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.

Well, perhaps the onus could be on the medical practitioner to get informed consent (perhaps in writing) prior to being in the position of being on the medical practitioner's territory, in a position of authority (as many patients, and more than a few medical practitioners seem to feel they are), with the student already in situ, and it appearing to have been taken for granted that they would consent? Perhaps making it very clear to the patient that it is completely okay if they do not consent? Of course, that might mean meeting the patient, who is of course supposed to be at the focus of patient centred treatment as I understand it, without the student there - perhaps the student could remove themselves for five minutes, while this is discussed and explained to the patient?

What's that saying again? It's easier to ask forgiveness than get permission? I do feel this practice smacks of that.

Yes, I had this! I assumed the consultant would be doing the op but it turned out to be two students? junior doctors? I don't really know who, one told me her name, the other said nothing. It was an op on my face under local and he was talking them through it, it was kind of interesting, but also worrying as they didn't always know the answers to the questions he was asking. None of this was explained to me and I felt awkward asking. I did feel uncomfortable but I didn't want to "make a fuss".

I was exceptionally cross when my health visitor breezed in with another woman and said this is 'X' and is trainee, and that was it. No consent sought, no opportunity for me to say anything and the two of them spent ages discussing DS in comparison with other baby's they'd seen that morning and 'X's' own baby. Had I been my usual self I would've said stop, aren't you supposed to ask for consent but I was all over the place after a difficult birth and DS needing ICU. Still makes me angry that HV didn't come to the door and say - I have a trainee with me today. Is it OK if we both come in to see you and DS? It was my sodding home and she treated me with so little respect or consideration.

I was a student nurse nearly 20 years ago, we always asked for consent.
Whilst I was training I had an abnormal smear and had to have a biopsy taken.
A nurse from my university was in the room . I point blank refused as funnily enough it's my choice. I even explained we were at the same university and I wasn't comfortable. They tried to pressure me but I refused, I felt guilty as it's part of her training but to be honest I would have been fine with a student from another uni watching for their learning but not someone I'd bump into at the canteen.

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?

Why on earth are you bothering to ask a patient if it’s ok for someone to sit in when they are ALREADY sat in the room? You are deliberately putting patients in an awkward position.Ffs ask the patient first then bring the student in. It’s not rocket science

@2022HereWeCome

I was exceptionally cross when my health visitor breezed in with another woman and said this is 'X' and is trainee, and that was it. No consent sought, no opportunity for me to say anything and the two of them spent ages discussing DS in comparison with other baby's they'd seen that morning and 'X's' own baby. Had I been my usual self I would've said stop, aren't you supposed to ask for consent but I was all over the place after a difficult birth and DS needing ICU. Still makes me angry that HV didn't come to the door and say - I have a trainee with me today. Is it OK if we both come in to see you and DS? It was my sodding home and she treated me with so little respect or consideration.

You've just reminded me, the same thing happened to me! DSs day 1 check, HV turned up "this is Sally, she's a student and I'm training her, your DS is her first baby!"

It was fine at the time, because I genuinely didn't mind, but if I had, what was I going to do, send her out of my house and make her sit in the car? Consent was presented as having already been given.

I’ve been to the breast clinic for lumps twice. On both occasions I was asked if I would mind if students came in to observe. On the first occasion there were two but dh was there also so it didn’t feel so bad. Particularly since I could see the sympathy in his face as he knew how mortified I was.

The second time I went on my own, with exactly the same sort of problem, and again agreed to a student coming in to observe. Which soon became ‘do you mind if X examines you also as there is actually something for him to feel here’. Which then became ‘do you mind if X attends the rest of your examinations as there is actually something to see here’. So then I had X trailing along for my mammogram, scan and biopsy which was fun. I agreed as I do think that they have to learn somewhere and I think she asked me because I did have a large lump but it was clear from the first examination that it was a minor issue so she wasn’t putting someone with a serious illness through it. Plus I didn’t actually want to upset the already mortified student, who incidentally looked about the same age as my teenage son. It was grim, but in fairness she did seek consent for everything. It was entirely my own fault for agreeing.

@JustLyra

What is your issue with me. I have not been patronising or rude. We have different opinions

That is okay.

Why are you freaking out about me simply saying i addressed the student in room possible reasons in my first post. I'm not saying you have to agree with my first post!

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.

See my reply to mbosnz if you want my oppinion on that, or not.

End of the day

Informed consent is essential. Communication is essential.

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.
Glad to hear you objected, why on earth would HCA's need to view a procedure they would never be doing? ( and as far as I know mine are always done by one nurse alone)

YABU to object to students being present. They are the future doctors and nurses who will be treating other people/yourself and how else are they supposed to learn? I do think they should ask permission but if you say no YABU.

@hangrylady

YABU to object to students being present. They are the future doctors and nurses who will be treating other people/yourself and how else are they supposed to learn? I do think they should ask permission but if you say no YABU.

They can learn on people who are comfortable with them learning on them. That's reasonable.

Patient centred treatment - not practitioner centred treatment. . .

@hangrylady

YABU to object to students being present. They are the future doctors and nurses who will be treating other people/yourself and how else are they supposed to learn? I do think they should ask permission but if you say no YABU.

You go ahead and have hoards of strangers ogle your privates while you are spread eagle and vulnerable. I won't allow myself to be treated as a piece of meat or a learning prop. But you do you!

"You go ahead and have hoards of strangers ogle your privates while you are spread eagle and vulnerable. I won't allow myself to be treated as a piece of meat or a learning prop. But you do you!"

Hoards of strangers! Behave yourself please. You can thank the likes of me for future medical professionals having proper training by seeing procedures in action. You're welcome.

I would most likely be fine with students observing if my consent was asked for before the students were in the room.

Being presented with students there and consent effectively being assumed is a big no for me and I would firmly tell them to leave.

I do not care how many notices are on the walls about students, they don't have the right to ride roughshod over properly obtaining consent.

hangrylady at times it is literally hoards of strangers. Personally I have done my bit for the future doctors of the world, and have decided that if it's anything intimate it's women only in the room - which is the direction those specialities are going in anyway, thankfully, so will be much easier in future. I will consent to students, but on my terms. I'm not a mannequin.

@hangrylady

"You go ahead and have hoards of strangers ogle your privates while you are spread eagle and vulnerable. I won't allow myself to be treated as a piece of meat or a learning prop. But you do you!"

Hoards of strangers! Behave yourself please. You can thank the likes of me for future medical professionals having proper training by seeing procedures in action. You're welcome.

You sound really rather silly telling another grown person to 'behave themselves please'!

I am very appreciative of the likes of you for enabling future medical professionals having proper training by allowing them to see your procedures in action. I just don't feel guilty for not doing the same, and certainly will not be guilted into it, either by you, by medical professionals, or by future medical professionals.

At my last smear there was a female student in the room. She was introduced to me and I was asked if I minded her observing the procedure. I was happy with all of that. If it had been a male student I would have been conflicted really. It is very important that students, of either sex, learn the procedures they may have to perform. However I am a human, not a visual aid , and I feel very uncomfortable seeing a male doctor for anything like that never mind having a male student involved. I realise it's not a sexual thing before anyone says that.

"I am very appreciative of the likes of you for enabling future medical professionals having proper training by allowing them to see your procedures in action. I just don't feel guilty for not doing the same, and certainly will not be guilted into it, either by you, by medical professionals, or by future medical professionals"

Well done you. As I said, you're welcome.

@hangrylady

"I am very appreciative of the likes of you for enabling future medical professionals having proper training by allowing them to see your procedures in action. I just don't feel guilty for not doing the same, and certainly will not be guilted into it, either by you, by medical professionals, or by future medical professionals"

Well done you. As I said, you're welcome.

Why thank you! Pats on the back all round, jolly good show, wot?!

The thing is, when you are having a medical procedure, you kind of are a mannequin. I honestly don't care and can detach from the situation and forget it immediately afterwards but I understand others may not be able to so apologies if I came across a little harsh.

I appreciate that, thank you, because, past master that I am at dissociation, I cannot dissociate when having medical attention, because of past experiences. I am not a mannequin, I am a person, and thankfully now, I am able to believe that and assert that. We are all different, with our different life experiences, and different abilities and tolerances as a result.

@Ducksareruiningmypatio Well not really, they could have had gov ads on TV to notify everyone, I didn’t know it was happening, only found out two years after the fact, when I started using social media. I am disabled, I have MH problems and I wasn’t reading newspapers daily.

@hangrylady Dissociation is extremely triggering for people with trauma

@RedToothBrush It IS really scary that many don’t seem to understand the concept of consent. I’ve seem a PP say she wouldn’t have dreamt of objecting, then it’s not actual consent, is it?