Nhs students and lack of consent.

I'm fine with it almost all the time, no matter the intimacy of the medical situation. Times I'm not fine with it would be more to do with if I was feeling somewhat fragile at that time. I do agree that it is very important that students are able to learn. I want them to learn. I sometimes deliberately raise (relevant) things with the main medical practitioner specifically so that they can learn (I have multiple long term health conditions).

BUT I will NOT put up with a lack of asking for, and obtaining without pressure, appropriate consent. I may allow them to stay, or I may not, but I will jolly well complain at some point, at the time or later, depending). Because others may not feel able to do so and I want to try to effect a change to how it should be.

And no, btw, NHS medics & allied professionals: you do not "consent people". You "ask for their consent" and give them enough time and information to give it (or not as the case may be), allowing for the urgency of the situation obviously. For anything that requires consent. No matter how busy you are. It's fundamental.

OP YANBU.

I wonder if having a student present at a GP visit affects the outcome. A GP at my surgery made a stupid and possibly life threatening desision. I wondered if he stuck to the rules or guidelines as she was present instead of doing the obviously right and logical thing going by my symptoms. I ended up in A and E next day in a life threatening situation. I regret not arguing with him at the time but I was too ill to.

Unlike the pp with raised hackles, mine are not because the descriptions of bad practice on the thread don't apply to my family member, she's compassionate and kind and treats her patients with kindness and respect rather than entitled contempt.

I don't understand why someone's hackles would be raised if their kid doesn't display the attitude and behaviour being discussed. It would be like me taking comments on a thread about aggressive police officers and then applying them to my non aggressive police officer child and taking it personally.

If you don’t want a med student to take an active part (or even a passive part) in your procedure or appointment, then you could tell your team that you aren’t comfortable with them.

I’ve had some pretty gnarly procedures (at a teaching hospital), whilst I am always happy to have a student midwife, nurse or doctor present, there were plenty of signs around staying if you aren’t happy to have students in your appointment you could tell your medical team.

I do agree that you should be asked if you’re ok with having students present. Personally, I’ve always been happy to give consent. Most of the students at the local teaching hospital were postgrads (alas the hospital was absorbed into another & closed), but there were occasional 18/19 year old (particularly nursing) students on the wards & in out patient appointments. Regardless of their speciality or role, I’ve found all students respectful & courteous.

I do come from a background of teaching though, so I can appreciate the benefit of real life teaching opportunities. If you’re not happy with it, speak up.

At my last appointment the door was open because of covid I wish they had asked if ok. I get there was me, student and Dr in very small room and open to a corridor rather than waiting room. But was going though personal health information. The Dr was a bit wooden at least the student seemed sweet.

@BarrowInFurnessRailwayStation Sadly, I see this too

Patients should be the central focus. Not doctors or nurses.

I find it's a culture problem in the NHS. We're supposed to be eternally grateful for the fact that we're being seen and to humbly defer to them over every aspect of our health.

I’m appalled at what you’ve gone through OP. Entirely unacceptable. I’m also appalled at the number of posters here who seem to need to tell you how it wouldn’t bother them and to ask you how you expect medical staff to learn. Well clearly that answers their own question.

You should not have been put in this position even once and if I were you I’d complain now, otherwise your hospital won’t learn about consent, proper treatment of patient privacy and the need for women to be able to relax for certain procedures.

@RedToothBrush In care work there’s something called Person Centred Care and it’s quite a big deal. I don’t understand how it doesn’t exist in the NHS. The NHS seems to need patients to protect it instead of vice versa.

Everytime there has been a student present I have been asked if I'm OK with it. I usually say it's fine as it has never been during something really personal. I think that is awful they didn't ask for consent when having your baby and it meant you didn't have any support because the midwife was helping the student. I would make a formal complaint.

To all complaining about consent do you realise it means to allowing procedures as well as students. For example if you go to see your GP because of some infection and he says 'I see you haven't had your flu vaccine , I'll do it now. You can refuse to have it if you don't want it. I'm type 2 diabetic and the nurse specialist at my GP surgery does my checks eg BP, foot health etc and then says hop on the scales , I always refuse because I don't want to know what I weigh and I certainly don't want there to be a record of it in my notes . Most people are like sheep and do what is requested of them .
Even in hospital consent can be implied consent . You get admitted , the nurse asks to check your BP. You agree to it thus giving implied consent . Every nurse might ask permission to do it every time but some might not as they can see by your charts that you haven't refused so far therefore 'implied consent'

The raise the heckles post says rather more than it should.

It says that the needs of the student are the central priority and that patients should serve them.

It has a disregard for anxiety being a medical condition and instead throws the shite about 'bravery' about in order to try and shame patients.

All because darling child might not get the prime education and opportunity see the textbook cases they want to observe for their portfolio.

The whole thing dehumanises patients and is utterly disrespectful to their needs. It reduces them to little more than a body rather than an individual.

And do not get me started on the crap about how patient should do x to stop it happening when there are numerous posters saying they aren't being given the opportunity to or are outright ignored or blackmailed if they quest it.

Patients should be the central focus. Not doctors or nurses.

This is about trust. If people don't feel comfortable with it, then they have a trust problem or a dignity issue of some kind going on. HCPs would instantly learn a lot about the background to a patient by thinking about why a patient is unhappy or might refuse to have an observer. They might actually learn as much as than a physical examination might reveal....

OP, i am sorry to hear of your experiences,
I think I have been lucky!
22 years ago, I was in labor and was asked if I minded having a male student midwife assist my labor, I didn't mind at all, it was my third birth, and I have to say was my best midwife. The birth was his last one to be assisted.
11 years ago my darling mother was dying from an aggressive cancer - mesothelioma -and our GP asked her if she would come to surgery to meet with students, Mums cancer had almost been missed and GP was determined that no students would miss it . Mum was very happy to do this.
I have been an inpatient several times in the last few years, and maybe I am lucky that our trust are very hot on the 'Hello My Name is' scheme. On my last admission, a very sweet student doctor, who had been introduced to me when consultant did his rounds popped back and asked if he could take a full case history.
It didn't worry me at all.. as students have to learn somewhere... and to be honest, if they don't ask they don't learn!

I always say hello to a student ask their name Which university they're from to put them at ease. They're experiencing many things new to them. Sat with a fourth year at Xmas friends son. The week before he was expected to flit between hospitals attending different specialities . He said that he had to get through traffic jams worried he would be late getting from one hospital to the next. He looked like hell had put on weight bad eating had spots and big bags under his eyes. He's a compassionate young man has been since he was a little boy.

They are a patient. Their medical needs trump a student’s need for practical experience every time.

And for some patients, which you would know if you’d read their posts on this thread, have felt compelled to say yes to a student being present even when they’re not happy about it, especially when the student is already in the room. It’s got nothing to do with being “brave” ffs.

I’m usually ok accepting a student but if I had to have lots of intimate examinations and dealing with cancer too I too would be reluctant

A "Hi I'm X, thanks so much for letting me attend. I'm just observing today so do let me know if you'd like me to step back or leave at any point' would go a long way towards putting the patient at ease and making them feel that they still have bodily autonomy.

Whenever I've needed a referral it's always to a large London teaching hospital and there have always been students present. How they have interacted with me has depended on the scenario - e.g. I had a non serious form of skin cancer removed, was quite relaxed about that appointment, didn't mind that there were about 6 of them and that the consultant was asking them questions to test their knowledge cos I felt pretty comfortable about the appointment anyway.

Most recently I went in to have my coil replaced, male consultant with a female student, that's a much more vulnerable scenario and tbh I would not really have been happy with a male consultant and a male student (I realise that every consultant was at one point a student!). Basically I think the more stressful the context of the appointment for an individual, the more the presence of someone learning can be unhelpful. As it was, I was happy that she held my hand, but there's no way I would have wanted a twenty something lad do that!

If it’s “no big deal” and “they need to learn” let them stick their fingers into each other. I am an abuse survivor and tend to freeze under stress, so am easy to coerce into agreeing to things I’m not comfortable with.

Even non-intimate exams are still uncomfortable for me if I’m outnumbered. I find it difficult to ask the questions I need to ask to understand or to self-advocate if I feel like the interaction is focussed on the student, not on my medical concerns.

I’ve even had it happen at a private physiotherapist. I put a stop to that quickly - physio is not something I enjoy having an audience for, nor be subject to a running commentary on my physique, health & posture.

@PearPickingPorky Oh yeah, that is blackmail, thank you for pointing this out, duh! I knew it was even worse than presumption 😞

[quote AutomaticMoon]@Spongeboob Another PP was told recently on the phone that if she wants a face to face appointment she’d have to allow a student to observe otherwise she wouldn’t get an appointment. The BMA rule that was posted up thread seems at odds with this presumption of consent.[/quote]
You are absoluetely not allowed to make appointments conditional on 'compliant' behaviour.

Thats definitely one worthy of a formal complaint. If its been written down, then they would be toast.