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.

don't believe OP fully. I believe there's elements of the truth and clear emotional hurt here. But no. I also don't agree with op demanding health professionals call her before appointment

I don’t give a shit what you believe. Plenty of medical people have confirmed that students are not asking for consent like they used to and plenty of people have had similar experiences.

At no point have I demanded I get a call so pack that in.

This is absolutely not ok. Consent should be asked for, every time.

I've always been asked if it's ok for a student to be present and never felt pressure to say yes. That's how it should be, in my opinion.

Has it occurred to you that when people have a bad experience with a student they are far more likely to decline students in the future? Who does this benefit exactly?

That's exactly what happened to me. Students trooped in for my forceps delivery without my consent. I still don't know how many there were or if they were male or female because I was barely awake, but it was horrific. I felt like I was giving birth in a train station.

For my second birth in a different hospital I wrote on my patient notes "Due to my first birth I do not permit any medical students to observe, and in particular I do not consent for them arriving for the actual birth."

It was respected, thankfully, and I felt much better about that birth on the whole.

NoRaceInThisHorse

Why do i have to keep repeating myself are you going to reply to anything I've said in a discussion?

1. not true at all.
   Also, presumably this issue is around pre + currently covid so.... Again. As said before, advocate/carer/family/friend ....

2. again. The majority of people, when asked on the day, 'this is X student, can they sit in/observe/treat' are happy to, on the day - in front of the student, answer yes or no.

If you aren't part of that majority then it's your responsibility to arrange to speak to staff before appointment or getting someone else to ring.

@MarbleQueen hun you literally argued with me that a phone call to a patient wouldn't take that long. .....

[quote HonestwithHope1]@JustLyra

Then you ring up before if it's that awful to say the word 'no' at a standard apppointment or you get an advocate/family member ect.

Simple.

Multiple people have also pointed out that it takes less than a minute to say yes or no, no excuses needed- and realistically the majority of people will happily answer the question honestly.

I don't believe OP fully. I believe there's elements of the truth and clear emotional hurt here. But no. I also don't agree with op demanding health professionals call her before appointment

I've had one experience in 28 years of life as a disabled person requiring numerous treatment, and I consented but didn't have full informed consent (see post) and never ever witnessed or done it myself re lack of informed consent. So yeah. multiple disregards in the space of a short time, for informed consent is strange.[/quote]
The point you are missing though is that the most vulnerable are the people that are most likely to feel unable to say no in a room full of students already sat in place.

The onus on getting clear, informed consent is not on patients. It’s on medical professionals. Shifting the responsibility is not acceptable and shouldn’t happen.

You’ve had one yet many others on the thread have had more than one. Your experience is not universal.

MarbleQueen oh give over. We discussed this. You said how in the example of student sitting in room, when arguing with me re in consent, that you should have been told via phone call pre apppointment. Then argued with me how long phone calls take

Nope. Didn’t happen. Perhaps you’ve got me mixed up with someone else.

I’m not keen on being accused of tantrumming or being emotional because I don’t want 3;teenage students watch me having a smear test. I’m not the only poster concerned about your lack of understanding about consent.

you literally argued with me that a phone call to a patient wouldn't take that long. .....

Which is not remotely the same as someone demanding something…

@justlyra.

Ta. Not shifting responsibility at all but agree to disagree

Informed consent is essential. Hope we can all agree on that one

After 26 incredibly painful hours being in labour I was asked if a student midwife could check
To see how man cm dilated I was- I said no way and was made to feel a bit mean!

I was asked if a student GP could watch my sons 10 week review- I said sure

Other than that I’m not sure I’ve had any more

[quote HonestwithHope1]@justlyra.

Ta. Not shifting responsibility at all but agree to disagree

Informed consent is essential. Hope we can all agree on that one[/quote]
Informed consent is essential.

Which is why people are arguing against pressured and presumed consent of already having students sat there pen in hand and casually dropping a “that’s ok?” on people last second.

I don't like students being present but how can they learn otherwise?

I’m not keen on being accused of tantrumming or being emotional because I don’t want 3;teenage students watch me having a smear test

Yeah i totally said that didn't I 🙄

Again

Informed consent is essential

@FangsForTheMemory

I don't like students being present but how can they learn otherwise?

By watching the people who are happy to have them there.

As shown on this thread, there are plenty of them.

MarbleQueen hun you literally argued with me that a phone call to a patient wouldn't take that long. .....

No hun I didn’t. Stop gaslighting.

@JustLyra

Again. Agree to disagree. On my first post I detailed why students may already be sat. So idk if you can understand some of those reasons. It aint a big plot to demean patients.

Whether a student is initially present or not does not reduce importance of informed consent and the onus on the patient to be honest with regards to consent. Unfortunately professionals aren't mind readers and do require verbal consent or not.

I'm very appreciative and grateful for those who are comfortable and okay to have students present and practise on them. Because I'm not. I make no apologies for this, or excuses. I don't have to explain to anyone or justify the history behind my discomfort, and therefore my blanket refusal. My midwife was thoroughly supportive of this, if not relieved. Thank God.

I had a health visitor, I think you call it over here, who had come to me once to discuss my postnatal depression. The next time she came, she brought a bright happy, no doubt lovely, student along with her, without having asked my permission beforehand, sat herself down on my couch, and then said, oh, this is student A, she's along to observe, I knew you wouldn't mind. Bloody useless for both of us, student and me both, as a result, because yes, I did fucking mind, so nothing further than the weather was discussed, and the minute they'd gone, I rang up and disenrolled myself from that pilot programme, explaining why.

The condescending, know it all tone of some who profess to be health care professionals on this thread makes it so very clear just how little some care about the mere patient's experience, or perception, and just why it can be so hard to say no - or get them to take it for an answer.

I thought the onus was on the medical practitioner to ensure they got informed consent?

Or is it a bit like when a man isn't a mindreader, and takes stunned silence as assent?

A quick filter through OPs posts shows she hasn't demanded or argued with anyone about special phone calls to herself to obtain consent.

@mbosnz

Good point.

Okay. So say I had a final year student in clinic with me. A patient i've just met comes in, I introduce self and get student to introduce themselves, I ask if it's okay if they sit in and make it clear student will go away if not.

Patient has relaxed body language, big smiles clearly says- not a problem at all, then spends most of the appointment talking with student and even laughing/making a few jokes, I allow it cause it's good practice for my soon to be qualified student, i'm happy to be second practitioner in X moment ready to be taking over if either there's questions student can't answer or potential concerns (there isn't)

This person then leaves and complains

How was I supposed to know?

Informed consent requires clear yes or no. So mostly verbally or strong nods/shakes of head/sign language/written ect.

We can only work with what we are given. The onus is on us to ask informed consent qs and use our clinical judgment best we can (if i had a patient clearly on edge I'd keep trying to check but that can also backfire + make people more agitated sooo...) or if i had a patient who came in with someone i thought was an abuser, all i can do is try my best to ask re informed consent (obviously in that situation pass to safeuarding)

The onus is also on the patient to communicate best they can

[quote HonestwithHope1]@JustLyra

Again. Agree to disagree. On my first post I detailed why students may already be sat. So idk if you can understand some of those reasons. It aint a big plot to demean patients.

Whether a student is initially present or not does not reduce importance of informed consent and the onus on the patient to be honest with regards to consent. Unfortunately professionals aren't mind readers and do require verbal consent or not.[/quote]
Do you enjoy being patronising and rude or is it just something you are good at? Agree to disagree doesn't mean that you are right and I have to accept that without any opinions of my own.

You may have detailed why students are there already, I however have detailed why that doesn't make it ok for every patient. The onus is on the medical profession to gain freely given, informed consent and putting patients in a position where they are faced with that doesn't always make it possible to be given.

No-one is asking professionals to be mind readers. Just to obtain consent in a situation that gives the best opportunity for the patient to be comfortable enough not to feel pressure to give it.

The onus of obtaining informed, pressure free consent is always on the medical profession.

It sounds like you’ve just been really unfortunate @MarbleQueen and I’m sorry to hear that. I’ve got a long term medical condition and go to hospital a lot yet have only been dealt with by a student twice. Once when in labour (consent given) once when in an ambulance having several seizures and my husband told me afterwards a student paramedic carried out a procedure (but did it well!)
In the future, remember you can always say no.

@HonestwithHope1

Warmduscher

HOW DARE YOU.

I've clearly fucking explained that my mum has an SMI and you dare say that. Seriously?????

The reality is. If you are that traumatised you can't speak on the day to refuse or give consent for a student. Then you ring up before stating i need only X person at appointment or you take an advocate or get an advocate to ring up on your behalf. I speak to every new service on my mums behalf before appointments and no doubt always will. I know the importance of informed consent.

My issue with OP is threefold

the tantrumming about the student daring to be in the room as the patient enters and how she claimed that wouldn't be consent despite clearly being asked by the health professional

The demand of a special phone call to them before their appointment (lol really they themselves can't have someone ring on their behalf or picking up phone themselves)

And her frankly, many unbelievable encounters with lack of informed consent (see my previous posts detailing why i think this is)

OP is factually wrong re consent + student initially in the room making it a lack of consent regardless. You are offensive.

Then report my post. That’s the process.

There is a reason that the bulk of the time people are asked about students before the students come in.