ASIS DEELIP MIRCHANDANI Batch: 2011

07120110051 Date of submission: 25-10-2013

Medical Disciplinary

PROBLEM

In recent years, our nation, Indonesia has developed and progressed very far in the medical
field and health services. This is evidently indicated by the increase in the number of new
hospitals and clinics that have come up in the last decade, not only in the capital city, but in
other cities as well. Another indicator for the improved system is by the decrease in mortality
rate of the nation and its health status. However good this statement may seem, to every
advantage, there is also a disadvantage. With many more seeking medical attention and
professional health, the quality and quantity of service must be increased. Both of them
should strengthen the other. An increase in quality itself but not quantity will leave the nation
into havoc and lack of medical resources while a lack of quality will leave the nation with a
below par medical department. This would eventually lead to migration and even seeking
medical attentions abroad discouraging health services in the country itself. It is a vicious
cycle.

One of the improved services and quality that must be very accurately monitored is the
medical disciplinary aspect. What is medical disciplinary? Basically medical disciplinary is a
set of rules and regulations set by an organization that guides a doctor in their day to day
practices. It is a marker of the set of things that can be done or cannot be done by the doctor.
When the things that are not allowed to be done by the doctor are committed, it is also known
as malpractice. Usually medical disciplinary is formulated by the people of the profession and
is legalized or legitimized by the nation or country. According to that, the country will have
certain laws and rules. Examples of some laws that are associated with medicine and health
care in Indonesia are:

 UU praktek kedokteran (no.29, 2009)

 UU kesehatan (no.36, 2009)
 UU rumah sakit (no.44, 2009)

In Indonesia, the organization responsible in controlling the medical discipline of doctors,

dentists and health care providers is called MKDKI (The Indonesian Medical Disciplinary
Board/ Majelis Kehormatan Disiplin Kedokteran Indonesia.) The MKDKI is a national
institution that is able to decide whether or not mistakes have been made by the doctors or
dentists in executing their medical or dental disciplines. The MKDKI also executes sanctions
on those who are proven to have broken the disciplinary code. What is meant by violation of
medical disciplinary code? Doctors and dentist are considered to have violated the medical
discipline if they perform:

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ASIS DEELIP MIRCHANDANI Batch: 2011
07120110051 Date of submission: 25-10-2013

 They operate a medical practice incompetently.

 They don’t perform their professional duties and responsibilities (i.e. they don’t
achieve the standards of medical practice).
 They act inappropriately in a way that damages the prestige and honor of the
profession.

In recent years, the complaints of violation of medical disciplinary have increased by folds.
Most of the complaints have targeted the general practitioners. Some examples of violation of
the medical disciplinary conduct are: Complications due to surgery, economical minded
hospitals, lowered standard of health care in the practitioner’s room, dishonesty in the
operation of a practice, operating a practice with a physical or mental disability, making false
medical reports, rejecting a patient without valid reason, committing sexual harassment,
neglecting a patient who needs immediate treatment and etc.

What are the sanctions that are given to the doctors or dentist that have violated the medical
disciplinary? The MKDKI sanctions doctors and dentist that have been proved to have
violated the law. The sanctions that can be given are:

 The written warning

 The annulment recommendation of Surat Tanda Registrasi (STR) or Surat Izin Praktik
(SIP)
 The obligation to do education or training at the medical institution.

All the actions of the MKDKI are based on the 29th law in the year 2004 regarding health
practices.

This organization aims at giving a balance of support to the doctors and to the patients as
well. They view a complain objectively and investigate further into the case. Decision is
made based on evidences and discussions within the organization itself. In my opinion, this is
quite a good system as the doctors and the patients have an understanding of the objective
rules that has to be followed. If this system runs successfully, the quality of health services in
the nation automatically increases which in turn decreases mortality rate and etc.

A problem that arises in today’s world is however the increasing amount of hyperbolical
news and stories of the media. Hyperbolical in this context meaning an exaggerated fact
which may also have opinions (not necessarily true) in it. Today a doctor is just warned by
the MKDKI about his violation of the rules, the media already invades the privacy of the
doctor and branding him of malpractice actions. The media usually targets the stronger and
more educated group (that is the doctors and dentist). The encourage the mass to go against
the doctor pressurizing the MKDKI to take further actions on the doctor. In this matter things
become more subjective and influential rather than objective and factual. This is probably the

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ASIS DEELIP MIRCHANDANI Batch: 2011
07120110051 Date of submission: 25-10-2013

greatest disadvantage a health care provider faces in today’s world. Their conflict of being a
doctor, a human and even a well-wisher can cost them a legal action and them being sued
under the law and justice system.

A psychological study revealed that there might be some reasons as to why some doctors or
dentists violate the medical disciplinary standards. They are:

 Intense workload
 Rationalization
 Greed
 Lack of competency

CONCLUSION

With increasing health care services and doctors, the quality of these services must increase
as well. One such quality is the disciplinary aspect of the medical field. Since the last decade,
many complaints have come up targeting the general practitioners. It is important for these
disciplinary aspects to be maintained to maintain the standard of health services of the nation.
In Indonesia, the organization that controls the discipline is the MKDKI. New problems are
arising because of the media and the exaggerated response of the patients. New and long term
solutions must be found to further improve this aspect of health care.

SUGGESTIONS

 Improvement in the awareness of medical ethics, discipline and law. This can be
conducted as intense seminars by IDI ( Ikatan Dockter Indonesia)
 Developing of a reporting system of violation for the patients which is very accurate,
detailed and not misleading
 Increasing the evidence searching team, to make the decisions more objective and less
biased.
 Limit of media breach before the final verdict is being passed out to eliminate
influence of the masses on governing bodies.
 Avoiding collaborations with pharmaceutical companies which are the leading cause
of violation of medical disciplinary rules.