICT OF INTEREST
Community
Society
QUALITY OF LIFE
Agus Purwadianto
Kepala Balitbangkes Kemkes
Staf Ahli Bid Hukum & HAM Kemenkokesra RI
Gurubesar I.K. Forensik & Medikolegal (07)
Doktor Filsafat (03)
MSi Sosio-Kriminologi (00)
SpF (konsultan etiko-medikolegal) (05)
Diplome of Forensic Med Groningen Univ (02)
SH (97), SpF (83), dr (79)
Ketua MKEK Pusat IDI, dosen IKF-ML FKUI/RSCM, Ketua
Kolegium IK Forensik Indonesia
Ex Karo Hukor Depkes RI
Ex Anggota WHO Global Advisory Vaccine Safety Committee
Ex Anggota UNESCO Global Ethics Observatory Law
Anggota Komisi Bioetika Nasional
Perintis/dosen S3 Kekhususan Bioetika FKUI


SAYA UCAPKAN
TERIMA KASIH
Kesimpulan
Profesionalism bukanlah sekedar
Kompetensi DR, namun muatannya adalah 80% etika
dan peneguhan janji publik seorang dokter
Kompetensi = landasan dari kewenangan, standar
pendidikan & standar profesi
Pelaksanaan Uji kompetensi merupakan pengalaman
baru bagi OP/PDSp, termasuk bagian utk Dr (umum)
Kewajiban Dr makin banyak yg urusannya via PDSp,
Kolegium, KKI, FK (alumni) & Depkes dlm upaya
pemutakhiran profesionalismenya.
Direksi, Komdik, Pan. Kredensial & Komite Disiplin
RS hrs tanggap thd penegakan etika & disiplin profesi
yg berdimensi etika sosial via SDM yg menguasai
etikolegal
hukumresponsif_depkes@yahoo.co.id