Nhs students and lack of consent.

Sorry, that was in reply to Lumos.

Indeed.

Either "it's just a body, no need to be embarrassed, they're students who want to be doctors!" and therefore this minor inconvenience is necessary...

Or it is actually quite a big deal and quite a lot to ask of someone when there is no benefit to them as an individual. And particularly a lot to ask when that patient is in the vulnerable position of being very unwell and under a lot of stress and upset.

In which case, since the benefits of medical students having access to bodies to practice on lies with the medical students themselves, then it is they who should offer up their bodies for practice. It will be much less of an issue for them to do it than patients, because a) the students themselves are benefitting, b) they are not ill so are not vulnerable like the patient is, and c) they are able to compartmentalise it as "just a body, no big deal, no need to be embarrassed" better than your average Josephine on the street can, so it won't cause them any psychological discomfort.

Yet that doesn't seem to be the case, which tells us something.

The solution for me would be to have specialists in women's sexual health / gynaecology within primary care rather than expecting all GPs to be able to do intimate exams well. Which would mean ongoing training etc. Specialists could work across practices.

The previous poster who said GPs are also being expected to perform prostate exams etc may be true but based on my older family members experiences of prostate issues, the GPs have taken a history and immediately referred on rather than doing any examinations themselves.

Hmm..... anyone would think that just maybe, it's actually a bigger deal than some would suggest!

Students do practice non intimate exams on each other

Why only non intimate?

The feeling I am also getting on this thread is that people don’t realise how much students are already involved in their care and it strikes me that Most people on here would not want that, for example the students will be present when all the cases are discussed at handover, they have access to the medical records of patients, they assist in operations (provide touching the patient assistance like retracting skin layers), look at samples in the lab etc, be part of resuscitation attempts . I do not believe that consent is ever taken for this any more than it would be for a qualified team member to do these things. (This does not include intimate exam under anaesthesia - this requires separate written consent)

I can only speak for myself but I find most of those things fine. I couldn't care less about them discussing my history when I'm not there, it's when they do it in front of me and I have to deal with their embarrassment/pity that pisses me off. It's hard enough to talk to one person about anything gynecological or regarding my mental health, adding extra bodies especially males makes the scales tip further towards me being unable to do so.

I don’t think patients smears are pay per view. In fact I said I didn’t. I’m trying to engage - I’m a woman I’ve had babies and emergency c section and the experience of what feels like 100 people run into the room to stare at you legs akimbo (and I also have to now work with some of these people day to day, gotta love having colleagues who have seen you starkers) I get it’s shit, No one should feel uncomfortable or have anyone they don’t want for any exam or procedure (other than a properly trained chaperone for intimate exams which I believe should be mandatory everywhere). That’s not debatable and I hope all medical professionals would agree. I have left many a room when a student and as I said still do now I’m qualified - when on Gynae I was always double checking it was ok for me to be there. Patients do withdraw consent mid procedure and that’s also ok. You stop straight away and if someone doesn't stop it’s assault. Usually means then a big discussion needs to happen about how we can make the procedure work better for the patient if it is essential for their health.

What has surprised me here is anger, the feeling that students are exploiting patients, that students should not automatically be involved in patient care that no one other than those essential for the provision of care should be present, and the feeling that these students are just folk off the street. This seems new, it’s talked about in medical circles but from the other side - why so many male doctors are barely competent in women health, how universities are cutting the qualification requirements for doctors as students are not getting enough exposure to certain types of patients and procedures. How trainee surgeons now days have assisted on many less cases. How newly qualified doctors don’t seem able to cannulate or insert NG tubes because they never did as students. Doctors qualifying now have less hands on training than their predecessors and that’s a worry as it seems to mean they are less competent, especially as COVID removed around a year of face to face training for the current cohort.

Also concerned that students seem so often to be thought of as disinterested. Students shouldn’t be grumpy in a corner - that is shit and hopefully they are going to be failed by their supervisor for being poor communicators, but it’s a worry there seem to be so many!

Students do practice non intimate exams on each other and also (or at least used to) learn how to take blood from each other etc. ThWhen I was a student due to lack of patients consenting to being examined, the medical school advertised for women to work as intimate anatomy demonstrators for students to learn examination on - I wonder what people think of that? It was also a big issue at some medical schools a few years ago as females from different ethnicities were not agreeing to this due to religious reasons causing upset amongst male students who felt they were being exploited by always having to be the examination models, but clearly we also want ethnic diversity in doctors. Plastic models are no substitute.

The feeling I am also getting on this thread is that people don’t realise how much students are already involved in their care and it strikes me that Most people on here would not want that, for example the students will be present when all the cases are discussed at handover, they have access to the medical records of patients, they assist in operations (provide touching the patient assistance like retracting skin layers), look at samples in the lab etc, be part of resuscitation attempts . I do not believe that consent is ever taken for this any more than it would be for a qualified team member to do these things. (This does not include intimate exam under anaesthesia - this requires separate written consent)

You should be given the choice of which nhs hospital you want your care in.

Uk medical undergraduate qualifications is a generalist qualification and then juniors doctors spend two years minimum rotating through lots of departments then they choose what type of doctor they want to be and start specialist training. A doctor must already be proficient in all the basic skills before they qualify as a doctor. This includes intimate examinations both of men and women - breast, prostate, testicular and vaginal. It does not include surgery so they would not have to perform a circumcision but does include more minor procedures such as suturing a wound and inserting a nasogastric tube. My medical school required each medical student to have delivered five babies in order to qualify but I think that might have been dropped as male students in particular were not being given permission.

So even if you want to be a psychiatrist or a knee surgeon you will have to be examined as competent in intimate examinations and then have a fairly high chance of working in obs and Gynae for a bit before you specialise. I don’t think students do think they are qualified before they are but they have to . I’m sure I’ll annoy someone with another non medical analogy but it’s like learning to drive - learners have to actually do all the stuff drivers do but with a supervisor and then when they pass their test they can do it on their own. Medical students have to learn to do all the things doctors can do because once they have passed their finals they are qualified to do it on their own from that point. Hopefully it’s reassuring to people that like learner drivers have to apply for a provisional licence medical students have to have DBS checks, ID checks, professional standards oversight, confidentiality training, resuscitation training, occupational health clearance etc just the same as the doctors do. They also have to do the same nhs mandatory learning and induction as all staff working in the nhs - they don’t just turn up from no where!

I’m a nurse. When I trained I always checked if it was ok for me to observe or carry out things myself.
As a patient there are some things I wouldn’t want more people that necessary there for. But then I did have a very traumatic experience where I almost died, and my child did die.
In any case, it would appear that there are so many people on this thread who are more than happy to allow students/juniors etc.
so the odd person saying no, shouldn’t be a problem really.

There isn’t a sorting hat; new doctors mainly make the decision to specialise in their chosen areas on the basis of which placements inspired them during their undergraduate course and in their foundation jobs.

In order to attract highly motivated people to become the consultant gynaecologists/ psychiatrists/ oncologists of the next decades, it is important that students are exposed to these areas of practice. A good grounding in Women’s Health isn’t just for future obstetricians and gynaecologists - it’s important in General Practice, Emergency Medicine, General Surgery, Oncology, Radiology, Anaesthetics etc.

Me too. I find all medical appointments really hard, but any sort of gynae/intimate procedures are absolutely horrific for me. I cry in the days leading to the appt, when driving there and am a quivering and sobbing mess by the time I get to the consulting room. If I arrived to find a bunch of onlookers, I'd walk straight back out.

A student midwife was with me throughout my sons birth, and she was lovely but I physically couldn't cope with what many women are describing on here. I'm not a piece of meat or a medical dummy to be touched and observed on someone elses say so.

I've examined more prostates during medical school than I have delivered babies.*

Every time with express informed consent from the person involved.*

Nice that the men always get to give expressed informed consent when they are having intimate examinations isn't it.

Shame the same can't be said for women- one quick look one the childbirth section on here will show how often consent seems to go out of the window when a woman is in labour. And that's just one example- unnecessary examinations under GA where no consent has been given is another. Sure there's plenty more.

@Sodthebloodypicnic - you could always have examined each other's prostates. If it's fine for patients it should be fine for you all. The same with vaginal exams.

@Changednamesorry You should know that cPTSD acquired from long term childhood abuse causes the symptom of not being able to trust adults in positions of authority and it’s not just ‘intimate’ procedures that are triggering, it’s any situation where your boundaries are trampled over and adults in positions of authority feel entitled to use of your body.

@Changednamesorry You mentioned ‘serious’ trauma, what is non serious trauma? What if they were just held hostage for a year but not raped, would that not count as ‘serious’ trauma?

@Knackeredmommy Aw please don’t feel guilty for not speaking up, I’m not surprised you didn’t, many of us just freeze when in a situation like this. I was never taught boundaries or how to stand up for myself and I think many are the same, how can we be assertive when the opposite is modelled for and expected from us?

I've examined more prostates during medical school than I have delivered babies.

Every time with express informed consent from the person involved.

Recently had an appointment for my son. We were informed on our way to the room that someone else would be sitting in. We were not asked if that was okay. We were not told why he was there. Neither of us were bothered as it was a quick physio appointment. But they didn't ask for consent. The other person in the room didn't take his head away from his laptop. I dont understand his reason for even being there.

Every other appointment in the past, I have always been asked if it was okay that another person was sitting in, along with the reason why they were there.

I wonder why they are no longer asking for consent with this kind of thing. Especially for more personal and private appointments.

@Knackeredmommy that's really bad. I'd have probably said he needed to leave but I know it's really difficult to do and I just really can't hack them being there. I actually phoned the hospital before my last colposcopy to ask them to ensure I only saw female HCP's. Told them I'd wait longer to see a woman if necessary.

In Spain where I live you don't get asked and it would be considered very odd to complain about medical students being present and outside serious trauma (rape victim not wanting students present at any intimate examination for example) I think that the default should be students present, no need to ask permission but that there is an "opt out" box.

@AutomaticMoon, it wasn't great, it's an uncomfortable enough awkward procedure as it is, he didn't say a word to me and I was just waiting for it to be over with as they discussed cells etc.. I don't know why I didn't speak up..

@Knackeredmommy That’s completely disgusting, I would be been suicidal if this was done to me. Luckily I don’t try to get help from NHS anymore so not much chance of it happening. But this is one of the reasons I have tokophobia and can’t have a baby, it’s not really fair.

Yes! I remember being asked previously if a student was present, if I was ok with it. Recently had a colposcopy and was told the young male student doctor would be present, not asked. My examination then lasted longer as she explained to him what she was looking at on the screen. Not great, I don't usually mind students but would've preferred not havocs one for that procedure.