Nhs students and lack of consent.

mbosnz

Not to sound heartless but personal phonecalls re this are an imposition. Services don't have the time or the staff.... People may not pick up, redial back while staff are busy, it may make mh worse ect.

Only time we gave calls like this were home visits on the day (obvious reasons)

Also agree with Njbrookes comments

@JustLyra ‘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.’

Seconded!

I don't quite get the spoons, unless you're talking about spoonfeeding? In which case, up there with calling people 'hun', that's not really appropriate in what should be a mutually respectful discussion.

@AutomaticMoon

As already mentioned several times it was ALL OVER the news, radio, TV adverts, cinemas, social media…. You’ve been called out because you have no idea what you’re talking about. Stop sprouting lies.

Oh and not everyone has a mobile phone but then the NHS - you know the ones who changed the law would be blamed for that with you too.

Go and educate yourself

@Elsiebear90

This! This! This! Sorry lol but perfectly summed up

@mbosnz

Running out of spooons but basically see the lovely insightful reply which I've been trying to communicate all throughout!

Nice talking to people and informed consent is clearly essential!

I think if you’re particularly nervous or sensitive about this topic it’s best to tell the person at the desk or call ahead first, or if possible bring someone with you to advocate for you.

Hopefully it wouldn't be too much of an imposition to require this to be communicated to patients, prior to the appointment? Not just by signs, which not all can read, but by the receptionist either at the time of making the appointment, or when reporting for the appointment, or preferably both, actually specifically stating this to patients? So patients can give genuine informed consent?

@mbosnz Wow, you re-phrased that so well and patiently. I wish I had your command of the English language 😭

In all the situations I’ve had a student present within an appointment they are usually already in the room usually due to the quick turn around of the appointments and them having a debrief after each patient.

But i am always made aware that they are a student giving me the chance to say if I would like them to leave.

I understand it can be uncomfortable in some situations and it is perfect okay to ask them to leave.

I’m a student paramedic and for us it is a little different as I’m always with my crew and always go into the house with them but I make that patient aware that I am a student and will constantly seek consent first of all for me to be in the room and then for anything that I carry out on the patient if they say they would prefer I don’t do it them my mentor (paramedic) with then proceed to treat that patient.

I feel it is upto the student to make the patient aware who they are and gain consent. I am forever grateful to all of the patient who have allowed me to be in the room/ treat them as without them I wouldn’t be able to learn and we would run out of health care workers.

Patients may (and often do) incorrectly assume a student nurse means a young female and then a middle aged man walks in, in that situation I think it would be significantly more embarrassing and uncomfortable for most people to then revoke consent upon seeing the student

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.

I 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.

@Itsalmostanaccessory Why are you being wilfully obtuse? They could have easily sent a text out to everyone to say ‘you’re organ donors’. Why do you feel personally attacked by this? I already said I was trying to not commit suicide and was advised by a MH professional to avoid the news.

I was a nursing student 3 years ago, when I was doing placements in general practice, for anything like smears the nurses would go and fetch the patient from the waiting room and ask them if it was OK while I wasn't present, so people didn't feel pressured to say yes.

On wards it wasn't really an issue unless I was doing a procedure, in which case they would always check the patient was okay for a student to do it. Normal day to day care wasn't consented in any different way than it would be if an HCA or nurse who worked there did it.

Back in the day (not that long ago) students would be left in charge of their patients on a ward and do pretty much everything. In the 60s and 70s it was more like they were left with a whole ward, overnight!

OP, the experiences you have had are mostly stepping over the line because of the intimate nature. There's no way anyone should be observing or participating without your consent and understanding of why they are there.

The thing is you can’t please everyone, some people want to see the student before agreeing others don’t. You could argue without seeing or meeting the student who they are agreeing to let into the room then the patient doesn’t have all the information needed to give consent for them to be present, because they don’t know who they are allowing in to the clinic room until after they have consented.

Patients may (and often do) incorrectly assume a student nurse means a young female and then a middle aged man walks in, in that situation I think it would be significantly more embarrassing and uncomfortable for most people to then revoke consent upon seeing the student than it would have been to ask the student to leave the room so they could discuss it with the HCP and then refuse. All you need to say is “can I discuss this with you in private first?” to the HCP if you really don’t want to refuse in front of the student.

I think if you’re particularly nervous or sensitive about this topic it’s best to tell the person at the desk or call ahead first, or if possible bring someone with you to advocate for you, because as HCP we aren’t perfect and one size doesn’t fit all. If we change the policy to suit one group of patients another group isn’t happy and complains.

I’ve always been asked if I mind having a student in and you should always be asked that question.

Sorry, misphrased that comment “some med students think….”

I’m a qualified nurse learning a new role, I always ask if it’s ok to stay and observe/participate. I also ask when I’ve had my own students.

Med students sometimes seem to think its odd when I say unless they have documented consent from the patient then they are not touching them when the patient is anaesthetised.

Okay, let me put it another way. If the student is already in place, it presents an appearance of assumption of consent. Surely the default should be an assumption of lack of consent, until consent has been given, and this is the situation as it should be presented?

Just one other thing, assuming that signs being up is sufficient, is assuming that everyone is able to read and understand those signs - which is not an assumption we should make, and certainly not in such circumstances.

So perhaps the onus remains with the practice to ensure that each patient is verbally informed at reception, and as far as is practicable, that they understand?

@mbosnz

There is no compounding of inequity with you being enabled to request a person who is not yet there, to become present, prior to you making your decision.

Yes there is. I am a physically vulnerable disabled woman with MH issues. Why should i be distressed at speaking up re needing to see student, manouvere a wheelchair potentially to make way for another person in room ect

All because other people want a blanket ban on students in room before consent qs is asked??

Neither 'wins'

Which is why I don't get people freaking and literally insulting me on here when i suggested communication

before appointment if you don't feel you can answer question with student there ...

Same for me. I'd recommend I communicate my wishes pre appointment.

Which I've been told to do yet the above example is apparently outrage worthy ...

@AutomaticMoon

No. You took a swipe at the NHS for bringing it in overnight in 2020 and you had no idea, no warning etc.
It was a new law that was in the news for literally years before it happened. So how was it the NHS? And how did they do it with no warning

@RegardingMary ‘Membrane sweeping should never be done without the explicit permission of the birthing person. But membrane sweeping is an invasive medical procedure meant to ripen the cervix or induce labor contractions, and it should never be done without an informed consent discussion. ...‘

The birthing person 🙄

@RegardingMary ‘MrsDeanWinchester75

Mine did, she said she was checking how I was progressing and whatever she did hurt so much I burst into tears, she then said she'd done a sweep.
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16/03/2019 23:17 StyleOfTheTimes

I had a midwife do the exact same thing to me. She was supposed to be checking how far along I was and was basically elbow deep inside me as I was trying to crawl up the bed in agony. Once she’d given up I said I didn’t think an examination would hurt so much she then told me she’d “tried to give you a sweep” never asked for one she never said she was going to do one.
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16/03/2019 23:35 ZippyBungleandGeorge

Mine said she was checking progress but did a sweep, it hurt so much I nearly kicked her’

Apparently it’s a common thing. They’re supposed to ask consent as it’s invasive procedure.

And yes, if there are signs up, saying that students may be present, then the onus is on the patient to say at the time of reporting to the clinic that they do not wish for students to be present at their appointment. And the onus is then on the practice to ensure this is communicated to the practitioner and students, and that this is respected by them.

If there are no signs up, then this should still be clearly communicated at the time of reporting to reception, as far as I'm concerned, and then the patient can say no students, or can say, I want to see the practitioner and the student before I made a decision.

Patients aren't mind readers, either, and they're often in something of a tizzy when they get there, one way or another.

There is a compounding of the inequity, with two medical professionals (albeit learning), already located in the room, prior to the patient being admitted to the medical professional's place of work - their turf.

There is no compounding of inequity with you being enabled to request a person who is not yet there, to become present, prior to you making your decision.