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?

And if this has turned into a sexism and victim blaming debate - I truly despair

I would speak to her, not do this by email.
Really saddened to see on this thread how many people just don't get dementia... still.

I think this it the one occasion when it is actually ok to say she was asking for the comments she got.

There are many reasons a patient may have disinhibition. How would you feel if every time you saw someone the first thing that came into your head came out of your mouth?

The student put the patient in a compromised position by the way she dressed. A student seeing patients should be aware of the reasons for dressing appropriately, to protect both themselves and their patients.

Horrible situation all round :(

I don't understand exactly what she was complaining about YOU for - you said she's complained about you embarrassing her. But how did you? Did she mean by not stepping in soon enough?

As the relative of any elderly woman with dementia and disinhibition, having read this thread there is no way, no way, I would allow her to take part in any training situation with medical professionals. No. Way. I will be making sure that when we take her to the GP or clinic and we are asked if a student can observe, or indeed undertake the consultation the answer will be no. I am not prepared to risk her being the subject of a complaint which may be based on the very fact of her illness.

They can find someone else, or better still, role play the scenario.

On the point of the student's dress, I have recently completed a course in a particular non-medical but health related therapy. It was drummed into us in every training session that we must be dressed appropriately - and I mean mentioned every single time. One guy persisted in turning up in a vest, and he was not allowed to take part in any of the practical assessments - and we were role playing, not working with real patients.

This story is absolutely horrendous.

As the relative of any elderly woman with dementia and disinhibition, having read this thread there is no way, no way, I would allow her to take part in any training situation with medical professionals. No. Way. I will be making sure that when we take her to the GP or clinic and we are asked if a student can observe, or indeed undertake the consultation the answer will be no. I am not prepared to risk her being the subject of a complaint which may be based on the very fact of her illness.

I can see why you would feel that considering the comments on this thread and the attitudes to dementia but what a loss that would be. My dh deeply appreciated the patients who volunteered for training/examinations/finals and who were treated in a teaching hospital and allowed their illness to educate the next generation of medical professionals. There is no substitution for a real patient and most students are incredibly grateful for them.

This man had dementia and presumably could no longer work and needed help to take care of himself but he was still serving his community by helping those students.

This student needs to grow up and grow tougher fast..

I am an older people's psychiatrist. These comments would be on the very mild end of what some of my patients with dementia have said to me. It is part of the job and you need to learn to handle it gently but firmly.

What she wore is 100% relevant.
It is about professional boundaries. If you expect patients to respect you and speak respectfully to you then you need to respect them and that starts with your attire. If you do not look like a professional then you run the risk you won't be treated like one.
People with dementia are reliant on non-verbal cues and hers were not giving out 'this is a professional'

I like to think I would have sent her home to get changed at the outset but hindsight is always a great thing.

I think you handled the situation fine. You terminated it to avoid further distress to the patient or to her and I would explain that in the letter.

I might possibly have taken her aside afterwards to check she wasn't upset but again hindsight.

I would say that I'm sorry she was upset and that I am happy to meet with her to discuss how we could have handled it differently but that some disinhibited comments are a thing that Drs need to deal with and actually reflecting on that and how to handle it in a teaching session is a legitimate learning experience.

WTF. I used to teach professionals how to interview children who'd been victims of abuse. I've had students turn up in all manner of inappropriate clothes - it's not on. A colleague had a student with a vest top of saying " Brunettes do it better" or something similar ( bearing in mind this can be seen by a judge). It's part of your role to feedback on the students entire presentation not just on the words they say. why didn't the student address the comments with the patient herself? Ive had little kids ask me all manner of personal comments in interview - you just have to develop a strategy for dealing with them and then carry on with your job. Although I don't think she was " asking for it" I think that some patients may feel more confident with a Dr who is dressed more professionally.

PS she's going to have a shock coming her way if she's upset by comments like that. Just wait till she's got some violent drunk / psychotic who wants to knock her head off

Firstly, she definitely should not have turned up for the interview so inappropriately dressed, secondly the patient was out of order to make such comments, but thirdly.....what the hell has it got to do with you?
If the student has a complaint she should address it to the correct department, without dragging you into it!

secondly the patient was out of order to make such comments,

Again....what part of "he has dementia" do you not understand?

Having read again what you quoted him as a saying I am not really convinced it amounts to sexual harassment in any case. Saying things like 'I can see what you had for breakfast' isn't a sexualised comment its a clumsy way of trying to express what you acknowledge to be true that her dress was inappropriate! My grandad used that phrase to comment on my outfits as a teenager that he considered risqué and I certainly did not take that as sexual. I understood that he disapproved.

For those who've asked I deal with such comments mainly by distraction, changing the topic or sometimes by a gentle challenge 'you musn't say things like that to your dr' or by ending the interview if very offensive eg a manic gentleman who recently asked me if I would like to take my top off so he could lick my nipples!

Agreed mamadoc humour, gentle admonition, distraction or withdrawing from the conversation are all techniques I'm sure those of us who've worked with patients with conditions like these have used.

I've just remembered the 'I can see what you've had for lunch' was once dealt with by a colleague (not the person who was skimpily dressed) by her saying 'well it won't be looking very appetising now!' And then distracting the commentator

It is truly upsetting to see so many posts here laying blame at the door of the gentleman with dementia for his remarks. To me the student's dress is slightly irrelevant - she has shown complete ignorance and lack of empathy for an extremely nasty and distressing medical condition. I would think she will make a very poor doctor.

My father had alzheimer's. It caused him to make remarks he would never ever have done during his life when he was well.
Disinhibition is slightly misleading because it suggests that the thoughts are in there but only inhibition is keeping them inside and preventing them being voiced. Not the case - my Dad did not have a sexist or violent bone in his body, he was the gentlest politest most loving man I have ever - inordinately proud of his daughters, a proud feminist and constant champion of the underprivileged and vulnerable.

In the late stages of his illness he began to make remarks about women's bodies (saying they had fat bottoms etc.) He would never in a million years have said or thought when he was well (he would never judge or comment on anyone's appearance). He would make remarks about getting gun and shooting people - he was a total pacifist and very anti violence - it wasn't him talking it was his illness.

The last thing he said to me on my last visit before he died was 'let me know when you are next coming so I can make sure I'm out' - it was heart breaking but it wasn't him - my dad adored me and I adored him. When he was well he'd say 'come back very soon' when I left.

These type of remarks are symptom of dementia, it is hard illness and distressing because it's symptoms are behavioural and the social rules of behaviour are very strict and the slightest deviation is met with outrage.

If a medical trainee had been aghast because a patient with an illness which had vomiting as a symptom had thrown up while she was talking to him, and she had complained about it, everyone here would be astonished at her ridiculousness.

But because she was outraged at a behavioural symptom people are saying the sick man should be told off, blamed, and she should be exonerated. Dementia patients get a very raw deal - they are laughed at disrespected and generally misunderstood by those who have no experience.

She knew she was seeing a man with dementia - maybe a bit of elementary homework would have saved her embarrassment. She sounds incredibly ignorant as do many people posting here.

secondly the patient was out of order to make such comments

Another ignorent statement. Do you have any idea of how offensive that is? I must remember to tell my mum how out of order she is for calling me at 5am for a chat.

Again go and educate yourself on dementia before commenting.

I would respond that the OP was dressed inappropriately for a professional setting and while you are not suggesting her outfit invited comment, as a separate issue, it should be noted for future classes.

And repeat what you told us here re. your comments being appropriate.

In future go with your gut and don't let students take part when not dressed suitably.

You shouldn't have to ask med students not to turn up dressed inappropriately.
Totally disrespectful and unprofessional of her. Also, sounds like she has little understanding of dementia. I'm not a medic but I know dementia sufferers sometimes don't have a filter and can speak/ behave inappropriately.
I do not believe you could be accused of victim-blaming given the circumstances. You sound like you behaved professionally.
Some one needs to have a few strong words with her!

In my daughter's Uni, gym type clothing seems to be the new jeans and T shirt for the girls. DD has gym clothes she wears to the gym and gym clothes that never go anywhere near a gym. Not that jeans and T shirt would be appropriate for seeing patients mind you.

My Dad had dementia and I try not to remember some of the inappropriate remarks he made. Thing is, we all knew this is what dementia patients do, and we weren't trainee medics. This young woman doesn't sound very committed to her course.

she will have been issued guidance on professional dress for patient contact/ comm skills sessions where she has to meet patients. She could be hauled over the coals in a meeting at the very least for deliberately faiing to comply with these rules. In future, perhaps send such students away from these sessions (cue complaints and wails of 'but we pay 9k a year')

you were very much in the right and bent over backwards to help her and allow her to complete the session - definitely include unprofessional dress/ failure to meet dress code and reiterate that this is contact with real patients who have given up their time to aid their learning

grr.

I can only suggest also that this prompts a year-wide reminder of professional behaviour, and that this could form the basis of some reflective practice for her or a short written piece of work on some of the common effects of dementia.
I don't think you did anything wrong whatsoever.

Leghoul has said something I held back from (wimp - from fear of 'that's too far' comments) I think it would be the least this student has to do to be asked to prove she knows more about dementia than she demostrated here, and produce a well researched essay!

Her lack of professionalism is apparent in a number of ways. I was once in a similar session and a girl arrived in gym wear when we were all wearing shirts namebadges etc. There was a real patient. Some comments were made but these were handled in a (so far as was possible, given her state of undress) more professional and understanding way, and she was apologetic that she had forgotten that the session was on that date, and took it with a healthy dose of humour. I've had patients scream in my face. I don't complain about it later.
While I loathe the hovering threats of regulators and ftp I think that she needs to remember she has contact with real patients as an integral part of her training, and that while nobody can predict or control the real patient, she can do her bit. The worst of all is not getting flustered but daring to complain about it later, when it's directly linked to the condition of the patient she was interviewing.
I suppose it's better to separate the issue from her clothing - but she needs a reminder - and make the issue about her complaining about a patient with dementia, which is ridiculous. Essays are quite evil but she sounds like it will take something like that to remind her of her role as a medical student.

Firstly, she definitely should not have turned up for the interview so inappropriately dressed, secondly the patient was out of order to make such comments, but thirdly.....what the hell has it got to do with you?
If the student has a complaint she should address it to the correct department, without dragging you into it!

Oh FFS. Talk about missing the point of the thread. Please go back and read, at the very least, the original post.

She's a med student who complains about s dementia patient making an inappropriate comment???!!!! Is she for fucking real!!!