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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:
Zombiemum1946 · 21/01/2022 23:40

I work in the nhs and usually consent is asked for at least 2 times. I will ask before taking the patient in and the doc will ask when the patient comes in. If the student is going to examine the patient the specialist will ask for consent and so will the student. Make a point of saying you want it made clear that you don't want students present at any apps. I've only had 3-4 people say no one the course of 20+yrs so it may be being taken for granted that you'll be fine with it. I'm so sorry you've been through this.

superking · 21/01/2022 23:39

Personally I'd far rather be treated by a student doctor under the supervision of a more experienced colleague, than the same student doctor a year later, newly qualified and with no one else observing/ advising. Obviously the ideal would be for everyone to be treated by experienced doctors but that's impossible!

Yes legally consent is important, but except in extreme cases I think it's pretty selfish to refuse it - how else are students meant to learn? And if they don't learn, we will run out of doctors. It's basically saying it's fine for them to practice on other people but not on you!

Wardrobes123 · 21/01/2022 23:39

I have seen a couple of incidents where a student has been present and no consent obtained. I also had to make a formal complaint when a junior doctor attempted to take blood from my needle phobic teenager while he was asleep (my son had a detailed care plan due to phobia and other issues - so obtaining consent from him was an absolute before any procedure). These things do happen.

My DS had regular hospital stays and used to love entertaining the students and answering all the questions they had about his medical condition. He was used as exam practice for several years as the doctors knew they could trust him.

But he had a difficult couple of years medically, during his teenage years. He quickly started refusing students as he felt very exposed and self conscious. On more than one occasion the students didn’t leave - DS told them to leave or he wouldn’t co-operate. For him it was so much more mentally than he could cope with. And that should’ve been respected during a difficult time.

I understand all students have to learn somewhere but when it is medical it is more sensitive and so a patients consent should be obtained and the patient able to refuse without any awkwardness.

AbandonedCharacter · 21/01/2022 23:39

'Apart from your birth story which does sound awful I think you're being a bit of a drama queen'

I'm going to assume that you missed that OP was a victim of abuse.

Spicez · 21/01/2022 23:38

[quote AutomaticMoon]@shouldistop I found out I’m an organ donor almost 2 years after I became one, completely unacceptable.[/quote]
Were you planning to do something else with your organs? Would you accept a donated organ if you needed one?

MargaretThursday · 21/01/2022 23:37

I've always been asked.

I will say that the student midwife when I had dd2 was absolutely amazing. She also gave me some knitted bootees her mum made for all the babies she delivered. I've got them in dd2's memory box.

AutomaticMoon · 21/01/2022 23:37

@shouldistop I found out I’m an organ donor almost 2 years after I became one, completely unacceptable.

OrlandointheWilderness · 21/01/2022 23:36

I'm a student nurse. Every time I meet a patient i introduce myself and ask if they are happy for me to be there during whatever I'm there for. I wouldn't think twice if they said no, and I wouldn't think any the less of them for it.

CherryPieface · 21/01/2022 23:36

I remember being a student with heart issues and being asked if students (at medical school at my university) could observe. I said no, I see these guys in the Union etc and I don’t want them to see me with my top off etc. doctor was really pissed off and I felt terrible but I still think it was the right thing to do.

Wineandrun · 21/01/2022 23:35

That student midwife will remember you and your baby forever. I’m sorry you felt so ambushed and uncomfortable but if it helps at all, you have played such an incredible part in her training, career and vocation.

BeatrixKiddo88 · 21/01/2022 23:34

I think you're heavily exaggerating! That's a huge list of appointments all with all these students milling about? I've had four children,hundreds of appointments in my life of all kinds and only ever had one student present and I live in London. If you don't want some one there say so and complain if you have to but remember everyone starts somewhere and this is how they learn,I've often thought it's strange I don't see it more often at any of mine. Apart from your birth story which does sound awful I think you're being a bit of a drama queen, sorry

Original poster
MarbleQueen · 21/01/2022 23:32

Here's how it works

You arrive (hopefully on time for appointment)

You walk in, see 2 people instead of 1.

You are asked if you will allow student to observe (however way they phrase the question you are still being asked)

Bollocks again.
The receptionist can ask at booking in. And you’re missing the point, they are not asking anyway.

OP posts:
IrritableOwlSyndrome · 21/01/2022 23:31

@SquirrelG

I do agree the patient should be asked for consent, but don't think it should be refused unless there is an extremely good reason.
And that's why I would find it hard to say no when asked when the student is there, if I had to give a good enough reason to be allowed to say I'd have to explain things I can't even talk to my dh about, to strangers. I probably wouldn't bother with smears or any kind of intimate health problem if a simple no thank you I'm not comfortable with that was enough.

What if my reason given isn't good enough? Who decides what's a good enough reason? What if the person asking me for the consent is a "not all men" type? and tries to change my mind or dismiss me anyway?

Blossomtoes · 21/01/2022 23:31

I worry about what these students are learning about consent in these circumstances.

I worry about what these students are learning about anything at all if patients kick up a fuss about them being present.

StoryOfANewName · 21/01/2022 23:30

Just to add that from what I’ve seen I would say in hospital it’s the norm for the student to already be there, but it’s also the norm for them to seek informed consent and, crucially, the norm for some patients to decline this. It’s par for the course and not an issue.

TheRemotePart · 21/01/2022 23:30

I’ve always been asked, all the way through my pregnancy etc.
Not bothered - that’s how they learn.
I’d be unhappy with males tho, if I’m honest

The only time I remember not being, was when I was early 20s ( so too afraid to challenge) and seen a male GP and was literally knee to knee with a young male student.
I think I had a UTI. Even then I wasn’t too shy or embarrassed about most things- but I do remember not being “asked” and just “told” he was observing ….

HonestwithHope1 · 21/01/2022 23:29

@SC215. Please don't stop this! It's a vital skill and you are clearly doing it in the right way!

NoRaceInThisHorse · 21/01/2022 23:29

@HonestwithHope1

Sorry that should be -

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then ask the question then potentially call them then get on with appointment.

Again,,i think your splitting hairs, the outcome is the outcome for your wishes of consent regardless if student is in the room when question is asked

Be very simple for the receptionist to do the asking and flag on the system if the patient says no, surely? If the next person has a flag, the student steps out. Simple. No time wasted.
SC215 · 21/01/2022 23:28

@NoRaceInThisHorse

We have signs up everywhere saying that it is a teaching hospital, students may be present, and to let the receptionist know if you would prefer not to have them in the room. I still thought it was important for students to introduce and ask the patient themselves, but maybe I will stop that now!

arghdilema · 21/01/2022 23:28

@Spicez why is an 18 year old less likely. Those who want to go into medicine are expected to have done work expensive/shadowing before the application is made. If op lives needs a large teaching hospital it's perfectly plausible to have a student at each appointment.

@SquirrelG not wanting to have an extra person looking at your vagina is a perfectly valid reason for a women not to consent to a student being present during a smear.

StoryOfANewName · 21/01/2022 23:28

I am sorry this has been happening to you. I am a medical student, albeit a fairly ancient one.

Where I am placed, it has been drummed into us from the start to:
a) introduce ourselves and our role, and ask for informed consent for each specific individual thing (eg observing, doing a specific procedure, etc)
b) raise concerns immediately if patient safety/dignity is being compromised, as it would have been in some of the situations you described above.

From what I have seen myself, everyone including the younger students have done this including in theatres when patients are asleep (ie gaining consent from the patient before scrubbing in.)

I am also a healthcare assistant and from what I have seen, the nursing students are very professional too. They are more hands-on/thrown into the deep end though so I am not sure what the protocols are for them, and whether midwifery students are similar. It may be they are more integral members of the workforce.

As far as medical students go, there are also various stages to avoid things being missed/patients feeling put on the spot. At the GP, for eg, the doctor would ask the receptionist to ask the patient on the phone first whether they consent to a student being present; then the GP would ask the patient in the waiting room; and then the student in the consultation room would introduce themselves and triple check.

I am aware that in a hospital setting it’s sometime hard to be so thorough but the last point, if not the latter two, should apply.

I would also like to stress that students should never act put out or take it personally if they ask if it is alright to observe/do a procedure/take a history and the patient declines, regardless of whether the student is already in the room. Of course this isn’t to discount the fact a patient may find it tricky or impossible to do so.

If you have the energy, I wonder if you could face contacting PALS and the relevant universities. Patient consent and dignity should be paramount, and the universities/ward managers etc should be very interested and worried to hear your testimony; or if they are trying to brush this under the carpet, then it would be all to the good to have it spelt out in black and white so it is harder to minimise.

HonestwithHope1 · 21/01/2022 23:27

Sorry that should be -

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then ask the question then potentially call them then get on with appointment.

Again,,i think your splitting hairs, the outcome is the outcome for your wishes of consent regardless if student is in the room when question is asked

Reallycantbesarsed · 21/01/2022 23:27

@HonestwithHope1

Gaining consent takes seconds and doesn’t prevent them from learning.

YES!

BUT

precious you clearly doesn't want to see any student before appointment

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then potentially call them back then ask question then get on with appointment.

Here's how it works

You arrive (hopefully on time for appointment)

You walk in, see 2 people instead of 1.

You are asked if you will allow student to observe (however way they phrase the question you are still being asked)

You say no

Student walks out.

Sorted in less than 2 mins :)

Then, if your having frequent appointments with X service you can ask for it to be specifically noted. Most services aren't joined up so you'd have to do them for all obvs.

Oh wow lovely! You do realise phoning people could easily take 10 mins with them hanging on the phone, or the redials or the interruptions if they phone back having missed your call

When the simple question could be asked far more quickly in person on the day

This !
Original poster
MarbleQueen · 21/01/2022 23:26

You left without having a smear?
What did they say when you said you were uncomfortable? What do you mean insinuated you were being silly?

The nurse acted like I was weird for feeling uncomfortable, they were trainees and had to learn. All girls together, nothing they hadn’t seen before and no reason to be shy or embarrassed.

It was nothing to do with being embarrassed. I don’t give a shit about them being embarrassed.I don’t want 4 people present for an intimate procedure. It’s not necessary and like many other women I find them extremely traumatic due to abuse.

Something else, and I have never seen it before.. Usually there is a standard bed against the wall with a curtain round it.

On this occasion there was a strange chair in the middle of the room with stirrup type things on and no curtain round it. The bottom of the chair was facing the door. I’ve never been back there and felt quite sick that I was ambushed like that.

OP posts:
SC215 · 21/01/2022 23:26

We should be asked "is it okay if a student/s sits in on this session?"

It's very easy.

But not by the student themselves, or in front of the student?