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Study Guide Medical Professionalism

~ CURRICULUM ~

Aims:
Comprehend the central position of professionalism in contemporary medical
practice
Apply professionalism in the context of primary health care settings
Learning outcomes:
Awareness of professional, moral, ethical and legal implications of medical practice
Comprehension of the significance of the three dimensions of professionalism
underlying contemporary medical practice
Develop awareness and basic skill required to nurturing professional personal
attributes: compassion, integrity, truthfulness, truth-worthiness, and lifelong
commitment or habit to maintaining professional competence and standards
Develop awareness and respect to the needs of a diverse patient population in terms
of gender, belief/religion, education, ethnicity, and socio-cultural background
Differentiate between professional, moral and ethical issues
Apply the principles of moral and ethical reasoning to deal with patient value issues
Capability to apply the basic principles of medical ethics in the primary care setting
Curriculum contents:
Defining professional, moral and ethical issues
The three dimensions/ components of medical professionalism
Common educational strategies to nurture the development of affective behaviors
Basic principles and strategies of cross-cultural communication
National and global legal systems governing medical practice
The principles of moral and ethical reasoning, and ways to avoid pitfalls
Skills related to applying the basic principles of professionalism in virtual or real
patients

Faculty of Medicine UNUD,MEU

Study Guide Medical Professionalism

~ PLANNERS TEAM ~
NAME

NO
1
2
4
5
7
8
9
10
11

DEPARTMENT

Dr. I.B. Alit, DFM. SpF. (Head)


Dr. I W. Sugiritama,M.Kes (Secretary)
Prof. dr. N.A. Bagiada, Sp. Biok.
Drs. Supriyadi, M.Si
Prof. Dr. dr. N. Mangku Karmaya, M.Repro
Dr. Hengky, Sp.F
Drs. Toya Wiartha,Apt.
Dr. I Wayan Sumardika,M.Med.
DR. Dr. Dyah Paramitha D. M.Kes

Forensic
Histology
Biochemistry
Psychology
Anatomy
Forensic
Pharmacy
MEU
Public Health

~ LECTURERS ~
NO
1
3
4
6
7
8
9
10
11
12
13

NAME

DEPARTMENT

PHONE

Prof. Dr. dr. N. Mangku Karmaya,


M.Repro
Drs. Supriyadi, M.Si.
Dr. Hariyasa Sanjaya, SpOG

Anatomy

0811387105

Psychology
Obstetry &
Gynaecology
Forensic Medicine
Forensic Medicine
Public Health
Pharmacy
Forensic Medicine
Pharmacy
Internal Medicine
Sanglah Hospital

08123606296
0361-7465168

Dr. Ida Bagus Alit, Sp. F


Dr. Dudut Rustyadi, Sp.F
DR. Dr. Dyah Paramitha D. M.Kes
Drs. Toya Wiartha,Apt.
Dr. Henky,Sp.F
Drs. Adioka, Apt
Prof.Dr.dr.K. Suwitra,SpPD. KGH
Dr. Ni Luh Dharma Kerti
Natih,MHSM

Faculty of Medicine Udayana University,MEU

081916613459
0818651015
0818357777
08123988486
08123803996
08164707248

Study Guide Medical Professionalism

~ FACILITATORS ~
Regular Class (Class A)
No
1
2
3
4
5
6
7
8
9
10
11
12

Name
Dr.dr.Dyah Pradnya Paramita
Duarsa, M.Si
dr I Gusti Agung Gede Utara
Hartawan, Sp.An
dr. I Gusti Ngurah Pramesemara
, S.Ked
dr.I Gusti Nyoman Darma Putra ,
Sp.KK
dr Ni Made Susilawathi, Sp.S
dr Ni Nyoman Metriani Nesa,
M.Sc.,Sp.A
dr. I Wayan Sugiritama, M. Kes
dr. Wayan Citra Wulan Sucipta
Putri
dr. Agus Roy Rusly Hariantana
Hamid, Sp.BP
dr. Gde Somayana, Sp.PD
dr. Ariesanti Tri Handayani ,
Sp.M
dr. Ayu Setyorini Mestika
Mayangsari, M.Sc,Sp.A

Group

Department

Phone

Venue
rd
(3 floor)

A1

Public Health

0818357777

A.301

A2

Anasthesi

08113891490

A3

Andrology

0361-8550344

A4

Dermatology

08124644451

A5

Neurology

08124690137

A6

Pediatric

081337072141

A7

Histology

08164732743

A8

Public Health

082140517310

A9

Surgery

08123511673

A10

Interna

081345136913

A.302
A.303
A.304
A.305
A.306
A.307
A.308
A.320
A.321
A.322

A11

Opthalmology

0818375611

A12

Pediatric

081353286780

Group

Department

Phone

Venue
rd
(3 floor)

B1

Neurology

0811385099

B.301

B2

Microbiology

08553711398

B3

Anasthesi

085238514999

B4

Surgery

0818484654

B5

Interna

081236194672

B6

Anatomy
Pathology

081338981853

B7

Fisiology

081337761299

B8

Surgery

08123923956

B9

Pediatric

08123641466

B10

Anatomy

08123921765

B11

Fisiology

081392017107

B12

Histology

081338605087

A.323

English Class (Class B)


No
1
2
3
4
5
6
7
8
9
10
11
12

Name
dr. Desak Ketut Indrasari Utami,
Sp.S
Dr.dr. Ni Nyoman Sri Budayanti,
Sp.MK(K)
dr. Dewa Ayu Mas Shintya
Dewi, Sp.An
Dr.dr. Tjokorda Gde Bagus
Mahadewa, M.Kes,Sp.BS
dr. Ida Bagus Putrawan, Sp.PD
dr. Herman Saputra, Sp.PA
dr. I Dewa Ayu Inten Dwi
Primayanti, M.Biomed.
dr. I Gede Budhi Setiawan,
Sp.B(K)Onk
dr. Dewi Sutriani Mahalini ,
Sp.A
dr. I Gusti Ayu Widianti
,M.Biomed.
dr. Dewa Ayu Agus Sri Laksmi ,
M.Sc.
dr I Gusti Ayu Dewi Ratnayanti,
M.Biomed

Faculty of Medicine Udayana University,MEU

B.302
B.303
B.304
B.305
B.306
B.307
B.308
B.320
B.321
B.322
B.323

Study Guide Medical Professionalism

~ TIME TABLE ~
DAY/
DATE

1
Monday
17-03-2014

TIME
Regular Class

English Class

08.00 08.15
08.15 09.00

09.00 09.15
09.15 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00
09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00
12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00

2
Tuesday
18-03-2014

3
Wednesday
19-03-2014

4
Thursday
20-03-2014

5
Friday
21-03-2014

Monday
24-03-2014

Tuesday
25-03-2014

Wednesday
26-03-2014

Faculty of Medicine Udayana University,MEU

ACTIVITY
Introduction to the Block
Lecture : Biomedical
Ethics and Patient Safety
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Medical
Professionalism
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Informed
consent & confidentiality
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Professional
Personal Attribute
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Patient,s right &
autonomy
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Empathy
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Awareness to
diversity
in
medical
practices
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Legal Aspect of
Medical
Practice
&
Pharmaceutical
Regulations related to
Medical Practitioners
Ind. Learning
SGD
Break
Student Project
Plennary

VENUE

CONVEYER

Class room
Class room

I.B Alit
Henky/Kunti

Disc. room
Class room
Class room
Class room

Facilitator
-

Disc. room
Disc. room
Class room
Class room

Facilitator
-

Disc. room
Disc. room
Class room
Class room

Facilitator
Alit
Hariyasa S.

Disc. Room
Disc. room
Class room
Class room

Facilitator

Disc. room
Disc. room
Class room
Class room
Disc. room
Disc. room
Class room
Class room

Facilitator
Prof. Mangku
Supriyadi
Facilitator
-

Disc. room
Disc. room
Class room
Class room

Facilitator
D. Paramitha
Dudut & Toya .

Disc. room
Disc. room
Class room

Henky/Kunti
Prof. Mangku

Prof. Mangku
Alit

Hariyasa S.
Prof. Mangku

Supriyadi
D. Paramitha

Facilitator
Dudut & Toya

Study Guide Medical Professionalism


9

08.00 09.00

09.00 10.00

27-03-2014

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00
09.00 10.00

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00

12.00 13.30
13.30 15.00
11.30 12.00
10.00 11.30
15.00 16.00

Thursday

10

Friday
28-03-2014

11

Wednesday
02-04-2014

08.00 09.00
10.00 13.00
13.00 15.00
08.00 09.00

12
Thursday
03-04-2014

10.00 13.00

13.00 15.00
08.00 09.00
13

Friday
04-04-2014

09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00

14

Monday
07-04-2014

14.00 15.00
08.00 09.00
09.00 10.30
10.30 12.00
12.00 12.30
12.30 14.00
14.00 15.00
08.00 09.00

15

Tuesday
08-04-2014

Wednesday
09-04-2014

09.00 10.30
10.30 12.00
12.00 14.00
14.00 15.00

Lecture : Criminal Law


and Medical Malpractice
Ind. Learning
SGD
Break
Student Project
Plennary
Lecture : Legal Aspect of
Medical Record, Medical
Certification and Visum
et Repertum
Ind. Learning
SGD
Break
Student Project
Plennary

BASIC CLINICAL SKILL


Guest Lecture
09.00 10.00
Student Project
13.00 16.00
Presentation (I,II,III)
Ind. Learning
10.00 13.00
Lecture : Medical
09.00 10.00
Certification and Visum
et Repertum Writing
Skill
Training
13.00 16.00

10.00 13.00
09.00 10.00

Ind. Learning
Translating the concept
and principle of medical
professionalism in
practice
12.00 13.30
Ind. Learning
Role Play
13.30 15.00
11.30 12.00
Break
Student Project
10.00 11.30
Presentation (IV)
15.00 16.00
Plennary
Medical Record
09.00 10.00
12.00 13.30
Ind. Learning
13.30 15.00
SGD
11.30 12.00
Break
Student Project
10.00 11.30
Presentation (V)
15.00 16.00
Plennary
Lecture : Prescribing
09.00 10.00
and Drug Safety
12.00 13.30
Lab Work (SGD 1-5)
13.30 15.00
Lab Work ( SGD 6-10)
10.00 12.00
Ind. Learning
15.00 16.00
Case Study/Feed Back/
Presentation
Preparation for Exam

Class room

Dudut

Disc. room
Disc. room
Class room
Class room

Facilitator
Dudut
Alit

Disc. room
Disc. room
Class room

Facilitator
Alit

Class room

IDI

Class room
Class room
-

Lecturer
Forensic Team

Forensic Team
Class room
(SGD 1-5)
Lab. Bersama
(SGD 6-10)
Class room

Disc. Room
Class room

Prof. Suwitra

Facilitator
Lecturer

Class room
Disc. Room
Class room

Prof. Suwitra
Dharmakerti

Class room

Lecturer

Class room
Class room

Dharmakerti
Adioka

Lab. Bersama
Lab. Bersama
Class room

Team
Team

Facilitator

Team

15

Thursday
10-04-2014

EXAMINATION

Block Team

Venue: Ruang Kuliah 4.01, 4th floor

Faculty of Medicine Udayana University,MEU

Study Guide Medical Professionalism

~ MEETING OF STUDENT REPRESENTATIVES AND


FACILITATORS ~
Meeting of student representatives and facilitators will be held on Friday 21th March 2014.
This meeting will be organized by the planners and attended by lecturers, student group
representatives and all facilitators. Meeting with student representatives will take place at
12.00 until 12.45 pm and meeting with the facilitators at 12.45 until 13.30 pm. The purpose
of the meeting is to evaluate the teaching learning process of the Block. Feedbacks and
suggestion are welcome for improvement of the Block educational programs.

~ STUDENT PROJECT ~
Student have to write a paper with topics that has been given by lecturer. The topic will be
chosen randomly on day 1, each small group discussion should work one paper. Students
make a paper as student project an will be presented in front of the class. The paper and
the presentation will be evaluated by respectively facilitator and lecturer.
Format of the paper :
1. Cover :
Tittle
Name
Student Registration Number
Faculty of Medicine, Udayana University 2014
2. Introduction
3. Content
4. Conclusion
5. References (minimal 3 refferences)
Note : 5-10 pages; 1,5 line spacing; Times new roman 12

~ ASSESSMENT METHOD ~
Cognitive assessment will be carried out on Monday 10th April 2014, 11.00 until finish. The
test will be consist of 100 questions with 100 minutes provide for working. SGDs and
student projects mark will be include in the final score as describe below. The overall
passing score requirement is 70. More detailed information or any changes that may be
needed will be acknowledged at least two days before the assessment.
Skill assessment will be carried out at the end of the semester using Objective
Structured Clinical examination (OSCE).
SGD will be reviewed every day by facilitator with a standard SGD assessment and
it contributes 5% to final score. Student projects as a summative assessment account for
15% of the final score.

Faculty of Medicine Udayana University,MEU

Study Guide Medical Professionalism

~ LEARNING PROGRAMS ~
Abstracts of Lectures
Lecture 1: Introduction to Medical
Professionalism

Human behavior in social intercourse should be regulated by a code of conduct for the
achievement of objectives can take place in an effective, beneficial and based on humanity.
Basically, all the values and norms are used as guidelines for ethical and moral rules of life.
Ethical and moral terms are often interchangeable. In general, guidelines on ethics-related
and should not be something that is done, because closely related to human dignity, is
absolute, objective, persistent, for long time. Meanwhile, the term moral mezabs practically
what made it good or bad. Related to moral values may grow or change as a period of time,
developmental age, ethnicity or place. Ethics and morals then become the basic of rules or
social norms as legal norms, etiquette, code of ethics, religion and other.
The doctor patient relationship is a part of social life. This relationship is meant to be a
common goal in meeting the needs. Therefore, the code of ethics that govern the doctorpatient relationship must be based on ethics and morals and related to law, etiquette and or
religion.

Lecture 2 : Biomedical Ethics


Learning Outcome
Critically analyse ethical issues commonly encountered in medical practice.
Apply the principles of biomedical ethics and ethical reasoning to formulate a framework
of ethical-decision making.
Demonstrate the ability to resolve ethical issues faced during common clinical scenarios.
Identify the ethical aspects involved in conducting research and apply ethical principles in
conducting research.
The global medical profession has maintained simple ethical standards for more than 4,000
years. A code of professional conduct like the Hippocratic Oath ("First of all, do no harm")
have shaped and guided the development of ethical standards in the medical profession to
maintain publics trust. Nowadays, developments in science and technology in the twentieth
century have led to advances in medicine and health care that have benefited millions of
lives. The changing context in which health care is provided has created new challenges for
health workers, health researchers, and the broader health care of the community.
Recently, the system of medical regulation through which doctors are held to account has
come under sustained criticism. A series of public inquiries have revealed incompetence,
dishonesty, and sexual misconduct by individual doctors, as well as weaknesses in systems
that failed to detect deviant behavior early and then to take action to protect patients. And
also, medical professionals increasingly find themselves confronted with moral questions
and ethical dilemmas. Professional misconduct, immoral and unethical decisions will cause
the erosion of patients trust that will lead to the end of the golden age of doctoring.
Biomedical ethics is one of the fundamental tools to maintain the publics trust in the medical
profession, encouraging the public to continue seeking for medical services. Applying
principles of biomedical ethics and prima facie duties in daily medical practice will sharpen

Faculty of Medicine Udayana University,MEU

Study Guide Medical Professionalism


the ethical reasoning ability. Knowing how to think ethically is very important, since it will set
a framework for moral decision making, because poor reasoning can lead to bad decisions,
and consequent harm to the patient and others.
According to World Medical Association (WMA), biomedical ethics is the study of moral
issues that occur in medicine, healthcare and the biological sciences. It has four major
subdivisions: clinical ethics, which deals with issues in patient care; research ethics, which
deals with the protection of human subjects in healthcare research; professional ethics;
which deals with the specific duties and responsibilities that are required of physicians and
other healthcare professions (medical ethics is one type of professional ethics); and public
policy ethics, which deals with the formulation and interpretation of laws and regulations on
bioethical issues.
Reference:
1. Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York: Oxford
University Press, 2008.
2. Jonsen A, Siegler M, Winslade W. Clinical ethics: A practical approach to ethical
decisions in clinical medicine. 7th ed. New York: McGraw-Hill Medical, 2010.
3. Tony Hope, et al. Medical ethics and law: the core curriculum. Edinburgh: Churchill
Livingstone, 2003.
4. World Medical Association Declaration of Helsinki: Ethical principles for medical research
involving human subjects, 2008.
5. National Institutes Of Health. The Belmont Report: Ethical principles and guidelines for
the protection of human subjects of research, 1979.
6. Kode Etik Kedokteran Indonesia (KODEKI)

Lecture 3: Informed Consent


Patients are entitled to make decisions about their medical care and to be given relevant
information on which to base such decisions. The physician's obligation to obtain the
patient's consent to treatment is grounded in the bioethical principles of patient autonomy
and respect for persons and is affirmed by Indonesian law and professional policy. A large
body of research supports the view that the process of obtaining consent can improve
patient satisfaction and compliance and, ultimately, health outcomes.
Physician must disclose relevant and detail information, so the patient can understand it
clearly. Both elements are necessary for valid consent. Physician should inform the patient
adequately about the treatment and its expected effects, relevant alternative options and
their benefits and risks, and the consequences of declining or delaying treatment. The
physicians goal is to disclose information that a reasonable person in the patient's position
would need in order to make an informed decision. Therefore, physician may need to
consider how the proposed treatment (and other options) might affect the patient's
employment, finances, family life and other personal concerns. Physician may also need to
be sensitive to cultural and religious beliefs that can affect disclosure.
The situation in which an adult lacks the capacity, for whatever reason, to make an informed
decision is somewhat confused. Where a patient is suffering from a mental condition, he
may be given treatment for his mental condition without consent. In emergency, such as an
accident where the victim is unconscious or shocked, no permission is necessary and
doctors must do as they think best for the patient in those urgent circumstance. Exceptions
to the principle of informed consent also occur with regard to persons with impaired, such as
children who are usually represented by a third party, such as parents or other close
Faculty of Medicine Udayana University,MEU

Study Guide Medical Professionalism


relatives, vis--vis the physician. Substitute decision-making poses two main questions:
Who should make the decision for the incapable person, and, how should the decision be
made? To answer these questions, physician should become familiar with the legal
requirements.
Refferences :

Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page 61-80

Lecture 4: Confidentiality

Physicians are obliged to keep information about their patients secret. The understanding
that the physician will not disclose private information about the patient provides a
foundation for trust in the therapeutic relationship. Respect for confidentiality is firmly
established in codes of ethics and in law. It is sometimes necessary, however, for
physicians to breach confidentiality. Physicians should familiarize themselves with
legislation governing the disclosure of certain kinds of information without the patients
authorization. Even when no specific legislation applies, the duty to warn sometimes
overrides the duty to respect confidentiality. The physician should disclose only that
information necessary to prevent harm, and should reveal this information only to those who
need to know it in order to avert harm. Whenever possible any breach of confidentiality
should be discussed with the patient beforehand.

Refference :

Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page 81-96

Beauchamp TL, Childress JF. Principles of biomedical ethics. 6th ed. New York:
Oxford University Press, 2008.
Kode Etik Kedokteran Indonesia (KODEKI).
Undang-Undang Republik Indonesia Nomor 29 Tahun 2004 Tentang Praktik
Kedokteran
Peraturan Menteri Kesehatan Republik Indonesia Nomor 290/MENKES/PER/III/2008
tentang Persetujuan Tindakan Kedokteran

Faculty of Medicine Udayana University,MEU

Study Guide Medical Professionalism

Lecture 5: Professional Personal Attribute

People come to physician for help with their most pressing needs-relief from pain and
suffering and restoration of health and well being. They allow physicians to see, touch and
manipulate every part of their bodies, even the most intimate. They do this because they
trust their physicians to act in their best interests.
What constitutes a good doctor? Is technical proficiency sufficient to be a good
doctor? Clearly, a physician cannot lack necessary technical knowledge and skills and still
be a good doctor. Less clear is whether a technically proficient physician can lack
interpersonal skills necessary to relate well to patients and still be a good doctor. The
physicians interpersonal skills are critical to establishing strong, trust-based physicianpatient relationships that offer multiple benefits. Most patients want a strong relationship
with a primary care physician.
The quality of a patients relationship with a physician can affect not only a patients
emotional responses but also behavioral and medical outcomes such as compliance and
recovery. Consequently, physicians have been urged to improve their communication and
patient education techniques, develop their empathetic abilities, encourage participative
decision making, and convey respect and dignity.
Patients need good doctors. Good doctors make the care of their patients their
first concern; they are competence, keep their knowledge and skills up to date,
establish and maintain good relationships with patients and colleagues, are honest
and trustworthy, and act with integrity.
Refferences :
1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page : 51-57
2. CMA. Professionalism in Medicine.2001
3. Bendapudi,N.M. et al. Patients Perspectives on Ideal Phsician Behaviours. Mayo
Clin Proc.2006.81(3):338-344

Lecture 6: Patients Right

Patient rights have recently become the centre of national attention in the practice of
medicine. Patient rights encompass legal and ethical issues in the provider-patient
relationship, including a person's right to privacy, the right to quality medical care without
prejudice, the right to make informed decisions about care and treatment options, and the
right to refuse treatment.
The purpose of delineating patient rights is to ensure the ethical treatment of persons
receiving medical or other professional health care services. Without any exception, all
persons in all settings are entitled to receive ethical treatment.
A patient's rights occur at many different levels, and in all specialties. The American Medical
Association (AMA) outlines fundamental elements of the doctor-patient relationship in their
Code of Medical Ethics. These rights include the following:

Faculty of Medicine Udayana University,MEU

10

Study Guide Medical Professionalism


o
o
o
o
o
o

The right to receive information from physicians and to discuss the benefits, risks,
and costs of appropriate treatment alternatives
The right to make decisions regarding the health care that is recommended by the
physician
The right to courtesy, respect, dignity, responsiveness, and timely attention to health
needs
The right to confidentiality
The right to continuity of health care
The basic right to have adequate health care

Refferences :

Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine.


Twelfth Edition.2003. page 8-14
Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page : 3-38

Lecture 7: Patients Autonomy


Medical care in the United States has rapidly moved away from a paternalistic approach to
patients and toward an emphasis on patient autonomy. At one extreme end of this spectrum
is the independent choice model of decision making, in which physicians objectively
present patients with options and odds but withhold their own experience and
recommendations to avoid overly influencing patients. This model confuses the concepts of
independence and autonomy and assumes that the physician's exercise of power and
influence inevitably diminishes the patient's ability to choose freely. It sacrifices competence
for control, and it discourages active persuasion when differences of opinion exist between
physician and patient. This paper proposes an enhanced autonomy model, which
encourages patients and physicians to actively exchange ideas, explicitly negotiate
differences, and share power and influence to serve the patient's best interests.
Recommendations are offered that promote an intense collaboration between patient and
physician so that patients can autonomously make choices that are informed by both the
medical facts and the physician's experience (Quill T.E., Brody, H., 2004).
.Refferences :
1. Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine.
Twelfth Edition.2003. page 8-14
2. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page : 3-38

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Lecture 8: Empathy
The origin of the word empathy dates back to the 1880s, when German psychologist
Theodore Lipps coined the term "einfuhlung" (literally, "in-feeling") to describe the emotional
appreciation of another's feelings. Empathy has further been described as the process of
understanding a person's subjective experience by vicariously sharing that experience while
maintaining an observant stance. Even more simply stated, empathy is the ability to "put
oneself in another's shoes."
Effective empathetic communication enhances the therapeutic effectiveness of the
doctor-patient relationship. Appropriate use of empathy as a communication tool facilitates
the clinical interview, increases the efficiency of gathering information, improved health
outcomes, better patient compliance, reduction in medical-legal risk, and improved
satisfaction of clinicians and patients.
Empathy was known as "bedside manner," a quality considered innate and
impossible to acquire. More recently, greater emphasis has been placed on empathy as a
communication tool of substantial importance in the medical interview, and many experts
now agree that empathy and empathetic communication are teachable, learnable skills.
Because empathy is such a powerful communication skill in medical practice, the
clinicians would scramble to learn about and use it at every available opportunity.

Refferences :
1. Batmanabane, V.Empathy: A vital attribute for doctors. Indian Journal of Medical Ethics.
2008. 5(3) :128-129
2. Hardee, J.T. An Overview of Empathy. The Permanente Journal.2003.7 (4):51-54

Lecture 9: Awareness to diversity in medical


practices

Culture consists of pattern, explicit and implicit, of and for behavior acquired and transmitted
by symbols, constituting the distinctive achievement of human groups. Culture is a human
creation, which includes codes of behavior, language, ritual and system of beliefs. The
essential core of culture consists of traditional ideas and especially their attached values. So
culture is learned, shared, ideas about and patterns of behavior.
A society is an organized group of individuals with specific boundaries, or criteria, of
membership. We will speak of both societies and cultures in term of levels of inclusiveness
(about gender as the cultural construction, values, norms and belief). Factors inherent
within a given culture are also likely to influence deeply the perception and definition
of illness, and any consequent actions. Although this subject highlights the different
influence on health and many this factors are inter-related.
Refference:
Ross J.Taylor. et al. Health and Illness in the community. Oxford University Press. 2003

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Lecture 10: Legal Aspect of Medical


Practice

According to the Assembly of Indonesian Law of Health, Law of Health includes all
regulation that is directly related to maintenance/services of health care and its application,
which includes Civil Code, Criminal Code and Law of Administration. Law of Health is
divided into two, direct and indirect.
Direct Law of Health is a law regulation that is directly related to maintenance of
health, such as:

Act Number. 29 Year 2004 concerns of Medical Practice


Act Number 36 Year 2009 concerns of Health

Indirect Law of Health includes all application of law regulation that is related to law
specialization, such as: Civil Code, Criminal Code and Law of Administration which can be
implied in maintenance/services of health care.
The purpose of Law of Health is to provide legal protection and assurance to both giving
and receiving parties in health care services. Thus, Law of Health consists of:

Medical/Dentistry Law

Clinical Pharmacy Law

Hospital Law

Community Health Law

Etc.

Medical Law is a Law of Health in a constricted meaning, which is also the core of Law
of Health which regulates the medical services. The meaning of Medical Law is divided into
a broad and constricted meaning.
Medical Law in the broad meaning is all the regulations in medical services, such as
medical services provided by doctors, dentists, nurses, and laboratories.
Medical Law in the constricted meaning is all the regulations that only cover the
doctors professions, such as:

Doctor-patient relationship

Medical Record and medical Confidentiality

Informed Consent

Medical malpractice

Euthanasia

Etc.

Refferences :
1. Shepherd, R. The Ethics of Medical Practice in Simpson,s Forensic Medicine.
Twelfth Edition. 2003.page 1-8
2. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page : 39-49
3. Sanbar, S.S. et al. Legal Medicine and Health Law Education in : Legal Medicine.
Sanbar, S.S. (Ed). 1998.Page 3-10
4. Piorkowski, J.D.Medical testimony and the expert witness in : Legal Medicine.
Sanbar, S.S. et al (Ed.). 1998. Page 132-144
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5. Wiradharma, D. Penuntun Kuliah Hukum Kedokteran. Page 25-35
6. Ohoiwutum, T. Bunga Rampai Hukum Kedokteran.page 1-13

Lecture 11: Pharmaceutical Regulations


related to Medical Practitioners

Drug can be formulated as one single active or multiple active ingredients to prevent,
minimize, eliminate, or cure the disease or symptoms of the diseases, or physical and
mental illness.
Based on the safety of drugs, there are 3 drug categories namely over the counter (OTC)
medicine, prescribed medicine, and narcotics. OTC medicine which colored with green and
blue circle can be collected from pharmacy without prescription while prescribed medicine
colored with red circle should be collected by prescription. Narcotics may result in addiction
and it should be collected by prescription only.
Drug is formulated in drug companies then it is distributed to Drug Distributor Company
which then distributed to Pharmacies, Drug Stores, Hospitals, other drug distributors. Drug
stores should not prepare prescription because there is no pharmacists who have the
competent to prepare prescription in the drug store. There are chapters in UU RI No 23 Th
1992, that should be put into consideration, such as:
Pasal 63 ayat 1 : pekerjaan kefarmasian, dilakukan oleh tenaga kesehatan yang
mempunyai keahlian kewenangan untuk itu.
Pasal 82 ayat 1d : barang siapa tanpa keahlian dan kewenangan dengan sengaja
melakukan pekerjaan kefarmasian, dipidana penjara maksimal 5 tahun dan atau denda
maksimal 100 juta rupiah.
Pasal 80 ayat 4b : memproduksi dan atau mengedarkan sediaan farmasi berupa obat atau
bahan obat yang tidak memenuhi syarat Farmakope Indonesia, dipidana penjara maksimal
15 tahun dan denda maksimal 300 juta rupiah.
Pasal 80 Ayat 2 c : Mengedarkan sediaan farmasi atau alat kesehatan tanpa ijin edar,
dipenjara maksimal 7 tahun dan atau denda maksimal 140 juta rupiah.
Per.Menkes No. 085/Menkes/Per/I/1989 pasal 4 ayat 1 : Mewajibkan dokter pemerintah
menggunakan / menulisobat essensial dengan nama generic dl pelayanan kesehatan
pemerintah
Per.Menkes No. 085/Menkes/Per/I/1989 pasal 9 : pelanggaran pada peraturan ini akan
dikenakan sangsi administrative dan atau hukuman disiplin
UU RI No. 22 th. 1997 tentang narkotika pasal 39 ayat 3 : rumah sakit, apotik, puskesmas,
dan balai pengobatan hanya dapat menyerahkan narkotika kepada pasien berdasarkan
resep dokter.
UU RI No. 22 th. 1997 tentang narkotika pasal 39 ayat 5 : Narkotika dalam bentuk suntikan
dalam jumlah tertentu yang diserahkan dokter, hanya dapat diperoleh dari apotik.
UU RI No. 22 th. 1997 tentang narkotika pasal 78 ayat 1b : Barang siapa tanpa hak dan
melawan hokum memiliki, menyimpan atau menguasai narkotika, dipidana penjara paling
lama 10 tahun dan denda paling banyak 500 juta rupiah.
UU RI. No.5 th.1997 tentang Psikotropika pasal 62 : Baranh siapa tanpa hak, memiliki,
menyimpan dan atau membawa psikotropika dipidana penjara 5 th dan denda 100 juta
rupiah
Refference :
Direktorat Jendral Pengawasan Obat dan Makanan Departemen Kesehatan RI.
Kumpulan Peraturan Perundang-Undangan Bidang Obat.1996

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Lecture 12: Criminal Law and Medical


Malpractice

In general, the understanding of criminal law is the law which legislate and control a
humans forbidden act and when this is disobeyed, the respected person will be charged
according to law. A doctor is said to have done a criminal act when he/she breaks the rules
stated in Indonesian Criminal Law (KUHP), and other laws, for an example, Law of
Health.
A patient or his/her familys dissatisfaction towards a medical care received from a
doctor or a hospital can evoke a legal action. The legal action occurred perhaps not
because of the mistake done by a doctor or the hospital, but because of the breach in
medical ethics, medical disciplines, or even the criminal act and the medical malpractice
itself. Occurrence of medical malpractice is solely because of the doctors negligence which
causes loss for the patient and his/her family. To prove a malpractice has occurred, there
are two proving procedures or mechanism, the first is direct proving method using 4D
criteria; Duty, Dereliction of duty, Damage and Direct causation. The second proving
procedure is via indirect method using doctrine Res Ipsa Loquitor (the thing speaks for
itself).
Refferences :

1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill Livingstone.
Edinburgh. 2003 page : 15-21
2. Flamm, M.B. Medical Malpractice and the physician defendant in : Legal Medicine
Sanbar, S.S. et al. (Ed.) 1998. Page 123-129

Lecture 13: Legal Aspect of Medical Record,


Medical Certification and Visum et Repertum
(Medico-legal report)
Doctor who main profesion for health sevices also has responsibility to make
medical documents in form of certificate needed by patient, third party and state in the name
of law. These medical documents consist of Health Certificate, Sick Leave Certificate,
Certificate of non-infected from any contagious disease and etc. There are trends of upward
need to medical certificate for many different purposes according to development of medical
technology and science. Nowadays, Certificate of Patternity, Certificate of Gender,
Certificate of Virginity and etc are frequently needed.
Basic principal of medical certificate on medicolegal aspect mainly consist of fact
and medical opinion. Facts based on medical examination meanwhile medical opinion made
according to medical procedure. Therefore, medical certificates are tightly attached to
medical confidentiality.
Doctor profession has many responsibilities, one of them is legal duty. This
responsibility is an obligation mainly assisting law and trial process. For instance, Visum et
repertum is medical certificate made for law enforcement. The division of visum et repertum
depends on substance needed by the state. Generally, it is differentiated in to Psychiatric
Visum et Repertum and Physical Visum et Repertum. Physical Visum et repertum can be
divided in to death victim Visum et repertum and live victim Visum et repertum. Meanwhile
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live victim visum et repertum can be made for physical violence and toxin VeR and sexual
harassment VeR.
Medical record in other hand is a note for all medical information collected from
patient examination and analysis including medical procedure performed. Medical record is
compulsory to all practicing doctor which has function for administration, legal, financial,
research data and education. Its legal function needed as a source for medical certificate
and VeR aside used as written evidence on medical dispute.
Refferences :
1. Hirsh, H.L. Medical Record in : Legal Medicine. Sanbar, S.S. et al (Ed.).1998. Page
280-296
2. Plueckhahn, V.D. and Cordner, S.M. Ethics, Legal Medicine and Forensic Pathology,
Second Edition. 1991. Page 111-122

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LEARNING TASKS

Introduction to Medical
Professionalism

Case 1
Do not treat someone if you do not want to be treated the same. This is a
parameter for everyone to treat somene else.
Assignments:
1. Try to explain this statement.
2. Give the example as many as you can.
3. How about this statement? :.....by the name of God, I have to kill you...

Case 2
Basically, confidentiality is one of our expression to appreciate human dignity.
Confidentiality may be broken in certain circumstances? Examples of this conflict of
duty may be seen in your practice. A school bus driver suffered from epilepsy. Do
you need to open this secret to the company with the result he was expelled? Give
your reason.
Case 3
A senior specialist doctors perform surgical operations with methods that have been
abandoned. This method, in addition took time longer and contain more risk to the
patient. Now there are new ways of operating a shorter, safer and more convenient.
Assignment :
What is your opinion? As a doctor, What will You do ?
Case 4.
In the practice of medicine, a physician violated medical ethics is mentioned but not
against the law. Instead it could be a doctor breaking the law but not unethical
Assigment:
Find the differences and similarities between the code of ethics and law !!

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Biomedical Ethics and Patient


Safety

CASE 1
It is Friday night and you have almost finished admitting your patient. You are just waiting
for his blood test results. The locum doctor taking over your shift is running late and you are
getting a bit stressed as you have a bus to catch back to Negara so that you can make it
home in time for your cousins birthday party. Just as you are about to leave your bleep
goes off. A nurse informs you that one of your patients, Endy, is having some chest pain. He
was admitted 2 days ago with pneumonia and you suspect that the pain is related to the
infection. You ask the nurse to do a set of observations and an electrocardiogram (ECG)
and say you will ask the doctor taking over to assess him. You then receive an incoming
call. It is your cousin, who is very drunk and urging you to hurry up as you are missing out
on all the fun. You tell her you are on your way. The locum arrives 20 minutes later and you
rush off straight away. Later that night you remember that you completely forgot to hand
over the patient who was having chest pain. You decide to ring the hospital and find that he
is now a patient on the coronary care unit, having had a massive heart attack only an hour
ago.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Have you shown the professional behavior in this case? (Explain your arguments based
on six behaviors of professionalism)
CASE 2
Janet is a first-time mother who comes to see you in your morning clinic with Jake, her 3year-old son. Janet has had to take time off her demanding job as Jake has been asked not
to come to the nursery for a few days because he has a very bad cold and the child-minders
are worried that the other children will pick up his bugs. He does not look very well. He is
listless and irritable and cries throughout the consultation. On examination he is slightly
pyrexia and has a runny nose. His throat is not red and his tonsils are not enlarged. He has
a dry cough. Janet tells you that he has not been sleeping well and has been off his food
although he has been drinking more than usual. She says this is the third time he has been
unwell since starting nursery 3 months ago. She demands that you prescribe some
antibiotics for Jake to help expedite his recovery as her boss will not give her any more time
off work to stay at home and look after him. She also criticizes your colleague, who saw him
last time, for failing to give him any antibiotics. She is convinced that this is a recurrent
infection with the same bug. You suspect that Jack has yet another viral illness and that
antibiotics will not help.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. What should you do in this situation? (Explain your arguments based on prima facie
duties, four quadrant approach, double effect principles, utilitarian/consequentialism
ethical theory, deontological/kantianism ethical theory, virtue ethics, KODEKI, and other
ethical theory that you know)
4. What are the foreseeable consequences of your decision? Can you justify this decision
to accommodate: the patient or the patients family value; to your consultant; and to your
peers?

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CASE 3
During the night you admit an elderly man who has fallen over and fractured his hip. He is
83 years old and lives in a residential home because he has difficulty mobilizing and caring
for himself. His medical history includes ischemic heart disease, polymyalgia rheumatic,
large bowel carcinoma and recurrent small bowel obstruction secondary to adhesions. He is
also partially sighted. While you are clerking him in he tells you about how lonely he has
become since his wife died 2 years ago. His children are elderly and cannot visit him that
often and his grandchildren have both moved abroad. He feels that he has lived his life and
that it is time for him to go and join his wife. He asks you not to treat him and to make him
not for resuscitation. Although he is lonely he does not seem depressed and you believe
that it is probably a reasonable request.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. What should you do at this point? (Explain your arguments based on prima facie duties,
four quadrant approach, double effect principles, utilitarian/consequentialism ethical
theory, deontological/kantianism ethical theory, virtue ethics, KODEKI, and other ethical
theory that you know)
4. What are the foreseeable consequences of your decision? Can you justify this decision
to accommodate: the patient or the patients family value; to your consultant; and to your
peers?
CASE 4
After having completed a study that involved the collection of tissue from the subjects, an
investigator wishes to perform additional analysis of the archived tissue samples. This
nature of this analysis was not explicitly stated in the original consent form.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should the investigator be required to obtain explicit consent for the new research?
(Explain your arguments based on prima facie duties, declaration of Helsinki, Belmont
report, double effect principles, utilitarian/consequentialism ethical theory,
deontological/kantianism ethical theory, virtue ethics, KODEKI, and other ethical theory
that you know)
4. What are the foreseeable consequences of your decision? Can you justify this decision
to accommodate: the patient or the patients family value; to your consultant; and to your
peers?

Informed Consent and


Confidentiality

CASE 1
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is
diagnosed with an abdominal aortic aneurysm (a weakening in the wall of the aorta which
causes it to stretch and bulge). The physicians inform her that the only way to fix the
problem is surgically, and that the chances of survival are about 50/50. They also inform her
that time is of the essence, and that should the aneurysm burst, she would be dead in a few
short minutes. The woman is a photo model and actress; she worries that the surgery will

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leave a scar that will negatively affect her work; therefore, she refuses any surgical
treatment. Even after much pressuring from the physicians, she adamantly refuses surgery.
Feeling that the woman is not in her correct state of mind and knowing that time is of the
essence; the surgeons decide to perform the procedure without consent. They anesthetize
her and surgically repair the aneurysm. She survives, and sues the hospital for millions of
dollars.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. What is your view on the application of the principle of informed consent in this case?
4. Try to find the reason, why the doctor decides as he did?
5. If you were doctor in this case, what would you do? (Explain your arguments based on
prima facie duties, the principle of informed consent, ethical theory, KODEKI, and legal
aspect)
CASE 2
Joice and Doni have been married for 12 years and have a 6-year-old son. Donis father
and grandfather died from cancer when they were in their early forties. Because of the
strong family history of cancer, Doni wanted to have a genetic test to find out his level of
risk. Although no clear diagnosis was possible, tests indicated that he was at risk of
hereditary non-polyposis colorectal cancer. Now, Doni is feeling tired and unwell, and has a
colonoscopy. The test reveals that he has inoperable bowel cancer. Joice is concerned that
their son might also be at risk of colon cancer when he is older. She asked you to do a
genetic test for his son to see if he is at risk.
Assignment:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should parents be allowed to have their children tested for adult-onset genetic
conditions? Why?
4. What would you do? (Explain your arguments based on prima facie duties, the principle
of informed consent, ethical theory, KODEKI, and legal aspect)
5. What are the foreseeable consequences of your decision? Can you justify this decision
to accommodate: the patient or the patients family value; to your consultant; and to your
peers?

CASE 3
Tony is 35 years old and is married. He has had unprotected sex with prostitutes on 2
occasions. Although he is asymptomatic, he becomes anxious about the possibility of
having contracted a venereal disease and consults his physician. After conducting a
thorough physical examination and providing appropriate counselling, Tonys physician
orders a number of tests. The only positive result is for the HIV blood test. The physician
offers to meet with Tony and his wife to assist with the disclosure of this information, but
Tony states that he does not want his wife to know about his condition.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should the doctor disclosed this information to his wife? (Explain your arguments based
on prima facie duties, the principle of confidentiality, ethical theory, KODEKI, and legal
aspect)

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4. What are the foreseeable consequences of your decision? Can you justify this decision
to accommodate: the patient or the patients family value; to your consultant; and to your
peers?
5. Does it make any difference if the Tonys diagnosis is not HIV? Explain!

CASE 4
A 75-year-old woman shows signs of abuse that appears to be inflicted by her husband. As
he is her primary caregiver, she feels dependent on him and pleads with you not to say
anything about it.
Assignments:
1. What is the ethical issue in this case?
2. What are the principles of biomedical ethics which can be implied in this case?
3. Should you report this case to the police? (Explain your arguments based on prima facie
duties, the principle of confidentiality, ethical theory, KODEKI, and legal aspect)
4. What are the foreseeable consequences of your decision? Can you justify this decision
to accommodate: the patient or the patients family value; to your consultant; and to your
peers?
5. If you are asked to testify and disclose patient information in court, what would you do?

Professional Personal
Attribute

CASE 1:
Mr. A complained that when urinating he had pain. He went to a hospital and was managed
by an urologist who said that laser treatment should be performed because it might be due
to prostate. So far only USG had been performed. The doctor was threatening to such an
extent that the patient sister started crying. The threat was made like this: If a laser is not
performed, you will have to read the holy verses," that is, he would die. This physician
proceeded to perform intravenous pyelography. Then the patient was instructed to undergo
a laser treatment that same evening by paying an advance of approximately Rp.
15.000.000,-. The patient was bewildered and contacted his brother who was engaged in
the health field. He told him to delay it for one day until he would reach there. But the
physician got angry and said, If this was not conducted, he would not care any more. It was
not until realizing who his brother was that the physician was alerted. He asked what he
should do to apologize for what he had done. Finally, the hospital director and one of his
staff apologized to his brother. The patients decided to go to another private hospital where
ultrasonography (USG) and other specific laboratory examinations showed that it was an
inflammation.
Assignments:
1.
2.
3.
4.

Identify the moral-ethical issue in this case


Identify the professional personal attribute in this doctor-patient relationship
What is your view about the doctors attitude in this case?
Has the doctor tried to demonstrate his/her empathy? Explain!

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CASE 2
Dr. P. an experienced and skilled surgeon, is about to finish night duty at 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 great deal of pain. Dr. P examines her and decides
that she has had either a miscarriage or self induced abortion. He does a quick dilatation
and curettage 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.
Assignments:
1.
2.
3.
4.

Identify the moral-ethical issue in this case!


Identify the professional personal attribute in this doctor-patient relationship
If you were doctor P, what would you do?
Has the doctor tried to demonstrate his/her empathy? Explain!

Patients Right and


Autonomy

Learning Tasks
1.
2.
3.
4.
5.
6.

what is patients right?


what is the purpose of patients right
Describe the basic of patients right?
What is patient autonomy
Discuss about paternalism in doctor-patient relationship?
Discus about the balance of physician recommendation and patient autonomy

CASE 1
The family of the patient in terminal state need your help to close the treatment.
Assignment
What is your respond in this situation?
CASE 2
Patient with HIV AIDS has plan to get married.
Assignment
What will you do?

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CASE 3
A patient come to the hospital and admitted to an intensive care unit with a chronic,
progressive illness and has a small but real chance of leaving the hospital alive if he submits
to invasive treatment. The patient feels that he has suffered enough, and he requests
supportive care only.
Assignment
What is your decision?
CASE 4
A very rich patient pays you a lot of money and asks you to copy the prescription from
another doctor. The drugs are very essential for his life.
Assignment
What will you do?
CASE 5
The 64-year-old patient suffering from diabetes mellitus, and gangrene had developed on
his leg causing sepsis with high fever, indicating it was a progressive gangrene. He was a
former lawyer. The doctor advised the patient and his family that he have an amputation to
prevent the spreading of infection and safe patients life. The family agreed, but the patient
did not. The family followed the doctor reasoning: I do not want the patient to die merely
because of gangrene and diabetes. Then the doctor told the family that if the patient fell
into a coma, the doctor would have the right to undertake a professional intervention to save
his life without having to obtain the patients approval. Once the patient went into coma, the
doctor asked the family to sign the informed consent for the amputation. The amputation
was finally done.
Assignments:
1. Identify the ethical issues in this case!
2. What is your view on the application of the principle of patients autonomy in this case?
3. Is there any violation to the patients right in this case? Give your reason!
4. What do you think about the patients autonomy, if the patient comes in a state of
unconsciousness?
5. What do you think about the patients autonomy, if the patient is a child?
6. What do you think about the patients autonomy, if the patient is mentally ill?
7. Has the doctor in this case applied the principle of informed consent? Explain!
8. Under What circumstance informed consent given by the family is justified ?
CASE 6
Mrs. X is 35 and is in need of dialysis. She is refusing treatment because she is scared of
the treatment which she believes is invasive. She has been counseled about the nature of
the treatment-there are no alternatives that would be of practical benefit. She is competent
to make treatment decisions. She understands that if she refuses dialysis she will die. She
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has a daughter of 15 years who lives at home. The clinicians feel very strongly that should
receive dialysis but despite numerous attempts to persuade her refuses.
Assignments:
1. Identify the ethical issues in this case!
2. What is your view on the application of the principle of patients autonomy in this case?
3. If you were a doctor in this case what would you do?

Empathy

Write an experience, when did you feel empathy and when you feel sympathy. Your feelings
descriptions should be clear that includes: how it came, when it came, why it came, and
what you're doing when it came.
Example of feeling description :
Waktu saya bertemu dengan pemulung tua ibu Ketut Sunie, hati saya tergetar, kok tegateganya petugas malam itu mengusir dia dari halaman kantor. Dia berjalan sendirian,
padahal dia sudah sangat tua dan renta....wah teganya. Hati saya semakin kasihan saat
melihat dia menyeret kantong plastiknya dan jika kelelahan dia tidur di emperan toko
dengan hanya beralaskan koran. Hati saya semakin trenyuh saat dia menceritakan
pengalaman hidupnya yang penuh dengan derita, ingin rasanya saya setiap hari
menyediakan makanan dan tempat beristirahat untuk dia,....E aaalah kok yha tega-teganya
anggota satpam itu
Once your feelings descriptionsis is clear, then describe whether these feelings can
affect your attitude toward the events on your everyday life. Give your opinion if these
feeling are useful for yourself and your profesion as a doctor and if useful how you maintain
these feelings.
Write your observation report with a brief on A4 paper with a font 12, 1.5 spaces line
as much as 4 pages. The report will be discussed at the Small Group Discussion, and also
will be discussed at the Plenary Session.
Assigments :
1.
2.
3.
4.

What is the difference between empathy and sympathy and give an examples !
Explain with your own word the definition of empathy!
Why empathy is important in medical practice
Is empathy can be developed or learned? If the answer is yes, how?

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Awareness to diversity in
medical practices

Task 1
Please try to interview one of your friends in SGD with the following questions:
1. What is her/his father (or family leader) name and job?
2. With whom are he/she staying at his/her house?
3. If one of the family members falls sick, who will label the illness?
4. Which health provider will he/she be taken to?
5. Who make the decicion for it (question no. 4)?
According to task above, please discuss within your SGD.
1. Why should we ask name and job of the family leader?
2. What image of the family could we get by asking name and job of the family leader?
3. What is the family type?
4. What can we imagine from the answer?
5. Why are they labeling the illness like that ?
6. What is their seeking behavior?
7. How is the decision making process in that family?
Please make a summary and we will choose a group randomly to present in front of
the classroom!

Task 2
Please try to interview an elderly person with the following questions:

1.
2.
3.
4.
5.
6.
7.

What is his/her name (full name)?


Where is he/she come from?
What is his/her ethnicity?
What is his/her occupation?
What is his/her last education?
What does he/she think about geriatric?
Is he/she enjoy his/her life?

Observation Guide
1. Observe his/her clothing.
2. Listen and observe his/her language and body language.
3. His/her behaviour.
4. His/her personal hygiene.
5. His/her topic in their conversation.
6. His/her expression in enjoying their life.
Please make a summary and we will choose a group randomly to present in front of
the classroom!
According to task above, please discuss within your SGD

1. By knowing his/her name, could you know what is his/her ethnic,


stratification(especialy ascribe stratification)?
2. Could you know the gender difference by the name?
3. Why do we need to know about their education and occupation? Please
explain your answer.
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CASE
Paul Farmer is a physician and anthropologist who for the last two decades has split his
time between Harvard and a medical clinic in rural Haiti. He has watched HIV/AIDS since its
earliest days in Haiti, and his writings put the pandemic into its historical and international
context.
In the early 1980s, Haiti had become the symbol of AIDS for North Americans, but
this was merely the latest definition of Haiti for Americans. For 200 years Haiti had been a
dark, sinister place. From the time of Columbus, the island was exploited by the Spanish
and then the French. As the Indian population died off, enslaved Africans were brought in to
work the plantations. Serious slave uprisings began in 1971, and by 1804 the Republic of
Haiti had become only the second country to free itself from European colonial rule. But the
first such country, the United States, still maintained slavery, and the example of Haitis
violent slave revolt terrified the planters of the American South. From the mid-19th century
the United States regularly sent warships to protect American interests in Haiti, and from
1915 to 1937 the U.S. Marines occupied Haiti.
Voodoo, with its dark, ecstatic rituals, added to the sinister image of this troublesome
land. In the early years of HIV/AIDS, when it was little understood, and when many poor
refugees from Haiti were found to be HIV positive, it was easy for North Americans to blame
Haitians for the disease.
From the Haitian standpoint, however, AIDS was just the latest indignity foisted on
the country from the United States. But a more proximate reason for the illness was
explained by Haitian folk beliefs in witchcraft-someone has sent misfortune to another. In his
earlier work(e.g., 1992) Paul Farmer emphasized the atmosphere of accusation and
counteraccusation that characterized the early days of HIV/AIDS, as well as the historical
and cultural contexts from which these accusations were made. In his later work (1999) he
concentrates on the effects of poverty. HIV/AIDS cannot be curred, but it can be controlled
by massive and very expensive medication that is simply out of reach of most Haitian
peasents :
One can be impressed by the power of modern medicine and yet dejected by
our failure to deliver it equitably . . . Moving along the fault lines of society,
HIV continues to entrench itself among the worlds poor and marginalized.
(Farmer, 1999:264-265)
And so this medical anthropologist, after years of facing the biological, cultural, and
historical aspects of HIV/AIDS, winds up with the realization that it is the inequalities built
into the transnational social system that will sustain and spread HIV/AIDS among the poor.
And once more we see the utility of thinking in terms of a biocultural model, for neither part
can be understood alone.(Heider, 2004 in Seeing Anthropology 3rd ed. p 414-415).
Learning Task
1.What is Haitian think about HIV/AIDS? Discuss with your group!
2. What is your perception of health?
3. What do we mean by illness? What the different with disease?
4. What do we mean by seeking behavior?
5. Why culture has important role to human health and illness?
6. Why physician have to understand about diversity and multiculturalism in the
societies?
7. Discuss, how are you develop the strategies of cross-cultural perspective in the
case above.
8. What are another determinant factor of the disease above that Paul Farmer
thought?

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Legal Aspect of Medical


Practice

CASE 1
A mother, 68 years old, who currently staying with her married child, have been
experiencing series of minor cerebral hemorrhage for the past 11 years and for the past two
years she has been unable to talk and showing signs of diminishing hearing abilities. This
has resulted in lack of communication between her and her family. The family later
requested a doctor to do euthanasia to her.

Assignments:
1. In your opinion, what the doctor should do?
2. In your opinion, is the doctor guilty if at all he/she grants the familys request of
euthanasia towards her (mother)? Explain!
3. What is your point of view regarding the ethical aspect in euthanasia?
CASE 2
A private practice doctor in a peripheral region, visited by patients with symptoms of
withdrawal syndrome due to narcotic addict.
Assignments:
1. If you were a doctor in this case, what should you do?
2. What follow-up should be done related to the patients habit of using
narcotics?
3. What is your opinion about the dispensing doctors in his/her practice?
CASE 3
A doctor on duty at the government hospital prescribes the patents drug for his/her patients
which are request by a medical representative of a particular drug manufacturer. The
hospital already has a hospital formulary and adequate and complete supplies of generic
drug.
Assignments:
1. What is your opinion?
2. While doing private practice the doctors buy drugs directly into the Large Pharmacy
(PBF), what is your opinion?

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Criminal Law and Medical


Malpractice
CASE 1
A female, aged 14 years old, went with her mother to a hospital with possible pregnancy
after forced to do an intercourse with her neighbor. The test results reveals positive
pregnancy test aged 6 weeks of gestation. The girl then consulted to psychiatry department,
diagnosed with mild post psychic traumatic depression. The mother then requested the
medical doctor to do an abortion procedure with an excuse that her daughter not yet ready
mentally and physically to conceive the pregnancy and so that she can be back to school
again.
Assignments:
1. In your opinion, what the doctor should do regarding the mothers request?
2. When the doctor agreess for an abortion, can the doctor be said to have done a
criminal act? Explain!
CASE 2
A young man, aged 21 years old, had a traffic accident. He is diagnosed with right epidural
hematoma by a surgeon in the hospital where he receiving treatment. The surgeon
suggested a trepanation procedure to be done to evacuate the bleeding occurred. In the
operation room, the surgeon has done the trepanation procedure in the left lobe instead of
doing in right lobe. After a while, the surgeon realized that he has mistakenly interpreted the
CT scan results. The surgeon then has done the trepanation procedure in the right lobe to
evacuate the bleeding. After operation done and the patient treated in the same hospital for
few days, the patient discharged in improved condition.
Learning Task
1. In your opinion, does the mistake done by the surgeon considered a malpractice?
How do you prove it?
2. After arriving home, the patient then realize that there has been a mistake in the
operation done (trepanation) and he decided to sue the surgeon to compensate the
damage done to him. In your opinion, how the surgeon should do or explain his
decisions to defend himself from a possible malpractice charge?
CASE 3
A 45-year-old man was suffering from intestinal cancer stage IV. The surgeon who handled
him post medically decided the patient to be operated though the possibility of success was
very little. However, it was preferable as compared with no operation. In consideration of the
patients weak condition and the anticipated influence of anesthetic, the surgeon undertook
the operation in a hurry in the hope that the patients condition would not become worse due
to the surgery. After the operation and during treatment, the patient complained of a chronic
stomachache despite long administration of analgesic. To find out the cause of pain, an Xray of the abdomen was made and the image showed that a metal instrument was lying
inside the patients abdomen.

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Assignments :
1. Does the doctrine res ipsa loqiutur apply on the above case?
2. Explain the term and condition of res ipsa loquitur!
3. What are the conditions that can serve as a defense on the above case?

Legal Aspect of Medical Record,


Medical Certification and Visum et
Repertum (Medico-legal report)

CASE 1
A husband punched his wife till made her fell and hit a table. This violence caused by his
suspicion on their 2 years old child not from their married. His wife was brought to hospital
and examined by doctor A. Doctor A recorded all findings from examination and treatment
given on medical record. On examination found bruises on right forehead and open wound
on left temple that required treatment.
His wife brought by police to hospital and asked for wound VeR. The victim want to
have Sick Leave Certificate for getting off from duty cause she works in a private company.
A few days later, her company asked for Medical Certificate needed to reimburst to health
insurance company.
On the other hand, her husband insist for patternity test to their child by DNA
examination to ensure the real father. Based on the test result, he want Certificate of
Patternity to the corresponding child.

Assignments:
1. Medical certificate has vary form according to patient need but in general it has the
same components. Discuss about this components!
2. Medical certificate required by the law must follow medicolegal procedures. Discuss
about this medicolegal procedure and how it is connected with profession responsibility
in law!
3. Discuss about medical confidentiality aspect on medical certificate making process!
4. If the requirement for medical certificate delayed after examination. Discuss about the
solution regarding to this certificate making process!

CASE 2
A policewoman escorted a 20-year-old girl who was a victim of sexual harassment. A doctor
at the emergency department examined her after obtaining the consent from her.

Assignment:
1. What the doctor should do to document the result of the examination?
2. The policewoman requested the doctor to make medico-legal report (visum et
repertum). Explain the role of and procedures to make visum et repertum!
3. According to the legal procedures, the attorney requests the doctor to give expert
witness at a trial. Explain the differences between witness and expert witness. What the
doctor should do if requested to stand in trial?

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BASIC CLINICAL SKILL

MEDICAL CERTIFICATION AND VISUM ET REPERTUM WRITTING SKILL


TRAINING

TRANSLATING THE CONCEPT AND PRINCIPLE OF MEDICAL


PROFESSIONALISM IN PRACTICE

MEDICAL RECORD

PRESCRIBING

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MEDICAL CERTIFICATION AND


VISUM ET REPERTUM WRITTING
SKILL TRAINING

Date and Place :

Friday, 03th April 2014

Class Room and Lab. Bersama

Facilitator : Forensic team


LATAR BELAKANG
Profesi dokter memiliki berbagai tanggung jawab meliputi tanggung jawab terhadap
pasien, tanggung jawab moral (moral duty), tanggung jawab hukum (legal duty) dan
tanggung jawab terhadap sesama dokter. Tanggung jawab moral berhubungan dengan
etika kedokteran sedangkan tanggung jawab hukum merupakan tanggung jawab profesi
terhadap negara. Dalam tanggung jawab hukum, profesi medis harus menerapkan
(aplikasi) ilmu dan teknologi kedokteran untuk membantu proses hukum dan peradilan.
Tanggung jawab hukum bersifat obligasi (keharusan) tidak bisa ditolak oleh seorang
dokter,karena akan dikenakan sanksi hukuman. Disamping itu,tanggung jawab hukum
secara universal di seluruh dunia berdasarkan konsep balancing public interest yang
menekankan dalam memenuhi tanggung jawab hukum dapat mengabaikan tanggung jawab
lainnya.
Salah satu tanggung jawab hukum bagi profesi dokter adalah pembuatan sertifikasi
medis baik untuk kepentingan masyarakat maupun kepentingan hukum. Sertifikasi medis
untuk masyarakat seperti penerbitan Surat Keterangan Medis dan Surat Keterangan
Kematian. Sedangkan untuk kepentingan hukum, sertifikasi medis berupa Laporan Medikolegal (medico legal report). Laporan Medikolegal di Indonesia secara khusus diberikan
nama VISUM ET REPERTUM.
Jumlah dan jenis sertifikasi medis berkembang sesuai dengan State of the art dari
perkembangan IPTEKDOK, sehingga sekarang banyak ragam sertifikasi medis, seperti
Surat keterangan keayahan, surat keterangan tidak berpenyakit menular, surat keterangan
kegadisan dan lain sebagainya.
Konsep dasar sertifikasi medis adalah FAKTA dan PENDAPAT yang disampaikan
secara tertulis oleh dokter tentang apa yang diperiksanya. Fakta merupakan bukti fisik dan
pendapat merupakan opini berdasarkan keilmuan kedokteran.
Sehubungan dengan Visum et Repertum, penerbitannya diatur oleh hukum positif di
Indonesia khususnya pasal 133 KUHAP. Sebagai Keterangan Ahli tertulis, Visum et
Repertum diatur dalam pasal 179 KUHAP dan pasal 180 KUHAP.
Istilah Visum et Repertum hanya ada di Indonesia dan tidak pernah ditemukan di
negara lainnya di dunia. Meskipun istilah Visum et Repertum hanya ada di Indonesia tetapi
konsepnya sama dengan konsep Laporan Mediko-legal di negara-negara lainnya. Secara
internasional, hukum memerlukan dua bukti yaitu bukti fisik (physical evidence) dan bukti
pendapat ( opinion evidence). Bukti fisik diperoleh dari pengamatan fisik secara implisit
yang pengertiannya sama dengan visum sedangkan bukti opini merupakan interpretasi
dari bukti fisik secara ekplisit dan pengertiannya sama dengan repertum.

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Kompetensi dokter sangat diperlukan profesionalitasnya dalam pendekatan implisit
dan eksplisit dari bukti yang tertuang dalam Visum et Repertum. Pendekatan implisit
(implisit reasoning) diperlukan dalam pengumpulan bukti fisik. Bukti fisik diperoleh dari
pemeriksaan dan observasi yang didasari komitmen teori, ilmu kedokteran dan tujuan medis
tertentu. Bukti pendapat (opinion evidence) merupakan interpretasi terhadap fakta medis
berdasarkan pemikiran kritis (critical thinking). Pemikiran kritis ini adalah unsur eksplisit
dalam pembuatan visum et repertum. Pemikiran kritis profesi dokter berdasarkan dua
pendekatan yaitu pendekatan medis (medical reasoning) dan pendekatan hukum (legal
reasoning).
Disamping itu, kompetansi dokter diperlukan dalam memberikan bukti yang sah dan
dapat diterima (admissible) di pengadilan berdasarkan relevansi, tidak tersanggahkan,
otentik, reliable dan tidak diperoleh dengan jalan yang melanggar hukum.
Berdasarkan uraian diatas, maka dapat disimpulkan pentingnya kemampuan klinis
pembuatan sertifikasi medis dan Visum et Repertum diberikan kepada mahasiswa
kedokteran dengan alasan sebagai berikut :
1. Profesi dokter memiliki berbagai tanggung jawab, diantaranya adalah tanggung
jawab hukum (legal duty). Tanggung jawab hukum bersifat obligasi dan didasari
konsep balancing public interest yang tidak bisa ditolak dan dapat mengabaikan
tanggung jawab lainnya.
2. Pembuatan sertifikasi medis, khususnya Visum et Repertum adalah salah satu
tanggung jawab hukum profesi dokter
3. Profesionalisme pembuatan sertifikasi medis dan Visum et Repertum harus terus
dikembangkan karena sertifikasi medis berkembang sesuai dengan state of the art
(SOTA) dari perkembangan IPTEKDOK.
4. Kompetensi dokter diperlukan untuk memberikan FAKTA dan PENDAPAT medis
secara tertulis baik untuk masyarakat maupun untuk hukum
5. Kompetensi dokter diperlukan dalam melakukan pendekatan secara implisit dalam
mengumpulkan bukti fisik dan pendekatan eksplisit dalam memberikan opini medis

TUJUAN
Tujuan Umum
Agar mahasiswa mempunyai kompetensi mengerti tentang konsep pembuatan
sertifikasi medis dan Visum et Repertum serta mampu membuatnya secara mandiri untuk
memenuhi kewajiban hukum profesi dokter
Tujuan Khusus
1. Mahasiswa mengerti tentang prosedur Mediko-legal penerbitan Sertifikasi medis dan
Visum et Repertum
2. Mahasiswa memahami anatomi umum dari sertifikasi medis dan Visum et Repertum
3. Mahasiswa mampu mengidentifikasi bukti fakta dari sertifikasi medis dan Visum et
Repertum
4. Mahasiswa mampu menuliskan secara naratif berdasarkan interpretasi medikolegal
bukti fakta dalam sertifikasi medis dan Visum et Repertum
5. Mahasiswa mampu memberikan opini terhadap bukti fakta berdasarkan pendekatan
medis (medical reasoning) dan pendekatan hukum (legal reasoning)
6. Mahasiswa mampu mengaplikasikan ilmu dan teknologi kedokteran terbaru dalam
pembuatan sertifikasi medis dan Visum et Repertum

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METODOLOGI PEMBELAJARAN
Pembelajaran dilakukan dengan metoda :
1. Kuliah interaktif (introduction lecture)
2. Small group discussion
3. Pemberian tugas belajar
4. Kemampuan klinis : dengan mengerjakan langsung pembuatan sertifikasi medis
dan konsep Visum et Repertum

Translating the concept and


principle of medical
professionalism in practice
Date and Place :

Monday, 4th April 2014

Class Room and Small Group Discussion

Lecturer : Prof.Dr.dr.K. Suwitra,SpPD. KGH

MEDICAL RECORD

Date and Place :

Monday, 7th April 2014

Class Room and Small Group Discussion

Lecturer : Dr. Ni Luh Dharma Kerti Natih,MHSM

PRESCRIBING

Objective : Demonstrate the ability to do the rational drug prescribing

Date and Place :

Tuesday, 8th Aril 2014

Lab Bersama (4th floor)

Facilitator : Drs. I.G.M. Adioka, Apt. and team


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SELF ASSESSMENT
Bioethic :
Self Assessment
1. What are value, ethics, and moral?
2. What are medical ethics, biomedical ethics, and bioethics?
3. Describe the historical background of medical ethics from the Code of Hammurabi
until modern medical ethics!
4. What are the double effect principle, virtue ethics, utilitarian, consequentialism
deontological, and kantianism ethical theory? How is it criticized?
5. Explain about the principles of biomedical ethics and prima facie!
6. Explain about the four quadrant approach to ethical decisions in clinical medicine!
7. Explain about the Belmont report and declaration of Helsinki!
8. Read and understand the articles of KODEKI (Kode Etik Kedokteran Indonesia),
then analyze each article based on the principle of biomedical ethics!
Professional Personal Attribute
1. What are the principles underlying the doctor-patient relationship?
2. What personal attribute constitutes a good doctor?
3. Why doctor should be competent?
4. What is honesty, and its role in doctor-patients relationship?
5. What is compassion, and its role in doctor-patients relationship?
6. What is truthfulness, and its role in doctor-patients relationship?
7. What is empathy?
8. What are differences between empathy and sympathy and antipathy?
9. What is the role of empathy on doctor-patients relationship?
10. How the doctor should apply empathy?

Awarness Diversity in Medical Practice


1. Explain about the perception of health and illness in the community.
2. Culture is one of determinant factors of human health and illness.
3. Explain with your own language and argue it.
4. Give an example, why we have to understand diversity and multiculturalism.
5. Describe, why you have to develop the strategies of cross-cultural perspective in health
care program.
Patients right and Autonomy
1. Describe the principles of patients autonomy
2. Is there any relationship between patients right and autonomy? Explain!
3. Explain under what circumstances a physician should or should not respect the patient's
right to autonomy
4. Describe the possible conflict that may arise between patient autonomy and the
interests of the family
5. Explain under what circumstances the patient lost his/her autonomy!

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Informed Consent
1. Describe the principles of informed consent!
2. Explain under what circumstances a physician should or should not respect the patient's
right to informed consent!
3. How to provide informed consent to the patient?
4. Describe the patient's right to informed consent in emergency circumstances!
5. Is a families informed consent justified? Under what circumstances?
6. Is there any relationship between informed consent and law? Explain!
7. Is there any relationship between informed consent and autonomy? Explain!
Confidentiality
1. Describe the principles of confidentiality!
2. When does disclosure not constitute a breach of the confidentiality?
3. What are the consequences if the physician breaches confidentiality?

Legal Aspect Medical Record, Medical Certification and Visum et Repertum


1. Interpret and mention the sustention of medical record!
2. Explain about civil and criminal problems that can arise from the use of medical record!
3. What are the similarities and dissimilarities between visum et repertum and medical
certificate?
4. What a doctor should do if he had been called to court and how should he behave in
court?
Legal Aspect of Medical Practice
1. What is the purpose of accomplishment in good medical practice?
2. What else do you know about the incumbency of a doctor pursuant to rules and
regulation that pertinent on execution of medical practice?
Criminal Law and Medical Malpractice

1. What is the intentional of Medical Malpractice?


2. Explain and mention the term and conditions of Medical Malpractice!
3. What is the intentional of medical adverse event?
4. Explain about the doctrine res ipsa loquitur

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~ CURRICULUM MAP ~
Smstr

Program or curriculum blocks

10

Senior Clerkship

Senior Clerkship

Senior clerkship

Medical
Emergency
(3 weeks)

Special Topic:
-Travel medicine
(2 weeks)

Elective Study III


(6 weeks)

Clinic Orientation
(Clerkship)
(6 weeks)

BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)

The
Cardiovascular
System and
Disorders
(4 weeks)

The Urinary
System and
Disorders
(3 weeks)

The Reproductive
System and
Disorders
(3 weeks)

BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)

BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)

BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)

BCS (1 weeks)

BCS (1 weeks)

Musculoskeletal
system &
connective
tissue disorders
(4 weeks)

Neuroscience
and
neurological
disorders
(4 weeks)

Behavior Change
and disorders
(4 weeks)

BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)

BCS (1 weeks)
Immune
system &
disorders
(2 weeks)

BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)

BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)

BCS (1 weeks)
Medical
Professionalism
(2 weeks)

BCS(1 weeks)
Communitybased practice
(4 weeks)

BCS (1 weeks)
Health Systembased Practice
(3 weeks)

BCS(1 weeks)
Evidence-based
Medical Practice (2 weeks)
-

BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)

Medical
communication
(3 weeks)

BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)

Growth
&
development
(4 weeks)

BCS (1 weeks)

BCS(1 weeks)

BCS: (1 weeks)

BCS (1 weeks)
Elective Study
II
(1 weeks)
5

BCS (1 weeks)

Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)

Elective
Study II
(1 weeks)

Special Topic
- Ergonomi
- Geriatri
(2 weeks)

Elective
Study I
(2 weeks)

The Visual
system &
disorders
(2 weeks)

Pendidikan Pancasila & Kewarganegaraan (3 weeks)

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~ REFERENCES ~
1. Tony Hope et al. Medical ethics and Law the core curriculum. Churchill
Livingstone. Edinburgh. 2003 page : 51-57
2. Beauchamp T.L. and Childress J.F. principles of Biomedical Ethics. 4th ed.
Oxford University Press. NY. 1994
3. CMA. Professionalism in Medicine.2001
4. Bendapudi,N.M. et al. Patients Perspectives on Ideal Phsician Behaviours.
Mayo Clin Proc.2006.81(3):338-344
5. Batmanabane, V.Empathy: A vital attribute for doctors. Indian Journal of
Medical Ethics. 2008. 5(3) :128-129
6. Hardee, J.T. An Overview of Empathy. The Permanente Journal.2003.7
(4):51-54
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1999

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