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BHP1-K7 Aspek Hubungan Dokter Pasien
BHP1-K7 Aspek Hubungan Dokter Pasien
Case study :
Dr. P, an experienced and skilled surgeon, is about to finish night duty at a medium sized community hospital. A young woman is brought to the hospital by her mother, who leaves immediately after telling the intake nurse that she has to look after her other children. The patient is bleeding vaginally and is in a great deal of pain.
Dr.P examines her and decides that she has had either a miscarriage or a self-induced abortion. He does a quick dilatation and curritage and tells the nurse to ask the patient whether she can afford to stay in the hospital until it is safe for her to be discharged. Dr.Q comes in to replace Dr.P, who goes home without having spoken to the patient.
Traditional interpretation of the physicianpatient relationship paternalistic rejected patient autonomy. Other problem : patient confidentiality in an era of computerrized medical records and managed care, and the duty to preserve life in the face of requests to hasten death.
Another challenge the care of infectious patients such as HIV/AIDS A person who is afflicted with AIDS needs competent, compassionate treatment.
Two major obstracles differences of language and culture. Evidence of consent can be explicit or implicit ( implied ). Competent patients have the right to refuse treatment, even when the refusal will result in disability or death. The physician has no obligation to offer a patient futile or nonbeneficial treatment.
The patient must be involved in the desician-making to the fullest extent allowed by his/her capacity. CONFIDENTIALITY The physicians duty to keep patient information confidential has been a cornerstone of medical ethics since the time of Hipocrates A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died
Physicians should view with a critical eye any legal requirement to breach confidentiality and assure themselves that it is justified before adhering to it. BEGINNING-OF-LIFE ISSUES The limited scope of this Manual means that these issues cannot be treated in detail here but it is worth listing them so that they can be recognized as ethical in nature and dealt with as such.
Each of them has been the subject of etensive analysis by medical associations, ethicists and government advisory bodies, and in many countries there are laws, regulations and policies dealing with them. Example : Contraception, Assisted Reproductiuon, Prenatal Genetic Screening, Abortion, Severely Compromised Neonates etc
CONSENT he did not obtain her informed consent to treatment. COMPASSION his dealings with her displayed little compassion for her plight. His surgical treatment may have been highly competent and he may have been tired at the end of a long shift, but that does not excuse the breaches of ethics.
Because society, and its physician environment, are importance factors in the health of patients, both the medical profession in general and individual physicians have significant roles to play in public health, health education, environmental protection, laws affecting the health or well-being of the community, and testimony at judical proceedings.
DUAL LOYALTY
When physicians have responsibilities and are accountable both to their patients and to a third party and when these responsibilities are incompatible dual loyalty Physicians may in exceptional situations have to place the interests of others above those of the patient.
Physicians should report to the appropriate authorities any unjustified interference in the care of their patients, especially if fundamental human rights are being denied Physicians should resolved any conflict between their own interests and those of their patients in their patients favour.
RESOURCE ALLOCATION
In every country in the world, including the richest ones, there is an already wide and steadily increasing gap between the needs and desires for healthcare services and the availability of resources to provide these services. One way that physicians can exercise their responsibility for the allocation of resources is by avoiding wasteful and inefficient practices, even when patients request them.
PUBLIC HEALTH
All physicians need to be aware of the social and environmental determinants that influence the health status of their individual patients. Public health measure such as vaccination campaigns and emergency responses to outbrakes of contagious disease are important factors in the health of individuals but social factors such as housing, nutrition and employement are equally
GLOBAL HEALTH
Global health is part of the much larger movement of globalization that encompasses information exchange, commerce, politics, tourism and many other human activities The failure to recognize and treat highly contagious diseases by a physician in one country can have devastating effects on patients in other countries IHR (International Health Regulation)
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