PROFESIONALISME

DOKTER
& ETIKA PROFESI
Agus Purwadianto
Ketua MKEK Pusat
Karo Hukor Depkes RI
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BAGAIMANA IBI ?
Professionalism
• Honesty
• Integrity
• respect for patients
– commitment to patients’ welfare
– compassionate regard for patients
• dedication to maintaining competency
in knowledge and technical skills
 Charter on
Medical Professionalism
Fundamental Principles:
• Principle of primary of patient welfare
• Principle of patient autonomy
• Principle of social justice

Annals of Internal Medicine, Vol 136 Issue 3, 5 Feb 2002

http://www.annals.org/cgi/content/full/136/3/243
 Professional Responsibilities

• Commitment to professional competence

• Commitment to honestly with patient
• Commitment to patient confidentiality
• Commitment to maintaining appropriate
relations with patients
• Commitment to improving quality of care
 Professional Responsibilities

• Commitment to improving access to care

• Commitment to a just distribution of finite
resources
• Commitment to scientific knowledge
• Commitment to maintaining trust by
managing conflict of interest
• Commitment to professional responsibilities

Please visit : www.professionalism.org

 Good doctors
“combine •
individual clinical
expertise and best
available external
evidence; they are
thoughtful,
evidence based
practitioners
 Good doctors
use "intangible personal •
resources" in the care of
their patients; …. attaches
to vocationalism in
medicine and to the
personal qualities
required of its practitioners,
including truthfulness
 Good doctors
reflective turn of mind •
open to audit
and to learning from
mistakes ....
personal qualities more
prominently than
proficiency in
knowledge and
technical skills.”
NOT PATERNALISM 
MUTUALLY PARTNERSHIP

NOT TRIBALISM 
COLLEGIALISM

NOT SELF-SACRIFICE
 SHARED RESPONSIBILITY
 GOOD MEDICAL PRACTICE
Elemen esensialnya adalah :
• professional competence,
• hubungan baik dengan pasien
dan kolega, dan
• kewajiban etika professional
JADI JANGAN : SOMBONG, RAKUS, MALAS BELAJAR, JAHAT,
MENGEKSPLOITASI PASIEN
Professional Competence
(Epstein & Hundert 2002)

The habitual & judicious use of

communication, knowledge,
technical skills, clinical
reasoning, emotions, values, and
reflection in daily practice for
the benefit of the individual and
community being served
6 Areas of competence

1. Patient care ( clinical

reasoning)
2. Medical knowledge
3. Practice-based learning &
improvement ( info managmnt)
4. Interpersonal & communication
skills  ↑ w/ PRINCIPLE’S BASED ETHICS (KDB)
5. Professionalism  CORE : ETHICS !!!!
6. System-based practice ( health
economics & teamwork)
Dimensions of Prof. Competence

• Cognitive
• Technical
• Integrative  GAB KEPUT. KLINIS + ETIKOLEGAL
• Context VIA PRINCIPLE
 VIA BASED
PRINCIPLE ETHICS
BASED ETHICS (KDB)

• Relationship  ETIKA SOSIAL (KESEJAWATAN)

• Affective/moral  ROLE MODEL, CULTURAL TRANSM

• Habits of Mind  PROFESIONALISM-DEBATES
Cognitive of PC (1)

Core knowledge
Basic comm. Skills
Info management
Applying knowledge to real-world
situation
Using tacit knowledge & personal
experience
Abstract problem solving
Self-directed acquisition of new
knowledge
 Dinamika Struktur Kedokteran

FK + CME/CPD IDI
REGULATORY BODY
Akreditasi AIPKI/IRSPI
KOLEGIUM

Sistim sertifikasi--yang Sistim regulasi praktek

bertujuan untuk menjaga kedokteran yang
dan menjamin kualitas bertujuan untuk menjaga
kompetensi seorang UJI kepentingan masyarakat
dokter untuk berpraktek; KOMPETENSI terhadap mutu pelayanan
kedokteran;
ASSOCIATION

LISENSI STANDAR IPTEK

MEDICAL

DEPKES = KKI
Sistim advokasi--yang DISIPLIN = MKDKI
PMKS 512/07
bertujuan untuk menjaga
kepentingan anggota PROFESIONALISM
profesi kedokteran; “SISA PELANGGARAN ETIK”
REKOMENDASI MKEK
KOMPETENSI
 Pasal 26, ayat 2, point b:Standar pendidikan
SIP profesi kedokteran- untuk pendidikan profesi
dokter spesialis- disusun oleh kolegium kedokteran.
Pasal 8, point 3:
Konsil Kedokteran Indonesia mempunyai
STR wewenang  mengesahkan standar kompetensi
dokter-;

REGISTRASI BERDASARKAN KOMPETENSI

SERTIFIKASI

Sertifikat Dr Spesialis Standar

Kompetensi Dr Umum Kompetensi
Konsil
Uji kompetensi Kedokteran
Standar
OP/PDSp
Pendidikan
(Kolegium )

Pasal 7, ayat 1, point 2:

Psl 29, ayat 3, point d: Syarat surat
tanda registrasi dokter 
Memiliki sertifikat kompetensi
Penjelasan Pasal: Huruf d 
Sertifikat kompetensi dikeluarkan oleh
kolegium yang bersangkutan.
Konsil Kedokteran Indonesia mempunyai
tugas  mengesahkan standar pendidikan
profesi dokter-;
Pasal 8, point 3:
Konsil Kedokteran Indonesia mempunyai
wewenang  mengesahkan standar
kompetensi dokter-;
TINDAK-TANDUK PROFESIONAL
VERSI UU PRADOK
• MENGATUR PELAKSANAAN PRAKTIK :
– HUBUNGAN PASIEN-DOKTER
– INFORMED CONSENT
– REKAM MEDIK
– RAHASIA KEDOKTERAN
– STANDAR: PELAYANAN, PROFESI, S.O.P.
– HAK DAN KEWAJIBAN
– KENDALI MUTU DAN BIAYA
– PEMBINAAN, DISIPLIN, PIDANA
AKUNTABILITAS PROFESI

• STANDAR PENDIDIKAN
• UJIAN & STANDAR KOMPETENSI
• STANDAR PERILAKU
• STANDAR PELAYANAN MEDIS
• STANDAR PROSEDUR OPERASIONAL
• PEDOMAN PEMBINAAN & PENGAWASAN
• PEDOMAN KENDALI MUTU, BIAYA, AUDIT
MEDIS

PR BAGI PDSp
 Dokter bermasalah
1. Kurang pengalaman dan tekanan kerja
2. Konflik pribadi
3. Kecacatan – infirmitas/inkapasitas
4. Kurang pengetahuan - inkompetensi
5. Berbuat kriminal
 Continuum of Problem Doctors
•

problem Litigious Defensive

doctors Society Medicine

Malpractice Crisis
Malicious
Prosecution
Ethico-legal
Conflict Persistent
 Continuum of Professionalism
Agus Purwadianto - 2008

• Dr
Bermasalah

Kompe- Kewe- Etika

tensi nangan Profesi

Ketrampilan kekuasaan Kualitas personal bonafide

Medik &
High Learning
Kelihatan Formal
Di”bawah
permukaan”
Dirasakan Pasien EKSTERNAL
INTERNAL : Nurani, sikap, Empati, “kekitaan”
Kepribadian, kes. mental Pahlawan kemanusiaan
 FASYANKES
Regulator/Pemerintah IDI/PDGI
Ditjen Yankes KLINIK/ IAI/OP LAINNYA
RUMAH
SEHAT

PROFESI BERSUMPAH

KODE ETIK Paling dipercaya publik

MAJELIS ETIK
SOP PELANGGARAN

OKUPASI

SELF-THERAPI : PARADIGMA SEHAT IN ACTION

PERMENKES SAINTIFIKASI JAMU

 Intensitas Kepercayaan
Penentu Penyebab Kematian
• Vital dlm hub antar orang asing & amat
rentan  bonafiditas > kontrak P-K
• Profesi kembangkan keahlian moral = syarat
konsisten & eksplisit bonafiditas  via
otokritik tujuan, nilai, sumpah & kode etik =
catatan publik & sejarah praktek
• Kepercayaan = harapan via keyakinan kuat
yg jadi tumbuh kuat 
– hirarki kepercayaan  awal kecil, lama
membesar.
 Ethico-legal System
Agus Purwadianto, 2005

CONTEXTUALITY
MEDICAL INDICATION BALLANCING
CONFLICT OF INTEREST
Health Personnel Law as
Health Facilities social engineering Value of
Health system Health
Medical Goals
PROFESSIONALISM
Patients’ Safety
Responsibility Accountability
Liability Professional
Ethics Discipline Dignity

SOCIAL CONTRACT

Patient/Client Community PUBLIC TRUST

Family Society
BEST INTEREST,
PREFERENCES, QUALITY OF LIFE
 Agus Purwadianto
• Kepala Balitbangkes Kemkes
• Staf Ahli Bid Hukum & HAM Kemenkokesra RI
• Gurubesar I.K. Forensik & Medikolegal (07)
• Doktor Filsafat (03)
• MSi Sosio-Kriminologi (00)
• SpF (konsultan etiko-medikolegal) (05)
• Diplome of Forensic Med Groningen Univ (02)
• SH (97), SpF (83), dr (79)
• Ketua MKEK Pusat IDI, dosen IKF-ML FKUI/RSCM, Ketua
Kolegium IK Forensik Indonesia
• Ex Karo Hukor Depkes RI
• Ex Anggota WHO Global Advisory Vaccine Safety Committee
• Ex Anggota UNESCO Global Ethics Observatory Law
• Anggota Komisi Bioetika Nasional
• Perintis/dosen S3 Kekhususan Bioetika FKUI
SAYA UCAPKAN
TERIMA KASIH
 Kesimpulan
• Profesionalism bukanlah sekedar Kompetensi DR, namun
muatannya adalah 80% etika dan peneguhan janji publik seorang
dokter
• Kompetensi = landasan dari kewenangan, standar pendidikan &
standar profesi
• Pelaksanaan Uji kompetensi merupakan pengalaman baru bagi
OP/PDSp, termasuk bagian utk Dr (umum)
• Kewajiban Dr makin banyak yg urusannya via PDSp, Kolegium, KKI,
FK (alumni) & Depkes dlm upaya pemutakhiran profesionalismenya.
• Direksi, Komdik, Pan. Kredensial & Komite Disiplin RS hrs tanggap
thd penegakan etika & disiplin profesi yg berdimensi etika sosial via
SDM yg menguasai etikolegal
hukumresponsif_depkes@yahoo.co.id