Professionalisme

Nur Azid Mahardinata, MD

PhD Student on Medical Ethics
University of Amsterdam
The Netherlands
The Noble Profession of
Medicine
There is no career nobler than that of
the physician. The progress and welfare
of society is more intimately bound up
with the prevailing tone and influence of
the medical profession than with the
status of any other class ....
Elizabeth Blackwell, M.D., 1889
 The practice of medicine is an art, not a
trade; a calling, not a business; a calling
in which your heart will be exercised
equally with your head. Often the best
part of your work will having nothing to
do with potions and powders ....
William Osler, M.D. 1925
Origins of Professionalism
from Latin by way of Middle
English, professi, the taking of
vows of a religious order
PROFESI
A profession is any group sharing a
special body of knowledge, standards of
education and practice, professional
associations, and an ethical framework
based in a social contract that permits a
high degree of self-regulation.
On that view, ethics is an important
descriptor for a profession, but ethics is
not its essential and indispensable
defining feature.
 AKUNTABILITAS PROFESI
DIDASARKAN PADA KONTRAK SOSIAL

Kontrak antarabetween
The contract kelompok profesi dengan
professions and society
masyarakat
is relativelyumum.
simple.
Profesi diberi monopoli dalam menggunakan
The professions are granted a monopoly over
keahliannya dalam pelayanan kpd masyarakat,
the use menimbang
dengan of a body ofotonominya,
knowledge,prestige
as welldanas
considerable
imbalan autonomy, prestige, and financial
finansialnya
rewards
Dan on the
sebaliknya understanding
profesi that they will
harus menjamin
kompetensi mereka, memberikan
guarantee competence, provide layanan
altruisticyang
altruistik,
service, andberperilaku
conduct yang
their bermoral dan morality
affairs with
berintegritas
and integrity
Cruess SR et al: MJA 2002 177 (4): 208-211
Professionalism
Professionalism is the basis of medicine's
contract with society.
It demands placing the interests of patients
above those of the physician, setting and
maintaining standards of competence and
integrity, and providing expert advice to
society on matters of health.
Essential to this contract is public trust in
physicians, which depends on the integrity of
both individual physicians and the whole
profession
A Physician Charter:
Three Fundamental Principles
Primacy of Patient Welfare
Serving the welfare of the patient
Altruism is key to the doctor-patient relationship
Patient Autonomy
Empowering patients to make informed decisions
Honor patient choice
Social Justice
Fair distribution of resources
Eliminate discrimination
Professional Responsibilities 1-3
Commitment to professional competence
Lifelong learning of medical knowledge and
clinical and team skills
Commitment to honesty with patients
Assuring that patients are completely and
honestly informed before and after treatment,
including disclosure of errors
Commitment to patient confidentiality
Applying safeguards to the disclosure of patient
information
Professional Responsibilities 4-6
Commitment to maintaining appropriate relations
with patients
Avoiding the exploitation of patients for sexual
advantage, personal financial gain, or any other private
purpose
Commitment to improving the quality of care
Working collaboratively to create systems contributing
to continuous quality improvement in health care
Commitment to improving access to care
Reducing barriers to equitable health care based on
education, laws, geography, and social discrimination
Professional Responsibilities 7-9
Commitment to a just distribution of finite
resources
Providing health care based on wise and cost-effective
management of limited resources
Commitment to scientific knowledge
Upholding current scientific standards and promoting
the creation and appropriate use of new knowledge
Commitment to maintaining trust by managing
conflicts of interest
Compromising professional responsibilities by pursing
private or personal gain
Professional Responsibility 10
Commitment to professional responsibilities
Working collaboratively and treating one
another with respect
Six Characters of
Professionalism
1. Altruism - best interests of patients over self interest
2. Accountability - at multiple levels: to individual
patients, to society, & to the profession
3. Excellence - conscientious effort to exceed ordinary
expectations and to commit to life-long learning
4. Duty - free acceptance of commitment to service
5. Respect for Others - patients, students, staff
6. Honor & Integrity - highest standards of behavior and
the refusal to violate ones personal and professional
codes
Challenges to Professionalism
Abuse of Power
Arrogance
Greedy (serakah)
Misrepresentation (kebohongan)
Impairment (cacat mental)
Lack of conscientiousness (krg rajin)
Conflict of interest
 Abuse of power
- Interactions with patients and
colleagues
- Bias and sexual harassment
- Breech of confidentiality
 Arrogance
- offensive display of superiority
- fostered by residency training
- destroys professionalism by:
1. losing empathy for the patient
2. Removing the beneficial role of
self-doubt
 Greed
- Money or power become the driving
force
- lose understanding, compassion and
personal integrity
- must always ask is this in the best
interest of the patient or my own
financial interest.
 Misrepresentation
- consists of lying and fraud
- both are conscious efforts
- Fraud is the misrepresentation of
material fact with the intent to
mislead ins. company fraud
 Impairment
- drug addicted, alcoholic or mentally
impaired physician protected or
unnoticed by colleagues and
allowed to care for unsuspecting
patients.
 Lack of Conscientiousness
- failure to fulfill responsibilities
- this is the physician who is committed
to doing the bare minimumtakes the least
amount of history, waits for an x-ray
report rather then review it himself,
does not return patients phone calls,
reviews charts rather than the patient,
(cont)
- the physician who is too busy to
fulfill his teaching responsibilities
to residents or students, comes late
for rounds or conferences and shifts
the care of patients to trainees not
yet prepared for unsupervised
responsibility.
 Conflict of Interest
- Avoid situations in which the interest
of the physician is placed above that
of the patient
1. Self referral
2. Acceptance of gifts
3. Utilization of services
1.Self referral
-Ordering of laboratory test or
diagnostic procedures for a patient
from businesses in which the
physician has a financial interest
2. Acceptance of gifts
- gifts or subsidies from drug
companies for travel, lodging, meals
or personal expenses to attend
educational conferences should be
discouraged or restricted.
3. Utilization of services
- Inappropriate procedures, multiple
unnecessary office visits, keeping
dying patients alive are all
examples of unprofessional and
unethical behavior
Thank You