LEARNING ONJECTIVES

Aimed competency:Conducting ethical justification in every professional activities as a

medical doctor. Subjects: Medical dispute

Lecture objectives:1. Undertanding the meaning, dynamics, prevention and

management of medical dispute.2. Undertanding the meaning, dynamics, prevention and

management of eticolegal conflict

CommunityMedical problems

TrustAppreciationSpecific privilegeSocial contract

DoctorMedical competentcy

QU ALITY

CARE

MEDICAL CARETherapeutic contract

Doctor

Patient

Mutual agreement

Therapeutic contract

A social contract specific characteristics

THERAPEUTIC CONTRACTSpecific characteristics

Formality: implicit, conventionObject: medical problemsAims: providers: effort to cure, not cure patients: cureResponsibility: providers: quality care patients: abiding and support the processCondition: mutual believe and respect

Therapeutict contract (between provider, a/o doctor and patient)

Right and Responsibility

Dissatisfaction

medical dispute

MEDICAL DISPUTE

Demand Contract Outcome Dissatisfied Complaint Allegation Auction

MEDICAL ALLEGATIONDissatisfaction to the outcome

1. Condition of the diseases

2. Adverse effects

3. Missed conduct• Negligence• Intentional

malpractice

PROVED MEDICAL AUCTIONMalpractice

• Therapeutic contract

• Damage to the patient

• Missed conduct

• Damage is due to missed conduct

System Science Moral

Ethics

Honorable

Quality care

The best

Standardbylaws

Efficient

Missed conduct ?

DISCIPLINED CARE

Administrative disciplineClinical disciplineEthical discipline

= MEDICAL DISCIPLINE

Missed conduct = undisciplined care

UUPK -MEDICAL COUNCIL

Practice based on standard

Standard = reference to disciplined care

MANAGEMENT OF MEDICAL ALLEGATION

Provider

Institution Ethical Committee

Professional Court - MKDKI

Common Court

MANAGEMENT OF MEDICAL ALLEGATIONProvider = Doctor

Review the processDiscuss the complaint * severity * MAE (Medicine Adverse Effect) * miss conduct ^ negligence ^ intentional - mal behave incongruency of perception? substantial wrong doing mutual agreement Accepting the situation Further auction

MANAGEMENT OF MEDICAL ALLEGATIONInstitution – Ethical Committee

Review the processDiscuss the complaint * severity * MAE * miss conduct negligence malbehave incongruence perception? mutual agreementAccepting the situation Further auction

Idem Providers +Intermediation+ Compensation Disciplinary action

Hospital Dinkes IDI MKEK

MANAGEMENT OF MEDICAL ALLEGATIONMKDKI - Professional Court

Allegation AssesmentDecision: do breaking the disciplines ?Sanction:

DeregistrationReschoolingSpecific attentionRefered to MKEK

Do not eliminate the right of the patient to undertake the auction to the civil and criminal court

MANAGEMENT OF MEDICAL ALLEGATIONCommon Court

Civil Court: Miss Conduct Compensation

Criminal court: Breaking specific laws/ regulation

Medical Dispute - Prevention

• Discipline care• Honorable care• Understanding the dynamics of the dispute ongoing preventive action.• Building up conducive doctor patient relationship: attentive empathic care through better communication skill.• Honest and responsible. Admitting the wrong doing.

HONORABLE CARERespecting mankind

Sifat Ketuhanan – power of the almightyKemurnian niat – pure intentionKeluhuran budi - wisdomKerendahan hati - humblenessKesungguhan kerja – hard workingIntegritas ilmiah dan sosial – Scientific and social integrity

Kesejawatan – peer spirit ALTRUISM

Therapeutict contract (provider and the patient)

Provider is a team within a system

Conflict among member of the team or Staff of the system

eticolegal conflict

ETICOLEGAL CONFLICTSophistication of medical technologyTeamwork approach through a system different health / medical professionals in rendering medical care conflict

Source of conflict:•Autonomy• Authority• Professional pride• Other interest• Character: Personal and professional behavior

ETICOLEGAL CONFLICTManagement

Provider

Institution Ethical Committee

MKEK Other health prof. Organization

Resolution of the conflict Formative action

ETICOLEGAL CONFLICTPrevention

Acknowledge and respect different professionals within the system.

Undertaken the role and behave according to their position within the system.

Consistently work according to the standard.

Enhancing peer spirit

END REMARK

Medical practice: a social contract. Operationally implemented as a therapeutic contract.

Contract lead to dissatisfaction, medical dispute legal auction. Should be prevented and managed properly in maintaining public trust and appreciation.

Medical care could lead to conflict among providers. Should be perevented and managed properly, in maintaining the spirit and the honor of medical profession.