Clinical guidelines sought to reduce malpractice
The Jakarta Post, Jakarta
Experts have called for standardized national clinical guidelines in an effort to reduce the number of cases of malpractice as well as to keep medical practitioners updated with the latest medical developments.
"Right now we have to follow different sets of procedures when we want to practice in different cities," a fresh medical graduate of Airlangga University, Linda Astari, said on Saturday.
She explained that each public hospital in every city had their own procedures in handling different clinical situations.
"If I practice at Dr. Soetomo General Hospital (in Surabaya, East Java), I have to follow their local procedures," she said. "It will be another set of rules in Malang, for example."
Linda suggested that a national guideline would help doctors, especially new ones like her, to have a single reference to deal with clinical cases. She admitted, though, that it would be a daunting task to reach a national consensus.
Clinical Practice Guidelines (CPG) are systematic procedures based on best evidence that assist practitioners and patients in making decisions about appropriate health care.
"CPG can assist even busy clinicians to make clinical judgments that will adapt to patients' conditions, circumstances and choice of treatment and reduce malpractice," Malaysian Ministry of Health health technology assessment unit head S. Sivalal said in a national health seminar in Jakarta on Saturday.
Sivalal explained that the use of CPG would reduce variation in the quality of health care delivery, replace unproven methods with proven ones as well as help achieve maximum cost benefit.
Malaysia has developed its CPG, although it has yet to make it mandatory. Several developed countries, such as the United Kingdom, France and Germany, have made the procedure obligatory for all medical practitioners.
To date, Malaysia has developed specific CPGs on childhood immunization, rational utilization of antibiotics, management of diabetes, obesity as well as dengue fever in children.
The guidelines are formulated through a mechanism of defining a specific issue, retrieving and critically appraising relevant literature and analyzing evidence (cases) to develop patient- oriented guidelines.
"CPG should be patient-oriented instead of disease-oriented," he said. Guidelines taken from different agencies should be taken into consideration in addition to local epidemiological data, clinical patterns as well as cost.
Documentation of guidelines has been found as far back as ancient Egypt and Greece, he added.
Sadly, Indonesia has yet to formulate standards -- moreover legally binding ones -- of medical and hospital services or a professional code of conduct, Indonesian Health Consumer Empowerment Foundation chairman Marius Widjajarta told The Jakarta Post.
"The drafting of government regulations on such standards started nine years ago, but we have not seen any of it enacted into law," he said.
Marius pointed out that with clear legal standards, both patients and medical practitioners would benefit as there would be a publicly known definition of malpractice, accidents and negligence.
The Indonesian medical service is annually confronted with thousands of complaints which are difficult to define as malpractice or accidents, he said.
The fact that the quality of medical services is being questioned in the country is leading to a loss of confidence in domestic health care.
Singapore recorded up to 40 percent of some 200,000 foreign patients in 2002 from Indonesia, while, the Malaysian Tourism Board recorded that 45,503 Indonesian patients had chosen hospitals in the neighboring country in 2004.
"It should be this government's commitment to pass the draft of the standards into legally binding regulations if we want to keep up with the quality of medical services of our neighboring countries," Marius said.(003)