to put this in my reply?

[creampie]

At the risk of outing myself I've changed a few details but the jist is the same.

I teach med students. One of their projects is a tutorial in which they interview real patients in a class room setting. This week is dementia week and I had a gentleman patient and his wife attend.

One of the female students arrived wearing an outfit that looked like she'd just come from the gym, Lycra leggings and neon racer back vest. They are more than aware that these are real patients, not actors, and that a degree of professionalism is required.

I should have turned her away but these are mandatory and she would have been in trouble with her tutor so I let it slide.

When it was her turn to interview the man made a few inappropriate comments. Nothing awful, no swearing, but along the lines of "you'll never drown" and "I can almost see what you had for breakfast"

I intervened and sent her back to her seat.

She has now formally complained about the patients attitude and that I embarrassed her in front of the class. I simply said, let's call it a day there, you can return to your seat. Nothing more.

I am livid. The formal reply I've written is along the lines of sorry you were embarrassed, but what the fuck do you expect if you have the disrespect to turn up dressed like that. Only in flowerier terms, obviously. I can't believe she's got the audacity and lack of insight to complain about this.

I really want to send it. However, I'm concerned some PC person in HR will accuse me of victim blaming. Would IBU to send this? What would you do?

Op, if she has put in a complaint about you, there must be some procedure to follow?

I'm thinking that that wouldn't be emailing her back & saying that her inappropriate dress was the cause!

I'm back!

Thanks so much for your thoughts and sharing your experiences. It's very helpful.

I'll just answer a few queries:

1. They are all massively aware of what professional attire consists of, and know they are supposed to wear it for any patient contact. The only thing I can think is that she either forgot that's what we were doing, or really doesn't care.

1. It's really common to use "expert patients" in this way. It's fully vetted. We've used this chap for ages, no problems before, and he was completely appropriate with the other students

1. There would be no point admonishing him. He wouldn't remember not to do it, and probably wouldn't even be aware of what he had said.

1. By not handling it well, I mean she didn't really say anything. Just sat there with her mouth open, looking like she might cry so I stepped in quickly sent her back to her chair and called the next student up. The patients wife looked mortified and it just seemed best to end the session rather than seeing if she would suddenly get a grip on it.

1. I also wondered if she thought that I might complain about her, and was just trying to get a complaint in first to head me off!

I've had a chance to calm down. This is a formal complaint so I can't just call her in for a chat, I need to reply formally. It has come via her tutor and HR. Her tutor is very hot on respecting patients who give up their time to help out, so I suspect she hasn't given him the full story. I'm going to have a quiet chat with him about what actually happened and see if he wants to see if she would like to withdraw the formal complaint and handle it informally, rather than it ending up on her record. If she does this, I'll have a quiet chat with her about handling difficult situations. I'll also send a reminder to all students about appropriate dress, and try not to focus too much on that. The next time someone turns up dressed inappropriately, I'm just going to send them away to change! I've learned that lesson.....

I feel really sad for the patient and his wife. It takes courage to go into that type of situation and you invariably do it with good intentions and because you want the students to see the human behind the illness

I bet the wife would be devastated if she found out about this complaint.

Exactly, his poor wife just looked mortified. She may well not want to take part in future after this, even if she doesn't know about the complaint. I feel awful for her

The ignorence of dementia shown by a minority of posters on this thread actually scares me to death. Perhaps those who think the poor man (who in my opinion is the victim) can be made to understand the inappropiatness of his remarks could come and explain to my lovely wonderful kind and caring mother why she should not throw rubbish into her neighbours garden (she denies it). Perhaps they could clarify to her the difference between ringing someone at 5am and 5pm. Oh and she should surely understand that her aunt has been dead for a few years so no she has not been talking to her on the phone. And when she shouts at me because of course she knows what she is doing and she would never be rude to her carers perhaps you could explain to her that she has. After all you know all about it. And this is why I will never agree to my mum participating in something like this.

Go educate yourselves on dementia.

The poor patient, i'm sure he would have been mortified had he realised the full implications of what he was saying. I teach medical students, and also work in mental health. There is a very strict dress code at my uni for clinical placements, of which all students are well aware, and I would have sent a student (male or female) away if dressed inappropriately (as this student was). I think the clothing issue needs to be raised with the undergraduate tutor as a separate issue to the student's attitude to a patient with dementia. I would suggest writing a contemporaneous account of what happened, and send all communication via the med school/undergraduate tutor rather than directly emailing the student - the last thing you need right now is to see the student for a 1:1 feedback session and it makes things worse rather than better (possibility of yet more complaints).

Also, if you dealt with the situation correctly by ending it, then isn't it just unfortunate that she feels embarrassed by you having done that?

Havent read the whole thread OP, but as someone who was a med student once upon a time there was a formal dress code for patient contact; include that in your reply

Cross posted with your reply. I agree that the student is probably jumping in with her version of events in order to pre-empt a complaint from you/the patient. A chat with the tutor seems the right way to go, and a reminder about the dress code sent out to all students so that there can be no accusations of singling anyone out.

Go educate yourselves on dementia.

I have no extra point to make, but this is worth repeating again and again and again.

Actually, maybe I have. When I started caring for people with dementia way back in the dark ages 80's, the 'buzz word' was 'reality orientation'. We had to remind them of the here and now and tell them that their mother died 60 years ago and they went to their husbands funeral 6 months ago and watch their heartbreak again and again. We would have been expected to challenge this behaviour, wrongly in my view.

Nowadays the watchwords are distract and not confront. Try to avoid arguing where possibly. It is a kinder way of dealing with people who will not retain the information you are giving them. We give them comfort, not confrontation!

Your first duty of care was to the patient, then the wife, then the student!

I'm with those utterly shocked and disappointed and frankly disgusted with those posters thinking the patient WITH DEMENTIA was at all responsible!

I'm an ex HCP I've worked extensively with people with conditions that make them disinhibited - of which THERE ARE MANY not just dementia but stroke, DVT, various cerebral incidents, mental illness, learning difficulties... Geez even 'simple' dehydration can cause this not to mention 'normal' and abnormal side effects to medication, Christ even diabetes (have none of you seen the scene in steel magnolias where Julia Roberts is having a hypo and being horrible to her mother? And as soon as it's remedied she feels awful and says she didn't mean it?)

What happened in this assessment was actually very mild! While I was doing my training I was dealing with a guy with bi-polar disorder who was hyper-sexual when manic and admitted. I was 19 with blonde hair and huge boobs! And although I was in a very unsexy uniform, no make-up, jewellery and hair scraped back I'd get some pretty explicit comments daily! There's ways of dealing with it! And I knew that at 19 and only 10 months into training! A med student must be at least 22 and well educated and really ought to know better! Both with dress AND attitude, not only to the patient but also to respecting the other students taking the assessment (turning up prepared by looking and behaving professionally and knowing dementia often includes disinhibited behaviour - surely basic sense at this level in her training?)

I think our blanche's posts are very good, I would hope it's people like them that's training med students.

Op yes hindsight is a wonderful thing but frankly you let the patient, the other students and the student who complained down by allowing her to take the assessment given it was clear she was unprepared both sartorially and emotionally. Hopefully you too will learn from this situation that it's best things like this are addressed early. From this perspective I am also talking from a position of someone who after my training I worked in a managerial role in a nursing home for the elderly and it was infuriating having to tell new, but qualified employees to consider their dress, attitude and preparation for working with people who often had dementia and similar conditions that affected normal social boundaries. Although part of the problem was shit hiring boundaries by my bosses!

And yes this student needs to learn to suck it up buttercup! This is nothing! I've been invited to threesomes, stripped in front of I don't know how many times (not for clinical necessity) had vomit, pee, blood and shit thrown at me, spat on etc etc

Christ she wouldn't last 5 mins in a&e on a sat night!

Glad you're feeling a bit better OP - I also agree with getting this thread deleted now that you've had a chance to cool down and get some opinions from others.

What stage of training? 1st year....possibly caught out and feels like a fool. 3rd year....daft. 5th year...give me strength!

The patient has dementia. The medical student needs to understand that patients who are ill say things they might otherwise not say. Patients with dementia will have very little understanding that they have been inappropriate.

I was told that the best guide for female doctors is to be covered neck to knees and to be wearing clothes that would still look decent if you had to jump on a bed to perform CPR. It's a good guide and still leaves lots of room for individuality and style.

Rosie my heart goes out to you. Thankfully my mum still knows who I am, but it is a long hard road for the demented and their family. A few of the posters on here have made very ignorent comments so let's hope they never have to experience the actual reality of it.

And sorry Op good luck with this.

I can't believe she thought that was appropriate getup. That patient (and others like him) and his wife have been generous enough with their time and presumably willing to undergo repeated enquiry during these sessions; to turn up to meet someone like that dressed like you're nipping to tessies on the way back from the gym is incredibly disrespectful.

Then the fact that she doesn't know that unfiltered comments like that are unfortunately very common for those with dementia....is doesn't bode well, does it?

YY to the previous poster who called dementia a thief. Horrific disease.

She needs to grow up and get over herself

Medicine is a profession. We trust Drs with the most precious thing- our health and at times when we are very vulnerable. A dementia patient is very vulnerable.

She should be dressing professionally and appropriately and focussing on her patient and their needs rather than herself.

Hope she never treats me or my family.

Lougle that's a great way to guide, sudden CPR on a moving trolley can be somewhat revealing!

Op I don't understand why you're so determined to protect this particular student from her own incompetence! If she was completely blindsided to the point she was near tears in THIS very mild situation she needs someone to sit her down and thoroughly discuss whether medicine is really a suitable career for her. How the hell would she cope with telling someone not nt that their loved one just died unexpectedly? Another thing I've had to do on more than one occasion. And I wasn't even a Dr.

THE MAN WAS A DEMENTIA PATIENT enough said. He and his wife attended in good faith to assist medical training. Utterly appalling from someone who wants to work with the general public.

Rosie, I'm sorry, I don't think I can be expressing myself very well. I was not trying to say that this patient is in control of either his thoughts or his words. I wouldn't put someone with dementia in the "healthy" category. What I'm trying (clumsily it seems) to express is that saying the recipient's clothing is to blame for abuse (even from a dementia patient) suggests that all (any) men can ever hope to control is their behaviour.

Taking and running with the labrador , the first time your mum mentioned it did you think you must have done something to make her think you had a labrador? If not, why do you assume the student provoked this behaviour?

It's possible to excuse him without saying she was asking for it, is all I'm saying.

It might not be PC, but I expect my doctor to be dressed professionally when I see her. All of the doctors at my GPs practice wear business attire, and hospital doctors are even smarter (when they're not in scrubs).

Older people will expect even more formality from medics. Gym attire isn't appropriate, and the patient shouldn't have said anything, but he has dementia!!

Perhaps a general email round about professionalism and professional standards?

And sorry to everyone else I seem to have offended. I am really not blaming him.

Oh this students attitude has given me the rage ! And she wants to work in Medicine ? Jesus - she needs to grow up - and then some

Actually I wish she was being kicked off the course, clearly not up to the job and I bet there's plenty others who didn't get that place on the course who'd be grateful and a damn site more compassionate and professional!