KONSIL KEDOKTERAN INDONESIA

PROFESIONALISME DALAM
PRAKTIK KEDOKTERAN:
Kompetensi, Kewenangan dan Etika

Dr.dr.Sukman T Putra, SpA(K), FACC

KONSIL KEDOKTERAN INDONESIA
 CV Dr. Sukman T Putra
Dokter, FKUI (1977)
Spesialis Anak (FKUI,1987), Konsultan Jantung Anak (1993)
Fellow, Pediatric Cardiology, Royal Childrens Hospital< Melbourne (1990-1991)
Doktor (S3). FKUI (2013)
Dokter Puskesmas di Provinsi Riau (1978-1983)
Ketua PP Ikatan Dokter Anak Indonesia IDAI (2005 2008)
Secretary General ASEAN Pediatric Federation (APF) ( 2002-2007 )
Ketua Dewan PDSm IDI ( 2003 2006)
Wakil Ketua Umum II PB IDI (2006-2009)
Sekretaris Jendral PP PERKANI (2004 -2007)
Wakil Ketua Perhimpunan Kardiologi Anak (PERKANI) (2007-2010)
International Fellow of American Academy of Pediatrics (AAP) 2004
Fellow American College of Cardiology (FACC), 2003
Council Member Asia Pacific Society of Pediatric Cardiology ( 2006-2008 )
Teasurer ASEAN Pediatric Federation /APF (2011-2014)
Wakil Ketua MPPK IDI (2009-2012)
Wakil Ketua MPPK IDI (2012 2015)
Ketua Divisi Pendidikab Profesi KK( 2014-2019)
Anggota Dewan Pakar, PB IDI (2015-2018)
 OUT LINE
Background & Introduction
Professionalism in Medicine
What is a Doctor and What does a Doctor do ?
What is a good Doctor ?
What is Competency in Medicine ?
Kompetensi Dokter di tingkat Pelayanan Primer
Ethics in Professionalism
The Role of Medical Association in Health Care
Take Home Message
Conclusion
 MEDICINE is more than the sum of our
knowledge about disease.

MEDICINE CONCERNS the experiences,

feelings, and interpretations of human
beings in often extraordinary moment
of fears, anxiety and doubt.

Stern DT. Measuring Medical Professionalism (2006)

SOCRATES: Tell me:
is a doctor in the precise sensea money-
maker or someone who treats the sick ?
Tell me about the one who is really a
doctor.

THRASYMACHUS:
Hes the one who treats the sick.

Plato, The Republic

What is a DOCTOR and
What does a Doctor DO
??
 What is a Doctor &
What does a Doctor do ?
A century ago :
the role of doctors was clear & simple
to acquire facility in the art of diagnosis
to grow in clinical judgment
to appreciate the relative value of symptoms
and the physical signs
to give the patients and his friends the
forecast or prognosis
to conduct the treatment that the patients
may be restored t health

Prof. William Osler (Oxford) MJA 2005;183:560-561

 What is a Doctor &
What does a Doctor do ?

One hundreds
years on.
...... ..........
Things has
changed

MJA 2005;183:560-561
 What is a Doctor &
What does a Doctor do ?

The medical profession is built

around a networks of relationships created
between the doctor and other people not only
sick people

Not all who visit DOCTORS are sick or

Patients
DOCTORS always remain for EVERYONE
The Good Doctor ( 2002 )
 Doctors are often portrayed
as:
Poor communicators
Arrogant
Defensive
Too quick to use jargon
Resistant to change
Self-interested
Operating in an exclusive
Highly paid club culture
Doctors in Society :
Medical Professionalism in changing world
Royal College of Physicians (2005))
 Patients need a
Good Doctors:

Care of their patients their

first concern
Keep their knowledge and
skills up to date
Maintain good
relationships with patients
& colleagues
Honest & trustworthy
Act with integrity
 Physician Today
are experiencing frustration as
changes in the health care delivery
system invirtually all industrialized
countries threaten the very nature
and values of medical
professionalism
Medical professionalism in the New Millenium:
a physician charter MJA vol 177,2002
 What is a Profession ?
A professionis an occupation
that regulates itself through systematic,
required training and collegial
discipline; that has a base in technical,
specialized knowledge; and that has a
service rather than a profit orientation,
enshrined in its code of ethics

Starr
 Profession is a complex
concept, the definition of which has
been attempted for centuries. It has
been studied and defined by many
from a variety of disciplines with some
agreements, much conflict, and
some useful additions.
The practice of medicine is NOT a
Business and can never be one
Our fellow creatures cannot be dealt
with as a man deals in corn and cost,
the human heart by which we live
must control our professional relations.

Sir William Osler, 1903

 1
A Profession is
a recognizable occupation in which
practitioners have a degree of autonomy
over their work, are involved in working
with significant applied theory, and work
within a framework of values and ethics
which are broadly agreed across the
2 occupation.

SS 2011
Definition of Professionalism
Professionalism is demonstrated
through a foundation of clinical
competence, communication skills,
and ethical and legal understanding,
Upon which is built the aspiration to and
wise application of the principles of
professionalism : excellence,
humanism, accountability and
altruism
A definition of professionalism

Measuring Medical Professionalism (2006)_)

Components of professionalism
Competence

Ethics Accountability

Collegiality Altruism

Standard of professional conduct

 Accountability of the physician
Patient Private
Government Payers

Proffessional competence
Legal and ethical conduct Proffessional competence
Adequacy of access Financial performance
All six domains

Lawyers Proffessional competence

Proffessional competence
And
Legal and ethical conduct
Adequacy of access
Physician Financial performance Employers
Courts
Proffessional competence Financial performance
Legal and ethical conduct
Adequacy of access
Public health promotion

Proffessional competence Proffessional competence Investors

Legal and ethical conduct Legal and ethical conduct
Professional Financial performance Financial performance
Associations

Hospitals Managed
Care Plants

Modified from Emanuel, E. J. et. Al. Ann Intern Med 1996;124:229-239

 Medical Professionalism
ACCOUNTABILITY

Procedures and processes by which one party

justifies and takes responsibility for its activities

self regulating activities for which physicians

can be held accountable, and range from their
professional competence and legal and ethical
conduct to financial performance
 What is professional competence?

The habitual and 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.
Competence builds on a foundation of basic
clinical skills, scientific knowledge, and
moral development
Kompetensi Dokter di Tingkat Pelayanan Primer
(Primary Care)

KONSIL KEDOKTERAN INDONESIA

STANDAR KOMPETENSI
DOKTER INDONESI
2012
 SISTEMATIKA SKDI 2012

Area Kompetensi

Kompetensi INTI

Komponen Kompetensi

Kompetensi yang diharapkan

Pada akhir pemelajaran

LAMPIRAN
Daftar Pokok Bahasan
Daftar Masalah
Daftar Penyakit
Daftar Keterampilan Klinis
 Komponen Area Kompetensi
1. Profesionalitas yang luhur (berke-Tuhanan
YME, mermoral dan etika dan disiplin)
2. Mawas Diri dan Pengembangan Diri (mawas
diri, belajar sepanjang hayat, mengembangkan
pengetahuan)
3. Komunikasi Efektif (berkomunikasi dengan pasien
dan keluarga, mitra dan masyarakat)
4. Pengelolaan Informasi (mendesseminasikan
informasi secara efektif pada pasien dan tenaga
kesehatan lainnya)
5. Landasan Ilmiah Ilmu Kedokteran (menerapkan
ilmu biomedik, humaniora, kedokteran klinik dan
kes.masyarakat, dan mengelola masalah kesehatan)
6. Keterampilan Klinis ( prosedur diagnostik dan tata
laksana) Sesuai dengan LEVEL Kompetensi
 Standards of care
Clinical guidelines
Practice guidelines
Protocols Must be:
Standard operating # Evidence-based
procedures # Periodically
Algorithms revised
Clinical pathways
Standing orders
In Indonesia

The same things to be

done with different ways

(NOT STANDARDIZED)

Prof Heyman,
Washington University (2008)
 KOMPETENSI

Pengelolaan Indformasi

Landasan Ilmiah Ilmu

Pebgelolaan masalah
Ketrampilan Klinis
Kedokteran

Kesehatan
KOMUNIKASI EFEKTIF
MAWAS DIRI DAN PENGEMBANGAN DIRI
PROFESIONALITAS YANG LUHUR

Pondasi dan Pilar KOMPETENSI (SKDI 2012)

Professiionalism in Medicine
Societys Expectations of Medicine :
Services fo the Healer
Assured Competence
Altruistic services
Morality and integrity
Accountability
Transparency
Source of objective advice
Medicines Expectations of Society:
Trust
Autonomy
Self regulation
Participation in public policy
Shared (patients and society) responsibility for helath
Status and rewards (non-financial and financial)
 DISIPLIN KEDOKTERAN
(MEDICAL DISCIPLINARY)

Sesuai dengan PERKONSIL No 4/2011

Tentang
DISIPLIN PROFESIONAL DOKTER
DAN DOKTER GIGI
( 28 pelanggaran disiplin)
 DISIPLIN KEDOKTERAN
(MEDICAL DISCIPLINARY)

Sesuai dengan PERKONSIL No 4/2011

Tentang
DISIPLIN PROFESIONAL DOKTER
DAN DOKTER GIGI
( 28 pelanggaran disiplin)
 Pelanggaran Disiplin
Professional Dokter (28)
Antara lain:
Melakukan Praktik Kedokteran dengan tidak kompeten.
Tidak merujuk pasien kepada Dokter lain yang memiliki
kompetensi yang sesuai
Mendelegasikan pekerjaan kepada tenaga kesehatan
tertentu yang tidak memiliki kompetensi untuk
melaksanakan pekerjaan tersebut
Menjalankan Prkatik Kedokteran dalam kondisi
kesehatan fisik dan mental yang tidak baik yang dapat
membahayakan pasien
Melakukan pemeriksaan atau pengobatan berlebihan
yang tidak sesuai dengan kebutuhan pasien
DLL (24)
 ETHICS of PROFESSIONALISM

ETHICS : simply refers to moral principles

of standards governing conducts

BIOETHICS : is essially an umbrella term for

moral conduct in broad area of life, sciences
and Medicine

Bioethics deals with issues related to

health and health care management,
animal welfare , environemental science
Encompass the following subjects :
Phylosophy of science, biotechnology, politics,
law, medicine and theology
WHO
 ETHICS of PROFESSIONALISM

CLINICAL ETHICS : patient-based clinical

decisionmaking
A system of principles governing medical
conduct with respects to patiens and family

The ethics of Professionalism in Medicine :

more concerned with the characteristics and behaviours of
physicians in the context of medicine as a PROFESSION
Desirable behaviours: Altruism, accountability, excellence, duty,
honor, integrity, respects each other
 Professional authority
(kewenangan profesi)

The legitimation of professional authority:

1. The knowledge and comptence of the professional have

been validated by a community of peers
2. The validated knowledge and competence rests on
rational scientific grounds
3. The professional judgments and advice are oriented
towards a set of substantives values such as health.

Paul Starr, 1984

Medical Health systems
schools

Professionals Healthcare
Organizations
Professional

Standard of Standards of care

professional
conduct:
Competence
Accountability Clinical governance:
Altruism Education & training
Collegiality Clinical effectiveness
Ethics Accountability
CPD R&D
Clinical audit
SS 2011
Risk management
What is the Role of
Professional
Medical Society ?
 MEDICINE IS, in essence a
MORAL ENTERPRISE
Its professional
association should be
built on ethical
foundation.
Such association
should promote the
interests of
those they serve

This sadly, has not always the case

when economic, commercial , and
political agendas so often take
precedence over ethical obligation
JAMA 1999;282: 984-986
AT PRESENT
Medical profession confronted to:
explosion of technology,
changing market forces
problems of health care delivery system
bioterrorism
globalisation

Increasing difficulties of
physician to meet their
responsibilties to patients and
society
 Health System
Financing
Access
Human resources

Quality of
Health
Care
 Revitalizing Professionalism
Role of associations important to:
- set and maintain standards
- to expand and disseminate
knowledge
- to inform the public

Institutions and professional societies

are necessary to support and stabilize
professionalism
 Hospital
Doctors Health Services
Provider Quality of
Health
Care
Health Care
Patients System

Hospital by Laws
Medical Acts
Hospital staffs
 Health System
Developing countries face many
challenges to building
robust,reliable health system:
insufficient financing
lack of inter-agency
coordination,
poorly function ing information
system
health worker shortages
We seek the system that gives physicians
the autonomy and freedom

To make the best decision to their patients

without the intrussions or
interferences from outsider; a system that
promotes professionalism, integrity and
highest ethical and educational
standards.........
21st Century Health Care Leader
 Professional Medical
Society Role

Education
Licensing
Regulation
Representation
WMA, 2005
 Conclusion
Professionalism in Medicine is built under the
construction of excellence,
humanism,accountability and altruism based
on Ethical & legal standing,Communication
skills, Clinical Competence
Professionalism including professional
competence- should be introduced in early years
of medical training and throughout residency
programs
Dalam Praktik Kedokteran : Level Kompetensi
profesi kedokteran, dan kewenangan klinis
terkait erat dengan Etika Klinis dan Disiplin
Profesi Kedokteran
 Take Home Massage
BE A Good Doctor : Professional and
Accountable
Patients need a
Good Doctors:
Maintain good
relationships with patients
& colleagues
Honest & trustworthy
Act with integrity