Clinical guidelines sought to reduce malpractice

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)