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Original poster

Nhs students and lack of consent.

809 replies

MarbleQueen · 21/01/2022 21:26

I’m wondering if something has changed within the Nhs. At one time you were asked if you minded having a student being present.In my area they are present at every appointment without any discussion and I’m getting fed up with it.

In the last two years these things have happened.

A student midwife was brought into my room and participated in my delivery without any discussion. She was instructed to break my waters and deliver my baby without any discussion with myself. The midwife focused on talking her through things instead of supporting me. I was alone because of covid restrictions. I later discovered it was the first baby she delivered. I felt like a piece of meat.

I went for a smear and when I walked in the room there was a nurse and 3 very young women present. When I asked who they were I was told they were trainee health care assistants. I objected and the nurse insinuated I was being a bit silly and shy. I left that appointment without it being done.

I had a dentist appointment for my first ever dental treatment. I told them I was nervous. Again when I went in, I was told, not asked that the 2 people present were dental students and would only be observing. The dentist focused on explaining things to them and actually allowed one to place the filling. I didn’t agree to this.

I went to a gp apointment for something intimate to find a man around 18 years old sat in the room. Again I had to ask who he was and was told he was a student. I had to ask for him to leave and it was really uncomfortable.

I had an apointment to have a very unpleasant procedure. There was the usual student perched in the corner without any discussion. Again I had to ask who they were and was told, not asked, that they would be observing. The doctor focused on explaining things to them and when the procedure was finished I actually realised 3 more students had been brought in to watch without me noticing.

I have previously had a type of abdominal cancer. I have checks with scans and have seen the same consultant for years. On my last visit there was the usual student perched in the corner without any discussion. On this occasion, and this occasion only, the surgeon suggested doing a VE. I asked him what information he was hoping to get from this considering he had a recent MRI scan in front of him and he simply dropped it. I strongly suspect this was going to be for the students benefit because it certainly wasn’t going to benefit me.

Each of these places have standard notices in their waiting rooms informing you that a student might be present but this is not consent. I think this is now something you have to actively opt out of instead of opting in.

Has anyone else noticed this happening? I worry about what these students are learning about consent in these circumstances.

OP posts:
Morgysmum · 23/01/2022 22:07

I don't blame you, they should ask, I had the contraceptive implant removed and a new one put in, in 2020. There was a student, but I was asked if it was OK if they observed, I was OK with that.
But I wouldn't be happy having a male, student in the room, when talking about female problems. They should definitely, ask your permission with that. As I would feel comfortable, talking to a male Doctor either, I know they know about these issues, but I thought they had to ask, if you would like a female nurse in.
I have had a student take my blood, when I gave blood, but this was with consent and before covid. I am going to the dentist on Monday, so I will see if I encounter a student there.

Original poster
MarbleQueen · 23/01/2022 22:04

And then if the student is allowed in, they're being slated for watching intently. I'm not sure what else they should be doing when observing a consultation!

I know this is really out there, but how about a basic Hello and introducing themselves?

In what other circumstances is it ok to stare intently at someone for 10 minutes without saying a word? When did that become ok? Why are people arguing that it’s just too much to expect medical students to have basic courtesy?

If you don’t realise how inappropriate and weird it is to silently stare at someone for ten minutes try it out on a strangers and come back and tell us what reaction you get.

OP posts:
LadyRoughDiamond · 23/01/2022 22:02

Just read this out to GP husband, who is pretty shocked. This should NEVER happen. You should ALWAYS be asked whether you consent to a student being in the room. Also, the door should be either locked or a ‘Do Not Enter’ sign displayed whenever an intimate examination is taking place.
Please do report this to PALS - it sounds like something has gone very wrong within your trust. The NHS takes this sort of thing seriously and the trust can even lose educational funding for not following procedures for things like consent.

Overtherails · 23/01/2022 21:50

Obviously there's massive work that needs to be done on this, but I think the replies demonstrate some of the problem. Some people want forms, some think forms aren't enough. Some want asked ahead of time, some want to see the student in question and then make up their mind. And then if the student is allowed in, they're being slated for watching intently. I'm not sure what else they should be doing when observing a consultation!

PearPickingPorky · 23/01/2022 21:50

[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]
That's not a presumption of consent, that's blackmail!

Namechangerextraordinaire1 · 23/01/2022 21:46

I think you've been 'unlucky' to have that many students observe
I've had it a few times and don't care usually as its never ben anything I'm personally concerned about and everyone has to learn.

Having said that, if they are actually doing any treatments I'd definitely want to know beforehand and I'd like to have the opportunity to refuse consent to being observed if I felt like it too

AutomaticMoon · 23/01/2022 21:44

@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.

CPL593H · 23/01/2022 21:40

I remember as a preteen child (so nearly 50 years ago) having a flock of medical students clustered around while I was having an assessment (almost undressed, don't know why) due to long term migraines. Wasn't asked of course, but I felt a bit ill and spaced out so didn't care.

As they drifted off, one young woman student hung back and said said "I don't think this child is very well" and peered closely at a developing rash no one else seemed to have noticed, including the consultant. She quietly told my mother she thought I needed to see a doctor ASAP (!!!!) and squeezed my hand. She was lovely.

GP called out the next day. I had scarlet fever, quite unusual in that period. I've never forgotten her and often thought what a wonderful doctor she must have made. I've consequently always agreed to the presence of students, although of course there should be consent on all occasions and it should not be pressurised.

Spongeboob · 23/01/2022 21:35

Obviously I had to call to cancel and try to rearrange but there was definitely no requesting consent, just stating that I would see the students before I would see a doctor.

Spongeboob · 23/01/2022 21:33

After sending in an econsult to my gp practice a few days ago, I was told I'd receive a phone call from a GP the next day. Instead I received a text that they had made an appointment for me (the following morning when I was unavailable at a further away but part of their "group" practice) and it stated that I would be seeing their medical students and then a named doctor.

PearPickingPorky · 23/01/2022 21:30

@m1shap3

If we didn't have students, however, there would be no future practitioners....
Part of being a medical student is learning how to treat vulnerable patients, protect their dignity, and be able to gain free consent.
PearPickingPorky · 23/01/2022 21:28

I wonder if the reason they have started presenting it as a given rather than asking for consent at the beginning Is because so many people were then saying no. And if everyone says no, then we are a bit stuffed, aren’t we?

Yikes, imagine if this was considered acceptable practice in other aspects of "consent": You can't convince anyone to agree on advance, so just don't ask her and carry on with what you want to do to her body, so you get what you need from her.

Anyway, long-term, doctors are shooting themselves in the foot here. If women don't feel like their dignity is being protected/considered in appointments generally (particularly gynae related), then women are going to be more apprehensive about the appointment and less trusting of the doctor. Therefore they will also be less willing to add to that already unnecessarily high discomfort by adding a student or two into the mix.

If I was spoken to in advance (eg at booking in or similar) and informed that there was a student/ trainee on but it was up to me whether I was OK with them being there, or I was offered to think about it for a few minutes and not put on the spot, then I might be more inclined to say yes. If the junior dr/med student also addressed me respectfully, introduced themselves, and also made it clear that they too were conscious of my dignity then that too would help put me at ease with the situation.

If doctors are not able to put their female gynae patients at ease then that is very much a problem with the doctors, not their vulnerable patients.

Nanny0gg · 23/01/2022 21:21

@Wnkingawalrus

Interested how you expect students to learn, OP.

Would you prefer the newly qualified person doing your smear test had never even observed the procedure?

Obviously they have to learn, but if it's a procedure you're nervous (or in my case, likely terrified) about, then having any observer there will not help you.

Hopefully there's enough willing patients about for it not to be a problem.

Holly60 · 23/01/2022 21:16

[quote AutomaticMoon]@Holly60 Why does it surprise you so much? Did you think she might have trauma from being raped or sexually abused as a child and that pelvic exams are triggering and nigh on impossible for some people to do even without extra people present?!?![/quote]
The previous PP did not give a reason so it would be total conjecture to speculate on WHY she said she wouldn’t have a trainee in her gynae appointments.

If this is the case for you I can understand why even this discussion is triggering. However that doesn’t mean I’m wrong in believing that medical trainees need to be able to learn on the job, the same as millions of other people in all sorts of professions. More so, quite frankly. I don’t want a poorly trained doctor treating me!

maybloss2 · 23/01/2022 21:16

I live in wales and haven’t noticed this. But I think it’s really worrying. Like you have said the student should be actively engaging with issues of consent and the patient should never be made to feel bad for saying no.
In the past when asked I’ve mostly said yes, but not when there was a crowd of students and it was intimate. Another time a student examined inside my ears and was too rough but was really very apologetic most students have actively thanked me for allowing them to be present and I appreciated that. But obviously not all have been properly prepared.

m1shap3 · 23/01/2022 21:13

If we didn't have students, however, there would be no future practitioners....

Holly60 · 23/01/2022 21:11

@AutomaticMoon

I’m not sure whether the culture of this country is contributing to this problem, there seem to be many people who feel that all womens’ bodies are automatically a training tool.
If having a trainee in the room whilst I have a gynae appointment means my daughter or grand daughters get the very best care available to them in the future, I’ll do it, every single time.
AutomaticMoon · 23/01/2022 21:09

@Holly60 Why does it surprise you so much? Did you think she might have trauma from being raped or sexually abused as a child and that pelvic exams are triggering and nigh on impossible for some people to do even without extra people present?!?!

Holly60 · 23/01/2022 21:09

[quote AutomaticMoon]@Brainstorm21 I don’t know about that but many medical procedures and surgeries can be watched on video so that can be a learning tool[/quote]
Interesting. If I had to choose between a doctor who had trained by working with patients in person and in close partnerships with other highly qualified doctors or a doctor who had trained by watching videos of procedures, I know who I would choose!

AutomaticMoon · 23/01/2022 21:07

I’m not sure whether the culture of this country is contributing to this problem, there seem to be many people who feel that all womens’ bodies are automatically a training tool.

Holly60 · 23/01/2022 21:03

[quote AutomaticMoon]@Holly60 HCPs on this thread have repeatedly reported that only very very rarely do people decline, read the thread[/quote]
I’m not disputing that. In fact it doesn’t surprise me in the slightest. What did surprise me was the PP who stated she wouldn’t allow a student in any of her gynae appointments. Likewise I’m surprised that another poster thinks that having specialists trained in women’s health is a ‘them’ problem.

In my experience the vast majority of women understand the imperative to have highly trained gynaecology specialists.

In short, I agree with you Smile

AutomaticMoon · 23/01/2022 21:02

@Holly60 Right now, this is the problem. So we should sort this out before worrying about a theoretical problem that won’t ever happen.

AutomaticMoon · 23/01/2022 21:01

@Brainstorm21 I don’t know about that but many medical procedures and surgeries can be watched on video so that can be a learning tool

AutomaticMoon · 23/01/2022 20:57

@Holly60 HCPs on this thread have repeatedly reported that only very very rarely do people decline, read the thread

Holly60 · 23/01/2022 20:53

@mbosnz

Um, the predicament is that of the teachers and the students. That is a 'them problem'.

Assuming that women will offer themselves up to be unpaid mannequins who don't feel they have the right to say no, or the power to say no, is not the answer.

Does it not become our problem when there are no specialists in women’s health??