Society

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 →

Health Care Reform. When do we need it, and how?!

/ Dr Maxine Szramka / Leave a comment

Burnout matchesFirst published in the European Medical Journal October 18 2017 I re-publish it here:

The buzz on the streets across the world is the need for healthcare reform. The costs of healthcare are exponentially skyrocketing globally and the rates of illness and disease are increasing, with mental health and chronic pain being in the top 5 causes of disease burden globally. Of the world’s population, 95% have some form of illness during the year; furthermore 81% of people with 5 or more health conditions are below the age of 65.1 The rising rates of chronic, non-communicable diseases across the planet are so rampant that the World Health Organisation (WHO) has labelled this as an epidemic.2

Globally, healthcare systems are struggling to cope with the burden of illness and disease they are faced with; the costs are expensive for healthcare organisations, governments, as well as consumers.

In today’s constrained financial times, the focus of healthcare reform has been on cost (including the cost of personnel) and how the cost will be sustained.

In the NHS, systems are stretched, with large numbers of staff leaving to work in lesser skilled roles for the same level of pay.3 The remaining staff are left in the tricky situation of coping with the high patient load with reduced numbers of colleagues.

In the USA, managed care has rationalised the delivery of healthcare with a focus on electronic health records for billable items, patient satisfaction, and business outcomes. This focus means professional autonomy has never been lower for healthcare professionals.

At the same time, the health and well-being of the medical professionals has reached an all-time low with burnout rates of more than 50%,4 rates of anxiety and high psychological distress greater than that of the general public,5 and suicide rates and suicidal ideation far higher than the general public.

The combination of these statistics highlights the potential difficulties associated with mental health faced by those in the medical profession and perhaps represents the tip of a growing iceberg.6 Continue reading →

Why do we make education hard?

/ Dr Maxine Szramka / 14 Comments

I spent a LOT of time in education. I have spent a LOT of time reading books trying to learn things. I studied medicine, which is lifelong and ongoing study. I’m still studying, all of the time in fact!

The language that is used in education is extremely complicated. We are taught with complex words delivered in complex and uninspiring ways. I have spent countless decades trying to survive, yes survive the most tedious and boring lectures and I know I am not alone here.

Who decided we needed to make learning boring and hard?

At what point does learning stop becoming fun and interesting and becomes some onerous boring chore of a task?

When we are small, we enjoy learning. It is a joy to learn new things about life and the world. Learning is made fun. We have fun learning new things, like…. walking, where the parks are, what animals are, and what our foot tastes like when we put it in our mouth…..

Adults do their best to support kids to learn. Toys are designed to make learning ‘fun’ for children. Things are kept simple.

But for adults? Is learning made fun? Even in high school?

At what age is it ‘right’ and decided to take the fun out of learning? Continue reading →

Medicine in the age of technology. Does the personal matter?

/ Dr Maxine Szramka / 5 Comments

There is much talk about ways we can reduce the costs of health care and to ‘streamline’ health care. There are some conversations that are happening about people putting symptoms into machines to generate diagnoses and then generate a treatment algorithm instead of seeing a doctor. This would of course make the cost of health care cheaper by eliminating the role of the physician, but is this really the best practice of medicine?

Can computers and algorithms really replace the role of doctor, or even nurse?

Even if it would reduce ‘costs’ by eliminating the personal contact in medicine, is this really the way forward in medicine?

Would it offer better patient ‘care’?

Would it even offer better patient ‘diagnosis’?

Many patients come to see me having put their symptoms in a symptom checker online only to be freaked out by the potential of multiple serious diagnoses, only to then find when they see me that they have something quite simple and nowhere near as severe as the symptom checkers had lead them to believe.

It takes skill, connection and experience to diagnose what is happening in a person as no two people have the same presentation of an illness and disease.
Continue reading →

The Silence of the Profession

/ Dr Maxine Szramka / 12 Comments

Many of us in Australia will remember an ad for toothpaste in the 1990s where a man (with a great toned and tanned upper torso mind you) has his back to us whilst he is facing the mirror brushing his teeth. We are told they can’t show us his face, because he is a dentist. Apart from learning about this particular brand of toothpaste (?!) we learn from this that medical professionals are not allowed to be seen in public.

For me this is a great adage of the medical profession where there is some strange notion that we should be neither seen nor heard, and this extends to many in the profession who feel constrained to be seen as a person in public, or to have and voice their opinion in public for fear of being hauled before the medical board, or having their reputation as a doctor undermined or destroyed.

Many doctors will not be on social media, have blog sites or websites, and do not want to have themselves in the public eye, lest something ‘go wrong’ and their reputations be destroyed.

But lets consider this.

Does this even make sense?

Why is it that we would feel that being seen as the person that we are would possibly get in the way of people respecting us professionally. And why do we seek so much to separate the two? Are we really such a Jekkyl and Hyde? Are we one person at work and then some strange demonic being in our private lives that we would not want anyone to know about? Surely not… Continue reading →

Why do we have laws?

/ Dr Maxine Szramka / Leave a comment

When we consider ‘the legal system’ as people who are not trained in the law, we naturally consider that the policing and the legal system are there to uphold our rights as citizens, to keep us safe from harm. We consider that the legal system and the laws are founded on some notion of truth, keeping society safe and true to what we all innately know are universal human values, of truth, decency, and respect. We know that we need order in society and that order needs to be founded on these key values, as it is those key values that underpin the functioning of society.

Yet when we turn to the legal system when something goes wrong or we are harmed, do we find consistency clarity and true support and laws upholding truth? Or do we find confusion and at times the protection of the rights of abusers in society? Certainly when you turn to the law with respect to cyber abuse, you find that the ‘rights’ of people to abuse and lie about people online are well and truly protected, particularly in Australia at the moment. Anyone who has had dealings in property realises that contracts do not necessarily endorse that which is decent or true.

How can this be so?

Continue reading →

Are we really civilised?

/ Dr Maxine Szramka / 3 Comments

At the moment in Australia and much of the West, we say that we are a civilised society. After all, we wear clothes, well, most of the time and go to work in offices, we have running water, toilets and live in houses which (usually) have roofs, walls and windows. We have television, electricity, cars, public transportation – of variable efficacy – we have family units, schools, education systems, the internet, hand held mobiles, small computers, big computers, shops, money and banks. We have ‘art’ and we have ‘music’. But are these the things that make us ‘civilised’? And to what are we comparing ourselves…

What is it that makes us civilised? Is it our ‘mod cons’ and the fact that perhaps we wear more clothes than what used to be termed so called ‘primitive savages’ ie the apes or early man? Is it because we have less body hair than the animal kingdom? Or is it because we have and live by certain values?

Surely it is the values that a society live and work on that are the foundation of a true society and surely a true civilisation is one where people live and work in harmony and love together? And thus is it not civilised to be loving and to treat people with decency and respect? Continue reading →

Refugee – or Person?

/ Dr Maxine Szramka / 13 Comments

There is a lot of talk in the news at the moment about ‘refugees’ and whether we should ‘take them’ or not, or intriguingly, whether perhaps we should only ‘take’ ‘Christian’ refugees…

But you can’t brand people.

People are people.

They are not a culture.

They are not a religion.

They are not a headscarf or fashion sense.

They are not a race.

They are not a country.

They are not a language.

They are not a ‘refugee’. They are a person.

We are all human beings.

We are all people, and the notion of putting boundaries, barriers and borders between us all is somewhat ludicrous. For starters, people do not actually own the land or Earth. Earth was not created with crazy outlines of borders between ‘states’ and ‘countries’ to be fought over. Earth itself is unified. Continue reading →