Nhs students and lack of consent.

[MarbleQueen]

I’m wondering if something has changed within the Nhs. At one time you were asked if you minded having a student being present.In my area they are present at every appointment without any discussion and I’m getting fed up with it.

In the last two years these things have happened.

A student midwife was brought into my room and participated in my delivery without any discussion. She was instructed to break my waters and deliver my baby without any discussion with myself. The midwife focused on talking her through things instead of supporting me. I was alone because of covid restrictions. I later discovered it was the first baby she delivered. I felt like a piece of meat.

I went for a smear and when I walked in the room there was a nurse and 3 very young women present. When I asked who they were I was told they were trainee health care assistants. I objected and the nurse insinuated I was being a bit silly and shy. I left that appointment without it being done.

I had a dentist appointment for my first ever dental treatment. I told them I was nervous. Again when I went in, I was told, not asked that the 2 people present were dental students and would only be observing. The dentist focused on explaining things to them and actually allowed one to place the filling. I didn’t agree to this.

I went to a gp apointment for something intimate to find a man around 18 years old sat in the room. Again I had to ask who he was and was told he was a student. I had to ask for him to leave and it was really uncomfortable.

I had an apointment to have a very unpleasant procedure. There was the usual student perched in the corner without any discussion. Again I had to ask who they were and was told, not asked, that they would be observing. The doctor focused on explaining things to them and when the procedure was finished I actually realised 3 more students had been brought in to watch without me noticing.

I have previously had a type of abdominal cancer. I have checks with scans and have seen the same consultant for years. On my last visit there was the usual student perched in the corner without any discussion. On this occasion, and this occasion only, the surgeon suggested doing a VE. I asked him what information he was hoping to get from this considering he had a recent MRI scan in front of him and he simply dropped it. I strongly suspect this was going to be for the students benefit because it certainly wasn’t going to benefit me.

Each of these places have standard notices in their waiting rooms informing you that a student might be present but this is not consent. I think this is now something you have to actively opt out of instead of opting in.

Has anyone else noticed this happening? I worry about what these students are learning about consent in these circumstances.

You really should be asked rather than told. I've mostly been asked but it's very difficult if the person is already in the room to say No. I work in the NHS in MH and always ask any trainee's to wait outside the room so I can ask the patient before inviting them in. I also always say it's ok to say no and don't invite them in if the patient seems hesitant at all.
I had a bad experience when I was 17- I took an overdose and was admitted to a ward. When the consultant came round the next morning the curtains around my bed just opened and there were 6 student drs standing there with him. It was really awful and unsurprisingly I didn't really feel I could talk about what had happened and how I was feeling. That was 25 years ago though and I had hoped things had moved on!

@HoppingPavlova

OP, you have every right to ask they not be present. However, as you seem completely inflexible about it in every situation I suggest you just have cards made up stating You are special and will not consider student observation or participation under any circumstance, and that you believe they should learn on everyone else but yourself. Thrust a card immediately at the supervising clinician when entering the room so you are all on the same page from the get go. Will make life easier for you.

Can I enquire if you are in any way appreciative of others who have gone before you that have enabled your treating clinicians to get the experience they have in order to treat you?

What a nasty, judgemental post.

Why don’t you RTFT so you understand that it’s the lack of consent that’s the issue, not the students being present.

My DD finished her degree last year, she had 3 placements and on every single one (3 different trusts), the patient was ALWAYS asked if they minded, vast majority, thankfully, didn't.
Same when she did her 2 week shadowing before starting as a 'carer.

She is now working full time but even during her induction, patients were asked if they minded a new starter observing.

Don't get how a 18yo would be observing in a GP surgery, years away from Med school.

Personally, i would never ask a student to leave, how else do they learn? but consent should be asked too.

Personally, i would never ask a student to leave, how else do they learn? but consent should be asked too.

What’s the point of gaining consent if you would never ask a student to leave anyway? And surely you understand that while you are happy with it, others aren’t?

@MissyB1

Yeah I’m calling BS on this thread.

If you suspect the OP of trolling, the correct way to deal with it is by reporting the thread to MNHQ.

Speculating on the thread is against talk guidelines.

That sounds awful OP. I've always had students explained and asked if it's ok.

Literally none of these would bother me.

But I get where you're coming from on the consent side of things.

@Warmduscher

Personally, i would never ask a student to leave, how else do they learn? but consent should be asked too.

What’s the point of gaining consent if you would never ask a student to leave anyway? And surely you understand that while you are happy with it, others aren’t?

Do you not know what the word "personally" means? then followed with "...consent should always be asked too"

Doubtless you also moan about lack of GP appointments and long NHS waiting lists too.

I used to get students occasionally when I was a kid - thinking about it, I was asked if I was OK with the student being there, but only after I'd entered the room and sat down and the student was already there. I was Gillick competent at the time, and I was OK with the student as it wasn't anything particularly embarrassing, but given how difficult grown women find it to be assertive in these situations, did they really expect a young girl to be able to say no in front of the student?

I think consent should be asked, ideally in advance, so patients have time to reflect on whether they are OK with it, rather than feeling pressured to say yes. And that consent should be asked again on the day, and that it can be removed if the patient decides for any reason they don't feel comfortable anymore.

Sometimes you're mentally resilient enough to think, 'It's fine, everyone needs to learn.' Sometimes you're so miserable and vulnerable that you can barely tolerate the lead physician being in your personal space. You'd have thought that a medical expert wouldn't need that pointed out...

On the odd occasion I have had to see my GP and a student might be there I was always asked for consent by the receptionist first when I arrived and checked in, before I even saw the doctor.

When I asked who they were I was told they were trainee health care assistants. I objected and the nurse insinuated I was being a bit silly and shy. I left that appointment without it being done.

Thats sufficient grounds for a formal complaint because you were placed under undue pressure and your 'no' was not accepted.

Did you raise a formal complaint?

Unless you do, then these hcps will just do it repeatedly.

If you raise a complaint and ask for it to be put on your file they you are unhappy about being used for training, then it adds weight to every subsequent time it happens again.

Its inexcusable.

Yes doctor have to be trained. But some patients are not appropriate subjects and consent must be properly sort and given.

No exceptions. Ever.

@Katya213

Six different appointments….that’s a lot of times in two years!

Maybe she has an unusual illness or a serious illness.

I went to my optician for a routine check up and there was a trainee Dr from our local hospital already in the testing room. I had to ask who the guy in the corner was as no one mentioned it. The person didn't speak to me about my eyes but only to the optician. I could have been a dog.

It wasn't even a NHS appointment, but one I was paying privately for.

Afterwards, I wrote a complaint letter explaining that I thought it was a cheek not to even ask me when it was purely a private appointment, and that the Dr did not speak to me.

I go to a different optician now.

Doubtless you also moan about lack of GP appointments and long NHS waiting lists too.

Wtf are you talking about?

Ds is a magnet for students (I think because he is an unusual complex case) and we have always been asked if it’s ok for students to be present so it’s never been an issue.

A fantastic opthamology student noticed something the consultant had missed which has been key in his ongoing treatment

I've always been asked for consent but I think the difference is they are present now. For example my hospital had notices up about being a teaching hospital and students being present but when I had an appointment with my consultant a junior doctor was already sat in the room and I was asked if he could stay. I consented but it does put pressure on people who might be less confident. Same with a midwife checkup the trainee midwife was aready in the room when I was asked if she would be allowed to be present and involved in the check up.

I have been in a similar situation re a smear. I find the process difficult (documented in notes) and was told I could not have my dh with me due to covid but having two students in the room was OK?

When I was a student we had to wait outside until the patient had been asked and then only enter if allowed. The patient was not put under any undue pressure then.

Do you not know what the word "personally" means? then followed with "...consent should always be asked too"

You also said “how else do they learn?”. That’s a question, not a personal statement, presumably directed to people who aren’t comfortable with having observers sitting in on their appointments.

@Woolandwonder

You really should be asked rather than told. I've mostly been asked but it's very difficult if the person is already in the room to say No. I work in the NHS in MH and always ask any trainee's to wait outside the room so I can ask the patient before inviting them in. I also always say it's ok to say no and don't invite them in if the patient seems hesitant at all. I had a bad experience when I was 17- I took an overdose and was admitted to a ward. When the consultant came round the next morning the curtains around my bed just opened and there were 6 student drs standing there with him. It was really awful and unsurprisingly I didn't really feel I could talk about what had happened and how I was feeling. That was 25 years ago though and I had hoped things had moved on!

Its v poor practice to have students present BEFORE asking for consent.

It creates a power dynamic that some people - particularly vulnerable people - find hard to challenge.

Its intimidating to be 1 person versus say 3. Even without the status of doctor and the idea that you might fear you will be refused treatment if you don't consent.

Anyone who isn't aware of this, really doesn't understand the fundamental principles of consent and undue pressure.

Thats the really troubling thing.

There are always patients for whom it is inappropriate for students to be even considered or for whom its particularly relevant to do as much as possible to ensure consent isn't under duress.

Consent relies on the principle that you should be able to say no without the no then being questioned or challenged or judged in anyway.

@AutomaticMoon

I can’t believe people trying to guilt OP. It’s a bit rapey. Students can also observe just about any procedure on videos online, if some doctors don’t seem able or willing to do the teaching, tactfully.

'A bit rapey'? Disgusting comment.

@MarbleQueen

Hi, my name is Adam, I'm a final year medical student, I'm here to observe for the day, is that okay?"

Your student is TELLING patients he’s going to be observing them. The “is that ok” isn’t really a question in those circumstances, and especially not in a group.

Why can’t you get consent from your patients in private then invite Adam in once they’ve agreed?

This is spot on.

How people are asked matters because one way makes it harder to say no, than another.

Saying you are going to do something and then asking for permission is flawed.

I'm a student with the nhs and I am so sorry this has been your experience. It really isn't on that you aren't being asked. With my training the first thing we were taught in year 1 was to seek consent ourselves to be present/ carry out an exam etc. I always make sure that the client knows who I am/ why I am there and clearly seek their consent for me to remain in the room. Even if my supervisor has gained their consent I also ask if it is okay as I don't want to do anything without consent.

Honestly, you experiences are not okay and if it happens again I would be wanting to take it further. Would be tempted to raise these issues now as well.

This sounds like seriously bad luck, as you can see no other posters seem to have had the same experience. It sounds quite specific to your trust.

The breaking the waters thing is really weird. I have never heard of a student midwife learn to break waters before assisting the birth of a baby (you say it was the first birth she had assisted with), that is really peculiar. I do wonder if you were misled there in some way. Student midwives would experience their first birth within their first week in an intrapartum placement but usually wouldn't break waters until a couple of years later - if at all. Many of us don't do it until we are qualified.

It also is highly unusual to break your waters 'without any discussion', for one it involves you adopting a certain position - not sure how this could be achieved without discussion. It tents to take some time and is really quite tricky to do for induction, so this whole thing sounds rather odd. I do wonder if the midwife did it and was talking the student through what she was doing.