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.

I’ll say it again, 4 of these appointments were routine appointments over a 2 year period.

A birth
A smear
A dentist appointment
A gp apointment.
2 appointments for an ongoing condition.

There’s some people on this thread who are or were students who seem really hostile about people declining students which is quite worrying.

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

Are you a student?

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

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

This is what used to happen and as far as I know it worked well.

The students would introduce themselves and were polite and friendly. Now they’re already in the room and don’t bother introducing themselves.

@Witchcraftandhokum

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

Two things - it’s not free and you are right - it’s not a popular opinion.

I've had a medical student yawn in my face while I was disclosing something very difficult, and another rolled their eyes. I've also had amazing care from student midwives and have been an AHP student myself, and currently have my own students. Patients should be able to give informed consent to having anyone present, and the qualified HCP should never ignore the patient in favour of the student. Informed consent is the key, at all times.

@Witchcraftandhokum

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

I agree with this. Unless they’re happy to have partially trained clinicians treat them (which is what many appear to be objecting to), they’re effectively saying that other patients should shoulder that burden. Seems pretty selfish.

@Witchcraftandhokum

It is not free. We pay for it in our taxes. Taxes in places like USA are low because they dont have healthcare included.

@Janesmom

We should be able to give consent.

I was asked if one student could watch while I had a pessary inserted into my vagina. I said yes. They then brought 6 of them in. I was in a the bed with the curtains drawn round, so not a lot of space. My legs open, and I had to sit like that for much longer than necessary so each student could come and have a look while the person teaching them explained what she was doing over and over again, demonstrating by putting her hand into me.

One student would have meant the procedure happend once with that student watching. Even two could have stood at the end together. But with 6, she has to do it and then imitate doing it a few times so they could all get a look. I was used as a doll basically. Do you think that is OK?

@Witchcraftandhokum

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

You don't think patients in a vulnerable position, in pain, scared, confused, with past trauma etc, should be allowed to say no?

Do you not believe in consent at all?

Posters advocating for a healthcare system that disregards patient consent are advocating for abuse.

I have to wonder why anybody would argue such an abhorrent position.

Itsalmostanaccessory that utterly awful.

It seems several people are having these experiences where they agree to one student and several are brought in.

@Witchcraftandhokum

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

Ignorance. It's not free healthcare and consent is central to all healthcare, not an optional extra.

Luckily our legal system prioritises consent even if you think patients should be abused and be grateful for it. Which is a fairly odd position to take for most decent human beings.

@MarbleQueen

Itsalmostanaccessory that utterly awful.

It seems several people are having these experiences where they agree to one student and several are brought in.

It's the culture of treating patients like objects not humans and it is deep-rooted in the NHS.

See also ward rounds, where a group of staff stand at the foot of a patient's bed discussing them like they're not there and in full earshot of the rest of the patients.

It will not change until we stop accepting it and stop telling people to be grateful for being dehumanised and violated.

I find it particularly objectionable when individuals attempt to defend abusive practices like this that should have been abandoned decades ago. There is no place for such conduct in a civilised society.

@Janesmom

Why are you defending abuse?

[quote draramallama]@Janesmom

Why are you defending abuse?[/quote]
I’m defending being a grown up and not freeloading. If that’s abuse to you, take a long hard look in the mirror.

@Janesmom

Are you going to reply to me?
Am I being a childish freelander for being angry at what happened to me?

Are you a student?

Uhm, no. Are you a clown?

I am however someone who was trained properly, who has trained many others and understands the importance of people being skilled adequately in order to go on to perform independently at the required standard. I also believe in informed consent but the reality is if you don’t believe in providing the opportunity for people to be properly trained then you shouldn’t have the expectation that your clinician can perform adequately to the standard required and should be happy with someone who has read a few books, watched a few videos and passed some theoretical exams.

@Muckymaisonette

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?

Seriously? A random person off the street?!

I’m defending being a grown up and not freeloading. If that’s abuse to you, take a long hard look in the mirror.

Just to use my experience, is it OK that nine students were looking into my vagina as an internal examination was about to be performed without my consent? Or should I not care because I wasn't cognisant enough to say yes or no?

I personally can't actually remember the whole thing, I wasn't under any sedation, but had had a lot of pain killers and had been awake for 36 hours, my eyes were rolling in the back of my skull. It was my husband who was appalled at how I was being treated and who asked them to leave.

It is an abuse of power to use someone's body who cannot consent. Absence of protest does not mean consent. Nothing to do with being an adult.

I've had some crappy experiences with med students or early career (exclusively doctors). Often young and blinded by their privilege.

One example: Chatting and flirting when taking history of my child after an op. Really inappropriate. I told them off and said that if any of my (blue chip) company's graduates behaved like that to me as a professional I'd have them disciplined. (Although I appreciate I do have a level of status with our grads)

They saw me as a "mum", a non-medical muggle and low status- and looked shocked once I pointed it out . But I had the social capital to do that. They would not have behaved like that in front of a consultant /professor so why treat me differently?

I hope I contributed to their education. I wasn't a "Karen", I was respectful and gave feedback in the context of improvement. I have been very surprised how "sheltered" a lot of my grads (much more privileged background than me) have been and I'm sensitive to that.

@Witchcraftandhokum

I know it's not a popular opinion but I don't think you should be able to take advantage of free health care but object to people being trained to carry it out.

It's not free! It is funded via taxes which most people pay!

As a doctor I always ask my patients whether it's ok.
I do have it on my letters that a trainee may be present and to let us know if they don't want this but I ask on arrival too!

@PearPickingPorky

I worry about what these students are learning about consent in these circumstances.

I feel the same as you.

And bring able to gain consent is an incredibly important part of being a healthcare worker.

It's very troubling.

Absolutely this.

At the birth is really shocking.

I would not be happy nor accepting of this.

Our GP practise has instigated an “opt out” type thing it seems. There are notices up telling you there are students and to tell the receptionist if you don’t want them present.

I really don’t agree with that way of doing it. Consent should be actively sought, not assumed.

I made a complaint about a local hospital just before covid for this. I was asked for consent for one student to observe a procedure. Midway through three other students came in and the doctor asked the first student if he’d like to complete the process.
It’s something I’ve had done several times, and have allowed students to do, but it was out of order to do that. My Dr was mortified and apologised. He had assumed because I’d been comfortable before that I’d be ok, but said himself that he shouldn’t have assumed.

It happens all the time and it’s not acceptable.

It's really shocking that you haven't been asked for consent. I have many hospital appointments and students are quite often present but I can't think of any occasion when I haven't been asked if it was ok. I think for gynaecological appointments people should be asked before they enter the room.