Nhs students and lack of consent.

Do you not believe in consent at all?

@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?

@Witchcraftandhokum

It is not free. We pay for it in our taxes. Taxes in places like USA are low because they dont have healthcare included.

I've had a medical student yawn in my face while I was disclosing something very difficult, and another rolled their eyes. I've also had amazing care from student midwives and have been an AHP student myself, and currently have my own students. Patients should be able to give informed consent to having anyone present, and the qualified HCP should never ignore the patient in favour of the student. Informed consent is the key, at all times.

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

A student delivered my second baby but I was asked for consent and they talked to me about the fact they were at the end of their final year and about to start as a fully trained midwife.

I have very complex pregnancies due to an unusual health condition and have had students observing appointments as it’s likely they’ll never see someone like me until they’re fully qualified otherwise. I don’t mind as I hope it will help someone else like me in future but again, they have always got consent.

Have also had the same at the GP, they have always asked consent and introduced the student.

It’s frankly just bad practise not to.

Nah that’s not ok.
I’m a nurse, and a medical student.
I always explain if I have a student with me to patients and explain they’re supervised but I still have to ask their consent for whatever it is I’m/they would be doing.
On my medical student placements, the doctor will collect the patient from the waiting room and ask consent for me to be in the room. If they’re not comfortable, no problem, I’ll find something else to do for 20 minutes. If they are, I come in and introduce myself as well.

Depends on the person. I'd have no issue with a group of students. As long as you can say no, I don't see any reason for a blanket rule against this stuff just because a minority of people might not like it.

It's not that i didn't like having nine students staring into my vagina, it was more that I couldn't have given informed consent to have any of them there. I wasn't "present" enough to be aware that my husband wasn't there for two hours, I was in no position to be consenting to allowing a crowd to be peering into my vulva.

My DM had to stop the doctor from pressuring me into having forceps, consent for which I would never, ever have given in my right mind.

I remember going to the gp once and I saw a trainee GP who asked very politely if I’d mind my consultation being videoed to help with his training. I agreed as I wasn’t there for anything that required any sort of intimate examination. Otherwise I wouldn’t have.

This thread has brought back something I'd completely forgotten.

Towards the end my first, very long and difficult labour, it was decided that I needed intervention, starting with ventouse and then forceps. I was whisked off to the room this was happening in and asked if I minded students being present. I did mind at that moment and said so.
Things got busy and at some point I realised there were quite a few students at the business end, watching as the doctor wrestled the baby out with forceps, blood dripping on to the floor. Obviously at that point I was pretty distracted but afterwards I wondered why they had allowed that when I'd clearly said no.
It was probably a good learning moment for them but still.

@Janesmom. I can see that some people would be fine with a group of students, but I think any consent has to include the number of students. So not 'are you ok for students to observe?' but 'are you ok for X number of students to observe, or would you prefer less or none at all?'.

I think where hospitals often take the piss is in the number of students. One student unobtrusively in the corner, fine. Nine students being given a lecture in front of your open legs, really not fine.

As well as consent (which I agree is crucial), it's also about personal dignity. Just because someone consents to have students there doesn't mean you should then ride roughshod over their personal dignity. And personally I think any more than one (or at most two) students behaving sensitively and unobtrusively is doing this.

I was transfered from my MLU to hospital in labour. Its a teaching hospital, and is amazing, but I was in no for state to consent to being observed by the crowd that piled in to see my epidural being sited. I just recall my back being cold and there being a lot of people.

DH sent them out (not politely) when he arrived and there were nine students about to watch me have an internal examination.

When I was being transferred, I went in the ambulance, he had to drive the car and was stuck in traffic for over 2 hours because there had been a crash. I was so out of it, I had no idea he wasn't there from the beginning. How can there have been informed consent in this situation?

@AutomaticMoon

That wasnt even the NHS. It was a change in law, by the government.

Law was proposed, debated, went through all the processes a law needs to go through. It was on the news regularly during that. Then in March 2019, it recieved royal assent. Again, it was on the news. the changes came into effect in 2020.

It was on the news for at least 3 years. It was debated, there were lots of opinion pieces about it.

If you dont follow news then that's on you. But this was widely publicized for a prolonged period before the law changed and then when it actually came into effect. Nobody just did it without telling anyone it without warning. You had years of warning.

I work as a specialist nurse and we seem to be having student nurses more and more frequently, I think it's the new student nurse curriculum where there are a number of clinical skills which they have to gain which are probably easier to experience in our type of setting rather than on the ward.

I always ask the patient's consent when I collect them from the waiting room for the student to sit in on the appointment. So far, I've never had any say no (I think that may be because we don't do anything particularly intimate). I did have one patient who had come to clinic quite distressed and I didn't even ask her if the student could sit in, I just told the student to go and have a coffee and I would come and get her once the appointment was finished.

Depending on the patient and how keen they seem to be to include the student, I may ask the student a couple of fairly straight forward questions (sometimes the patient joins in in trying to get the right anwer). Other times, I may briefly explain something, such as a blood result, a clinical finding, or something interesting in their history which is relevant to what we are doing (such as taking a blood pressure, avoiding the arm with the fistula for dialysis, which the patient may then tell them a little about what dialysis involves or invite them to feel it buzzing). I don't ignore the patient to explain anything to the student but explain it to them both which patients actually seem to appreciate. Obviously some patients wouldn't appreciate that, I had one recently who said he was happy to have the student in the room, but he didn't really want to be at the appointment and whilst he would have been interesting for the student to be taught about, she just sat quietly in the corner of the room and I just did his appointment as though she wasn't there.

In theory I don't mind students observing or getting involved at all. In practice, it also depends on how I feel about the appointment/treatment in question due to vulnerability and distress, and - most importantly- how I'm asked or if they've bothered to ask at all. I'm usually not afraid to be a bit blunt and stand up for myself- but not always. Being asked in a pressured way, having someone try to make me change my mind by impliying I'm being silly or being volun-told a student will work on me can be really overwhelming.

Fwiw I've had students or trainees/juniors twice. One was for a minor gynae treatment and I agreed because I was asked immediately and felt ok and even if I'd said no to her treating me, was still happy to have her watch. The other was for an ultrasound & trans-vaginal ultrasound and I can't really remember how well the subject was introduced. I was more preoccupied with not wetting myself but I think I was asked asap & agreed. Had procedures been more stressful/scary or the people more pushy I wouldn't have said yes. Definitely wouldn't want students taking my blood- hard to find veins, sitting on mh or possible bad news appointments, including the more serious ante natal ones and definitely no gawping groups.

Thankfully I've never had a trainee chiropractor either. I definitely would refuse to have them watch or work on my neck. I don't want someone "learning" on my neck, especially when I'm frightened to be touched there by anyone anyway. Took the chiropractor three sessions for me to be ok with being touched there. Similarly they're welcome to observe my wondrously hyper mobile ankles and the bone in my left foot that won't stay in place- but I have a low painthreshold and years of rehab on the joint at risk. No way.

I have always found that the treatment is better when students are observing or being instructed! My ds was delivered by a student midwife and I have had many students observe / treat me over the years.
My experience has been the opposite of the op.

What your saying does seem very wrong.

Saying that I have no problems everyone has to learn, I’ve had both male & female student nurses look after me & I was the only person on the maternity ward who consented to let a male midwife look after me. I had a student midwife look after me before & after an operation and the care I received was outstanding - however each time consent has been sought.