Nhs students and lack of consent.

www.bma.org.uk/advice-and-support/ethics/medical-students/ethics-toolkit-for-medical-students/adults-with-capacity-and-consent

"Is additional consent required for students to be present during consultations?
Yes. The doctor carrying out the consultation should explain to the patient that an observer or observers would like to sit in on the consultation, who they are and why they wish to observe.

Patients must feel able to refuse consent to the presence of students or other observers during their consultation, examination or treatment. They should be reassured that their decision will, in no way, affect their treatment. Wherever possible, patients should be given the option of considering the request prior to the arrival of the observers. (my emphasis).'

Interesting.

You cannot please everyone, as everyone is different, some people on here have expressed they want to see the student first before consenting others don’t, unless we get complaints about our procedure and we’re following the correct guidelines then I see no reason to create extra work for the sake of it. Personally unless it’s something intimate I have no issue with students being there, and if it was something intimate I would rather see the student first before consenting, because I would have no issue with a female student watching me have a smear for example, but I wouldn’t want a male student watching unless I felt comfortable with him, which I wouldn’t know until I met him.

[quote HonestwithHope1]@justlyra.

Ta. Not shifting responsibility at all but agree to disagree

Informed consent is essential. Hope we can all agree on that one[/quote]
A student in the room already, and a casual "is it OK for student to observe?" is NOT consent. Students should stay out the room until consent is obtained.

Because I've been there. I've been the patient in this situation, years ago, back when I was an anxious mess and unable to assert myself. I found myself saying Yes, when inside I was screaming for the student to leave the room. I felt pressured into having that student in the room when I didn't want them there.

These days, I'm much more assertive, but if the student is there already, it's still difficult to say "sorry, please leave the room". I was in a long, abusive relationship, and it left scars that meant I had to re-learn assertiveness after I left.

So there is much more to consent than "just say yes or no".

[quote Itsalmostanaccessory]@Janesmom

We should be able to give consent.

I was asked if one student could watch while I had a pessary inserted into my vagina. I said yes. They then brought 6 of them in. I was in a the bed with the curtains drawn round, so not a lot of space. My legs open, and I had to sit like that for much longer than necessary so each student could come and have a look while the person teaching them explained what she was doing over and over again, demonstrating by putting her hand into me.

One student would have meant the procedure happend once with that student watching. Even two could have stood at the end together. But with 6, she has to do it and then imitate doing it a few times so they could all get a look. I was used as a doll basically. Do you think that is OK?[/quote]
My god, that's dreadful.

They absolutely should not be penetrating you for no clinical reason! That is definitely complaint worthy.

I don't assume that there will be a student present, because it isn't axiomatic, or necessarily common. Once again, you talk about signs. Signs aren't terribly useful if you cannot read them, for whatever reason, so I don't think signs by themselves completely discharge a medical practices obligation to ensure informed consent. It can be quite difficult for young patients, at their first appointments without parental accompaniment to know what is normal, what is appropriate, and to communicate reluctance or concern to an adult in a position of authority. Ditto for women who have English as a second or third language, and from cultures of deference.

It is difficult to know you should bring an advocate if you haven't been advised it could be a good idea, and you don't know that students may be present - which if you're new to a country, for example, you may not know.

I think HCP's need to take some level of responsibility, as the trained medical professional with full knowledge of their legal obligations and their practices procedures to ensure that when people are consenting, they do actually want to consent, have full knowledge of their right not to consent, and understanding of how to invoke that right.

@AutomaticMoon

They sent flyers out to everyone in Scotland when the change happened up here. I'm sure England did something similar.

My point is, you came onto a thread about consent in the NHS and blamed them for something they did not do (the change in the law) and accused them of doing it secretly (which is not at all true; you were given a few years of warnings).

I dont like people pedaling false information.

I think most people who access healthcare know there’s a chance students may be present at some point during one of their encounters, it’s quite common, it’s happened to me numerous times as a patient, even if they don’t there are usually signs in the department stating there could be, so if they feel this strongly about not having students there and know that on the day they won’t be able to decline if the student is in the room then yes they should call ahead, tell someone on the desk or bring an advocate who will speak up for them. Alternatively, they could just ask to speak to the HCP alone when asked and decline then, there are a multitude of options available for how to decline.

Patients do have to take some level of personal responsibility for speaking up for themselves as well, and if they’re unable to for whatever reason then they should bring an advocate with them, because as patient you could feel pressure to agree to anything in a healthcare setting for many reasons and it’s important for us a HCP to know that when you’re consenting you actually do want to consent and it’s not just because you feel too scared to say no or show that you’re hesitant.

So, a person should tell the person at the desk, or call ahead first, or bring an advocate - even though they haven't been told they should do this if there is an issue? The onus is on them, but they're not given the information, but that's okay, because as far as you're concerned most (but clearly not all, given the responses here) 'seem to be happy' with seeing the student first?

@MarbleQueen 😝

*is relevant to this thread. I’m sorry if it’s not.

‘Oh, and the law and professional guidance are both equally clear that compliance does not equal consent.

Consent must be freely given, informed, and capacitous otherwise it is not legally valid.’

I copied this from a thread about membrane sweeps without consent, thought the bit about ‘compliance doesn’t equal consent’

Tbh I’ve worked in the NHS for years and I’ve never actually come across this being an issue when the patient was asked at the time and the student was properly introduced (seen complaints when that didn’t happen), so until it is raised as an issue I don’t see any reason to add extra work for the receptionists by changing the procedure as most patients seem to be happy with seeing the student first.

[quote AutomaticMoon]@mbosnz Wow, you re-phrased that so well and patiently. I wish I had your command of the English language 😭[/quote]
Thank you AutomaticMoon, that's very kind!

@user1497207191 ‘ was troubled with attitude at a recent GP appt. I phoned for an appt and was told it would be a phone consultation unless I agreed to a medical student appt with GP supervision. Clear intention that if I wanted face to face I had to accept a medical student.’

That’s not real consent 😞

Back in the days when you had face to face GP appointments 🙄 our surgery regularly had students in. They always got consent. When you arrive the receptionist initially tells you and asks if you mind. Then when you get in for your appointment the GP introduces the student & confirms your consent

When I was in hospital there were students at times. If it was just the consultants rounds nothing was said but if the consultant wanted to do any kind of examination (none were intimate examinations) he always checked for consent

Um, when I'm talking about phone calls, I'm talking about when the patient has rung up to make an appointment. Not about another phone call being made. If the onus is to be on the patient to give informed consent prior to reaching the consulting room, then when the appointment is made, the person making the appointment with the patient could (and should) ensure the patient is okay (or not) with students present. This could be repeated when they report to reception.

That way the patient is not ambushed at any stage of the consultation, and the student either can, or cannot be present, as per the patient's wishes.

Informed consent is not just a tick box, or it shouldn't be. It shouldn't be a bother. Practitioners who think it is, and treat it like it is, are the problem, not patients who don't meekly accede to the practitioner's default practices and preferences.

MarbleQueen

You have got to be kidding me.

I said this right at the bloody beginning. For the opposite situation. Got a load of grief and what, now people originally telling me how wrong i was to suggest that... suddenly... Parrot back what I'm saying??

,

“Then the answer surely is “Do you mind if a female student observes?” or “Do you mind if a male student observes?” rather than shoving all the responsibilities onto patients?

Especially when the most vulnerable patients are the ones least likely to feel able and confident enough to object in front of said student.”

It’s the responsibility of the patient to not give consent if they don’t want to consent, unless they are being pressured in anyway then that consent is valid.

In this day and age with gender pronouns and what not it’s not always as simple as calling someone male or female. Also, sometimes people just feel uncomfortable with someone regardless of gender and find it hard to articulate why, as a patient I’ve had HCPs I feel comfortable with and other ones for some reason I don’t, I’d find it quite hard to then revoke consent upon seeing someone and explain why in that situation.

@rubystiles They could have sent a letter then to inform everyone, for those without a mobile phone, or a landline phone call. I have no idea what I’m talking about and I’m spouting lies, regarding my own lived experience? If you say so 🙄

mbosnz

Oh sorry! I'm disabled and running out of energy to think properly so don't want to keep talking much longer as things get miscommunicated when I'm tired/in pain like now lol

It's been a great thread with a lot of insightful comments. Thanks for replying respectfully :nice talking to you :)

I went for a contraception check up before having kids and was asked if I
Minded a student being there
No says I and then it turned out the student was a girl in the year above me at my school