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?

Reading this thread on my break in a secure EMI unit in disbelief. The ignorance around dementia on this thread is staggering.
*
Expotition* although your posts seem to be well meant, it is still difficult to not find them a) ridiculous and b) offensive despite their obvious ignorance

Distraction all the way here , I remeber a young Dr getting some rather lewd comments on her attire even though it was perfectly reasonable dress and I intervened with a ' oh it is lovely , is it from M&S , you can't beat Marks can you for quality , bet you still have shirts that you have had for years , they wash so well dont they , anyway I am whittering on , my name is Frumpet and I am a nurse and this lady is Dr lovely and she needs to take some blood , only a little bit no need to worry , have you told the Dr about being in the RAF ?'

Although sometimes I worry that they give in and be pleasant just to shut me up !

expotition you have to remember , that female dementia patients also exhibit this type of behaviour too , women are just as capable of sexual harrassment as men .

I'm a doctor. Sometimes patients with dementia say things they wouldn't have ever said, no matter how you're dressed. My friend used to get patients commenting on her skin colour too. Even without a diagnosis of dementia; poorly, scared patients say all sorts of things.

I remember as a 3rd year med student meeting an elderly man with frontal dementia. He and his wife gave time just to speak to us. He also made comments about the nurse's huge boobs and also called me a little girl throughout. The way the nurse handled it taught me a lot about dementia.

I think the way the student dressed is actually fairly irrelevant because you cannot avoid comments from patients, it's a part of the job. The student needs to learn about dementia! And then learn some humility. And then yes, she needs some new clothes!

Maybe you could focus on the patient's condition and the student's reaction to this in your reply to her complaint, and then leave the inappropriate dress to the university as they can address this generically to all students.

In my experience, a hot headed reply will snowball and not have as much of an impact as if you focus on the really distressing issue here- which is her lack of empathy to a poorly patient who has given up their time for her learning.

It isn't clear from your post how far this girl is through her medical training, how experienced she is in dealing with patients etc. Could she have been particularly nervous?

I actually don't think you handled the situation that well; by stopping their interaction early you drew more attention to it, and taught her nothing about how she could actually deal with such a situation in future. Dealing with difficult patients is par for the course as a doctor, but that doesn't mean every doctor immediately knows how to handle such patients without help and guidance.

Okay I have got some sleep & reread my own posts & I totally see now that one of them in particular failed to express what I meant at all. I apologise to everyone who understandably read my post as blaming him. I'm going to make one last attempt at saying what I mean, feel free to ignore it if life is too short.

1. Medics should dress professionally. It is okay to remind them of this. It would have been okay to turn her away.
2. Dementia patients may say offensive things to anyone. They are not to blame for this. The student is unreasonable to complain about the patient.
3. Given these (& other) patients may be offensive to anyone, students need tools for dealing with it, not for it to be dismissed as avoidable if they dressed a different way.

Again, I really apologise for the impression I gave in that post. I'm not as ignorant as you think of this issue. (But I can see why you thought so.) to everyone currently dealing with this & I'm sorry for spoiling your evening.

Hcp here when training (a few years ago) and if we meet patients we werent allowed to see them without our white uniform on so we were professional. Im shocked she throught that she was suitablity dressed to meet a patient. As for the comment by the patient...come on everyone..thats nothing compared to day to day contact with patients. If this lady complains about that comment she not suitable for working with patients end of story.

The patient has dementia, not completely responsible for his actions. She was completely Unprofessional and has no right to be insulted.

eh, to feel insulted

1,2 &3 I agree

But I still say that dressing appropriately is one of the tools for dealing with it.

It gives a visual clue that this is a professional person. If you dress casually that is a non-verbal cue to patients to interact casually.

It's about boundaries: how you dress, how you introduce yourself, how you speak, body language, distance maintained. You need to think about all these things and deploy them appropriately

Eg I also do not sit on patients beds if at all avoidable not just because you may get a wet bum but because it is not respectful. I do not touch patients without their permission or if I do eg hand hold for a distressed person I have thought about it.

This is not analogous at all to a woman's right to wear what she wants on a night out. I tell male and female students off about their dress if need be. The tight trousers on some young male Drs these days are equally not appropriate.

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

totally agree

people who are ill and people who are in pain say and do things that they would not normally do, as a hcp you should be able to expect and accept that, if you can't you are in the wrong job

Mamdoc suspect we may have trained around the same time. Not sitting on beds etc was starting to be seen as old fashioned but the best educators I had insisted it was still unprofessional (not to mention unhygienic I maintain its this casual attitude that's led to rise of mrsa etc too)

Expotition, I totally get what it is you're trying to say and I think, in normal everyday circumstances, we would all agree with you. Consulting patients is not normal everyday circumstances and even less so when those patients have mental health issues. It is essential for doctors to be dressed appropriately (as has already been well explained) for a multitude of reasons. The girl's gym gear was inappropriate. Just as if she had worn a boiler suit, haz mat gear, full highland dress or a bikini and waders! It may not be "pc" but it's a fact that had she dressed in suitable, professional attire the patient and his wife would have been more at ease. The elderly particularly hold doctors in high esteem and as an authority to be respected and obeyed. A teenager in gym clothes is going to struggle to project that image and vulnerable patients will not feel confident in her. Just exactly as they wouldn't feel confident in a young male doctor in gold lamé and hooker shoes!

YY Mamadoc, the visual clues bit is so important. My dad only has early stage dementia, but for him everyone in a uniform dress is a nurse, in a white coat a Dr and he knows how to act. The integrated care team don't wear uniform and it really throws him.

In this scenario, , I also feel deeply for the patients wife. When mum was at the stage of saying anything that passed through her mind (and she had pretty profound personality changes) it was mortifying for dad and I got him some little cards which explained that she had dementia as it upset him so much he couldn't find the words to tell people why she'd say things. You couldn't stop or deflect her either once her brain was in the mode to say something.

She's got absolutely no chance with EMI patients then her attitude stinks!

I would simply say that: Although I felt your attire was not the professional look expected of a med student, I allowed you to partake in order to maintain credibility with your tutor. In future please ensure you are wearing something deemed professional and appropriate for interviewing patients to avoid further embarrassment.

That's a gracious post from you at 09:17 expotition. It's always good to see someone taking things on board and reassessing.

When you provide your factual account of the incident OP, you might want to include what you wrote above 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 in more neutral terms. Best to bring this out into the open to prevent the student using it against you: "But she allowed me! If she'd enforced the rules it wouldn't have happened!"

I think you should raise the clothing issue, but not in a "what do you expect if you dress like that", but to point out that patients, especially those with dementia or other vulnerabilities, find it reassuring if people present themselves in an expected manner. That they feel reassured and confident in their care giver if that person presents themselves in a professional manner, both in dress and attitude, rather than doing something unexpected such as wearing sports kit or clothing more suitable for a casual situation. It helps the junior person to present themselves with authority as well.

Thanks everyone, really helpful. I've had a quiet chat with her tutor, and she hadn't given the whole story. It sounds very much like trying to head off a complaint she thought I would make about her poor attitude and performance. He's understandably not happy, and is going to see if she wants to rethink a formal complaint before my response ends up in her performance record.

Sounds good! I wonder if she will be able to reflect on it properly? I suppose her tutor will gaina lot of insight from her next move/reaction.

I hope she stops and thinks past her certain embarrassment and doesn't let anger/a feeling you are closing ranks ruin this for her.

Good :)
Will her tutor have a word with her re her attitude?
I also wonder if she will be able to reflect back on what has happened....

Ah, you and Rosie's instincts were correct!

Sneaky, sneaky.

Everyone's allowed one fuck up, hopefully she'll learn her lesson properly with this and she'll turn out to be a good doctor in future.

She sounds like quite the little madam. Hope she sees sense and grows up before she's unleashed on an unsuspecting populace. Anyone with a grain of sense would know you don't go to a situation like that in fucking gym clothes.

I'm embarrassed for her. How utterly clueless and lacking in common sense, intuition and humility can she be. All important qualities for a doctor. She has a rough ride ahead.