CURRICULUM VITAE

Nama : Prof. DR. Dr. Samsuridjal Djauzi, SpPD-KAI,

FACP

Pendidikan : - Fakultas Kedokteran UI, 1969

- Spesialis Ilmu Penyakit Dalam FKUI, 1976
- Konsultan Alergi-Imunologi, 1986
- Doktor dibidang Alergi-Imunologi FKUI, 1999
- Honorary Fellow of American College of
Physician, 2001
- Guru Besar FKUI

Jabatan : - Pengajar Dept. Ilmu Penyakit Dalam FKUI

- Chairman Indonesian Association of Physician
in AIDS Care

Penulis Ruang konsultasi Kesehatan Kompas Minggu sejak 1990

 Samsuridjal Djauzi
Department of Internal Medicine, Faculty of Medicine
Jakarta
Etika Kedokteran
 Menuntun Kita untuk membedakan mana yang baik
dan tidak baik dalam melakukan pelayanan
kedokteran
 Hukum lebih mengacu kepada mana yang benar dan
tidak benar menurut hukum
 Adakalanya etika kedokteran sejalan dengan hukum
namun dapat terjadi etika kedokteran tidak sejalan
dengan hukum
Case
 Male 32 years old going to clinic due to chronic cough
and weight loss. He just released from prison , he was
sentenced 4 years for narcotic case. He seperated from
his wife and has one son 4 yeras old. He worked in a
restaurant but he was fired after found HIV positif.
Now he stays with his friend because his family don’t
want him to go home. He lost his identity card and he
has not social security card. He has stopped to inject
morphine since 6 months ago
Barriers to access health care ?
 Is he vulnerable to get sick ?
 Is it easy for him to access health service
 What is the perception of community of intravenous
drug user
 Can he get a job
 Why his family dont want to support him
 How is the sustainibility of care
 How health care provider could help him
Statement from People Living with
HIV/AIDS
 I feel pain from stigmatization is more than
symptomps of my disease
(Susanna Murni )
Akses Kesehatan untuk kelompk
vulnerable
 Siapa yang disebut kelompok vulnerable.
 Apa yang menyebabkan mereka menjadi vulnerable.
 Bagaimana perbedaan layanan yang diperoleh
kelompok vulnerable dengan yang bukan.
 Bagaimana seharusnya sikap petugas kesehatan
terhadap kelompok vulnerable.
 Bagaimana seharusnya kebijakan pemerintah terhadap
kelompok vulnerable ini
Professionalisme
 What is professionalism?
 What constitutes professionalism?
 How to measure your professionalism?
Harapan masyarakat kepada dokter mencakup :
1. Mampu mengobati pasien dengan cara mutakhir, teliti dan
terampil
2. Mampu mendengarkan, menghormati pendapat pasien, berlaku
santun dan penuh pertimbangan, berkomunikasi dengan baik,
memberikan nasihat tanpa menggurui
3. Mampu menyimpan rahasia, bersifat jujur dan punya integritas,
dan tetap memberikan asuhan walaupun ilmu kedokteran tidak
berhasil lagi
4. Mampu mempertahankan hubungan luwes, sehingga pasien
pendapat penjelasan lengkap dan dilibatkan dalam keputusan
tentang asuhan
Definition
 Professionalism in medicine requires the physician to
serve the interests of the patient (and community)
above his or her self-interest.
 Professionalism aspires to altruism, accountability,
excellence, duty, honor, integrity, and respect for
other. (ABIM, 2000)
 Professionalism
• Role of the doctor within
the health service
– Understanding of the health
care system
– Understanding of clinical
responsibilities
– Appreciation of doctor as
researcher
– Appreciation of doctor as
mentor or teacher
– Appreciation of doctor as
manager including quality
control
– Team working
• Personal Development
– Lifelong Learner
– Self awareness
– Self confidence
– Self regulation
• Self care
• Self control
• Personal time management
– Motivation
• Achievement drive
• Commitment
• initiative
– Career choice
 Elements of Professionalism
 Altruism is the essence of professionalism. The best
interest of the patients, not self-interest, is the rule.
 Accountability is required at many levels - to individual
patients, society and the profession…
 Excellence entails a conscientious effort to exceed
normal expectations and make a commitment to life-long
learning…
 Duty is the free acceptance of a commitment to service.
 Honor and integrity are the consistent regard for the
highest standards of behavior and refusal to violate
ones personal and professional codes.
 Respect for others (patients and their families, other
physicians and professional colleagues such as
nurses, medical students, residents, subspecialty
fellows, and self) is the essence of humanism…"
MODEL KOMUNIKASI : INFORMASI MILIK BERSAMA

MENDENGARKAN AKTIF MOTIVASI

DOKTER SALURAN TERBUKA PASIEN

EMPATI RASA PERCAYA

 TIGA LINGKUP YANG MEMBENTUK KEMAMPUAN

Bisa mengubah suatu Bisa melalukan tindakan

Bisa menyelesaikan
perasaan menjadi praktis secara otomatis
masalah baru
milik kita dan sangat efisien

Bisa menafsirkan Bisa menanggapi Bisa mengendalikan

data perasaan orang lain suatu tindakan
praktis

Bisa mengingat Bisa menerima Bisa meniru tindakan

kembali fakta perasaan orang lain yang diperagakan

Lingkup ketrampilan Lingkup ketrampilan Lingkup ketrampilan

berpikir berkomunikasi tindakan praktis

Kemampuan sesudah Guilbert, WHO 1981

mengikuti pendidikan
Lack of Professionalism
Signs and Symptoms (ABIM, 2001)
1- Abuse of power:
 abuse while interacting with patients and colleagues;
 bias and sexual harassment; and
 breach of confidentiality;
2- Arrogance (offensive display of superiority and self-
importance);
3- Greed (when money becomes the driving force);
4- Misrepresentation (lying, which is consciously failing to
tell the truth; and fraud, which is conscious
misrepresentation of material fact with the intent to
mislead);
Lack of Professionalism…con’t
Signs and Symptoms (ABIM, 2001)
5- Impairment (any disability that may prevent the
physician from discharging his/her duties);
6- Lack of conscientiousness (failure to fulfill
responsibilities);
7- Conflicts in interests (self-promotion/ advertising or
unethical collaboration with industry; acceptance of gifts;
and misuse of services – overcharging, inappropriate
treatment or prolonging contact with patients).
 Knowledge

Decision making skills and clinical

reasoning and judgment Patient management

Basic, Social and

clinical sciences Patient investigation

Performance
Of task Clinical skills

Practical procedures

Personal Development
Health promotion and
& Lifelong Learning
Disease prevention

Role of the doctor within the health service and community

 Medical students & professionalism!
University of Toronto students reported:
 47% very frequently, frequently or occasionally had been
placed in a clinical situation where they felt pressure to act
unethically
 61% had witnessed a clinical teacher acting unethically
 61% this happened very frequently, frequently or
occasionally
 Understanding the clinical dilemmas that shape medical
student’s ethical development: questionnaire survey and
focus group study

Hicks, Lin, Robertson et al BMJ 2001;322:709-10

 How can We Teach Professionalism?
• Role Modeling
• Bed Side Teaching
• Simulated Patients
• Small Group Discussions

We teach students the ideal, but they learn from the real
 Do that.. &
Don’t do that
Follow Me
 Cipto Central Hospital Culture
 Profesionalisme kompeten, bertanggung jawab, dan
memberikan yang terbaik
 Integritas jujur, disiplin, konsisten, menjunjung
tinggi moral, etika dan kemanusiaan
 Kepedulian proaktif, peka, tanggap, ramah,
bersahabat, saling menghargai dan bekerja sama
 Penyempurnaan berkesinambungan kreatif, inovatif,
dan terbuka terhadap perubahan
 Belajar dan mendidik belajar berkesinambungan dan
mendidik dengan santun
How can Professionalism
be Assessed?
 Performance
or hands on
Does assessment
Professionalism

Portfolios
Shows how
Written,
Knows how Oral or
Computer
Knows based
assessment
Miller’s Triangle
Evaluation aspect
 Minor lapses,

 Major lapses and

 “Critical events”

Subject to judgment and hence a review process is in

place.
Minor lapses
 Minor lapses are errors but have minimal
consequences. Often there is no awareness of
the unprofessional act or it occurs after the fact.
There may often be mitigating circumstances.

 Examples:
1. Student falls asleep on a stretcher in the hall of the hospital.
2. Student does not meet deadline for paper due to family illness
but does not notify anyone.
Major lapses
 Major lapses are errors but have serious
consequences. Often there is awareness of the
unprofessional act . Usually, there are no
mitigating circumstances.
 Examples:
1. Student refuses to return phone calls and e-mails from a
professor.
2. Student does not answer his pager from the emergency room
3. Student rushes in to see a patient with “interesting” findings
despite being told to not do so.
Critical events
 Critical events are serious events that will require
immediate action by the supervisor. It is a clear
violation of the code of conduct.

 Examples:
1. Student being dishonest either by lying or misrepresenting
himself/herself.
2. Student hitting a patient.
3. Student being sexually inappropriate with a patient or fellow
member of the health care team.
 Professionalism

Excellence

Humanism

Accountability

Altruism
Ethical and Legal Understanding

Communication Skills

Clinical Competence (Knowledge of Medicine)

Arnold and Stern, 2006

MENEHONO TEKEN WONG KANG WUTO
MENEHONO MANGAN WONG KANG LUWE
MENEHONO BUSONO MARANG WONG KANG WUDO
MENEHONO NGEYUP MARANG WONG KANG KODANAN

SunanDRAJAT
SUNAN Drajat ((WALISONGO,
Wali Songo) LAMONGAN)
 Professionalism
• Role of the doctor within
the health service
– Understanding of the health
care system
– Understanding of clinical
responsibilities
– Appreciation of doctor as
researcher
– Appreciation of doctor as
mentor or teacher
– Appreciation of doctor as
manager including quality
control
– Team working
• Personal Development
– Lifelong Learner
– Self awareness
– Self confidence
– Self regulation
• Self care
• Self control
• Personal time management
– Motivation
• Achievement drive
• Commitment
• initiative
– Career choice
Continuing Professional Development
 Internationally there is a move from continuning
medical education (or clinically up date) to continuing
professional development (medical,managerial, social
and personal skills)
 Continuning professional development is a process of
lifelong learning in practice
 Recertification of practitioners is required, continuing
professional development is an important part of the
process
Incentives and Penalties
 Financial reward :Belgium 4% bonus based on salary
 Publication of lists of doctors who have fulfilled the
requirement of professional development programme :
UK Royal College of Obstetrician and Gynaecologists
 Mandatory contracts with hospitals and insurers :
Italy, Luxembourg,Portugal
 Penalties : Lose 20% of fees : Norway
Succesful Lifelong Learners Believes
 Attitude is everything
 I will....I can.....I do
Habit
 Begin with the end in mind
 Accept responsibility for your own learning
 View problems as chalengges
 Have confidence in your self as a competent,effective
learner
 Create your own learning toolbox
 Use technology to your advantage
 Teach/mentor others
Keselamatan Pasien
 Unsur Penting dalam mutu layanan
 Berkaitan dengan atau tak berkaitan dengan pasien
 Barkaitan dengan pelayanan kedokteran maupun tak
berkaitan dengan pelayanan kedokteran
 Faktor yang menentukan : kebijakan, sistem, infrastruktur,
peralatan, sumber daya manusia
 Keamanan dalam pemberian obat : jenis obat, indikasi,
cara pemberian, dosis, efek samping, pemantauan
Final Words
“There is a tendency to underemphasize the
personal characteristics… , because they are
harder to measure, and to overemphasize
the more easily measured indices of
academic achievement”
Cohen (2002)

“Students tend to internalize and perpetuate

the patterns of behaviour that surround
them- the way they see people treating each
other and the way they themselves are
treated”.
TS Inui