I’m a doctor. I’ve been a target of cyber-abuse for 6 years. Its time for our laws to change.

/ Dr Maxine Szramka / 8 Comments

Yes its true. I’ve been cyber-abused for 6 years. And I’m not alone.

Daily, doctors, health care professionals and other people are being abused, bullied, harassed and defamed online. These actions are unacceptable and remain unlegislated against, placing people, our health care professionals, in vulnerable positions of harm and potential harm, every moment.

As a doctor in our training 20 years (ish) ago, most of us knew nothing about social media, because, well, it didn’t exist. However, with the rise of the internet and social media the world has become a very different place.

We are fortunate in this society that we have laws that legislate against people causing direct harm to people through for example physical abuse, which is known as assault, or other acts of violence or murder or rape for example. Such acts that bring about gross harm to people ought rightly to be legislated against.

When someone physically assaults you, it is a one-off event,  defined by time, contained by the physical contact, even though the scars both physical and emotional can live for sometime until they are healed. Of course, assaults can be repeated, but the period of each assault is limited by time of physical contact and the physical presence of the person assaulting you.

However, with the unregulated and unlegislated internet, someone can abuse you online and the abuse is there 24 hours a day, in the work place, in your home, in your car, in the bathroom, everywhere, every moment of the day. There is nowhere you can go to escape the abuse as it is permanently there, for all to see, not just you. And as we know, abuse is there to incite others to further abuse and bring about harm, so it makes sense to consider that cyber-abuse is the modern day plague of public health. It is permanent 24/7 abuse, and you never know where the blow is going to come from or when.

At present in our unregulated internet anyone, anywhere, can write whatever they want about you, under the cover of anonymity, and even if they are not anonymous they can still write whatever they want about you as there is zero accountability for abusive actions online.

Despite the fact that most of us spend practically 24 hours online and much of our lives are online and we go online to research things, after 10 years of ‘social’ media, we still do not have appropriate legislation to prevent harm coming to people from the online environment. Continue reading →

Open Letter to the Medical Board of Australia: human rights violations in the proposed code of good medical practice

/ Dr Maxine Szramka / 6 Comments

In August 2018, Miranda Devine, a journalist, let the world know that proposed changes had been made to the Australian doctors code of good medical practice. We discovered that submissions were called for but were closing in just a few days. Changes that were being proposed intended to even more thoroughly clamp down and limit freedom the doctors have as ordinary people to express in public. Interestingly, most doctors were not aware of the proposed changes that were being made.

Here follows the letter that I wrote to them in response to their call for general comments:

Dear Medical Board,

I’m writing in response to the proposed changes to the medical code of good medical practice. I am the first person to stand up and say that we need a code of good medical practice, one that equally supports us as doctors and people as patients.

I regret to say that the current code of good medical practice does not perform such a function in its existing role, nor its revised form and in fact the revised form raises even further concerns regarding the protection of the fundamental human rights that all doctors as people ought to have honoured. It is our duty as a profession to take care of the people in the profession and people who seek the support of the profession equally so, as whilst we consider people disparate and separate then we are not supporting the health and well-being of the all, and this is patently seen in the statistics of ill health and misery that affect the medical profession. We as doctors who know about the association of cause and effect and environmental medicine scientifically know that there is no such thing as truly random. We all know there are occupational hazards related to poor working conditions which include the entire systems that people work in. Doctors, too, as people are affected by the systems they work in and their ill health reflects the poor health of the systems they are in.

The Code of Good Medical Practice reflects such a system as it is a foundation by which doctors are investigated and prosecuted. Continue reading →

My Health Records. Whose records are they anyway?!

/ Dr Maxine Szramka / 12 Comments

E Health Record adj

My Health Records. The name suggests that they are the record of the person about whom the records are being made. You. Me. But, is this really the case?

If the records were truly ‘yours’ or ‘mine’, then why are they compulsory with a huge rigmarole to go through to get out of them known as ‘opt out’?

We operate under the premise of freedom of choice in this country. However, it has been reported that once a record has been created, even if you opt out, the data will still be kept. To have a system where it is opt-out and a record is automatically created for all people and from which data cannot be deleted even if a person opts out of the system is a matter that fundamentally violates freedom of choice and autonomy.

Why keep data if the records are voluntary and the ownership of the patient?

What are the hidden agendas here?

There certainly are benefits to the notion of a shared health record. Patient convenience, results easily available for all carers who access the record. But we need to question, what data is being stored, and why, and what data is being and will be accessed, and by whom? Continue reading →

Are doctors allowed to have freedom of speech? Or do we need to be thought policed?

/ Dr Maxine Szramka / 6 Comments

hes got an opinion

Recently the code of practice of doctors proposed to restrict freedom of speech for doctors. Of course, such terms were not directly used in the proposition of the code, but in the newly introduced section of professionalism it stated that:

“Community trust in the medical profession is essential. Every doctor has a responsibility to behave ethically to justify this trust. The boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to acknowledge and consider the effect of your comments and actions outside work, including online, on your professional standing and on the reputation of the profession. If making public comment, you should acknowledge the profession’s generally accepted views and indicate when your personal opinion differs. Behaviour which could undermine community trust in the profession is at odds with good medical practice and may be considered unprofessional”

Where are the limitations in such a statement? And when is that possible, on twitter?!

When say, on twitter when discussing politics, or the finer principles of knitting or ironing – or football  – can we deliver the professions ‘generally accepted views’, and, why should we?

Who gets to determine the professions ‘generally accepted views’? And who should?

And since when does having a medical degree mean that you are no longer allowed to contribute to or participate in public debate unless it is ‘profession sanctified and sanctioned’?

Are we to now as professionals seek written permission from the board for any opinions that we have and espouse in public? On any topic? This is madness! And this is exactly what the wording of this section entails.

Freedom of speech is a fundamental human right that is available to everyone, and it is there for a reason.

Continue reading →

Are your goals limiting your well-being?

/ Dr Maxine Szramka / 1 Comment

Goal Kicking adjIn life, we are taught that having goals is a good thing that we should set them and we should and ought to aspire to them.

But have you ever considered the possibility that even doing such a thing as setting a goal is actually placing a limit on who and how you can be?

What happens when you get the goal?

How do you feel then?

And if you don’t meet the goal, then what happens to you, how to you feel?

If you’re like me, probably disappointed, and perhaps devastated. Sometimes we react in response to these feelings with either withdrawal or ramping it up and acting out and this can lead to uncaring behaviour which brings further harm to our bodies and our lives.

Have you ever considered the possibility that once you set a goal that it comes with a whole palaver of how you achieve that goal, when you achieve it and whether or not you achieve it?

Have you ever considered the thought that in the depths of your body there is a unique psychology that actually sets up a goal as something that is a limit, around which you base your entire life?

Thus, have you considered the possibility that by setting yourself a goal or a mile line or a timeline that you have set yourself up to fail? And that by setting yourself up to fail the true tragedy is that you don’t reveal who you are in full or what you are capable of doing?

We don’t think of this usually in society – but, what if there was far more for you and to you than that goal which you set? And that by setting that goal you have limited all that you can and will be? Continue reading →

Living with Heart in Medicine. Is it possible? Is it of benefit…

/ Dr Maxine Szramka / 2 Comments

Living with heart in medicine adj.jpg

In medicine we are taught to think and live life from our heads.

We are taught facts and figures, and we are taught to be rational.

We are taught to approach things logically, from our heads, and we learn to relate to people from our heads.

We are perpetually analysing data, from our heads, and we end up talking from our heads.

There is a focus on mental acuity, mental strength and mental perspicacity.

But given that medicine is people and people love and care from their hearts, then where is the focus on connecting with people from our hearts?

We all know deep within that love and care for people is the foundation of medicine and healthcare. Its absolute bedrock.

When we are ill, we do not crave our mothers or fathers to speak to us with mental acuity, or to rattle off facts to us about the latest studies. We seek to be met with their hearts, with love and care. And deep down this is what we all seek. To be loved and to be and to feel cared for.

Given that medicine is about people, and at our core we all seek to be loved and to feel cared for, and this is a vital part of healing and feeling well – then why do we not make this a focus in medicine?

Where did the heart of medicine go?

Continue reading →

Self-Care. The pillars of well-being

/ Dr Maxine Szramka / 3 Comments

Colonnade green adjIn steps 1 1a and 2 we discovered that self-care is about taking care of yourself in all areas of your life so that you feel amazing and have an amazing life. That we are here to thrive in life and not to survive in life. We learned that self-care begins with developing a way of being with ourselves and that every small change that we make that builds quality in our lives has a knock-on effect in other aspects of our life. We learned to start with what the biggest thing is in front of us and go from there.

If we understand that self-care is about taking care of ourselves in all areas of life, then what areas of life might that be?

In classical ‘work-life balance’ training we learn to separate work from something that is called life, but in truth everything is life and we take our quality and our sense of well-being everywhere, and our well-being is affected by how we are in all areas of life.

To develop a true sense of well-being we need to take care of ourselves in all areas of life, because it is ourselves and our bodies that are living in all areas of life.

If we are not well in one aspect of life, that affects all other areas of our life.

Deepening our self-care and our well-being is a continuous process of learning about ourselves.

To start to understand where we can learn and grow it helps to consider the different areas of life that are key to our well-being.

I consider that these pillars are: Continue reading →

Self-Care. Step 2.

/ Dr Maxine Szramka / 1 Comment

Red Rose Bush adj

Step 1 in self-care is knowing that self-care is about taking care of yourself in all areas of life so that you can feel amazing and lead an amazing life.

Step 1 a in self-care is knowing that caring for ourselves begins with a certain quality. It is not just about function it is about the way that we care for ourselves.

Step 2 in Self-Care is knowing that each thing that you do makes a big difference and that each small thing in life can have a knock on effect in other aspects of our life.

In the same way that when things go bung in our personal lives or in our professional lives, we know that other aspects of our life can be affected in the negative, so too when we make positive choices in our lives that can have a positive knock-on effect in other aspects of our lives.

For example if we decided to focus on one area of our life such as food and make changes there that nurture us and take care of us, then that quality will feed into other areas of our lives. Being hungry – or hangry –  does not help us focus at work!

Feeling nurtured and nourished with food helps the body feel settled. When we are settled, we are more able to be well in and with life, beyond meal time.

Have you also ever noticed how a good night’s sleep seems to make a big difference if there are problems or issues in life? Or made things that seemed so big and insurmountable, suddenly exactly that, surmountable? This is the example of the effect of quality in one aspect of life feeding quality in other aspects of life.

When we first start taking care of ourselves it can seem big and insurmountable and we wonder where to start!

The key, is to start with something, to start with what is right in front of you, and bring your quality and care to that area.

And then you will not only see benefits in that area directly, but you will also start to see knock on effects in other areas of life.

Continue reading →

Self-Care. Step 1 a.

/ Dr Maxine Szramka / 2 Comments

Red Rosesadj

Step 1 with Self-care is knowing that you deserve to feel amazing, and that it is possible to feel amazing AND still do your job! In fact, even better than before 😉 Working in daily stress and tension is not a prerequisite to being a health care professional!

Yes our jobs can be stressful and there are aspects of the day that will challenge us from time to time, but there is no actual need for us to live daily in misery and tension and feeling unsupported.

Whilst there are many issues with the health care system that are yet to be rectified, the good news is that the power is still within us to make the changes towards well-being to empower ourselves to still feel well within the system. And then in time, of course the systems do need to change.

Feeling well is not about putting up with the systems the way that they are and accepting abuse, far from it.

Feeling well is not to please the administrators or the bureaucrats who are now exhorting us to ‘be resilient’ and ’put up’ with the failures and abuses in the system.

Feeling well is for us, because we deserve it and we are worth it.

Who doesn’t want to feel well?!

Step 1a is developing our quality.

Everything that we do in life comes with a certain quality. It is the quality of people that we feel and appreciate more than exactly what they do.

For example someone can yell at you “you are amazing’ but if they are saying it through gritted teeth and are angry at you, you will feel the deceit in the words.

If someone says with openness and love and care you are amazing, you will feel the warmth and the resonance in their words.

If someone touches you on the shoulder and it comes with control or is imposing, you will hate the touch, but if someone touches you with care and is unimposing, you will feel loved and amazing.

If someone helps you adjust your clothes, or tucks you into bed with cold rush and frustration you will feel it and you won’t feel cared for even though you are having something done to you that is supposedly caring. If someone does the same action with a caring presence you will feel cared for with that action.

Thus, it is the same with ourselves.

If we give ourselves food and it is rushed and just on the go, we will not feel cared for. It will be a functional empty exercise. But if we prepare our food in a way that is caring, and eat in a way that is caring of ourselves, then we will feel cared for.

Taking care of ourselves means taking care of ourselves in all aspects of our life, but it is the quality in which we do this that makes the biggest difference. Continue reading →

Self-care. Where do I start?!

/ Dr Maxine Szramka / 4 Comments

Daffodils adjThere is a growing buzz word on the streets that is ‘self-care’. We as doctors now need to ‘self-care’. But what exactly does that mean?!

When I speak to most people, they like me years ago don’t have a clear understanding on what it is to take care of ourselves.

When I speak with people about self-care their responses are usually, after a prolonged pause and thinking along the lines of:

‘Pampering yourself from time to time’

‘Making sure you eat healthy’

‘Knowing when your mental health is bad’

‘Having hobbies outside of medicine’

All those things are part of self-care, but they are not the all of what self-care is.

Most of us know that when we are ill, we need to take care of ourselves and get rest.

But what if we took care of ourselves all of the time?

Might that change the quality of life that we daily live in?

True self-care is not just about what we do to rescue ourselves when we are blue and down and out, but it is about taking care of ourselves in all aspects of our lives so that we lead amazing lives, feeling truly well.

In Medicine, our concept of life is that we survive life, that we survive the day, that we survive the week, and thus it makes sense that when we consider self-care that it is something that we do the bare minimum to make it through the day, the week and the year without dying.

But if we shift our focus and consider that we are here to live truly well in life, to thrive instead of survive, then that shifts our focus on the way we take care of ourselves.

The way that we feel comes from the way that we live life, in all areas of our life.

There is no one area of our lives that we can compartmentalise as being separate from any other aspect of life. We are the same body, literally, in all of life. We all know how stress at work can feed into and affect our home life, and vice versa. Thus self-care is about taking care of ourselves in all areas of life.

Self-care is not just doing the things that function, it is about the way that we do things with and for ourselves.

Self-care begins with a quality. Continue reading →