KOMITE MEDIK DALAM REALITA

KOMITE MEDIK DALAM REALITA
PRIJO SIDIPRATOMO
KETUA MKEK IDI 2015-2018
DISAMPAIKAN DALAM SOSIALISASI PENEGAKAN DISIPLIN
KKI 2016
HOTEL SANTIKA BEKASI 23 MEI 2016
 Tugas Komite Medik
Meningkatkan profesionalisme staf medis yang bekerja
di RS dengan cara:
a. melakukan kredensial bagi seluruh staf medis yang
akan melakukan pelayanan medis di RS;
b. memelihara mutu profesi staf medis; dan
c. menjaga disiplin, etika, dan perilaku profesi staf
medis.
 Kewenangan Komite Medik
Memberikan rekomendasi :
1. rincian kewenangan klinis (delineation ofclinical
privilege);
2. surat penugasan klinis (clinical appointment);
3. penolakan kewenangan klinis (clinical privilege)
4. perubahan/modifikasi rincian kewenangan klinis
(delineation of clinical privilege);
5. tindak lanjut audit medis
6. pendidikan kedokteran berkelanjutan
7. pendampingan (proctoring)
8. pemberian tindakan disiplin
Panitia Adhoc
Pasal 14
• Dalam melaksanakan tugas dan fungsinya komite medik dapat
dibantu oleh panitia adhoc.
• Panitia adhoc sebagaimana dimaksud pada ayat (1) ditetapkan
oleh kepala/direktur RS berdasarkan usulan ketua komite medik.
• Panitia adhoc sebagaimana dimaksud pada ayat (1) berasal dari
staf medis yg tergolong sbg mitra bestari.
• Staf medis yg tergolong sebagai mitra bestari sebagaimana
dimaksud pada ayat (3) dapat berasal dari RS lain, perhimpunan
dokter spesialis/dokter gigi spesialis, kolegium dokter/dokter gigi,
kolegium dokter spesialis/dokter gigi spesialis, dan/atau institusi
pendidikan kedokteran/kedokteran gigi.
REALITAS DI LAPANGAN
CONTOH KASUS
HASIL WHITE PAPER KKI
Case 1
Post coiling 2 hours
Post coiling 24 hours
Case 2
• DSA thrombolytic with r-TPA result :
– RICA: Total occlusion of Right M1 using rTPA 30 mg
– Post thrombolysis: Failed recanalization
– LICA: Normal
THE QUESTION ?
•
•
•
•
IS IT COMPLICATION ?
IS IT LACK OF COMPETENCY ?
IS IT UN ETHICAL ?
IS IT POTENTIAL FOR MALPRACTICE CASE ?
“Today’s culture of medicine is
hostile to altruism, compassion,
integrity, fidelity, and selfeffacement”
Coulehan
Academic Medicine, Vol. 80, No. 10 / October 2005
“Failure to affirm the primacy of the
patients’ welfare will result in a
loss of the public trust and
medicine’s slide from a revered
profession to an occupation
populated with technical experts”
Hafferty
http://cmsne.org/Documents
MEDICAL ETHICS
• "Medical ethics is a discipline/methodology for
considering the implications of medical
technology/treatment and what ought to be."
• The principles of proper professional conduct
concerning the rights and duties of the physician
himself, his patients and his fellow practitioners, as
well as his actions in the care of patients and in
relations with their families.
Medical Sciences Library, UWI
Ethics are …
•
•
•
•
Moral Principles
What is good and bad
What is right and wrong
Based on value system
www.pdn.ac.lk
Historically
• Medical ethics may be traced to guidelines on
the duty of physicians such as the Hippocratic
oath
• A physician must recognize responsibility to
patients first and foremost, as well as to
society, to other health professionals, and to
self.
• These are not laws, but standards of conduct
which define the essentials of honorable
behavior for the physician
www.pdn.ac.lk
Four basic Principles of
Medical Ethics
BENEFICENCE
• Physicians have a primary obligation to use
the best available diagnostic and therapeutic
interventions to promote the well-being of
their patients by preventing or curing
diseases, relieving suffering and improving
their health-status
• Altruism contributes to the trust that is central
to the physician-patient relationship
European Society of Radiology Code of Ethics
As of March, 2013
Non-maleficence
• While maximizing the patient’s well-being,
physicians should minimize the medical
interventions’ burdens and risks for the
patient
• They should render service with full respect
for human dignity and the best interest of the
patient
European Society of Radiology Code of Ethics
As of March, 2013
autonomy
• They should completely and honestly inform their
patients ,safeguard confidentiality within the
boundaries of law and empower patients to make
informed decisions about diagnostic and
therapeutic interventions
• Patients’ decisions about their care must be
paramount, as long as those decisions are in line
with ethical practice and do not lead to demands
for inappropriate care
• Any diagnostic or therapeutic intervention
requires the patient’s informed consent
European Society of Radiology Code of Ethics
As of March, 2013
social justice
• The medical profession should promote justice
in the health care system including the fair
distribution and cost-effective use of limited
health care resources
• Physicians should work actively to eliminate
discrimination in health care, whether based
on age, gender, sexual orientation, race,
religion, socioeconomic status or any other
social category
European Society of Radiology Code of Ethics
As of March, 2013
THE POTENTIAL RISK IN INTERVENTIONAL
NEURORADIOLOGY
RELATED TO
•
•
•
•
•
CONTRAST MEDIA
X RAY
DEVICES
THE STANDARD EQUIPMENT
SKILL OF THE OPERATOR
Kompetensi (contoh)
• Kompetensi medis untuk dokter spesialis di Amerika
Serikat diatur oleh ACGME (Accreditation Council for
Graduate Medical Education)
• Contoh : Pada kompetensi untuk melakukan
prosedur endovascular neuroradiology, seseorang
harus menyelesaikan program fellowship yang
terakreditasi ACGME
– minimal 1 tahun untuk spesialis radiologi
– tambahan 1 tahun pelatihan diagnostic imaging untuk
spesialis non-radiologi
www. acgme. org
CONTOH MELEWATI BATAS
KOMPETENSI
BAGAI FENOMENA GUNUNG ES
• SANGAT MUNGKIN KETIDAK
PATUHAN PADA ATURAN
SANGAT BESAR
• HARUS ADA UPAYA YANG
TERUS MENERUS DAN
MENGUTAMAKAN
KEPENTINGAN PASIEN
BERDASARKAN EVIDENCE
DAN ETIKA