Friday, November 29, 2013

The End of Impunity Era for Doctors?


Following the arrest of their fellow practitioners over malpractice charges by the Supreme Court’s ruling stemming from the death of a young mother during a ceasarian section, waves of protests sent ripples throughout the nation. The medical community staged a rally to support their fellow members, demanding the ruling to be reviewed and the doctors be freed immediately.
They feared the verdict would provide legal basis to criminalize doctors if a patient dies in spite of their best efforts to uphold the highest standard of ethical conduct to save patients’ life. For that reason, they were demanding legal certainty and security while carrying out their medical practices.
The Supreme Court found the three doctors; Dewa Ayu Sasiary Prawani, Hendy Siagian and Hendry Simanjuntak, guilty of negligence resulting in death and sentenced them to ten months in prison. They failed to receive the written consent of the family or patient before conducting the surgery. It was the duty of doctors to warn patients and families of known risks of a procedure or course of treatment, popularly known as the duty of informed consent. Further aggravated err; they forgot to check the patient’s vital signs with an electrocardiogram (EKG).
In their defense, they argued they had done their best efforts to save both mother and child. Sadly, the mother died of heart failure by a gas embolism. There was obviously a difference between deliberate acts of malice and non-intentional mistakes, even though the outcome is fatal in both cases.
They tried to save life, and not to take it. This difference means that they should be treated completely differently and not be criminalized. The case criminally charging the doctors over an error in administrative procedures is feared to drive doctors away from the practice of medicine or interfere with patient treatment and safety, some argued.
As a result, the prospect of going to jail for something they did while trying their best to treat a patient, will affect treatment decisions and hinder improvements in care.
Meanwhile, some legal experts say the verdict is a way to root out harmful errors. It’s also handed down by a judge with high judicial integrity whose decisions are perceived as accountable and just.
This is to say that the professional class of doctors do no longer possess any impunities if found guilty of negligence and malpractices towards patients and which leads to a trial in a court of law.
In addition, most patients do not have the knowledge to notice whether doctors have properly diagnosed or treated their illnesses. Some have the courage to lodge malpractices allegations, and end up waiting to settle out the court. But many just accepted their ‘fate’ as the will of God.
Consequently, most cases of malpractices went unpunished because some said due to “the conspiracy of silence “demonstrated by doctors. That is almost gives the medical professionals with impunity. Hence, the ruling is extremely rare and possibly unprecedented in the medical community in this nation.
Nonetheless, the growing unrest among medical community is perfectly understandable as medical negligence or misadventure was and still remains a serious concern all over the world, including in the developed countries. As in the case of euthanasia and abortion, these problems have been one of the most debatable issues of controversy in the United States and other developed countries over the past decades. It is not just a medical ethical problem, but also having legal, philosophical, religious and political dimension.  
For me personally, I have mixed feeling towards this uproar. I have my own bad and good experience toward doctors. Many do their job great. The patients’ well-being and life is their number one priority. Only few dare to perform reckless medical decision-making, and if such happenstance takes place, it usually relates to financial circumstance; the poor uninsured patient often receives poor-service.

Recently my dad was admitted to the intensive care unit at our local hospital in Solo in the dead of night due to hemorrhagic strokes (bleeds) resulted from a weakened vessel that ruptures and bleeds into the surrounding brain. His whole body paralyzed. He suffered difficulty to breathe due to lack of oxygen flowing to his brain. He was pale as a corpse.
Once he was admitted to an emergency room. The health personnel there without delay provided their best health care treatment to save his life. Once, he was stabilized, the nurse escorted my family to settle the administrative and financial procedures for the next stage of an in-patient admission.
“Saving life priority over financial hurdle” demonstrated by these health personnel had saved my dad’s life.
Another completely opposite story disclosed by one of my colleagues. His father suffered similar attack. Yet, before admitted to the ER, the health personnel requested him to provide legal guarantee of who would cover the medical expenses. Once this was settled, then the patient was treated accordingly.
Many poor families do not have such basic needs of health access due to financial constraints. Often, such patients lose their life unnecessarily because they do not receive proper medical treatment they urgently need. “Financial provision is above the life saving policy.”
So, in my opinion, the verdict of criminally charging the doctors can be a good start to advocate for legislative reforms to define criminal conduct and prohibit the criminalization of health care decisions made in good faith, including cases involving allegations of medical malpractice.
The rules should be clarified. If malpractice is discovered, they should be punished accordingly. And if they had worked in accordance with the high standard medical procedures, then they should walk free.


Saturday, November 16, 2013

In Pursuit of Happiness over Promotion

I was struck by my friend’s plain matter-fact question related to promotion over lunch. I slightly raised an eyebrow.

“I have been working head to toe for about eight years with absolutely nothing to show for it. I thought that would secure me a promotion as a reward. But look at me now, still miserably at the same old spot. What have I done wrong? Was it because I come from second class job career path?” He blurted out in anger, then slumped down into the chair. His shoulders slumped forward in disappointment.

I held my breath, thinking to say something genius or just trying to find ‘proper words’ as not to offend him. I offered him a look of sympathy. In the end, words failed to materialize and we lost in our own thoughts.
He is one of the many people graduating from college with idealistic notions that being brilliant at college, then great at job would guarantee them a place in the corporate sun with their company. Reality often feels like a slap on the face.

He failed to notice that promotion is a tricky mix of advanced interpersonal skills, self-marketing, competent work, responsibility, strategy and sometimes ‘connection’. Missing any of these elements, you might end up working for ages for a company and never receive the promotion you deserve.

Being great is not enough. I know he’s great at what’s he’s doing, surpassing his team’s expectation. Unfortunately, he lacks of advanced interpersonal skills and rarely markets himself. Consequently, he becomes a shining diamond in the deepest end of the ocean. No one notices him, as he never comes to the surface of the deep ocean.

Another friend of mine had promotion recently. Oddly, she was not happy at all about it. She stubbornly said she wish she could turn back the hand of time.

“Congratulations! You’ve been promoted! Oh… um, by the way, we’re sorry we’re not going to pay you another nickel, even as you take greater responsibilities, work longer hours!” She said cynically, a flicker of fire lit in her black coal eyes.

I gaped in surprised. My jaw dropped. Are you kidding me? Seriously?

She rolled her eyes, annoyed and irritated.

I recollected myself and smiled awkwardly before giving her a sympathetic friendly embrace.

I view this jarring scenario as having an air of unreality about it. It’s hard to believe that something like this is happening. Then, a bitter recollection emerged on the surface of my consciousness. I have suffered similar scenario, well although it was not as tragic as that of my friend.

So, I should have known. It’s an ordinary reality. With so many workers running scared these days and job seekers flutter around in abundance, promotion-without-a-raise is a gambit some are forced to reckon with.  
Recounting these two tales, I smile lightly. I always have this silly motto that often invite criticism and skepticism from my colleagues, “I don’t want to go after promotion as long as I have decent job to feed my family and a handful of smiles from friends that keep me happyJ. Do the best and let God do the rest.”

They called me a pessimist, having no big dream at work. In my defense, I told them I was more interested to pursue happiness over promotion.

 Getting my head bald for working tirelessly to get promotion is absolutely not in my list . It’s enough having spent most of my precious time on clogged streets. There’s no room left for frustration of such silly promotion, lol. What matters is landing on the job I love that I’ll never have to work a day in my life, lol.

I remember once a renowned Indonesian author of short stories, essays, and movie scripts, Seno Gumira Ajidarma, said in his “Menjadi Tua di Jakarta” (Becoming Old in Jakarta):

"Alangkah mengerikannya menjadi tua dengan kenangan masa muda yang hanya berisi kemacetan jalan, ketakutan datang terlambat ke kantor, tugas-tugas rutin yang tidak menggugah semangat, dan kehidupan seperti mesin, yang hanya akan berakhir dengan pensiun tidak seberapa." 

"How terrible it would be to grow old with memories contains only road congestion, fear of coming late to the office, soulless routine tasks, and  a machine-like life, and  only end up with meager pensions."


Blood for Life

http://www.thejakartapost.com/news/2013/11/01/citizen-journalism-let-s-donate-blood.html

Arriving early this morning, I saw hundreds of people lining up to donate blood. There was a spark of joy in their eyes, full of enthusiasm to save life. Despite the long queue, they seemed eager to contribute.

Ibu Ani was one of dozens of volunteers who participated in the three-day blood donation event held by Bank Indonesia annually, in cooperation with the Indonesian Red Cross (PMI). She said it was her second time to donate blood. Asked the reason, she said it was the least act of charity she could make, a noble cause to save life.

“First time, I was afraid it would hurt and affect my health. To my surprise, it was easy and painless. I felt healthier afterwards. And I always get a goodie bag in return.” 

I knew the organizing committee always offered attractive gifts to attract more donors, from cheap smartphones to traveling bags. It is always a great success. 

According to the PMI, there is always a constant lack of blood despite the vigorous campaigns for blood donation. Indonesia needs to recruit more that 4.8 million regular blood donors annually, about 2 percent of the total population. However, only 3.5 million blood donations can be collected on a regular basis because so few people are aware of the importance of giving blood. 

This leaves a staggering shortfall of 1.3 million donors-worth of blood supply, preventing a substantial amount of life-saving blood transfusions. The PMI along with various institutions hold blood drives regularly to cope with the shortage. 

Blood centers around the country are increasingly relying on small tokens of appreciation — gift cards or goodie bags — to entice blood donors. At a time when fewer people are giving blood, these gifts can often lead to more donations, at least in the short term. 

I remember three years ago, my cousin suffered a severe hemorrhage after giving birth to a baby girl. Her face was ashen-white, as if a ferocious vampire had drained her blood.

Her doctor said she needed a blood transfusion immediately at least five ampoules (blood bags). The hospital could only provide three ampoules so we needed to immediately find blood donors to make up the shortfall.

Thank God, my aunt had a matching blood type. Some of the neighbors also volunteered to donate. It was a critical situation of life and death. We still regard it a miracle to get her back alive after such a crisis. It was indeed a gift of life. The experience relates to the idea that saving a life without doubt incites a feeling of heroism. 

In addition, the success of major medical operations is not without the essential, though often overlooked foundation: blood donors. What’s more is that research findings have discovered donating blood can help reduce the risk of heart attacks and cancer; and be beneficial for weight watchers as people burn up 650 calories with every pint donated.