Misunderstanding usually occurs because there is no effective and clear communication between the communicant and the communicator. But more than that, communication doesn’t only refer to the message that needs to be delivered, but also how we deliver it. This will give an impression for the recipient. If the impression received is bad, then it is possible for misunderstandings to occur, even leading to disputes.
On August 8, 2021, Kacapikir as an educational program from the Angsamerah Foundation has conducted a case study webinar entitled “A Study of Potential Disputes Between Healthcare Facilitators and Patients.” This webinar discusses a case told by a patient’s family regarding healthcare services at a healthcare facility.
The webinar started with a chronological recap experienced by the patient and family, moderated by dr. James Allan Rarung, SpOG, MM from the United Indonesian Doctors Association (Perhimpunan Dokter Indonesia Bersatu/PDIB), followed with an explanation by Dr. dr. Hj. Endah Labaty Silapurna, MHKes as Deputy Chair of the Indonesian Health Law Society (Masyarakat Hukum Kesehatan Indonesia/MHKI), up to an open discussion with the participants.
From the chronology presented, a 63-year-old female patient (late) has a 20-year history of Diabetes Mellitus and Hypertension. However, since a few years ago, the late patient had been complaining about experiencing shortness of breath and coughing at night. Because the late patient was a BPJS (Indonesian Health Insurance & Social Security) member and registered at a Puskesmas, she was finally treated and referred to Hospital A. After catheterization was carried out, the late patient was diagnosed with level 3 chronic heart disease and was advised to undergo cardiac bypass surgery (CABG – Catheterisation Coronary Artery Bypass Grafting).
According to the family, problems began to arise when the late patient was referred to Hospital A. The family felt that the services provided by the doctors and healthcare workers at Hospital A gave a very bad impression. Many irregularities were felt by the family in receiving services from Hospital A, even after the surgery was carried out and the late patient had to be referred to Hospital B which according to the family had worse service than Hospital A. The late patient finally breathed her last in November 2019.
Next, after the chronological presentation and explanation from dr. Endah, many participants were actively asking questions and giving responses in this case study. Likewise with fellow doctors who also discussed the perceived irregularities in the chronological presentation of cases, thus this could be a lesson, not only for the healthcare workers and providers, but also for patients and their families.
dr. Allan himself advised patients and families to be critical and actively ask questions, so that they could clearly understand the procedures that would be performed on the patient. Especially when they are about to undergo surgery, it is the duty of the healthcare workers and doctors to explain in detail the steps that will be carried out and the risks that may happened, therefore the patient and family can decide whether they are willing to undergo surgery or not. The patient or family has the right not to sign the informed consent (approval letter), and the patient also has the right to get a complete examination as needed.
In the (Indonesian) Law no. 44 of 2009 concerning Hospitals, it is fully explained about the rights and obligations of patients and hospitals. Whenever the patient or the patient’s family feels that there are rights that are not obtained, it can be reported to the hospital first to find a solution in order to prevent a dispute. “The hospital definitely wants to provide the best service, so if anything happened, we must submit complaints both to BPJS and the hospital. Communication is necessary between every element, either hospital management, healthcare workers, BPJS and patients,” explained dr. Endah.
dr. Endah concluded several points on this case study webinar:
- If a case like this occurs, the patient or family can make a request for mediation to the Indonesian Doctors Association (Ikatan Dokter Indonesia/IDI) so it can be processed accordingly.
- The importance of knowing the legal aspects (rights & obligations) between doctors – patients and also patients – hospitals.
- The importance of effective IEC (Information Education Communication) from all related parties.
- It is important for healthcare workers to implement the SOPs and policies that have been regulated. These policies also need to be evaluated and adjusted to the real conditions on the ground.
- The need for clarity in the informed consent to be signed by the patient’s family.
As the founder of Angsamerah, dr. Nurlan Silitonga also shared her experience as a patient which led her to conclude that the majority of patients in Indonesia often feel inferior. dr. Nurlan suggested for all of us who are patients of healthcare services to be able to focus and digest the messages delivered by the doctors properly to prevent any regrets in the future. dr. Nurlan thinks that patients should be taught to be brave enough to express their doubts as well.
What must be considered in providing healthcare services is the attitude and ethics towards patients and their families. So as healthcare facilitators, we must be able to communicate well and have empathy in order to prevent disputes. This is also why training and education is very important for healthcare workers. Angsamerah as a primary healthcare facilitator always prioritizes a safe, comfortable and friendly service for patients and families.
However, keep in mind that in this case study, the chronology presented was only taken from the perspective of the patient’s family without any clarification from the healthcare facilitator. It would be so much better if cases like this were seen from two different perspectives, namely the patient – family and the healthcare worker – hospital. In this way, reliable conclusions can be drawn and appropriate solutions can be found.
Hopefully, through this case study, we all get valuable lessons and able to prevent the same incident from happening again, thus we can improve the quality of the services, especially during the current pandemic where the need for healthcare services has increased drastically.
Re-watch the case study webinar “Studying Potential Disputes Between Healthcare Facilitators and Patients” (Sunday, August 8TH, 2021) on Angsamerah’s YouTube channel.