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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:
Elsiebear90 · 22/01/2022 19:56

“I would say the difference, is in the imbalance of power.

The patient is in the medical practitioner's room, on their turf, their place of authority. With their student. So, it's two against one. It's being effectively presented as a fait accompli, that a patient could potentially feeling they're going to be judged, or upsetting the apple cart, if they don't go along with the status quo as it's being presented.

Many people feel vulnerable when seeking medical treatment, insecure and unequal to the person that has the knowledge and the power in that situation. It's simply adding to the inequity of the situation.”

You could say that about anything though, patients may feel like they’re going to be judged if they refuse anything the HCP asks consent for, simply because of the perceived power imbalance there. Consent should be freely given without pressure, if there is no actual pressure or consequences for declining and consent was given then that’s valid consent. We can’t read minds, we never know what someone is really thinking or why they’re giving consent, all we can do is ask for consent and make sure that we aren’t doing anything that pressured them into agreeing, if someone happily agrees then we have to take that as consent. It’s up to you as an individual to speak up if you don’t want to consent, you can’t consent to something and then later complain your consent wasn’t valid because you imagined there would be negative consequences for your refusal when in reality there would have been none.

Some people would prefer to see the student before consenting and others wouldn’t so as HCP what are we supposed to do when everyone is different? We have signs everywhere saying students may be present and you have the right to refuse, so if we ask you to consent to a student being there and you happily say yes with no hesitation how are we supposed to know that you weren’t happy for the student to be there?

AutomaticMoon · 22/01/2022 19:54

@RegardingMary She thought she might as well!🤦🏻‍♀️ The entitlement of it is astounding.,Like she was doing you a favour and sweeping the floor! I’m sorry I don’t have children cause of ptsd and Tokophobia so not sure what a sweep is but I bet it’s not a favour to you since you requested NOT to have it 😞 At this point I’m starting to think that it’s true that 30% of people are authoritarians, v demoralising

HonestwithHope1 · 22/01/2022 19:53

@AutomaticMoon

But there's an imbalance of power making me feel uncomfortable having to ask for their student to be present before i can make informed consent. ...

HonestwithHope1 · 22/01/2022 19:52

@mbosnz

But I'm still having to be out of my comfort zone as a patient having to ask the student to be in room for consent question.

... If i have to be out of my comfort zone because the blanket rule is no students exist in room (until consent is asked) due to others feeling uncomfortable not able to ask students to leave the room for the answer to consent question (and possibly the appointment) ...

How is that taking into account my needs ?

This is what I mean. It's complex.

AutomaticMoon · 22/01/2022 19:48

@mbosnz ‘Many people feel vulnerable when seeking medical treatment, insecure and unequal to the person that has the knowledge and the power in that situation. It's simply adding to the inequity of the situation.’

That’s exactly it, for some people who have chronic illness or struggling to get a diagnosis or MH problems and have no quality of life, it’s a life and death matter. There’s a huge imbalance there but it seems as only a v small minority are aware of this fact Sad

RegardingMary · 22/01/2022 19:45

@AutomaticMoon

Don't get me started on sweeps!!

I've had 4 children, I know what a sweep feels like. I was examined in my last labour and despite verbalising it moments before the examination and despite it being written in my birth plan, the midwife did a sweep. I know this because when I asked to her why have you done a sweep? I've not consented to that.

She told me
'Well I was there anyway so just thought I might as well.'

mbosnz · 22/01/2022 19:43

[quote HonestwithHope1]@mbosnz

from what you've said, you feel the onus is on you to ensure you give informed consent, as a patient?

As said

Practitioners aren't mindreaders, we can use all the best clinical judgment in the world but as per the clearly fictional example (but poss real situation) i gave you. It isn't perfect

Patients need to be honest when the question of informed consent is asked.

Informed consent needs to be asked

Communication is vital

I'd rather student is in the room when I'm asked, i'd ask that if they weren't ... however people were clearly up in arms when i said how if you are uncomfortable with student being present for qs being asked/appointment, let them know. Then obviously at appoointment incormed consent would still be asked

What's the difference between me being willing to begrugenly adapt to having to ask the potential student to be in room so i can decide ... And people having to adapt to having to ask if student is not there for informed consent qs ?

Then there's your average lot who wouldn't care there's 1 potential extra in room at standard appointment

....[/quote]
I would say the difference, is in the imbalance of power.

The patient is in the medical practitioner's room, on their turf, their place of authority. With their student. So, it's two against one. It's being effectively presented as a fait accompli, that a patient could potentially feeling they're going to be judged, or upsetting the apple cart, if they don't go along with the status quo as it's being presented.

Many people feel vulnerable when seeking medical treatment, insecure and unequal to the person that has the knowledge and the power in that situation. It's simply adding to the inequity of the situation.

AutomaticMoon · 22/01/2022 19:39

‘Consent is a constant thing, and should be sought at very new interaction.‘

This is the right way to do it. This is why I previously said all this guilting of OP is a bit rapey. It’s a violation to treat people as mannequins, like they owe you their body to practice or observe their on. Consent not freely given is not real consent. There is a huge entitlement problem with surgeons, they freely discuss on open forums how they feel like they don’t have to ask consent for their student to do pelvic exam on anaesthetised woman cause the surgeon is cutting your abdomen up anyway later.

HonestwithHope1 · 22/01/2022 19:34

@mbosnz

from what you've said, you feel the onus is on you to ensure you give informed consent, as a patient?

As said

Practitioners aren't mindreaders, we can use all the best clinical judgment in the world but as per the clearly fictional example (but poss real situation) i gave you. It isn't perfect

Patients need to be honest when the question of informed consent is asked.

Informed consent needs to be asked

Communication is vital

I'd rather student is in the room when I'm asked, i'd ask that if they weren't ... however people were clearly up in arms when i said how if you are uncomfortable with student being present for qs being asked/appointment, let them know. Then obviously at appoointment incormed consent would still be asked

What's the difference between me being willing to begrugenly adapt to having to ask the potential student to be in room so i can decide ... And people having to adapt to having to ask if student is not there for informed consent qs ?

Then there's your average lot who wouldn't care there's 1 potential extra in room at standard appointment

....

HacerSonarSusPasos · 22/01/2022 19:33

@winterchills

I get why in certain situations you may feel uncomfortable and have the right to refuse however the students really really need to learn so of course they are going to be there. They are the future nurses, doctors, dentist and consultants and need the learning experiences?
And there will always be plenty of people who will have zero objection to have them present.

Doesn't mean everyone has a duty to do it. We have different levels of comfort around privacy/nakedness not to mention cases of anxiety stemming from prior abuse/trauma. And we all deserve to be treated with consideration and respect, not be used as props by default.

Getting prior clear consent simply protects the most vulnerable patients, it's not going to prevent those who are open to it from continuing to volunteer. So where's the harm?

AutomaticMoon · 22/01/2022 19:32

@PickledGhost You sound like you know what real consent is, lovely to see. But it should be standard for everyone else too :)

mbosnz · 22/01/2022 19:31

@MarbleQueen

How do we deal with this?

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

Maybe you could get a card printed out to let them know you’re special and should be asked in front of both.

Oooof! Grin
Original poster
MarbleQueen · 22/01/2022 19:30

How do we deal with this?

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

Maybe you could get a card printed out to let them know you’re special and should be asked in front of both.

OP posts:
RegardingMary · 22/01/2022 19:30

We get a lot of trainee dentists and hygienists.

In fact a few times I've had a trainee for examinations it's been fine and I've got a scale and polish which I never tend to get from the dentist. I may reconsider if it was a procedure similar to a root canal and I did refuse before we got in the room when DD went for an extraction, she was 7 and I didn't want it taking a second longer than needed to.

viques · 22/01/2022 19:29

I had a student/ newly qualified person doing a heart scan At the end she said rather awkwardly “ I just need to speak to my supervisor” which put the terrors up me as I assumed she had seen some thing wrong! When he came in it turned out she had done the scan wrong, and all was well. My worst experience was at Hammersmith Hospital when I had 10 students ( I counted them) at a pregnancy appointment .......

AutomaticMoon · 22/01/2022 19:29

@AngelinaFibres Dr Kate Granger, she sounds like a lovely human, tragic that she died so young.

PickledGhost · 22/01/2022 19:26

*high, even Hmm

mbosnz · 22/01/2022 19:25

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

Well, I guess you could ask to see the student and practitioner together - from what you've said, you feel the onus is on you to ensure you give informed consent, as a patient?

PickledGhost · 22/01/2022 19:25

@RegardingMary

I'm a nurse, so I understand the importance of students having hands on experience or even just sitting in.

My local dentist, GPs and hospitals do have signs warning of students being present and aay to let staff know in advance if you don't want them in the room.

However, as a nurse, first and foremost its my job to teach new students patient consent and respect. I'm not doing that if I just foist a student upon you. Consent is a constant thing, and should be sought at very new interaction.

So...

'This is Becca my student, is it okay if she sits in'

'Is it okay with you if Becca weighs you/ does your BP/steps closer to watch this procedure'

At no point should the patient be made to feel uncomfortable for refusing

This!

When I was a student i never minded if it wasn't appropriate for me to sit in, no matter the reason, because respect and consent were held in Hugh esteem on my course. And I never mind now if a patient declines a student now. The patient is at the centre of each interaction, they are who is important. For every patient who declines, there are plenty more who do consent so I'm not worried about the future of my profession.

AutomaticMoon · 22/01/2022 19:25

@Itsalmostanaccessory That’s not very nice, it’s on me that I don’t follow daily news after trying to survive a suicide attempt? I was actually advised to avoid the news due to my mental illness.

Original poster
MarbleQueen · 22/01/2022 19:24

My local dentist, GPs and hospitals do have signs warning of students being present and aay to let staff know in advance if you don't want them in the room

Several people have expressed disbelief about students at the dentist and I’ve never experienced it before this occasion. This is the first I have heard about dentists having signs about students.

I wonder what has changed.

OP posts:
mbosnz · 22/01/2022 19:24

They need the learning experiences, but that does not mean that every one has to provide them with those learning experiences. That is why meaningful and informed consent is supposed to be sought.

winterchills · 22/01/2022 19:22

I get why in certain situations you may feel uncomfortable and have the right to refuse however the students really really need to learn so of course they are going to be there. They are the future nurses, doctors, dentist and consultants and need the learning experiences?

HonestwithHope1 · 22/01/2022 19:21

How do we deal with this?

You have

People who don't mind the student being in room when asked the question, and would answer honestly regardless of feelings

People who are traumatised and then (seperately) people just in general up in arms about the thought of a student being there when you are asked consent

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

So.... What then?

AngelinaFibres · 22/01/2022 19:21

@greenmarlin

The thing is, when you are having a medical procedure, you kind of are a mannequin.

No I'm not. I'm a person.

There was a doctor, who sadly died of cancer, who started the 'Hello my name is' campaign. It was to stop hospital doctors talking about a patient to students and other staff without first introducing themselves, and anyone else, to the patient. It is the same principle in any area of medicine, precisely because the patient is absolutely not a mannequin and must never, ever be thought of as one .