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Judi Januadi Endjun
Sanny Santana Novi Resistantie Febriansyah Darus
Divisi Fetomaternal Departemen Obstetri dan Ginekologi RSPAD Gatot Soebroto Jakarta 2005
PENDAHULUAN REDUCING LITIGATION RISKS IN O&G STANDAR PROFESI MATERI AJAR JENJANG PENDIDIKAN LANJUTAN KESIMPULAN
Krisis ekonomi multidimensi, terutama akhlak, keimanan, kejujuran Pendidikan ?? Tuhan menyuruh kita JUJUR, Tuhan yang memberi kita rejeki, mengapa kita harus tidak JUJUR Bekerja secara TIM (kesetaraan) Masalah medikolegal terbanyak : OBGIN
liable to face litigation in respect of mal-practice Cases are highlighted in the press and sometimes on TV The general public has grown to expect high standards and expectations of their specialists .PENDAHULUAN O&G by the nature of their work are more often than most practitioners in other fields.
PENDAHULUAN Health and safety the mother and child Child birth is the period of time when accidents both avoidable and unavoidable tend to happen The most hazardous journey anyone ever makes in one’s life is the passage through the 10 cm of the birth canal .
2005 .REDUCING LITIGATION RISKS IN O&G Medical Protection Society (MPS) Clinical Guidelines Communication Medical Records Medical Problems Avoiding litigation in O&G Dermot Mac Donald.
2005 .Medical Protection Society Medico-Legal Claims in O&G The Medical Defense Union The Institute of O&G The College of O&G Society (ISOG. etc) Medical Faculty The Lawyer Dermot Mac Donald.
Clinical Guidelines Systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions Practice of good medicine Avoid medico-legal challenge Dermot Mac Donald.2005 .
Epidemic of legal challenge facing the practitioner of O&G in day to day practice Defensive medicine has become the norm Dermot Mac Donald.2005 .
Communication The teaching and learning of communication skills have become a significant part of the medical undergraduate curriculum The patient who eventually makes the decision in regard to their management may lighten the doctor’s responsibility Lack of informed consent is a constant plea by Plaintiffs The amount of detail to give the patient about possible risks and complications is always a difficult decision Dermot Mac Donald.2005 .
Communication In the event of serious complication or mishap : The consultant in charge should speak to the patient and / or family as soon as possible The patient should be given a factual account in simple language together with an apology if indicated Saying sorry does not constitute an admission of legal liability The doctor should over-elaborate on the event nor give an over-optimistic prognosis The MDU. 1991 .
Communication It is most important not to apportion blame – at least not until a thorough investigation of all the relevant facts has taken place The patient and family should be given time to consider what happened and the consultant should offer to meet them a second time Case conference with all involved the patient and relatives do not hear inaccurate or different accounts from various members of staff The MDU. 1991 .
Legibility and Signing Timing Alteration Detail Storage Dermot Mac Donald.Medical Records Partograms are recommended.2005 . and careful maternal and fetal records should be entered on these.
Legibility and Signing The notes should be legible. clearly dated and timed with a identifiable signature A stamp of the doctor’s name beside the signature may diminish problems of identification years later as the defence is prepared .
55 Baby delivered. etc) and Also the time at which the notes are actually written. 15. 170 to 180 The notes should indicate some explanation for the delay and documented . Such as FHR 180.05 Decision to perform CS.20 Clinical notes written and completed after 20 minutes Accompanied by an exact note of the detail.Timing Very important to write the exact time of the event (CS.50 C. For instance : 14. 14.00 Fetal bradycardia of 80 bpm.S commenced. 14. forcep’s. 14.. delivery.
etc should be explicitly written when fetal heart trace (or IA) suggests abnormality . plans. decision.Timing EFM records : comments should be written (and signed) on actual trace : interpretations.
clearly signed . The time.Alteration Notes must not be altered. such alteration must be made by drawing a single line through the original (so that it can still be read. If alteration are necessary. date etc and reason for making the alteration clearly stated and again.
Writing notes and keeping records of the treatments may become more important than the actual treatments .Detail The more explicit the information recorded. the more helpful it will be in defence. “Failure to progress” by actual detail of “cervix 5 cms dilated with no progress for 3 hours despite oxytocin and membrane rupture” Doctors are trained to help patients and treat their ailments.
Storage All records must be carefully stored last they are required in consultation in future years The EFM should be carefully stored in the patient’s record file .
Medical Problems Intra partum fetal hypoxia : cerebral palsy Trauma – fetal Trauma – maternal Retained swabs Perineal tears & Episiotomies Complications of CS Vaginal repair Retained placental tissue Rhesus disease Incompetent cervix/cervical cerclage Abdominal hysterectomy Ureteric & Bladder injury Bowel injury Retention of foreign body Diathermy burns. etc .
yang bersifat mengikat pada anggotanya.STANDAR PROFESI Kumpulan standar yang ditetapkan oleh organisasi profesi. standar etika. terdiri dari standar kompetensi. dan standar pelayanan medis Standar bersifat dinamis Draft Standar Profesi POGI.2005 .
asih. 2005 .STANDAR ETIKA Sesuai dengan Pedoman Etik O&G dan KODEKI Altruisme : kepentingan klien diutamakan Integritas : berilmu & profesional Menjunjung tinggi harkat & martabat profesi Kesejawatan : sumpah dokter & profesional Akuntabilitas : dapat dipertanggungjawabkan Memberikan pelayanan terbaik Siap sedia menjalankan profesinya Mampu berkomunikasi secara profesional dengan prinsip saling asah. dan asuh Kepemimpinan yang baik dan profesional Draft Standar Profesi POGI.
STANDAR KOMPETENSI Pencapaian kompetensi minimal Harus terus dikembangkan (Continuing Professional Development) dan Continuing Medical Education Panduan Pendidikan Dokter Indonesia JJE/RSPAD/2005 .
STANDAR PELAYANAN MEDIK SOP SPM Tempat Praktek Catatan Medik dibuat berdasarkan CMBM : evaluasi lanjutan memakai sistim SOAP JJE/RSPAD/2005 .
Genetics. Neonatology.MATERI RUJUKAN ABOG. Ultrasound. etc Journals : Placenta. White Journals (ISUOG). etc JJE/RSPAD/2005 . ACOG. RCOG. etc : Guidelines Clinical Conference Scientific meeting. Courses. etc Textbooks : Fetal-medicine.
JENJANG PENDIDIKAN LANJUTAN Spesialisasi (Klinikus) Pendidik (S1 – S2 – S3 – Guru Besar) Non Medis “Tidak berpraktek” JJE/RSPAD/2005 .
4. 2005 . 3. Ensure the competency of your support staff Admit if you are wrong Keep a rein on your lawyers Release medical reports and record promptly Generally to avoid litigation General advice R. Nathan. 5. 2. 6.AVOIDING LITIGATION IN O&G 1.K.
Generally to avoid litigation Listen carefully to the patient’s complaints Examine the patient Explain her problems and the treatment you would recommend Record all of the above Recommend to a specialist whenever you think it necessary Update your knowledge of medicine Give due concern to slow progress of labour or failure of the fetal head to descend Avoid allowing inexperienced or unqualified staff to be in attendance & the failure of the specialist to attend Ensure an adequately equipped delivery room Keep the patient briefed of her progress .
penelitian. Kemauan memperbaiki diri. dan Kesejawatan merupakan pilar dasar yang harus tetap dijaga Apa yang dapat kita berikan agar pendidikan. penelitian.KESIMPULAN Krisis multidimensi berdampak buruk terhadap dunia pendidikan (kualitas luaran anak didik). dan pelayanan kesehatan Kejujuran. Komunikasi. dan pelayanan dokter di Indonesia tidak semakin terpuruk ?? JJE/RSPAD/2005 .
THANK YOU .
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