HUMANIORA PENGANTAR KLINIK

8/13/2019 HUMANIORA PENGANTAR KLINIK

1/69

Doctors Profession:

Introduction

Djoko Wahono Soeatmadji


2/69
http://images.google.co.id/imgres?imgurl=http://www.bermuda-online.org/HospitalEmergency.jpg&imgrefurl=http://www.bermuda-online.org/kemh.htm&usg=__YQX0WkOCBhN3FG1ZNSztRVNjHGU=&h=378&w=550&sz=30&hl=en&start=20&tbnid=adEoEGfJZSdCLM:&tbnh=91&tbnw=133&prev=/images%3Fq%3Dhospital%26gbv%3D2%26hl%3Den%26sa%3DG


3/69

To greater opportunity, responsibility, or obligationcan fall to the lot of a human being than to become aphysician. In the care of the suffering, [the

physician] needs technical skill, scientific knowledge,and human understanding. . . . Tact, sympathy, andunderstanding are expected of the physician, for thepatient is no mere collection of symptoms, signs,disordered functions, damaged organs, and disturbed

emotions. The patient is human, fearful, and hopeful,

seeking relief, help, and reassurance


4/69

The Doctor for the 21st

Century The Issues

-The Wider Context

- Emerging Challenges- The Responses of Medical Education

- The Direction of Reform

The World Summit on Medical Education,

Edinburg 8 12 August 1993


5/69

The doctor of the 21st

century must be redesign !!!
http://images.google.co.id/imgres?imgurl=http://2.bp.blogspot.com/_VVUpMQNZneQ/Sb_IBqA2ZwI/AAAAAAAAACE/TYGwMTcfA-Q/s400/puskesmas3.jpg&imgrefurl=http://khalikholic.blogspot.com/&usg=__xeD9sZHYxbw0DxfDzkSgRP_rj3A=&h=256&w=400&sz=26&hl=id&start=113&tbnid=Ay8BJzTbn2uouM:&tbnh=79&tbnw=124&prev=/images%3Fq%3DPUSKESMAS%26gbv%3D2%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D108


6/69

The Doctor for the 21st Century1. Promote health, prevent and treat disease,

and rehabilitate the disable (in acompassionate, ethical way), within resourcesconstrain)

2. Providers of primary care3. Communicators

4. Critical thinkers5. Motivated life-long learners6. Information specialist7. Citizen of the World

8. Practitionars of applied economics, sociology,anthropology, epidemiology and behaviouralmedicine

9. Health team managers10. Advocate for communities

The World Summit on Medical Education, Edinburg 8 12 August 1993


7/69

DOCTOR = DOCERE =to teach"

. physicians should share information andmedical knowledge with colleagues, withstudents of medicine and related professions,and with their patients


8/69

Ethical medicine strives todo goodand to do no

harm The medicalprofession must fullfill its

social contract better


9/69

Social and Ethical Issues

in MedicineApproach to Medicine, the Patient, and

the Medical Profession (Medicine as a

learned and humane profession) Bioethics in the Practice of Medicine

Care of Dying patients and Their

Familes

Social and Economic Issues in Medicine


10/69

APPROACH TO THEMEDICINE:Medicine as a

learned and humaneprofession


11/69

What is Expected of thePhysician ?

The practice of medicine combines both scienceand art

Science base technology

Deductive reasoning

Knowledge of he patient, mutual trust and ability tocommunicate with patient


12/69

Does not make a GoodPhysician

Advances in:

genetics

biochemistryimaging technology

laboratory technology

therapeutic maneuvers and modalities


13/69

A good physician has thecombination of :

Medical knowledgeIntuitionJudgement


14/69

Medicine is a profession

that incorporates scienceand the scientific methodewith the art of being aphysician.


15/69

The art of caring andcomforting, guided bymillenia of common senseas well as systemic

approach to medical ethicsremain the cornerstone of

medicine.


16/69

The essential humanistic qualitiesof caring and comforting can

achieve a little if they are notcoupled with understanding of howmedical science can and should be

applied to patients


17/69

Care givers of ancient times and premodern

cultures..Some of their potions contained whatare known to be active ingredients that form thebasis for proven medications..

Modern medicine should not dismissthepossibility that this unproven approach may behelpful, but should adopt a guiding principlesthat all interventions (traditional or newlydeveloped) can be tested, with the expectationthat any beneficial effects can be exploredfurther to determine their scientific basis..


18/69

Internal Medicine(Inneren Medizin):Emphasized the physiology andchemistry of disease; not just

the pattern or progression ofclinical manifestation.


19/69

.. The scientific basis of medicineis remarkebly recent compared

with its long and generallydistinguished of caring andcomforting patients

Hospitalism referred not to expertise inhospital care, but rather to the

aggregate of iatrogenic affections thatwere induced by hospital itself.


20/69

Modern medicine has moved rapidlypast organ physiology to anincreasingly detailed understanding

of cellular, sucellular, and geneticmechanism.

Health, disesase, and individuals

interaction with environment arealso determined substantially bygenetics


21/69

Methods for evaluation theapplication of scientific

advances to the individualpatients and to populations


22/69

The randomized controlled trialsometimes with thousands patients

at multiple institutions, has replacedanecdote as the preferred methodefor measuring the benefits and usesof diagnostic or trherapeuticintervention


23/69

Principles of Patient Care

Principles of Patient Care

Practice Guidelines

Medical Decision-Making

Evaluation of Outcomes


24/69

APPROACH TO THE

PATIENT


25/69

Patients commonly present withcomplaints (symptoms), these

symptoms, may or may not beaccompanied by abnormalities onexam (signs) or on laboratory

testing

Conversely, asymptomatic patientsmay have signs or laboratoryabnormalities, and laboratoryabnormalities can occur in theabsence of symtoms or signs


26/69

Illness & Disease


27/69

The patients-physician interactionproceeds through many phases ofclinical reasoning and decisionmaking

The approach to diagnosis and

therapy should not be equated withcookbookmedicine

Tailoring


28/69

To care for patients as anindividual, the physicianmust understand thepatientas a person (human)


29/69

APPROACH TO The

MEDICAL PROFESSION


30/69

In a profession, thepractitioner puts the welfare

of the client or patient abovehis or her own welfare..


31/69

Professional Responsibilities:

Commitment to Professional competence

Honesty with patients

Patients confidentiality

Maintain appropriate relations with patients

Improving the quality of care

A just distribution of finite resources

Scientific knowledge

Maintaining trust by managing conflict of interest

Professional responsibility

Brennan T et al. Ann Intern Med 2002; 1136: 243-246


32/69

The explosion in medicalknowledge has led to

increasing specialization,defined initially by organsystem and more recentlyby locus of principal activity(inpatient vs outpatient)


33/69

The changing medical care

environment places increasingemphasis onstandards, outcomes,and accountability..

Clinical guidelines and critical pathwaysderived from randomized controlled trialand evidence-based medicine potentially

can lead to morecost-effective andbetteroutcomes


34/69

A health insurance systememphasizes cost-effective care, gives physicians and health

care providers responsibility for the healthof population and the resources required toachieve these goals, must exist in acompetitive environment in whichpatients

can choose alternativesif they are notsatisfied with their care.


35/69

The physicians responsibility to

represent the patient best interestand avoid financial conflicts .

If the limitting of options is basedoverhelmingly on cost rather than onmeasures on quality, outcomes, andpatient satifaction it is likely that the

historic relationship between the patientand the truly profesional physician will befundamentally compromised


36/69

In the current health careenvironment, all physiciansand trainees must redoubletheir commitment to

professionalism


37/69

BIOETHICS IN

PRACTICE OF MEDICINE


38/69

Modern advances in medicaltechnology, antibiotics, dialysis,

transplantation, and intensivecareunits have created thebioethical dilemmas that confront

the physicians in the 21

st

century


39/69

Patients-Physician

Relationship Whatever the patients attitude ideally

should be based on thorough

knowledge of the patients, mutual trust,and ability to communicate with oneanother


40/69

Patients as individuals whose problemstranscend their complaint

Patient(s) is not just a case(s) ordisease(s)

The duty of patients principal

physician is to guide them throughillness


41/69

The ideal patient-physician relationshipshould be based on thorough knowledge ofthe patient, mutual trust and ability to

communicate with patient

Qualtity of clinician interest in

humanity


42/69

Informed Consent


43/69

Fundamental Elements

For Disclosure To Patients Diagnosis and prognosis

Nature of proposed intervention

Reseonable alternative intervention Risk associated with each alternative

intervention

Benefits associated with each alternative

intervention Probable outcomes of each alternative

intervention


44/69

Terminating MedicalIntervention ?

Assisted Suicide andEuthanasia ?


45/69

Care of Dying patients


46/69

Care of Dying patients : Is the patient comfortable (Pain and symptom

control ? All that hurts ?)

Shared decision making (What is a gooddeath ?)

Are the psychosocial and spiritual concerns ofthe patients and family being address

(Psychosocial and spiritual support) ?

Whre does the patient prefer to receive care ?

C S t i


47/69

Common Symptoms inSeriously Ill Hospitalized

Patients (% 0f Total Patients)At any time Severe and

Frequent

PainDyspneu

Anxiety

DepressionNausea

5149

47

4534

2323

16

146

Desbiens NA et al. J pain Manage 1999;17:248-255


48/69

Patients Perspective on AGood Death

Control pain and other symptoms

Avoid inappropriate prolongation of

dying when life no longer enjoyable Relieve burden on the family

Achieve a sense of control

Strenghten relationships with lovedones

Singer PA et al. JAMA 1999; 218:163 - 168


49/69

Shared bad news ?


50/69

Palliative CareApproaches to providing comfort fordying persons without necessarily

modifying the underlying medicalcondition


51/69

Medical Ethics


52/69

Six of the values that commonly apply tomedical ethics discussions are:

1. Beneficence- a practitioner should act in the bestinterest of the patient. (Salus aegroti suprema lex.)

2. Non-maleficence- "first, do no harm" (primum nonnocere).

3. Autonomy- the patient has the right to refuse orchoose their treatment. (Voluntas aegroti suprema lex.)

4. Justice- concerns the distribution of scarce healthresources, and the decision of who gets what treatment(fairness and equality).

5. Dignity- the patient (and the person treating thepatient) have the right to dignity.

6. Truthfulnessand honesty- the concept of informedconsenthas increased in importance since the historicalevents of the Doctors' Trialof the Nuremberg trials andTuskegee Syphilis Study.
http://en.wikipedia.org/wiki/Beneficencehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Justicehttp://en.wikipedia.org/wiki/Dignityhttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Truthhttp://en.wikipedia.org/wiki/Honestyhttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Doctors%27_Trialhttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Doctors%27_Trialhttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Tuskegee_Syphilis_Studyhttp://en.wikipedia.org/wiki/Doctors%27_Trialhttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Informed_consenthttp://en.wikipedia.org/wiki/Honestyhttp://en.wikipedia.org/wiki/Truthhttp://en.wikipedia.org/wiki/Dignityhttp://en.wikipedia.org/wiki/Justicehttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Primum_non_nocerehttp://en.wikipedia.org/wiki/Beneficence


53/69

BeneficencevsAutonomy
http://en.wikipedia.org/wiki/Beneficencehttp://en.wiktionary.org/wiki/autonomyhttp://en.wiktionary.org/wiki/autonomyhttp://en.wikipedia.org/wiki/Beneficence


54/69

Professional ResponsibilityViolations (in general)

Conflicts of interest

Mishandling of client Disclosure of confidential information


55/69

Experience, common sense, andsimply being a good person do notguarantee that physicians can

identify or resolve ethical dilemmas


56/69

SOCIAL AND ECONOMIC

ISSUES IN MEDICINEMedicine is practiced in a social,economic, and political context

It takes more than excellent medical careto improve the health of the patients

Many of the determinants of the health ofindividuals and populations lie outsidetraditional clinical activity


57/69

Economic Considerations

in the Practice of Medicine

health is a political issue


58/69

Most illness has its origins in

social condition

health is a political issue

and those enjoying care do not

want to share it ..

Both in the underdeveloped and the

developed world the medical

contribution is largely inappropriate

to health need and does not copewith helth problems of the vast

majority

gap between health care and

medical care has become evenwider

A safe water supply

makes a major


59/69

the success storiesof

better health inunderdevelopedcountries have hadmore to do withchanged economic and

political systems andimproved nutrition,water provision, andsanitationthan with

technological modern

medicine

Adequate nutrition as aprerequisite for health

Environmental condition

have major impact in

health

Agriculter and health are

two closely related

factors

makes a major

contribution to health


60/69

AccessibleAppropriate to needs

Afordable
http://www.saibaba-fund.org/images/hospital.jpghttp://www.saibaba-fund.org/images/hospital.jpg


61/69

Conflict of Interest

Hippocratic Oath


62/69

ATwelfth-century

Byzantinemanuscript ofthe Oath

Hippocratic Oath

Hipocrates OathIswear by Apollo,

Asclepius, Hygieia, and

Panacea, and I take to

witness all the gods, all thegoddesses, to keep according

to my ability and my

judgment, the following

Oath
http://en.wikipedia.org/wiki/12th_centuryhttp://en.wikipedia.org/wiki/Byzantine_empirehttp://en.wikipedia.org/wiki/Apollohttp://en.wikipedia.org/wiki/Asclepiushttp://en.wikipedia.org/wiki/Hygieiahttp://en.wikipedia.org/wiki/Panaceahttp://en.wikipedia.org/wiki/Panaceahttp://en.wikipedia.org/wiki/Hygieiahttp://en.wikipedia.org/wiki/Asclepiushttp://en.wikipedia.org/wiki/Apollohttp://en.wikipedia.org/wiki/Byzantine_empirehttp://en.wikipedia.org/wiki/12th_centuryhttp://en.wikipedia.org/wiki/12th_centuryhttp://en.wikipedia.org/wiki/12th_centuryhttp://upload.wikimedia.org/wikipedia/commons/1/1a/HippocraticOath.jpg


63/69

Doctor Patient Relationship

Empathy Sympathy


64/69

Empathy Sympathy

Enemy

V i I
http://images.google.co.id/imgres?imgurl=http://www.digitaljournal.com/img/9/0/1/2/2/1/i/5/0/0/o/doctor-patient.jpg&imgrefurl=http://www.digitaljournal.com/image/50000&usg=__OiE55fGMknsL8saU2hZCiIj01Z8=&h=600&w=425&sz=88&hl=en&start=17&um=1&tbnid=pHtIEUbPXvT1UM:&tbnh=135&tbnw=96&prev=/images%3Fq%3Ddoctor%2Bpatient%2Brelationship%26hl%3Den%26sa%3DN%26um%3D1http://images.google.co.id/imgres?imgurl=http://www.historycooperative.org/journals/hah/9.1/images/wilde_fig01b.jpg&imgrefurl=http://www.historycooperative.org/journals/hah/9.1/wilde.html&usg=__6FylIsGgPS1e7pE-OMd10emO6a8=&h=637&w=640&sz=78&hl=en&start=11&um=1&tbnid=NlQxwVudpZj4kM:&tbnh=136&tbnw=137&prev=/images%3Fq%3Ddoctor%2Bpatient%2Brelationship%26hl%3Den%26sa%3DN%26um%3D1http://images.google.co.id/imgres?imgurl=http://www.cbc.ca/news/background/healthcare/gfx/patient-doctor-392.jpg&imgrefurl=http://www.cbc.ca/news/background/healthcare/patient-doctor-relationship.html&usg=__AwPBfJijU1Ycf_9XC7YYTHkUg0o=&h=247&w=392&sz=33&hl=en&start=6&um=1&tbnid=jJR5YAn3Z_ya_M:&tbnh=78&tbnw=123&prev=/images%3Fq%3Ddoctor%2Bpatient%2Brelationship%26hl%3Den%26sa%3DN%26um%3D1


65/69

Various Interests

Medical Nursing

Owners

Investors Patients/Family

Insurance

PharmaceuticalIndustry

Government Medical Education

Medical Profession

Lawyer

Etc

Bargaining / Conflict


66/69


67/69


68/69

Thank you for your attention

Batu, July 1, 2006


69/69

To greater opportunity, responsibility, or obligationcan fall to the lot of a human being than to become aphysician. In the care of the suffering, [thephysician] needs technical skill, scientific knowledge,

and human understanding. . . . Tact, sympathy, andunderstanding are expected of the physician, for thepatient is no mere collection of symptoms, signs,disordered functions, damaged organs, and disturbed

emotions. The patient is human, fearful, and hopeful,

seeking relief, help, and reassurance

HUMANIORA PENGANTAR KLINIK

Documents