Nhs students and lack of consent.

What is needed is an easy and non confrontational way for the few who don't want students present to be able to say so, preferably in advance to avoid embarrassment. Ideally it should be something the receptionist sorts out when checking in, with a note on the records to signifiy consent or non consent.

Students also need to be trained/prepared to accept when a patient doesn't want them present without feeling awkward or taking it as some kind of personal insult. It needs to be accepted as a normal choice and not personal.

The NHS is a teaching service so students being taught on placement is just what happens, if they cannot learn practically in addition to lectures how on Earth are they going to practice on their own?!?

Again for those at the back, it’s not the responsibility of patients to come up with solutions as to how medical students should get enough training.

The NHS is a teaching service so students being taught on placement is just what happens, if they cannot learn practically in addition to lectures how on Earth are they going to practice on their own?!?

I work with the ambulance service and most crews have students attached but you'd be unlikely to know who was who unless you're reading everyone's epaulets, it's certainly not normal practice to point out the student and ask if they remain in the room, they're there to assist and learn, and they're part of the team. I suppose that's the difference between in/out of hospital services as they wouldn't be standing/gawping, they'd be getting involved taking observations etc from the first day of placement. The only time it would be mentioned that they were a student would be if they were to undertake a procedure i.e. "Mark is one of our student paramedics, would it be ok for him to place your cannula..."

Of course our bodies are precious to ourselves, given the choice we'd all choose to be seen by the top consultant/most experienced member of staff. However some of us will be a brand new surgeons first patient, have the wound the nurse practitioner closes for the first time, the first patient a paramedic performs CPR on.

I'm a Paramedic and due in part to a lack of placement opportunities the first time I'd ever seen a baby delivered was when working as a solo responder, it was just myself and mum on scene and no crews available. I certainly didn't admit at the time I'd only seen it on video and put on my best air of calmness I could. Fortunately all went well. Would have loved to have a student with me that day!

@JennieTheZebra - I think you're being disingenuous. Many people have not suggested that people with MH difficulties should never have students. There is a difference between someone with MH difficulties objecting to bring treated like a piece of meat during intimate examinations and objecting to students being involved in their MH treatment. Numerous posters have in fact said that they would welcome students interacting with them and treating them like fellow human beings rather than gormless staring at them.

For me personally if I was having outpatient mental health treatment I would have less of a problem with my doctor introducing a student after we had built up a relationship of trust and if said student introduced themselves properly and interacted with me like another human.

I don't have the answer to where it's inpatient treatment and patient can not fully consent due to lack of capacity. I can only talk from my experience.

@RedToothBrush - your post at 10.01 is amazing. You summarised the issue very well.

@JennieTheZebra

It isn’t the job of patients to come up with a solution to the problem of how medical students are supposed to get enough hands-on training. I don’t understand why you think it is.

Realistically putting a trainee on a mental health ward before they are fully trained elsewhere isn't really appropriate. Its a speciality and should be treated as such.

It is. That’s why mental health nurses have completely separate training. Paediatric nurses do too.

All the posters saying you dont understand why OP is being so precious about it... dont you understand consent? OP has a right to be as "precious" as she wants. If she doesnt feel comfortable then thats it, no consent. There are plenty who will consent, plus others who will consent because they feel obligated to (not true consent). OP is likely to be in the minority so the students will still learn.

@RedToothBrush what do you think of HCAs/support workers who start work on the ward their first day more or less, potentially with zero experience in this type of work? Where do you propose mental health student nurses (yes it is specialised and the course is one in its own right) gain experience?

@RedToothBrush

A student MH nurse will have max 1 semester (so 12-16 weeks) of lectures before being placed in a MH setting, so a community MH team or a ward. Student MH nurses at my uni start their placement after 6 weeks of lectures. MH nursing IS a speciality so they don’t learn anything else so there’s no other areas to “build up” in. As for restraint training, this is learnt “as and when” and tends, due to insurance, to only be done by qualified nurses unless it’s a real emergency but, at night for example, a final year student nurse might be the most senior person immediately around, especially if acting as “nurse-in charge”. This way of training MH nurses is standard around the world, not just in the NHS. Would you do it differently?

Not only that, it depends on the nature of the problem and what stage of distress someone is at. A proper assessment of the patient prior to making them a subject of students is appropriate. An 'on the spot' request, shouldn't really happening. Plus, some people will be fine with a request - cos y'know, not all mental health patients are the same.

Where you have a patient who has trust issues and a stated on record expression of not liking HCPs then its probably not a good idea to be approaching them... and it should be part of training to think about who is appropriate to observe and who is not...

You want to try giving birth to twins there were about 500 people in the room
The thing is they have to learn, but you are right you ought to at least be asked.

[quote RegardingMary]@AutomaticMoon

Don't get me started on sweeps!!

I've had 4 children, I know what a sweep feels like. I was examined in my last labour and despite verbalising it moments before the examination and despite it being written in my birth plan, the midwife did a sweep. I know this because when I asked to her why have you done a sweep? I've not consented to that.

She told me
'Well I was there anyway so just thought I might as well.'[/quote]
This is absolutely disgusting and is assault. How dare she? I am so sorry that happened to you.

Its sad that people think in 2022, that being concerned about your mental health or dignity is 'being precious' rather than considering why certain practices could be improved to ensure that people don't need 'to be precious'.

There really are some cracking oneliners littering this thread from posters who are willfully and deliberately missing the point and can't be arsed to take the time to read and consider the experiences of others and why this has caused actual distress to them. Instead they are happy to call people who are suffering from trauma or anxiety as 'being precious'.

Cos obviously treating trauma and anxiety are not health issues.

The utter ignorance and total lack of empathy that leaps off the screen is staggering sight to behold isn't it?

Do people have any opinions on how students learning to work with people who have mental health problems (eg MH nurses) should be trained? Many PPs have suggested that people with MH problems shouldn’t have students in at all/shouldn’t be asked due to trauma or pressure, but for a student MH nurse this patient group makes up their entire placement experience. I know that someone’s trauma shouldn’t be a “teachable moment” but if no one’s trauma is ever used for teaching then students just don’t learn about trauma. The same goes for people who lack capacity. Many inpatients on a MH ward will lack capacity, so in theory can’t consent to students but, in practice, MH wards make up a large proportion of MH nursing placements and those wards only really function because the students are acting as HCAs. What’s the solution?

I don't really understand why you're being so precious about it.

In my case, it's because my trauma is not a teaching moment. If I attend appointments for antenatal reasons or my daughter's hv check up, I don't think it's acceptable to sit and listen to a hcp discuss the reasons for my ptsd diagnosis with a student. They framed it as important experience for the students, seeing how trauma can affect maternity care/mothering but it made me feel absolutely rubbish and wishing to disengage.

Attending appointments is hard without more obstacles being placed in the way. Oddly enough my diagnosis is all over my notes because when I present with such random things as a burn (caused whilst sleep deprived reaching over a boiling kettle) or a broken bone I get asked if it's self harm linked but yet they never seem to make the leap that hearing someone else's take on my trauma or extra bodies in a room where I'm exposed and vulnerable could be problematic.

It’s amazing that after a thread full of examples as to why people may not want to be observed during appointments people are still playing the “baffled why you wouldn’t” line.

We seem to be caught in a cultural race to the bottom where the mentality is we should be grateful for what we are given by the precious NHS and are unable to constructively criticise and say that poor standards in bedside manner leave to poorer clinical outcomes and poorer mental health.

For a country which makes a big song and dance about having the best health care system in the world this is utterly fucked up.

You don't improve and make advances in health care by saying 'oh just put up and shut up'. And its coming from people who are All Right Jack types who don't have mental health concerns. They are effectively happy to throw those who really struggle with this type of thing (often for a perfectly valid reason that stems from a past life experience which has left them vulnerable or traumatised in some way) under the bus. As long as they are getting the health care thats sufficient for them to hell with everyone else.

Lets spell this out. People who are secure and don't have anxiety health problems are happy to ignore those health problems because mental health is unimportant and we should only be concerned about physical health. Mental health is an indulgence and something that people should just snap out of.

How do we progress and move the NHS forward with public and clinical attitudes like that? Is that really the model of health care we want? Is that really universal health care for all in the vein of NHS ideology thats held up as the gold standard?

We know that poor mental health costs this country billions which are passed onto other government budget lines or other NHS departments. The cost effectiveness of acting like a gigantic god complex dickhead when you are a doctor, does not stack up. People will seek medical attention earlier if they aren't afraid and have a good relationship and trust with the health care system. That means that overall they cost the NHS less.

Numerous studies and reports have found the same. They have been focused on particular aspects of care but the findings all state similar.

The bullshit of just suck it up or we will have no doctors is a logical fallacy based on fear not fact. It is accelerating problems with costs to the NHS which will only exacerbate the issues we have. Its certainly not going to fix the problem. Its likely to make it far worse.

And it leaves a whole bunch of vulnerable people or those with (often diagnosed) anxiety issues up shit creek in the mean time - at a cost to their health.

A slow hand clap is the only deserving response to all the people on this thread going on about 'duty' and 'bravery'. It sounds like attitudes towards shoulders who were hospitalised with shell shock a century ago who were thought of as weak and not doing service to the country in the way they should have. Bollocks to that.

People should make formal complaints because it is the only thing that leads to official recognition of the problem. Force the NHS to address it. That will lead to improvement. Better experiences with staff might even inspire patients to join the NHS themselves as nurses and doctors...

Or could it be that there are potentially complex reasons as to why she might feel uncomfortable, because you know, we are all actually different and not everyone feels like you?

I figure these students will be treating me when I'm old, so I'm happy to let them learn with me as their patient.

I don't really understand why you're being so precious about it. They have to learn somewhere, it's not like they're doing it for shots and giggles

That said though, you should be asked and give consent. I've had a trainee midwife, plenty of GPs, trainee doctors in hospital, trainee dentist. Not a trainee nurse yet though

I actually see this as another barrier to healthcare for a lot of people, especially women, who face enough barriers as it is. As if it's not difficult enough, trying to even get a GP appointment, no GP service at weekends when you work full time in the week and struggle with appointments, particularly as a single parent, having to tell a receptionist the nature of your problem (I do understand the need for triage but in some circumstances it can make than initial phone call even more difficult when you are struggling), a lack of female HCP's in certain areas. These are already barriers to healthcare that exist so having to walk in to an appointment and face a medical student who is already there waiting, and have to be the one to ask them to leave, rather than being asked for consent before a student even enters the room (prior to appointment would actually be best!) just makes things even more stressful for some people and potentially creates another barrier.

[quote Kteeb1]@Warmduscher I said 'words to the effect of'. It was not a direct quote.[/quote]
Even“words to the effect of” in the example you gave allows no room for objection, only query.

@Warmduscher I said 'words to the effect of'. It was not a direct quote.

Some posters on here seem to think the primary purpose of a medical consultation is not to give care and treatment to a patient, but to provide training experience for students, and that anyone who objects - for whatever reason - should be prepared to explain how they expect students to learn if they don’t agree to it.