Nhs students and lack of consent.

I agree OP, fortunately (it should be standard so it's sad I feel fortunate) I have always been asked and had my wishes respected, but this should absolutely be the case across the board without any exceptions. Although I can see how some mental health settings can be more complex- many don't consent to being sectioned at all let alone particular treatments and members of staff who they see; although there must be tight guidance that considers this surely?!

@RedToothBrush no I am not, if anything you are twisting things and not reading posts properly. You are obviously ignorant to mental healthcare settings and the training nurses do who go on to qualify as nurses in this speciality, so perhaps just don't comment on stuff you don't have a clue about :)

@LumosSolem

it's all about what suits the medical profession and the NHS and nothing to do with what is best for patients.

Sums up the current state of the NHS perfectly really.

@Orangesox

How do you think we should manage students in areas where very few patients have capacity (say PICU or a forensic ward)?

However if I did manage to get there I would not be happy about students being there but DH not being allowed to support me.

This is such a good point- people haven't even been able to have support from a loved one when being told the most devastating news about their health during the pandemic- yet it's ok for medical students to be present, increasing the number of people?

Yes they have to learn (not the job of the patients to figure out how this is best done btw) but once again- it's all about what suits the medical profession and the NHS and nothing to do with what is best for patients.

I wonder how many agree to it when they wouldn't ordinarily

And when 'consent' is obtained in that manner how can it be true consent? It's really unpleasant actually- apply that to another situation where someone may feel vulnerable and they are being pressured to consent. And that is where we appear to be in some areas of the NHS.

YANBU - I say this as a Healthcare Professional. I regularly have already Qualified Post-Graduate Students come to undertake placements within my clinic, not only do a pre-warn my patients and allow them the opportunity to reschedule, but on the day, I then ask each and every one of my patients if they are happy for the student to observe, and if appropriate to undertake their examinations which are not intimate in any way. Some don't want to be observed, some are happy to be observed but not for the student to undertake the assessment, some are happy for the student to crack on under my supervision. Every single person should be able to give informed and unbiased consent. If someone is in no fit state to consent, then in my opinion the student should not participate - I feel very strongly about bodily autonomy and my role as a patient advocate. I would be disgusted to play any part in a situation where someone felt that they could not speak up for themselves or felt pressured into agreeing to something they were not comfortable with.

As a patient I am more than happy for students to participate in pretty much any aspect of my care, as is my right to consent to. But nobody should feel bullied into it. As students, whilst opportunity is sometimes thin on the ground, you expect that some people will not want you to participate, and it forms a huge part of our education as healthcare professionals about balancing the best interests of the person with their capacity to consent. I'd argue that unless I was about to bleed out everywhere, and the rest of the medical team had been murdered leaving only the student capable of saving me, that it still wouldn't be in my best interest to violate my consent in almost every situation to put it bluntly. Students can't become confident and competent practitioners in their own right if they're enabled to ride roughshod over a persons' bodily autonomy.

If the NHS hadn't got itself in such a mess over consent and wasn't so oblivious to the needs of people (women in particular) who have had traumatic experiences, trust might well have not been lost in the first place. This is the nub of the issue.

You don't regain trust by coming out with emotional blackmailing. You rebuild trust by institutional level cultural change.

That ultimately requires people to say 'hang on a second, wtf are we doing tolerating the current system and why aren't we overhauling it completely?' 'Why are we making it a big deal that certain practices about requests over students are utterly outdated?' 'Why are students shadowing doctors in particular situations in large groups?' 'Why are students shadowing doctors, when they aren't actively participating, when the logistical practicalities of being stood in the corner of the room, mean they get no benefit?' 'Why are we teaching students about bedside manner with patients at all? Is this something we could do in other ways?'

As I will keep saying, the onus keeps being put back on patients in a way that applies undue pressure - including asking patients to come up with alternative ways to train doctors it seems.

Its so reminiscent of the culture of victim blaming, I find it disturbing.

My GP wanted me to have an over 40s check up. I declined as I have a needle phobia and was told DH wouldn't be able to accompany me because of Covid. The GP didn't seem to understand the only way I would actually get there is if he took me but that's another story! However if I did manage to get there I would not be happy about students being there but DH not being allowed to support me.

I've had trainee students at almost every gyno appointment I've been to, both male and female. It doesn't bother me in the slightest as I've never seen medical appointments as specifically private, and I like that I can contribute to learning.

But I believe you should always be asked, and your opinion respected. If you are not comfortable then they shouldn't be there, and they should absolutely not perform procedures on you without your consent.

My GP always has students with them and I am always asked if I mind. What has changed is they are now already in the room instead of being outside and then brought in once you've consented. I've always been OK with it they way they are positioned in the small room means it would be a faff to have to ask them to leave and then move your chair out the way and the whole awkward silence etc so I wonder how many agree to it when they wouldn't ordinarily.

I know because a long time ago before I got ill I was a student nurse. (Adult general nurse).
Consent is actually a big thing.

I'm shocked by OPs smear experience.
I attended some smear appointments as a student but left the room on the request of certain patients.
I personally would refuse to have one extra person present let alone 3!!
If the practice nurse had a funny attitude to me being shy then let her. I have to take diazepam before my smears and some nurses don't get it. That's up to them.

When I've recently had psychiatrist or psychologist appointments recently I've been
asked if students can attend.
I say yes or no depending on how I feel at the time.
For example there was a trainee police officer and I refused because I felt paranoid around the police at the time but recently I said yes to a trainee psychologist because she seemed quite alright.

You know you can always withdraw consent DURING an appointment or procedure too if you are not comfortable with the student.

If you read my previous posts you would see I'm in total agreement with OP, but I was intrigued by your post relating to other settings.

Okay I mean repeating the same thing over and over doesn't really help. The issue of consent overall is a lot deeper in MH care settings when the majority of patients haven't actually consented to being there anyway, but by the by- interested what alternative for having mental health nursing students around mental health patients you propose whilst they train?

My local hospital is a University Hospital, I'd usually be the 1st in line to say how shit my hospital is but I have to say we're always told when there is a student sitting in on an appointment or doing any procedures. Same at my GP Surgery.

I'm generally happy enough to have them there for most things, but I don't imagine I'd be happy for a male student to be present during any intimate procedures. However, I do now completely refuse students taking blood from me, I'm not an easy patient to take blood from and I've had one too many traumatic experiences of students unsuccessfully trying over and over again! I need an expert!

[quote Promleafyus]@RedToothBrush are you confusing my post with someone else's? You posted about students in mental health care settings, which is what I responded to and your snappy reply didn't seem to actually be in response to it.[/quote]
Why is it for PATIENTS to sort DOCTORS responsibilities and to enforce what is ALREADY written into medical ethics in the uk?

What is already supposed to be being done, is quite frankly, regularly run roughshot over, because it serves the interests of the medical establishment.

It does not serve the interests of patients to ignore protocols over consent.

HTH

I had a student midwife deliver my baby (until a doctor was needed). I was not asked. The midwife barely even addressed me, and the student looked very nervous. It was during the pandemic and my first child.

I don't mind students learning with me as a patient, but I expect to be the primary focus, not the student's learning!

I agree this is getting out of hand.

@RedToothBrush are you confusing my post with someone else's? You posted about students in mental health care settings, which is what I responded to and your snappy reply didn't seem to actually be in response to it.

[quote Promleafyus]@RedToothBrush it doesn't answer the issues you raised in the post I was replying to, no, so I guess it doesn't help![/quote]
Why is it for PATIENTS to sort DOCTORS responsibilities and to enforce what is ALREADY written into medical ethics in the uk?

What is already supposed to be being done, is quite frankly, regularly run roughshot over, because it serves the interests of the medical establishment.

It does not serve the interests of patients to ignore protocols over consent.

@RedToothBrush it doesn't answer the issues you raised in the post I was replying to, no, so I guess it doesn't help!

They are victim blaming.

We know how widespread that is.

Those arent questions for me, those are questions to ask at the time!

Are you illiterate or have you missed all the posts where posters have said they find it extremely intimidating and difficult to challenge things when they are outnumbered and there are people now in the room with them?

Why wasn't the situation about what would happen thoroughly explained? Why is it the patient's responsibility to ask and not the doctor (who is in the legal position of responsibility) not required to do this? Why are you putting it on the patient when the balance of power is with the HCP?

This is a form of victim blaming. This poster said they felt distressed by the situation and you've said its her fault.

As I say and I will reiterate, there are a lot of posters on this thread who simply lack any empathy and don't care about anyone but themselves.