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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:
HonestwithHope1 · 22/01/2022 18:21

@JustLyra

What is your issue with me. I have not been patronising or rude. We have different opinions

That is okay.

Why are you freaking out about me simply saying i addressed the student in room possible reasons in my first post. I'm not saying you have to agree with my first post!

Just to obtain consent in a situation that gives the best opportunity for the patient to be comfortable enough not to feel pressure to give it.

See my reply to mbosnz if you want my oppinion on that, or not.

End of the day

Informed consent is essential. Communication is essential.

LuaDipa · 22/01/2022 18:20

I’ve been to the breast clinic for lumps twice. On both occasions I was asked if I would mind if students came in to observe. On the first occasion there were two but dh was there also so it didn’t feel so bad. Particularly since I could see the sympathy in his face as he knew how mortified I was.

The second time I went on my own, with exactly the same sort of problem, and again agreed to a student coming in to observe. Which soon became ‘do you mind if X examines you also as there is actually something for him to feel here’. Which then became ‘do you mind if X attends the rest of your examinations as there is actually something to see here’. So then I had X trailing along for my mammogram, scan and biopsy which was fun. I agreed as I do think that they have to learn somewhere and I think she asked me because I did have a large lump but it was clear from the first examination that it was a minor issue so she wasn’t putting someone with a serious illness through it. Plus I didn’t actually want to upset the already mortified student, who incidentally looked about the same age as my teenage son. It was grim, but in fairness she did seek consent for everything. It was entirely my own fault for agreeing.

CorneliusBeefington · 22/01/2022 18:19

@2022HereWeCome

I was exceptionally cross when my health visitor breezed in with another woman and said this is 'X' and is trainee, and that was it. No consent sought, no opportunity for me to say anything and the two of them spent ages discussing DS in comparison with other baby's they'd seen that morning and 'X's' own baby. Had I been my usual self I would've said stop, aren't you supposed to ask for consent but I was all over the place after a difficult birth and DS needing ICU. Still makes me angry that HV didn't come to the door and say - I have a trainee with me today. Is it OK if we both come in to see you and DS? It was my sodding home and she treated me with so little respect or consideration.
You've just reminded me, the same thing happened to me! DSs day 1 check, HV turned up "this is Sally, she's a student and I'm training her, your DS is her first baby!"

It was fine at the time, because I genuinely didn't mind, but if I had, what was I going to do, send her out of my house and make her sit in the car? Consent was presented as having already been given.

Original poster
MarbleQueen · 22/01/2022 18:19

Okay. So say I had a final year student in clinic with me. A patient i've just met comes in, I introduce self and get student to introduce themselves, I ask if it's okay if they sit in and make it clear student will go away if not.

Patient has relaxed body language, big smiles clearly says- not a problem at all, then spends most of the appointment talking with student and even laughing/making a few jokes, I allow it cause it's good practice for my soon to be qualified student, i'm happy to be second practitioner in X moment ready to be taking over if either there's questions student can't answer or potential concerns (there isn't)

This person then leaves and complains

How was I supposed to know?

Why on earth are you bothering to ask a patient if it’s ok for someone to sit in when they are ALREADY sat in the room? You are deliberately putting patients in an awkward position.Ffs ask the patient first then bring the student in. It’s not rocket science

OP posts:
JWhipple · 22/01/2022 18:18

I was a student nurse nearly 20 years ago, we always asked for consent.
Whilst I was training I had an abnormal smear and had to have a biopsy taken.
A nurse from my university was in the room . I point blank refused as funnily enough it's my choice. I even explained we were at the same university and I wasn't comfortable. They tried to pressure me but I refused, I felt guilty as it's part of her training but to be honest I would have been fine with a student from another uni watching for their learning but not someone I'd bump into at the canteen.

2022HereWeCome · 22/01/2022 18:14

I was exceptionally cross when my health visitor breezed in with another woman and said this is 'X' and is trainee, and that was it. No consent sought, no opportunity for me to say anything and the two of them spent ages discussing DS in comparison with other baby's they'd seen that morning and 'X's' own baby. Had I been my usual self I would've said stop, aren't you supposed to ask for consent but I was all over the place after a difficult birth and DS needing ICU. Still makes me angry that HV didn't come to the door and say - I have a trainee with me today. Is it OK if we both come in to see you and DS? It was my sodding home and she treated me with so little respect or consideration.

Livelifeinthebuslane · 22/01/2022 18:12

Yes, I had this! I assumed the consultant would be doing the op but it turned out to be two students? junior doctors? I don't really know who, one told me her name, the other said nothing. It was an op on my face under local and he was talking them through it, it was kind of interesting, but also worrying as they didn't always know the answers to the questions he was asking. None of this was explained to me and I felt awkward asking. I did feel uncomfortable but I didn't want to "make a fuss".

mbosnz · 22/01/2022 18:07

What's that saying again? It's easier to ask forgiveness than get permission? I do feel this practice smacks of that.

mbosnz · 22/01/2022 18:06

Well, perhaps the onus could be on the medical practitioner to get informed consent (perhaps in writing) prior to being in the position of being on the medical practitioner's territory, in a position of authority (as many patients, and more than a few medical practitioners seem to feel they are), with the student already in situ, and it appearing to have been taken for granted that they would consent? Perhaps making it very clear to the patient that it is completely okay if they do not consent? Of course, that might mean meeting the patient, who is of course supposed to be at the focus of patient centred treatment as I understand it, without the student there - perhaps the student could remove themselves for five minutes, while this is discussed and explained to the patient?

JustLyra · 22/01/2022 18:03

There is a reason that the bulk of the time people are asked about students before the students come in.

Warmduscher · 22/01/2022 18:03

@HonestwithHope1

Warmduscher

HOW DARE YOU.

I've clearly fucking explained that my mum has an SMI and you dare say that. Seriously?????

The reality is. If you are that traumatised you can't speak on the day to refuse or give consent for a student. Then you ring up before stating i need only X person at appointment or you take an advocate or get an advocate to ring up on your behalf. I speak to every new service on my mums behalf before appointments and no doubt always will. I know the importance of informed consent.

My issue with OP is threefold

the tantrumming about the student daring to be in the room as the patient enters and how she claimed that wouldn't be consent despite clearly being asked by the health professional

The demand of a special phone call to them before their appointment (lol really they themselves can't have someone ring on their behalf or picking up phone themselves)

And her frankly, many unbelievable encounters with lack of informed consent (see my previous posts detailing why i think this is)

OP is factually wrong re consent + student initially in the room making it a lack of consent regardless. You are offensive.

Then report my post. That’s the process.
BigYellowHat · 22/01/2022 18:02

It sounds like you’ve just been really unfortunate @MarbleQueen and I’m sorry to hear that. I’ve got a long term medical condition and go to hospital a lot yet have only been dealt with by a student twice. Once when in labour (consent given) once when in an ambulance having several seizures and my husband told me afterwards a student paramedic carried out a procedure (but did it well!)
In the future, remember you can always say no.

JustLyra · 22/01/2022 18:01

[quote HonestwithHope1]@JustLyra

Again. Agree to disagree. On my first post I detailed why students may already be sat. So idk if you can understand some of those reasons. It aint a big plot to demean patients.

Whether a student is initially present or not does not reduce importance of informed consent and the onus on the patient to be honest with regards to consent. Unfortunately professionals aren't mind readers and do require verbal consent or not.[/quote]
Do you enjoy being patronising and rude or is it just something you are good at? Agree to disagree doesn't mean that you are right and I have to accept that without any opinions of my own.

You may have detailed why students are there already, I however have detailed why that doesn't make it ok for every patient. The onus is on the medical profession to gain freely given, informed consent and putting patients in a position where they are faced with that doesn't always make it possible to be given.

No-one is asking professionals to be mind readers. Just to obtain consent in a situation that gives the best opportunity for the patient to be comfortable enough not to feel pressure to give it.

The onus of obtaining informed, pressure free consent is always on the medical profession.

HonestwithHope1 · 22/01/2022 18:00

@mbosnz

Good point.

Okay. So say I had a final year student in clinic with me. A patient i've just met comes in, I introduce self and get student to introduce themselves, I ask if it's okay if they sit in and make it clear student will go away if not.

Patient has relaxed body language, big smiles clearly says- not a problem at all, then spends most of the appointment talking with student and even laughing/making a few jokes, I allow it cause it's good practice for my soon to be qualified student, i'm happy to be second practitioner in X moment ready to be taking over if either there's questions student can't answer or potential concerns (there isn't)

This person then leaves and complains

How was I supposed to know?

Informed consent requires clear yes or no. So mostly verbally or strong nods/shakes of head/sign language/written ect.

We can only work with what we are given. The onus is on us to ask informed consent qs and use our clinical judgment best we can (if i had a patient clearly on edge I'd keep trying to check but that can also backfire + make people more agitated sooo...) or if i had a patient who came in with someone i thought was an abuser, all i can do is try my best to ask re informed consent (obviously in that situation pass to safeuarding)

The onus is also on the patient to communicate best they can

IrritableOwlSyndrome · 22/01/2022 17:58

A quick filter through OPs posts shows she hasn't demanded or argued with anyone about special phone calls to herself to obtain consent.

mbosnz · 22/01/2022 17:49

I thought the onus was on the medical practitioner to ensure they got informed consent?

Or is it a bit like when a man isn't a mindreader, and takes stunned silence as assent?

mbosnz · 22/01/2022 17:48

I'm very appreciative and grateful for those who are comfortable and okay to have students present and practise on them. Because I'm not. I make no apologies for this, or excuses. I don't have to explain to anyone or justify the history behind my discomfort, and therefore my blanket refusal. My midwife was thoroughly supportive of this, if not relieved. Thank God.

I had a health visitor, I think you call it over here, who had come to me once to discuss my postnatal depression. The next time she came, she brought a bright happy, no doubt lovely, student along with her, without having asked my permission beforehand, sat herself down on my couch, and then said, oh, this is student A, she's along to observe, I knew you wouldn't mind. Bloody useless for both of us, student and me both, as a result, because yes, I did fucking mind, so nothing further than the weather was discussed, and the minute they'd gone, I rang up and disenrolled myself from that pilot programme, explaining why.

The condescending, know it all tone of some who profess to be health care professionals on this thread makes it so very clear just how little some care about the mere patient's experience, or perception, and just why it can be so hard to say no - or get them to take it for an answer.

HonestwithHope1 · 22/01/2022 17:47

@JustLyra

Again. Agree to disagree. On my first post I detailed why students may already be sat. So idk if you can understand some of those reasons. It aint a big plot to demean patients.

Whether a student is initially present or not does not reduce importance of informed consent and the onus on the patient to be honest with regards to consent. Unfortunately professionals aren't mind readers and do require verbal consent or not.

IrritableOwlSyndrome · 22/01/2022 17:47

This reply has been deleted

Message deleted by MNHQ. Quotes deleted post

Original poster
MarbleQueen · 22/01/2022 17:46

MarbleQueen hun you literally argued with me that a phone call to a patient wouldn't take that long. .....

No hun I didn’t. Stop gaslighting.

OP posts:
RobinHumphries · 22/01/2022 17:45

This reply has been deleted

Message deleted by MNHQ. Here's a link to our Talk guidelines.

JustLyra · 22/01/2022 17:45

@FangsForTheMemory

I don't like students being present but how can they learn otherwise?
By watching the people who are happy to have them there.

As shown on this thread, there are plenty of them.

HonestwithHope1 · 22/01/2022 17:42

I’m not keen on being accused of tantrumming or being emotional because I don’t want 3;teenage students watch me having a smear test

Yeah i totally said that didn't I 🙄

Again

Informed consent is essential

FangsForTheMemory · 22/01/2022 17:42

I don't like students being present but how can they learn otherwise?

JustLyra · 22/01/2022 17:42

[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]
Informed consent is essential.

Which is why people are arguing against pressured and presumed consent of already having students sat there pen in hand and casually dropping a “that’s ok?” on people last second.