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.

@MarbleQueen

I feel like I’m in some sort of other universe.Several people keep asking how are they expected to learn. Gaining consent takes seconds and doesn’t prevent them from learning.

They can learn after they have gained informed consent. They shouldn’t be anywhere near patients until they grasp the very basic concept of informed consent.

No wonder so many women have horrific births when health professionals don’t grasp this concept.

I’m surprised people think it’s ok the dentist thought it was ok to lie and practice on me without my consent.

Yep. Absolutely its about respect for patients and the overall culture towards patients.

If seeking consent properly isn't deemed a priority, what else is ignored or disrespected in terms of patient care?

There was a study a few weeks back stating that female patients get poorer outcomes if they have a male surgeon. The same wasn't true if they were a male patient or they had a female surgeon.

Something is going on here at a cultural level. Listening to a patient better means quicker diagnosis, better patient doctor relationships and better outcomes. We know this. So when it's demonstrated that the patient's input on consent is a nuisance or inconvenience or something that should be coerced in some way, its demonstrating a poor wider culture.

Tbh, I'd be more inclined to consent if it was done in a reasonable fashion, rather than put on the spot in front of the student.

What you are saying by having the student present when asking is that the student is more important than the patient and that its conveyer belt medicine where you cease to be an individual. You are just another case.

And you are teaching this culture to the next generation.

No its not ok. On so many levels and its worrying that so many people don't understand nor value the fact that the circumstances and the way you are asked for consent matter.

For me, its damaging to trust before you even start if aren't fully aware that the how matters.

It does sound like you've been unlucky. Sorry to hear.

I've always been asked if students can be there. I say yes to female and no to male.

This is a horrific invasion of privacy. The odd time I've been attended by a medic with a student its only ever one. It's always been explained to me who they are, it has never felt intrusive and I wouldn't have dreamt of objecting. I wonder if it makes a difference that the doctor or midwife in charge was a woman, I am suspecting yes.

I've always been asked, most of the time the medical students introduce themselves.

On my last op there was a student shadowing the anesthetist, I asked the student if she wanted to intubate and the anesthetist was very clear to the student that anything else would be assault.

I think it's better for a student to learn to intubate with an anesthetist at their side and not in an emergency,

I think it’s good you stuck up for yourself. It’s nice I guess to help the students but it’s your body at the end of the day so YANBU.

I have always been asked if it's ok to have a student present and, having been a student, I have no problem with them. I can see how it would be difficult for some people though.

It's also highly unlikely that a student delivering her first baby would be asked to break your waters.

@PrivateHall

How to say “I don’t believe you” without saying “I don’t believe you”.

If you are thinking of applying to a healthcare course/training scheme you can ask to visit and as part of that you can get to sit in on a consultation.

The patient might be under the impression that the student was a student doctor or nurse but it could be someone off the street.Not so bad if it’s audiology but about à gynaecological examination?

A large part of this depends on how it is done. And that depends on the interpersonal skills of the medical professional and the students themselves.

If there were multiple students just staring at me in silence with clipboards and I was made to feel like a medical spectacle, I would feel uncomfortable even if I had given consent in advance. One of my friends had a vaginal twin birth and, having agreed to one student, she had to put her foot down when a group trouped in. She said they were just staring at her and standing around her awkwardly while she was in pain. It stressed her out and she was worried it was going to slow things down.

On the other hand, I didn't feel uncomfortable having a student at my midwife appointments or having a dental student, because there was only one student who felt like part of the team and had a role to play fetching stuff and generally being useful. And I was normally asked if they called the student over to look at something rather than being ignored as they talked over me.

Personally, I wouldn't feel awkward in most situations (including internal examinations) with one student there as they're just 'the student'. I would like to be asked though. But with more than one I would feel awkward - if there's a group of students, patients can be treated more like a teaching experience than a person and that's not right!

What your saying does seem very wrong.

Saying that I have no problems everyone has to learn, I’ve had both male & female student nurses look after me & I was the only person on the maternity ward who consented to let a male midwife look after me. I had a student midwife look after me before & after an operation and the care I received was outstanding - however each time consent has been sought.

I have always found that the treatment is better when students are observing or being instructed! My ds was delivered by a student midwife and I have had many students observe / treat me over the years.
My experience has been the opposite of the op.

@AutomaticMoon

Well something must’ve changed because in 2020 the NHS felt entitled to enrol all citizens on the organ donor list, without asking or anything.

That wasn't some closely guarded secret It was very well reported

In theory I don't mind students observing or getting involved at all. In practice, it also depends on how I feel about the appointment/treatment in question due to vulnerability and distress, and - most importantly- how I'm asked or if they've bothered to ask at all. I'm usually not afraid to be a bit blunt and stand up for myself- but not always. Being asked in a pressured way, having someone try to make me change my mind by impliying I'm being silly or being volun-told a student will work on me can be really overwhelming.

Fwiw I've had students or trainees/juniors twice. One was for a minor gynae treatment and I agreed because I was asked immediately and felt ok and even if I'd said no to her treating me, was still happy to have her watch. The other was for an ultrasound & trans-vaginal ultrasound and I can't really remember how well the subject was introduced. I was more preoccupied with not wetting myself but I think I was asked asap & agreed. Had procedures been more stressful/scary or the people more pushy I wouldn't have said yes. Definitely wouldn't want students taking my blood- hard to find veins, sitting on mh or possible bad news appointments, including the more serious ante natal ones and definitely no gawping groups.

Thankfully I've never had a trainee chiropractor either. I definitely would refuse to have them watch or work on my neck. I don't want someone "learning" on my neck, especially when I'm frightened to be touched there by anyone anyway. Took the chiropractor three sessions for me to be ok with being touched there. Similarly they're welcome to observe my wondrously hyper mobile ankles and the bone in my left foot that won't stay in place- but I have a low painthreshold and years of rehab on the joint at risk. No way.

I work as a specialist nurse and we seem to be having student nurses more and more frequently, I think it's the new student nurse curriculum where there are a number of clinical skills which they have to gain which are probably easier to experience in our type of setting rather than on the ward.

I always ask the patient's consent when I collect them from the waiting room for the student to sit in on the appointment. So far, I've never had any say no (I think that may be because we don't do anything particularly intimate). I did have one patient who had come to clinic quite distressed and I didn't even ask her if the student could sit in, I just told the student to go and have a coffee and I would come and get her once the appointment was finished.

Depending on the patient and how keen they seem to be to include the student, I may ask the student a couple of fairly straight forward questions (sometimes the patient joins in in trying to get the right anwer). Other times, I may briefly explain something, such as a blood result, a clinical finding, or something interesting in their history which is relevant to what we are doing (such as taking a blood pressure, avoiding the arm with the fistula for dialysis, which the patient may then tell them a little about what dialysis involves or invite them to feel it buzzing). I don't ignore the patient to explain anything to the student but explain it to them both which patients actually seem to appreciate. Obviously some patients wouldn't appreciate that, I had one recently who said he was happy to have the student in the room, but he didn't really want to be at the appointment and whilst he would have been interesting for the student to be taught about, she just sat quietly in the corner of the room and I just did his appointment as though she wasn't there.

@AutomaticMoon

That wasnt even the NHS. It was a change in law, by the government.

Law was proposed, debated, went through all the processes a law needs to go through. It was on the news regularly during that. Then in March 2019, it recieved royal assent. Again, it was on the news. the changes came into effect in 2020.

It was on the news for at least 3 years. It was debated, there were lots of opinion pieces about it.

If you dont follow news then that's on you. But this was widely publicized for a prolonged period before the law changed and then when it actually came into effect. Nobody just did it without telling anyone it without warning. You had years of warning.

I was transfered from my MLU to hospital in labour. Its a teaching hospital, and is amazing, but I was in no for state to consent to being observed by the crowd that piled in to see my epidural being sited. I just recall my back being cold and there being a lot of people.

DH sent them out (not politely) when he arrived and there were nine students about to watch me have an internal examination.

When I was being transferred, I went in the ambulance, he had to drive the car and was stuck in traffic for over 2 hours because there had been a crash. I was so out of it, I had no idea he wasn't there from the beginning. How can there have been informed consent in this situation?

I think where hospitals often take the piss is in the number of students. One student unobtrusively in the corner, fine. Nine students being given a lecture in front of your open legs, really not fine.

As well as consent (which I agree is crucial), it's also about personal dignity. Just because someone consents to have students there doesn't mean you should then ride roughshod over their personal dignity. And personally I think any more than one (or at most two) students behaving sensitively and unobtrusively is doing this.

@Goldbar

I think where hospitals often take the piss is in the number of students. One student unobtrusively in the corner, fine. Nine students being given a lecture in front of your open legs, really not fine.

As well as consent (which I agree is crucial), it's also about personal dignity. Just because someone consents to have students there doesn't mean you should then ride roughshod over their personal dignity. And personally I think any more than one (or at most two) students behaving sensitively and unobtrusively is doing this.

Depends on the person. I'd have no issue with a group of students. As long as you can say no, I don't see any reason for a blanket rule against this stuff just because a minority of people might not like it.

@Janesmom. I can see that some people would be fine with a group of students, but I think any consent has to include the number of students. So not 'are you ok for students to observe?' but 'are you ok for X number of students to observe, or would you prefer less or none at all?'.

This thread has brought back something I'd completely forgotten.

Towards the end my first, very long and difficult labour, it was decided that I needed intervention, starting with ventouse and then forceps. I was whisked off to the room this was happening in and asked if I minded students being present. I did mind at that moment and said so.
Things got busy and at some point I realised there were quite a few students at the business end, watching as the doctor wrestled the baby out with forceps, blood dripping on to the floor. Obviously at that point I was pretty distracted but afterwards I wondered why they had allowed that when I'd clearly said no.
It was probably a good learning moment for them but still.

I remember going to the gp once and I saw a trainee GP who asked very politely if I’d mind my consultation being videoed to help with his training. I agreed as I wasn’t there for anything that required any sort of intimate examination. Otherwise I wouldn’t have.

Depends on the person. I'd have no issue with a group of students. As long as you can say no, I don't see any reason for a blanket rule against this stuff just because a minority of people might not like it.

It's not that i didn't like having nine students staring into my vagina, it was more that I couldn't have given informed consent to have any of them there. I wasn't "present" enough to be aware that my husband wasn't there for two hours, I was in no position to be consenting to allowing a crowd to be peering into my vulva.

My DM had to stop the doctor from pressuring me into having forceps, consent for which I would never, ever have given in my right mind.

Nah that’s not ok.
I’m a nurse, and a medical student.
I always explain if I have a student with me to patients and explain they’re supervised but I still have to ask their consent for whatever it is I’m/they would be doing.
On my medical student placements, the doctor will collect the patient from the waiting room and ask consent for me to be in the room. If they’re not comfortable, no problem, I’ll find something else to do for 20 minutes. If they are, I come in and introduce myself as well.

A student delivered my second baby but I was asked for consent and they talked to me about the fact they were at the end of their final year and about to start as a fully trained midwife.

I have very complex pregnancies due to an unusual health condition and have had students observing appointments as it’s likely they’ll never see someone like me until they’re fully qualified otherwise. I don’t mind as I hope it will help someone else like me in future but again, they have always got consent.

Have also had the same at the GP, they have always asked consent and introduced the student.

It’s frankly just bad practise not to.