CHAPTER I

INTRODUCTION

1.1 Background
Family Doctor is the 23rd block on semester 7 of Kurikulum Berbasis
Kompetensi (KBK) system in Medical Faculty of Muhammadiyah Palembang
University. One of the strategy from these curriculum is Problem Based
Learning (PBL). Case tutorial is one of the implementation of this PBL
methode. In this section, Students are divided into small groups and every
groups will be guided by a mentor or a lecturer as a facilitator who will guide
the students to solve the case.
Tutorial process is a part of student’s evaluation exactly as a formative
evaluation. These evaluation helps the students to reach the aim of study.
Tutorial process is also requirment for students to join the block’s exam
called OSOCA (Objective Structure Oral Case Analysis) which is included in
summative evaluation. The aim of summative evaluation is assesing the
student’s achievement in order to determine the competencies that have been
achieved. Summative assessment is done by referring to the learning
taxonomy proposed by Bloom that consist of cognitive, psychomotor, and
affective assessment.

1.2 Purpose and Objectives

The purpose and objectives of this case study tutorial, namely:
1. As a report task group tutorial that is part of KBK learning system at the
Faculty of Medicine, Muhammadiyah Palembang University.
2. Can solve the case given in the scenario with the method of analysis and
learning group discussion.
3. Achieving the objectives of the tutorial learning method.

1
 CHAPTER II
DISCUSSION

2.1 Tutorial Data

Tutor : dr. Thia Prameswarie M.Biomed
Moderator : Muhammad Avif Ababil
Secretary : Tania Alsyabilla
Notulis : Dhella Octorisa Putri
Date and Time :
1. Tuesday, November 26th 2018
Time : 08.00 to 10.00 p.m
2. Thursday, November 28th 2018
Time : 08.00 to 10.00 p.m
Rules :
1. Everyone in the group should express their opinion
2. Gadget should be nonactive or in silent mode.
3. Ask for permission if want to go outside.
4. Eating and drinking are not allowed in the room.

2.2. Case
Dr Ali is a primary health care provider who collaborate with BPJS in order to
implement national health care insurance program. On the previous moth, dr Ali
percentage percentage of referring non specialistiv cases that was within aprimary
care competence to Class D hospital, were 9%.
One of dr ali patient, named Anan, the eldest of three sisters aged 10 years old
were clinically diagnose with asthma bronchiale, of which her grandfather from
her father also suffered. dr ali were not implementing holistiv diagnostic with
biopsychosocial concept based on mandala of health and not only that, he also
wasn’t implementing familial diagnostic.
Dr Ali on treating this cases also did ot considering familial role , health influence
to family, and familial influence to health. dr ali while practicing medical services

2
were not implementing family doctor principles and the treatment given by him
were only farmacological treatment, as the result, anan asthma often relapses.

2.3. Seven Jump Steps

2.3.1 Clarification of Terms
BPJS (Social Insurance Organizing Agency) is a public
legal intity due to carry up social health insurance.
Primary health Practioner who sees people that have come
care previder medical problems most of term a doctor
Asthma Is common disorder of the airways that involve a
bronchiale complex interaction of airflow obstruction
bronchial hyper respersive and underkyig
inflammation.
Holistic diagnostic Procedure for diagnostic that pay attention to may
aspect that may cause that patient to be sick
include physic and envirenment
Biopsycosocial Biopsychosocial is a concept for understanding
health and illness a dressing biology psychology
and social factors
Hospital Class D Washave ability transitition because one day it
will be upgrade to be hospital Class C. the ability
of Class D only give medical general care and
dental care.
Family Doctor A way to improve the range target and /or health
services access in its own working area.
Mandala of A logical model which depict the varities
Health determinant of individual health.
2.3.2 Problems Identification
1. Doctor Ali is a primary health care provider who collaborate with
BPJS in order to implement national healthcare insurance
program. On the previous month , dr ali percentage of referring

3
 non specialistiv cases that was within aprimary care competence
to Class D hospital, were 9%
2. One of dr ali patient, named Anan, the eldest of three sisters aged
10 years old were clinically diagnose with asthma bronchiale, of
which her grandfather from her father also suffered. dr ali were
not implementing holistiv diagnostic with biopsychosocial
concept based on mandala of health and not only that, he also
wasn’t implementing familial diagnostic.
3. Dr Ali on treating this cases also did ot considering familial role ,
health influence to family, and familial influence to health. dr ali
while practicing medical services were not implementing family
doctor principles and the treatment given by him were only
farmacological treatment, as the result, anan asthma often
relapses.

2.3.3 Problems Analysis

1. Dr Ali is primary health care provider who collaborate with
BPJS in order to implement nation healthcare insurance
program. On the previous month , dr ali percentage of
referring non specialistiv cases that was within aprimary care
competence to Class D hospital, were 9%.
a. What is a function of primary health care provider (FKTP)?
Answer :
Generally these first-level health facilities provide non-
specialist health services, including outpatient and one-day
inpatient care. The main functions of primary level health
care (primary) or as a gate keeper are:
 first contact
 continuity
 comprehensiveness and
 coordination

4
b. What is the classification of FKTP ?
Answer :
Based on Regulation Of The Organizing The Social Health
Guarantee Number 2 of 2015
The form of health facility as referred to in paragraph (2) may
be obtained in the form of FKTP, consisting of:
a. Puskesmas or equivalent;
b. Doctor's practice;
c. Dentist's practice;
d. Pratama clinic or equivalent; and
e. Primary D Class Hospital or equivalent.

Synthesis :
 Puskesmas is one of the most important public health
service facilities, a technical implementing unit of the
district / city service that is responsible for organizing
health development in a work area
 Pratama clinic is a clinic that organizes basic medical
services. The leader is a doctor or dentist, the medical
staff at the Pratama clinic consists of at least two
doctors or dentists
 Private doctor clinic
 Private dental clinic

c. What is the referral program skn ?

Answer :
Definition
Health service referral system is the organization of health
services that regulates the mutual transfer of duties and
responsibilities of health services both vertically and
horizontally which must be carried out by participants of

5
health insurance or social health insurance, and all health
facilities.

General requirements
1. Individual health services consist of 3 (three) levels,
namely:
a. First level health services;
b. Second level health services; and
c. Third level health services.
2. First-level health services are basic health services
provided by level health facilities first.
3. Second-level health services are specialist health services
performed by specialist doctors or specialist dentists who
use specialist health knowledge and technology.
4. Third-level health services are sub-specialty health
services performed by sub-specialist doctors or sub-
specialist dentists who use sub-specialist health
knowledge and technology.
5. In carrying out health services, first level and level health
facilities continued must conduct a referral system with
reference to applicable laws and regulations
6. Participants who want to get services that are not in
accordance with the referral system can be included in the
service category that is not in accordance with the
procedure so that it cannot be paid by BPJS Health.
7. Health facilities that do not implement a referral system,
the Health BPJS will do recredentialing on the
performance of the health facilities and can have an
impact on the continuation of cooperation.
8. Referral services can be carried out horizontally or
vertically.

6
9. Horizontal referral is a referral made between health
services at one level if the referrer cannot provide health
services according to the needs of the patient due to
limited facilities, equipment and / or personnel that are
temporary or permanent.
10. Vertical referral is a referral made between health
services of different levels, can be done from lower
service levels to higher service levels or vice versa.
11. Vertical referral from lower level of service to higher
level of service is done if:
a. patients need specialist or subspecialistic health
services;
b. The referrer cannot provide health services
according to the needs of the patient due to limited
facilities, equipment and / or personnel.
12. Vertical referral from higher service levels to lower
service levels is carried out if:
a. Patient health problems can be handled by lower
levels of health services according to their
competence and authority;
b. The competence and authority of the first or
second level of service is better in handling these
patients;
c. Patients need further services that can be handled
by lower levels of health care and for reasons of
convenience, efficiency and long-term care; and /
or
d. The referrer cannot provide health services
according to the needs of the patient due to limited
facilities, infrastructure, equipment and / or
personnel.

7
d. What are the benefits for a doctor who colaborate with BPJS?
Answer :
According to Peraturan Menteri Kesehatan no 27 tahun 2014,
because of the BPJS using kapitation which means kapitation
is prospective , then the benefit for doctor Ali as a primary
health care provider will be get a payments are more fair in
accordance with the complexity of service and faster claims
process.

e. What are the requirements needed by doctor to collaborate

with BPJS?
Answer :
According to Permenkes RI number 71 years 2013 about
health service in national health insurance, pasal 6 :
Requirements needed by doctor to cooperate with BPJS :
1. Have practice lisence
2. Have NPWP
3. Cooperate agreement with laboratorium, pharmacy, and
other network
4. Statement letter about ready to comply related provisons
with national health insurance

f. What is the function of BPJS?

Answer :
Health care BPJS as referred to in Article 5 paragraph (2)
letter (a) has a function to organizing a health insurance
program. Meanwhile, BPJS Employment as referred to in
Article 5 paragraph (2) letter (b) has the function of
organizing work accident insurance programs, death
insurance programs, pension insurance programs, and old age
benefits.

8
g. What is the policy of BPJS?
Answer :
1. UU No. 40/2004 concerning SJSN
2. UU No. 36/2009 concerning Health
3. UU No. 24/2011 concerning BPJS
4. PP No. 101/2012 About PBI
5. Presidential Regulation No. 12/2013 Regarding Health
Insurance

h. What are the program of BPJS ?

Answer:
In the Social Security BPJS program is divided into 5 types
of social security programs and the implementation is made
in 2 organizing programs:
1. The program organized by the Health BPJS, with the
program being a Health Insurance, effective starting
January 1, 2014.
Healthcare insurances in Indonesia have existed since the
Dutch colonial era. After independence, and after the
recognition of sovereignty by the Dutch Government in
1949, in efforts to ensure the need for health services for
the community, especially civil servants and their
families, continued by Prof. G.A. Siwabessy, the Minister
of Health who served at the time. He proposed an idea to
immediately organize a universal health insurance
program, which at that time began to be implemented in
many developed countries and was growing rapidly.
Through the National Health Card-Indonesia Health
Insurance Program (JKN-KIS) organized by BPJS

9
 Kesehatan, the country is present in our midst to ensure
that all Indonesian citizens are protected by
comprehensive, fair and equitable health insurance
(BPJS Kesehatan, 2017).

2. Programs organized by BPJS Employment, with the

program is Work Accident Insurance, Old Age Insurance,
Pension Insurance, and Death Insurance which is planned
to commence on July 1, 2015.
According to BPJS Ketenagakerjaan, work accident
insurance provide protection for the risks of accidents that
occur in relationships work, including accidents that
occur during the journey from home to the work place.
While life insurance Providing benefits of cash given to
heirs when participants died not due to workplace
accidents. The old age insurance are in the form of cash
in the amount of accumulated value contributions added
to the development results. Pension insurance is social
security that aims to maintain the degree a decent life for
participants and/or their heirs with provide income after
participants, enter retirement age, experiencing disability.

i. What is participants obligation in BPJS?

Answer :
Accrording to BPJS Kesehatan (2017), there are several
obligations for BPJS’s participants, which are:
Participants Obligations:
1. To register themselves and their family members as 
BPJS Kesehatan participants.
2. To pay BPJS Kesehatan contribution.
3. To submit completely and accurately individual and
family member data.

10
 4. To report changes of the individual and family
member
data, such as: changes in class, rank or amount of sal
ary, marriage, divorce, death, birth, address and first
level health facility.
5. To prevent participant card from getting damaged,
lost or unauthorized use.
6. To comply with all the terms and conditions and the
health facility procedures.

Synthesis:
Accrording to BPJS Kesehatan (2017), there are several
rights and oligations for BPJS’s participants, those are:
Participants Rights:
1. To receive card as participants’ identity in order to
obtain health services.
2. To obtain benefits and information regarding rights
and obligations as well as health service procedures
in accordance with the applicable terms and conditio
ns.
3. To obtain health service in partnered health facilities
of BPJS Kesehatan, and.
4. To express complaints/grievances, critiques and
suggestions verbally or in writing to BPJS Kesehatan

Employers Obligations
1. To register themselves and their employees as Health
Insurance Participants to BPJS Kesehatan.
2. To calculate and collect contribution which must be
paid
by the employees through deduction of their salary/w
ages.

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 3. To pay and deposit premium of BPJS Kesehatan.
4. To submit correctly and accurately the data of
themselves, their work, and their family members
which includes:
5. Data of employees including their family members re
gistered for the scheme according to the data of hired
employees.
6. Data of wages reported must correspond the amount
of wages the employees receive.
7. Participation data in the social security program must
correspond the participation stages.
8. Changes to the Business or Legal Entity data
includes: address of the company, management of the
company, type of business entity, number of
employees, data of employees and their family and
changes to the amount of wages of each employee.

j. What is the meaning on the previous month , dr ali

percentage of referring non specialistiv cases that was within
aprimary care competence to Class D hospital, were 9% ?
Answer :
The meaning percentage of referring non specialistiv cases
were 9% is exceed from normal limits. The target of meeting
the special non-specialist outpatient referral ratio by FKTP in
accordance with the agreement between the health BPJS and
the first level health facility association, namely:
a. Target safe zone <5% each month
b. Achievement target of <1% each month
(UU RI, 2015)

12
k. What is the effect of referral non specialistic case were 9%?
Answer :
The effect of referral non specialistic case were 9% is funds
to be provided by BPJS will be reduced.

l. What is the indicator of evalution of performing primary

health case ?
Answer :
Regulation of the health insurance provider body number 2 in
2015
Article 33
(1) Non-specialist Case Outpatient Reference Ratio Indicator
(RRNS) as referred to in Article 31 paragraph (2) letter b is
calculated with the following calculation formulation:
RRNS = number of non-specialist case referrals x 100
number of FKTP referrals
(4) The non-specialist case outpatient referral ratio as referred
to in paragraph (1) is an indicator to determine the optimal
coordination and cooperation between FKTP and Advanced
Level Health Facilities so that the referral system is organized
according to medical indications and competencies.

m. What are the program of national healthcare insurance ?

Answer :
Jamkesnas is a program of the national social security system
Law No.4 of 2004, which is included in:
1. Health insurance
2. Guaranteed work accident
3. Old age guarantee
4. Pension guarantee
5. Guaranteed death

13
n. What are type class of hospital ?
Answer :
Azwar (1996) declared hospitals in Indonesia in terms of
abilities that should be divided into five types, namely:
1. Hospital Type A
A class hospital is a hospital that is able to provide
extensive specialist and sub-specialist medical
services. A class hospital is determined as the highest
referral hospital (top referral hospital) or central
hospital.

2. Hospital Type B
Class B hospitals are hospitals that are able to provide
extensive specialist medical services and limited
subspecialists. Class B hospitals are established in
each provincial ibukoata (provincial hospital) which
provides referral services from district hospitals.
Teaching hospitals not included in class A also
contribute as class B hospitals.

3. Hospital Type C
Class C hospitals are hospitals that are able to provide
limited specialist medical services, namely internal
medicine services, surgical services, pediatric health
services and midwifery services and supplies. Class C
hospitals will be established in each district, which
offers referral services from puskesmas.

4. Hospital Type D
Class D hospitals are transitional hospitals because one
day they will increase to Class C hospitals. The ability

14
 of Class D hospitals only provides general medical and
dental services. Class D hospitals also accept referral
services originating from public health centers.

5. Hospital Type E
Class E hospital is a special hospital (special hospital)
which provides only one type of medical treatment, for
example leprosy hospital, lung hospital, cancer
hospital, heart hospital, mother and child hospital,
dental and mouth hospital and etc.

o. What is the procedure to referring primary care to hospital ?

(A-E)
Answer :
Referral services can be carried out horizontally or vertically.
Horizontal referral is a referral made between health services
at one level if the referral cannot provide health services
according to the needs of the patient due to limited facilities,
equipment and / or personnel that are temporary or
permanent. Vertical referral is a referral made between health
services of different levels, can be done from lower service
levels to higher service levels or vice versa.

Vertical referral from lower service levels to more service

levels height is done if:
a. Patients need specialist or subspecialistic health
services;
b. The referrer cannot provide health services according
to the needs of the patient due to limited facilities,
equipment and / or personnel.

15
Vertical referral from higher service levels to lower service
levels is carried out if:
a. Patient health problems can be handled by lower
levels of health services according to their
competence and authority;
b. The competence and authority of the first or second
level of service is better in handling these patients;
c. Patients need further services that can be handled by
lower levels of health care and for reasons of
convenience, efficiency and long-term care; and / or
d. The referrer cannot provide health services according
to the needs of the patient due to limited facilities,
infrastructure, equipment and / or personnel.

Partial Reference
a. Partial referral is sending patients or specimens to
other health care providers in the context of
establishing a diagnosis or providing therapy, which
is a series of patient care in the Health Facilities.
b. Partial references can be:
1. sending patients for supporting examinations or
actions
2. delivery of specimens for supporting
examination
c. If the patient is a partial referral patient, then the
patient's guarantee is performed by referring health
facilities.

Terms of tiered referral services can be excluded in the

following conditions:
a. Emergency situation occurs; Emergency conditions
follow applicable regulations

16
 b. disaster; Disaster criteria are set by the Government
Central and or Local Government
c. Specificity of patient health problems; for cases where
the treatment plan has been upheld and the therapy can
only be carried out in an advanced health facility
d. Geographical considerations; and
e. Consideration of the availability of facilities

2. One of dr ali patient, named Anan, the eldest of three sisters aged
10 years old were clinically diagnose with asthma bronchiale, of
which her grandfather from her father also suffered. dr ali were
not implementing holistiv diagnostic with biopsychosocial concept
based on mandala of health and not only that, he also wasn’t
implementing familial diagnostic.
a. What is the meaning one of dr ali patient , named anan,the
eldest of three sisters aged 10 years old were clinically
diagnose with asthma bronchiale, of which her grandfather
from her father also suffered ?
Answer:
The meaning one of dr ali patient, named anan,the eldest of
three sisters aged 10 years old were clinically diagnose with
asthma bronchiale, of which her grandfather from her father
also suffered is Herediter

b. What is the definition of biopsychosocial concept ?

Answer :
Biopsycosocial concept is main tools from family medicine:
1. Holistic diagnostic
2. Family diagnostic
3. Treatment comprehensively for individu and family

17
 4. The 'bio' component of this theory examines aspects of
biology that influence health. These might include
things like brain changes, genetics, or functioning of
major body organs, such as the liver, the kidneys, or
even the motor system. 
5. The 'psycho' component of the theory examines
psychological components, things like thoughts,
emotions, or behaviors.
6. The 'social' component of the BPS examines social
factors that might influence the health of an individual,
things like our interactions with others, our culture, or
our economic status.

c. What are the principles of mandala of health ?

Answer:
Mandala of Health is to study the surrounding factors that
might trigger or cause symptoms to appear in addition to
possible biomedical problems. Mandala of health is a
management concept of looking at a person consisting of
body, mind, and spirituality influenced by personal behavior,
psychosocial economics, environment, physical environment,
human biology. Each of them is influenced by community,
culture, biosphere. Natural Riwiyat disease (level of
prevention), comprehensive (stage of disease continuum,
stage of prevention, form of intervention, purpose of
intervention). Behavior intervention using the health believe
model. Family diagnosis using genograms, family forms, and
family cycles (Hancock, 1985).

The purpose of the Mandala of Health is to examine the

surrounding factors that might trigger or cause symptoms to
appear in addition to possible biomedical problems. Doctors

18
 cannot see patients only physically because each human
being also consists of physical (body), soul (mind),
spirit .Every human being is influenced by 3 circles:
 Family
 Community
 Culture
Therefore, when patients complain of health problems, it is
necessary to study the surrounding factors that might trigger
or cause these symptoms to appear in addition to possible
biomedical problems (Hancock, 1985).

Gambar 2.1. Mandala of Health Model.

Sumber: Hancock, 1985.

d. What are the principle of familial doctor care generally and in

this case ?
Answer :
Principle of family doctor services are:
a) Comperehensive and holistic services
b) Continuous service
c) Services that Prioritize prevention
- Primary preventive
- Secondary preventive
- Tertiary preventive

19
 d) Coordinative and collaborative services
e) Personal services for patients as an integral part of the
family
f) Services that reflect the family, work environment and
environment in which they live
g) Services that Uphold ethics, morals and law
h) Cost conscious and quality conscious services
i) Services that can be a audited and accounted
(Whinney, 2012)

e. What are the effect of dr ali are not implementing holistic

diagnostic & familial ?
Answer:
1. Cannot propose an overall pattern or concept of the
occurrence of a disease so that it cannot cope
comprehensively.
2. Completion of a problem or a disease is not
comprehensive so the case is not resolved completely.

f. Why a holistic diagnostic important for this case ?

Answer :
Holistic diagnostic has an aspects that is individual aspects,
clinical aspects, internal aspects, external aspects, and
functional aspects, that’s as well as through personal social
history, family assessment tools (genogram, family map,
family life cycle, family life line, APGAR (Adaptation,
Partnership, Growth, Affection and Resolve) and SCREEM
family (Social, Cultural, Religion, Economic, Education, and
Medical), risk factors, disease and illness.

The holistic diagnostic is important because to gain

information essential for diagnosis, planning and

20
 implementation. It shows respect for the patient's preferences
and preserves the patient's dignity (Whinney, 2012)

g. How to do genogram in this case ?

Answer :

3. Dr Ali on treating this cases also did ot considering familial

role , health influence to family, and familial influence to
health. dr ali while practicing medical services were not
implementing family doctor principles and the treatment
given by him were only farmacological treatment, as the
result, anan asthma often relapses.
a. What is the meaning of dr. Ali on treating this cases also did
not considering familial role, health influence to family and
familian influence to health ?
Answer:
dr Ali did not implement the family doctor principles as he
should be. As like we already discussed before, there are nine
characteristics of a family doctor.

b. What is the definition of family ?

21
 Answer :
Family is two or more than two individuals who join in
because of blood relations, marital relations or oppointment
and they live in one household, interact with earch other and
in their respective roles, create and maintain culture.

c. What is the function of family in this case ?

Answer :
There are 8 family functions and the following are
explanations (Wirdhana et al., 2014):
a. Religious function
The function of the family as the first place for a child
to recognize, cultivate and grow and develop religious
values, so that they can become religious, good-
spirited people with strong faith and devotion to God
Almighty.
b. Socio-cultural function
The function of the family in providing opportunities
for all members of his family in developing diverse
national social cultural resources in a single unit.
c. Function of Love and Affection
Family functions in providing a solid foundation for
the relationship between husband and wife, parents
with their children, children with children, and kinship
relations between generations so that the family
becomes the main place for the life of life that is
extinct with love and inner love.
d. Protection function
Family functions as a place of refuge for their families
in fostering a sense of security and peace and warmth
for every member of their family.
e. Reproduction Function

22
 The function of the family in planning to continue the
offspring who have become human nature so that they
can support the welfare of mankind universally.
f. Function of Information and Education
Family functions in giving roles and direction to their
families in educating their descendants so that they can
adjust their lives in the future.
g. Economic function
Family functions as supporting elements for family
independence and resilience.
h. Function of Environmental Development
The function of the family in giving capacity to each
member of his family so that he can place himself in
harmony, harmony and balance in accordance with the
rules and carrying capacity of nature and the
environment which is always changing dynamically at
any time.

In this case, not only physical problems, asthma can also

affect the psychological, social and economic conditions of
sufferers. Environmental factors affect individuals with
asthma predisposition, to develop asthma, which leads to
exacerbations and symptoms of asthma that stay. Some
things that are included in environmental factors, namely:
allergens, cigarette smoke, air pollution, respiratory
infections, socio-economic status and family size
(Maryono, 2009).

d. What are the steps of comprenshive treatment in this case ?

Answer:
- Pharmacologist
- Non pharmacologist

23
 - Education or do a counselling
- Prevention
- Rehabilitative
- Familial role and community role
(Asti, 2015).

e. Why anan asthma often relapses ?

Answer :
Because dr. ali didn’t give education, conseling, prevention,
and familial role, so the performance of dr. ali as a family
doctor was not good enough.

f. What should dr ali do in order to treat anan ?

Answer :
Must have re anamnesis and diagnostic patient in holistic
anamnaesis and holistic diagnosis and treat Anan

24
 comprehensively by using family support outside using
medical treatment.

g. How is the influence of family to health status ?

Answer :
The family gives the biggest influence, if the family has
implemented healthy lifestyle patterns and behavior, each
family member will be accustomed to do it, the family is the
basis for planting values to each individual, including health
values, so the family will determine whether a person's
healthy behavior or not. The role of the family is very
important in improving the degree of health and quality of
life, namely through behavioral change towards clean and
healthy living behavior in the family and community
structure, environmental improvement (physical, biological,
socio-cultural, economic), assisting the implementation of
health services in the form of promotive, preventive, curative,
rehabilitative, and participate in the process of control and
evaluation of service delivery (wirdaha, 2014).

4. How is Islamic point of view in this case?

Answer :
َ‫ي َواَل ْالقَاَل ِئ َد َواَل آ ِّمين‬
َ ‫يَا َأيُّهَا الَّ ِذينَ آ َمنُوا اَل تُ ِحلُّوا َش َعاِئ َر هَّللا ِ َواَل ال َّشه َْر ْال َح َرا َم َواَل ْالهَ ْد‬
َ ‫ْالبَيْتَ ْال َح َرا َم يَ ْبتَ ُغونَ فَضْ اًل ِم ْن َربِّ ِه ْم َو ِرضْ َوانًا ۚ وَِإ َذا َحلَ ْلتُ ْم فَاصْ طَادُوا ۚ َواَل يَجْ ِر َمنَّ ُك ْم َشنَآنُ قَوْ ٍم َأ ْن‬
‫ص ُّدو ُك ْم‬
‫ع َِن ْال َم ْس ِج ِد ْال َح َر ِام َأ ْن تَ ْعتَدُوا ۘ َوتَ َعا َونُوا َعلَى ْالبِ ِّر َوالتَّ ْق َو ٰى ۖ َواَل تَ َعا َونُوا َعلَى اِإْل ْث ِم َو ْال ُع ْد َوا ِن ۚ َواتَّقُوا هَّللا َ ۖ ِإ َّن‬
ِ ‫هَّللا َ َش ِدي ُ“د ْال ِعقَا‬
‫ب‬

Mean :
In achieving maximum treatment, a doctor must implement a
comprehensive treatment, so that patients who experience
complaints can improve with the permission of Allah, because only

25
God is the most healing. In this case a doctor as an intermediary in
terms of treatment, when a doctor runs his profession as well as
possible, namely by implementing comprehensive treatment, in
this case a doctor has done good, and included in the case of
helping in terms of virtue.

Allah says in the Qur'an Surah Al Maidah verse 2, that ... "And
please help you in terms of virtue and piety, and do not please help
in matters of evil ..."
In Case mentioned that anan suffering from bronchial asthma,
where this disease is a disease that is caused due to several things
such as genetic, and triggers such as foods that are allergenic. In
this case, a doctor must provide education related to food or things
that can reduce the symptoms / disease by giving direction to the
patient or the patient's family in order to maintain the food that is
eaten, where the food eaten is not only good, but also halal ... and
the opposite.

26
2.3.4 Conclusion
Dr ali is primary health care provider didn’t considering principle
familial doctor care when practicing medical service and in
comprehensive treatment that caused anan asthma often relapses.

2.3.5 Conceptual Frameworks

Were not
Dr ali didn’t implementing holistic implementing family
diagnostic with biopsychosocial concept doctor principle

Incomprehensive
treatment

Anan asthma often

relapses

27
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Al-Qur’an QS;Al-Maidah ; 2

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