Bedah Buku: Evidence-Based Practice: Menjembatani Kesenjangan antara Penelitian dan Praktik dalam Pelayanan Kesehatan
Buku ini merupakan karya Prof. dr. Moh. Hakimi, Sp.OG(K) PhD. Latar belakang penyusunan buku ini ialah penulis berharap dokter dapat memberikan bukti terbaik untuk pertanyaan klinis atau evidence based. Selain itu, praktisi kesehatan tidak memiliki cukup waktu untuk membahas satu hal. Evidence based ini menggantikan paradigma lama yaitu praktek kedokteran yang didominasi pengalaman atau experience based practice. Awal tahun 80-an, ada paradigma baru yaitu praktek kedokteran harus berbasis bukti, kita tidak lagi menekankan intuisi. Mengapa hal ini penting? Jadi, hal yang kita (dokter-Red) lakukan sudah diteliti dan terbukti bermanfaat. Praktisi kesehatan abad 21 harus memahami kosa kata baru di evidence based practice. Praktek kedokteran merupakan praktek seumur hidup atau selalu baru, ada pengetahuan, tata cara, harapan, jadi kita perlu melakukan yang terbaik untuk pasien, kita perlu dokter yang mengevaluasi diri dan meningkatkan kompetensinya dengan banyak sumber terbaru. Selain itu, dunia kedokteran atau kesehatan kita membutuhkan Kemkes yang mendukung, misalnya dengan berlangganan Cochrane Library seperti yang sudah dilakukan Malaysia. Tidak heran, banyak warga Indonesia yang berobat ke Malaysia berkat perkembangan tersebut.
dr Mubasysyr Hasanbasri, MA sebagai pembahas dalam acara ini menyatakan, praktek kedokteran ialah praktek yang mengobati. Poin pertama yang disampaikan pembahas, FK sendiri ingin dokter berbasis pada science. FK mempromosikan agar ide ini terjadi, namun, banyak juga dokter yang tidak berfokus pada evidence tetapi berfokus pada obat. Poin kedua ialah konteks buku ini di Indonesia, provider pengobatan bukan hanya dokter, malah lebih banyak yang lain. Praktek pengobatan yang tidak berbasis science ini harus diamati, agar lebih berhati-hati. Hal ini diperparah sayangnya masyarakat percaya dengan iklan seperti 'kesembuhan' dari pengobatan alternatif. Jika secara professional, maka pemberi layanan akan disumpah demi kepentingan pasien. Namun sayangnya, Kemkes membiarkan praktek ini, sementara dokter ingin masyarakat lebih peduli dengan praktek pengobatan. Misalnya negara tetangga yaitu Malaysia, standar pengobatannya sudah terbuka. Poin ketiga ialah tanggung jawab perguruan tinggi (PT) bagaimana membangun mahasiswa sebagai professional. Jika ingin mengkaji evidence, kita bisa menengok situs Cochrane. Evidence yang ditemukan Cochrane, lembaga yang mengkaji mana yang paling kuat dari banyak hasil evidence/penelitian.
Diskusi:
Nurjayati (Perpus UGM), treatment sakit di Belanda yaitu hanya diberi saran untuk beristirahat. Apakah psikologi masyarakat kita yang jika tidak diberi obat, maka akan sembuh sendiri atau sembuh karena sugesti dokternya?
Prof. Hakimi menjawab banyak dokter yang praktek menurut keyakinan masing-masing. "Nah, hal ini yang harus dikurangi melalui praktek berbasis bukti", tambah Hakimi. Jadi kondisinya, sistem pelayanan kesehatan dan praktek kedokteran yang sudah berbeda. Sistem pembayaran di luar negri dibayarkan oleh pihak ketiga. Perilaku dokter harus diatur dalam peraturan yang jelas, namun hal ini belum diatur di Indonesia. Dulu, dokter adalah dewa yang menentukan segala-galanya. Di era ini, dokter harus menjelaskan masalah dan memberi beberapa opsi pemecahannya.
dr. Mubasysyr menyatakan banyak faktor yang mempengaruhi, misalnya ada pihak farmasi yang mensponsori. Lalu keadaan ini diperparah dengan perlindungan konsumen yang masih buruk. Menuruut hemat saya, karena ini menyangkut hak asasi yang kuat, kita perlu membuat dan menegakkan legalitas obat, ungkap Mubasysyyr. Kemudian, Prof. Hakimi menjelaskan bahwa melalui The Cochrane Library, kita bisa cek obat yang kita konsumsi sesuai atau tidak. Harus ada pmberdayaan pasien.
dr. Mubasysyr menambahkan jika ada sistem kesehatan yang baik, pelayanan Negara kita bisa meningkat kualitasnya. Pemberdayaan masyarakat perlu kita lakukan dan ini bersifat kolektif, kita perlu melahirkan public health advocacy. Prof. Hakimi menegaskan perilaku dokter dan pasien yang tidak professional, banyak juga pasien self doctoring dan konsultasi ke dokter google. Watchfull waiting- menunggu tapi waspada, itu yang sebaiknya kita lakukan saat belum memutuskan tindakan medis apa yang diambil untuk kita atau saudara kita. Ada dokter yang terlihat sibuk sendiri-sendiri. Kita harus cari second opinion, dokter spesialis selalu mencari second opinion ke teman sejawatnya. Kita ada catatan RS yang bertanggung jawab itu. Malaysia dan Singapura, mereka lebih update dan ini bukan suatu hal yang aneh jika masayarakat Indonesia banyak yang berobat kesana. Maka, pekerjaan rumah kita ialah kepercayaan masyarakat harus diperbaiki. Belajar dari praktek di negara maju, kita bisa melihat statistik, mana RS yang melakukan operasi tertentu. Jadi kita bisa memilih, poinnya RS itu akuntabel bisa membangun kepercayaan.
Diskusi:
Sinse dan refleksiologi, bagaimana jika dilihat dari kacamata medis?
Prof. Hakimi menyatakan dua hal tersebut sudah diterima di Barat, asal aman, tidak apa-apa.
dr. Mubasysyr, menegaskan masalah dosis itu yang tidak jelas untuk oengobatan alternatif. Saya menganjurkan kita harus tahu obat tersebut dan kontennya. Lembaga pengawasan obat di Amerika, dan jika diteliti maka benaritu berbahaya. Kita harusnya meragukan. Kita ada di lautan pengobatan yang luar biasa, pengawasan obat dan provider layanan tidak jelas/tidak ketat.
Kesimpulan: kita harus mewaspadai praktek pengobatan yang tidak berbasis keilmuan dan kita harus mencari evidence sendiri. Semua harus ada bukti otentiknya.
Video Rekaman
SESI I PART I
SESI I PART 2
SESI II PART 1
SESI II PART 2
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