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

Community
Medical problems
Trust
Appreciation
Specific privilege
Social contract
Doctor
Medical competentcy

Q
U
A
L
I
T
Y
C
A
R
E

MEDICAL CARE
Therapeutic contract
Doctor
Patient
Mutual agreement
Therapeutic contract
A social contract specific characteristics

THERAPEUTIC CONTRACT
Specific characteristics
Formality: implicit, convention
Object: medical problems
Aims: providers: effort to cure, not cure
patients: cure
Responsibility: providers: quality care
patients: abiding and support the
process
Condition: 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 ALLEGATION
Dissatisfaction to the outcome
1. Condition of the diseases
2. Adverse effects
3. Missed conduct
Negligence
Intentional

malpra
ctice

PROVED MEDICAL AUCTION

Malpractice
Therapeutic contract
Damage to the patient
Missed conduct
Damage is due to missed conduct

Missed conduct ?
System

Science

Moral

bylaws

Standard

Ethics

Efficient

The best

Honorable

Quality care

DISCIPLINED CARE
Administrative discipline
Clinical discipline
Ethical 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 ALLEGATION

Provider = Doctor
Review the process
Discuss the complaint
* severity
* MAE
* miss conduct
^ negligence
^ intentional - mal behave

incongruency of perception?
substantial wrong doing
mutual agreement
Accepting the situation
Further auction

MANAGEMENT OF MEDICAL ALLEGATION

Institution Ethical Committee
Review the process
Discuss the complaint
Idem Providers +
* severity
Intermediation
* MAE
+ Compensation
* miss conduct
Disciplinary action
negligence
Hospital
malbehave
incongruence perception? Dinkes
IDI
mutual agreement
MKEK
Accepting the situation
Further auction

MANAGEMENT OF MEDICAL ALLEGATION

MKDKI - Professional Court
Allegation
Assesment
Decision: do breaking the disciplines ?
Sanction:
Deregistration
Reschooling
Specific attention
Refered to MKEK
Do not eliminate the right of the patient to
undertake the auction to the civil and criminal
court

MANAGEMENT OF MEDICAL ALLEGATION

Common 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 CARE
Respecting mankind
Sifat Ketuhanan power of the almighty
Kemurnian niat pure intention
Keluhuran budi - wisdom
Kerendahan hati - humbleness
Kesungguhan kerja hard working
Integritas 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 CONFLICT
Sophistication of medical technology
Teamwork 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 CONFLICT
Management
Provider
Institution
Ethical Committee
MKEK
Other health prof. Organization
Resolution of the conflict
Formative action

ETICOLEGAL CONFLICT
Prevention
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.