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UPAYA MENCEGAH
MALPRAKTEK DALAM BIDANG
FETOMATERNALJudi Januadi Endjun
Sanny Santana
Novi ResistantieFebriansyah Darus
Divisi Fetomaternal
Departemen Obstetri dan Ginekologi
RSPAD Gatot Soebroto
Jakarta
2005
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AGENDA BAHASAN
PENDAHULUAN
REDUCING LITIGATION RISKS IN O&G
STANDAR PROFESI MATERI AJAR
JENJANG PENDIDIKAN LANJUTAN
KESIMPULAN
JJE/RSPAD/2005
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PENDAHULUAN
Krisis ekonomi multidimensi, terutamaakhlak, keimanan, kejujuran Pendidikan ??
Tuhan menyuruh kita JUJUR, Tuhan yangmemberi kita rejeki, mengapa kita harus tidakJUJUR
Bekerja secara TIM (kesetaraan)
Masalah medikolegal terbanyak : OBGIN
JJE/RSPAD/2005
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PENDAHULUAN
O&G by the nature of their work are more oftenthan most practitioners in other fields, liable toface litigation in respect of mal-practice
Cases are highlighted in the press andsometimes on TV
The general public has grown to expect highstandards and expectations of their specialists
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PENDAHULUAN
Health and safety the mother and child
Child birth is the period of time when accidents
both avoidable and unavoidable tend to happen
The most hazardous journey anyone ever
makes in ones life is the passage through the10 cm of the birth canal
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REDUCING LITIGATION
RISKS IN O&G Medical Protection Society (MPS)
Clinical Guidelines
Communication Medical Records
Medical Problems
Avoiding litigation in O&G
Dermot Mac Donald,2005
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Medical Protection Society
Medico-Legal Claims in O&G
The Medical Defense Union
The Institute of O&G The College of O&G
Society (ISOG, etc)
Medical Faculty The Lawyer
Dermot Mac Donald,2005
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Clinical Guidelines
Systematically developed statementswhich assist clinicians and patients inmaking decisions about appropriate
treatment for specific conditions
Practice of good medicine
Avoid medico-legal challenge
Dermot Mac Donald,2005
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Epidemic of legal challengefacing the practitioner of O&G
in day to day practice
Defensive medicine hasbecome the norm
Dermot Mac Donald,2005
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Communication
The teaching and learning of communication skills have
become a significant part of the medical undergraduate
curriculum
The patient who eventually makes the decision in regard to
their management may lighten the doctors responsibility
Lack of informed consent is a constant plea by Plaintiffs
The amount of detail to give the patient about possible risks
and complications is always a difficult decision
Dermot Mac Donald,2005
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Communication
In the event of serious complication or mishap :
The consultant in charge should speak to the patient and / orfamily as soon as possible
The patient should be given a factual account in simplelanguage together with an apology if indicated
Saying sorry does not constitute an admission of legal liability
The doctor should over-elaborate on the event nor give anover-optimistic prognosis
The MDU, 1991
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Communication
It is most important not to apportion blame at leastnot until a thorough investigation of all the relevant
facts has taken place
The patient and family should be given time toconsider what happened and the consultant should
offer to meet them a second time
Case conference with all involved the patient andrelatives do not hear inaccurate or different
accounts from various members of staff
The MDU, 1991
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Medical Records
Partograms are recommended, andcareful maternal and fetal records shouldbe entered on these.
Legibility and Signing Timing
Alteration
Detail Storage
Dermot Mac Donald,2005
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Legibility and Signing
The notes should be legible, clearly datedand timed with a identifiable signature
A stamp of the doctors name beside thesignature may diminish problems ofidentification years later as the defence is
prepared
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Timing
Very important to write the exact time of the event (CS,forceps, delivery, etc) and
Also the time at which the notes are actually written.
For instance : 14.00 Fetal bradycardia of 80 bpm; 14.05Decision to perform CS.; 14.50 C.S commenced. 14.55Baby delivered. 15.20 Clinical notes written and completedafter 20 minutes
Accompanied by an exact note of the detail. Such as FHR180, 170 to 180
The notes should indicate some explanation for the delayand documented
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Timing
EFM records : comments should be
written (and signed) on actual trace :
interpretations, decision, plans, etc should
be expl ic i t lywritten when fetal heart trace(or IA) suggests abnormality
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Alteration
Notes must not be altered.
If alteration are necessary, such alteration mustbe made by drawing a sing le l ine through the
or ig inal(so that it can still be read.
The time, date etc and reason for making the
alteration clearly stated and again, clearly signed
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Detail
The more explicit the information recorded, themore helpful it will be in defence.
Failure to progress by actual detail of cervix 5cms dilated with no progress for 3 hours despiteoxytocin and membrane rupture
Doctors are trained to help patients and treat theirailments. Writing notes and keeping records of thetreatments may become more important than theactual treatments
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Storage
All records must be carefully stored last
they are required in consultation in future
years
The EFM should be carefully stored in the
patients record file
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Medical Problems
Intra partum fetal hypoxia :
cerebral palsy
Trauma fetal
Trauma maternal
Retained swabs
Perineal tears &
Episiotomies Complications of CS
Vaginal repair
Retained placental tissue
Rhesus disease
Incompetent cervix/cervicalcerclage
Abdominal hysterectomy
Ureteric & Bladder injury
Bowel injury Retention of foreign body
Diathermy burns, etc
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STANDAR PROFESI
Kumpulan standar yang ditetapkan oleh
organisasi profesi, yang bersifat mengikat
pada anggotanya, terdiri dari standar
kompetensi, standar etika, dan standarpelayanan medis
Standar bersifat dinamis
Draft Standar Profesi POGI,2005
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STANDAR ETIKA
Sesuai dengan Pedoman Etik O&G dan KODEKI Altruisme : kepentingan klien diutamakan
Integritas : berilmu & profesional
Menjunjung tinggi harkat & martabat profesi
Kesejawatan : sumpah dokter & profesional
Akuntabilitas : dapat dipertanggungjawabkan
Memberikan pelayanan terbaik
Siap sedia menjalankan profesinya
Mampu berkomunikasi secara profesional dengan prinsip
saling asah, asih, dan asuh
Kepemimpinan yang baik dan profesional
Draft Standar Profesi POGI, 2005
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STANDAR KOMPETENSI
Pencapaian kompetensi minimal
Harus terus dikembangkan (Cont inuingProfess ional Development) dan
Con t inuing Medical Educat ion
Panduan Pendidikan Dokter Indonesia
JJE/RSPAD/2005
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STANDAR PELAYANAN MEDIK
SOP
SPM
Tempat Praktek
Catatan Medik dibuat berdasarkan CMBM :evaluasi lanjutan memakai sistim SOAP
JJE/RSPAD/2005
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MATERI RUJUKAN
ABOG, RCOG, ACOG, etc : Guidelines
Clinical Conference
Scientific meeting, Courses, etc
Textbooks : Fetal-medicine, Ultrasound,
Neonatology, Genetics, etc
Journals : Placenta, White Journals (ISUOG), etc
JJE/RSPAD/2005
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JENJANG PENDIDIKAN
LANJUTAN
Spesialisasi (Klinikus)
Pendidik (S1 S2 S3 Guru Besar)
Non Medis
Tidak berpraktek
JJE/RSPAD/2005
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AVOIDING LITIGATION IN O&G
1. Ensure the competency of your supportstaff
2. Admit if you are wrong
3. Keep a rein on your lawyers
4. Release medical reports and recordpromptly
5. Generally to avoid litigation6. General advice
R.K. Nathan, 2005
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Generally to avoid litigation
Listen carefully to thepatients complaints
Examine the patient
Explain her problems andthe treatment you wouldrecommend
Record all of the above
Recommend to a specialist
whenever you think itnecessary
Update your knowledge ofmedicine
Give due concern to slowprogress of labour orfailure of the fetal head todescend
Avoid allowinginexperienced orunqualified staff to be inattendance & the failure ofthe specialist to attend
Ensure an adequatelyequipped delivery room
Keep the patient briefed ofher progress
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KESIMPULAN
Krisis multidimensi berdampak buruk terhadapdunia pendidikan (kualitas luaran anak didik),penelitian, dan pelayanan kesehatan
Kejujuran, Kemauan memperbaiki diri, Komunikasi,dan Kesejawatan merupakan pilar dasar yangharus tetap dijaga
Apa yang dapat kita berikan agar pendidikan,penelitian, dan pelayanan dokter di Indonesia tidaksemakin terpuruk ??
JJE/RSPAD/2005
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THANK YOU