LEARNING OBJECTIVES

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 Q
Medical problems U
A
L
Trust I
Appreciation T
Specific privilege Y
Social contract
C
A
Doctor R
Medical competentcy E
 MEDICAL CARE
Social
Doctor
 Mutual agreement
Patient

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

Right and Responsibility

Dissatisfaction

Patient  malpractice
Doctor  “I don not think so”
 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

4. Intentional
 PROVED MISSED CONDUCT
Malpractice
• Therapeutic contract

• Damage to the patient After decision by:

Professional court
Civil court
• Missed conduct Criminal court

• 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
* intentional mal behave
 incongruence perception?
 mutual agreement

Accepting the situation

 Further auction
 MANAGEMENT OF MEDICAL ALLEGATION
Institution – Ethical Committee
Review the process
Discuss the complaint
* severity Idem Providers +
Intermediation
* MAE
+ Compensation
* miss conduct  Disciplinary action
* intentional mal behave
 incongruence perception? Hospital
 mutual agreement  Dinkes
 IDI
Accepting the situation MKEK
 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.